Ma Ijaiya

Ruptured Uterus: A Study of 100 Consecutive Cases in Ilorin, Nigeria

Objectives: To determine the incidence, aetiology, trend, management maternal and fetal outcome of uterine rupture at University of Ilorin Teaching Hospital, Ilorin, Nigeria. To compare the results with previous reports from this centre.

Analysis of 348 consecutive cases of primary postpartum haemorrhage at a tertiary hospital in Nigeria

A retrospective analysis of 348 cases of primary postpartum haemorrhage (PPH) that occurred at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between 1 January 1993 and 31 December 1996 was carried out. The incidence of PPH was 4.5%. Booking status of the patients had no relation with occurrence of PPH in this study (P > 0.05). The risk of PPH in advanced maternal age (over 35 years) and grandmultiparity (para 5 and over) was twofold higher than low maternal age (< 25 years) and low parity (para 0–1), P < 0.05, respectively. The incidence of PPH was higher in deliveries conducted by midwives than doctors (P < 0.05). Anaemic patients (PCV ⩽ 30%) were more at risk than non-anaemic patients (P < 0.05). Uterine atony, 183 (53.8%) was the most common cause of PPH and a combination of uterotonic agents and uterine massage were effective in controlling PPH in 171 (49.1%) of the cases. Seven (2.0%) patients required hysterectomy. One-third of the patients had a blood transfusion. To reduce the incidence of PPH, we recommend that doctors should supervise the delivery of parturients at risk of PPH and advocate health education against high parity.

Maternal mortality in a Nigerian teaching hospital - a continuing tragedy.

The aim of this review is to determine the maternal mortality ratio (MMR) in a Nigerian tertiary health institution (University of Ilorin Teaching Hospital, Ilorin, Nigeria). The review was done through a retrospective analysis of maternal mortality records. The MMR for the 6-year period (1997-2002) was 825 per 100,000 live births. The common causes of maternal mortality included severe pre-eclampsia/eclampsia, 30 (27.8%); haemorrhage, 22 (20.4%) and complications of unsafe abortion 16 (14.8%). Grandmultiparous and patients aged 40 years and above were at the highest risk. This hospital-based MMR is very high and when compared with previous reports showed a 150% increase. Most of the maternal deaths are, however, preventable. Increased efforts at educating women, improvement of the socioeconomic conditions of the populace and strong political commitment in making emergency obstetric care available in rural and district hospitals are some of the measures that need to be adopted to reduce this avoidable tragedy.

Rectovaginal fistula following sexual intercourse: a case report.

Female genital fistula is an important feature of the developing countries gynecology. Most of the rectovaginal fistulae encountered in the tropics are due to obstetrics causes and genital malignancies. In developed countries, radiation injury and Crohns disease are also common etiological factors. The index case is reported to highlight the rare situation, where a 24-year old married nullipara sustained low rectovaginal fistula following normal coitus. She was later divorced by her husband.

Pattern of cervical dilatation among parturients in Ilorin, Nigeria.

OBJECTIVE To evaluate the pattern of cervical dilatation in live singleton pregnancies with spontaneous onset of labor and to compare any differences among nulliparas (P ara 0) and multiparas (Para >or=1). MATERIAL AND METHODS Descriptive statistics are presented for 238 consecutive labor patients with spontaneous onset, >or=37 weeks gestation, live singleton pregnancy and who had spontaneous vertex delivery at the University of Ilorin Teaching Hospital, Nigeria, from May 2004 to June 2004. Pre-labor rupture of membrane and referred cases were excluded. RESULTS The mean cervical dilatation on presentation and duration of labor before presentation in labor ward among nulliparas were 5.40 cm and 6.66 hours; and among multiparas, 6.45 cm and 5.15 hours, respectively, the overall mean being 6.12 cm and 5.63 hours, respectively. The average time spent to achieve full cervical dilatation from time of arrival in labor ward was longer in nulliparas (4.80 hours) than in multiparas (3.60 hours) (t test not significant; P> 0.05). Overall mean total length of first stage of labor was 9.36 hours, while the total length of first stage of labor was 11.03 hours and 8.53 hours for nulliparas and multiparas, respectively (difference is significant; t test P< 0.05). Significant negative correlation existed between parity and total length of first stage of labor. Mean cervical dilatation rate in labor ward (active phase) was higher in multiparas (1.83 cm/h) than in nulliparas (1.76 cm/h), but the difference was not significant (t test P> 0.05). No significant correlation existed between rate of cervical dilatation and maternal age, gestational age and fetal size. CONCLUSION It is evident from this study that higher the parity the shorter the length of first stage of labor; however, significant difference existed only in the first half of first stage of labor between nulliparas and multiparas. Mean rate of cervical dilatation was greater than the WHO-specified and Philpotts lower limit of 1 cm/h in active phase of labor.

Posterior cervical lip for juxtacervical vesicovaginal fistula closure (M. Ijaiya's technique).

The use of the posterior lip of the cervix to close juxtacervical fistulae (M. Ijaiya’s technique) may be particularly useful when the anterior lip of the cervix is involved in the pressure necrosis and it is difficult to achieve a tension-free repair. This technique is recommended for postmenopausal patients with a normal cervical smear and endometrial biopsy. It is easier, less time-consuming and less bloody than abdominal route repair. Vaginal capacity is preserved.

Acceptability of Measures Aimed at Preventing Mother-to-Child Transmission of HIV among Pregnant Women

OBJECTIVE To assess the acceptability of measures aimed at preventing mother-to-child transmission of HIV among counseled and yet-to-be-counseled antenatal women in a federal medical center in Nigeria. METHODS A valid and reliable questionnaire was interviewer administered to newly booking antenatal women who were yet to be counseled about HIV/AIDS and women on an antenatal follow-up visit who had already been counseled about HIV/AIDS. RESULTS A total of 108 newly booked women and 116 women on follow-up visit responded to the questionnaire. The proportion of the counseled women who accepted HIV screening (98%) was significantly higher than the proportion of the yet-to-be-counseled women who would want to be screened (88%). Also, the proportions of the counseled women who accepted HIV screening so as to benefit from interventions like prevention of mother-to-child transmission, antiretroviral therapy and prevention of transmission to partner were significantly higher than the proportions among the yet-to-be-counseled women. The majority of the women in the study would accept antiretroviral drugs and avoidance of breastfeeding to prevent mother-to-child transmission, while only 29 (14%) respondents would accept cesarean section to prevent mother-to-child transmission. There was no statistically significant difference in the proportion of the counseled women (15%) who would accept cesarean section to prevent mother to child transmission when compared to the proportion among the yet-to-be-counseled women (11%). CONCLUSION Antenatal HIV screening is acceptable to most pregnant women attending our hospital, and while many would accept antiretroviral drugs and avoidance of breastfeeding to prevent mother-to-child transmission of HIV, there is low acceptability of elective cesarean section.

Pattern of sexually transmitted infections in human immunodeficiency virus positive women attending antenatal clinics in north-central Nigeria

Background: Sexually transmitted infections (STIs) are prevalent during pregnancy and may have adverse sequalae in both mother and fetus. Interactions between these infections and human immunodeficiency virus (HIV) synergize and may cause adverse pregnancy outcomes and reverse the gains of prevention of mother to child transmission of HIV. Objectives: The objective of this study is to determine the prevalence of candidiasis, trichomoniasis, gonococcal infection, syphilis, and bacterial vaginosis in HIV pregnant women and compare with HIV negative controls. Materials and Methods: A case-control study was conducted during the period from April to December 2010 at the Department of Obstetrics/Gynecology of University of Ilorin Teaching Hospital and three Primary Health Centers in Ilorin. A total of 160 HIV positive pregnant women attending antenatal clinics were recruited, along with the same number of HIV negative matched controls. A structured proforma was used to collect information from patients, vaginal examination was performed and samples were taken from the endocervix and the posterior vaginal fornix with swab sticks. Results: STIs were recovered from 142 women, giving overall prevalence of 44.4%. HIV infected women had a higher prevalence (60%) compared to uninfected (28.8%). The most prevalent STI was vaginal candidiasis (29.1%), followed by bacterial vaginosis (9.7%), and trichomoniasis (5.6%). The prevalence of candidiasis, bacterial vaginosis, and trichomoniasis was higher among HIV positive pregnant women compared to HIV negative controls ( P Conclusion: The prevalence of candidiasis, bacterial vaginosis and trichomoniasis was higher in HIV infected pregnant women compared to uninfected. Routine screening of HIV infected pregnant women for these organisms is advocated.

Bacterial vaginosis: Prevalence and associated risk factors among non-pregnant women of reproductive age attending a Nigerian tertiary hospital

Aim To determine the prevalence and risk factors associated with bacterial vaginosis (BV) among non-pregnant women of reproductive age group. Methods A cross-sectional study among non-pregnant asymptomatic women aged 19 to 45 years, attending the gynaecological clinic at University of Ilorin Teaching Hospital, Ilorin, Nigeria. Participants were counselled and an informed consent was obtained. This was followed by vaginal swabs for microscopy, culture and sensitivity. Diagnosis of BV was by Nugents criteria. Data analysis was by Statistical Package for Social Sciences (SPSS) version 20.0. Chi-square and Yates corrected chi-square were calculated, and p value <0.05 was significant. Results Among the 212 participants, prevalence of BV was 40.1%; it was common among women aged 25–34 years (50; 58.8%), the married (77; 90.6%) and those with tertiary education (39; 45.9%). The risk factors for BV were common among women with laboratory evidence of the infection, however statistically significant risk factors were the use of intrauterine device (OR 1.61, 95%CI 0.543–4.759; p0.020) and previous voluntary termination of pregnancy (OR 1.04, 95%CI 0.600–1.808; p0.047). Conclusion There was high prevalence of bacterial vaginosis in the study population. Universal screening and treatment of cases may assist in lowering the associated morbidity.

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria.

BACKGROUND The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C). OBJECTIVE To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it. METHODS A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant. RESULTS Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this. CONCLUSION Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C.