Oc Ezechi

Poor obstetric performance of teenagers: is it age- or quality of care-related?

We studied prospectively the effect of antenatal care on the obstetric performance of teenagers seen at a university teaching hospital over a 14-month period. When the obstetric complications among the teenagers were compared to their older counterpart, there were significantly higher complication rates, especially anaemia, preterm delivery, low birth weight and neonatal admission. After controlling for utilisation of antenatal care, significant differences were observed only in the incidence of low birth weight babies. In conclusion, this study has shown that the poor obstetric outcome of teenage pregnancy is related to non-utilisation of prenatal care rather than their biological age.

Socioeconomic barriers to safe motherhood among booked patients in rural Nigerian communities

This study examines the socioeconomic barriers to safe motherhood in booked patients in the Ife-Ijesha health administrative zone, Nigeria. During the period of study (January 1998 to December 1998), 161 booked patients of Ife State Hospital, Ile-Ife and Wesley Guild Hospital, Ilesha presented with an avoidable obstetric emergency, Seventeen (10.6%) presented during the antenatal period, while 89 (55.3%) and 55 (34.2%) presented in labour and postpartum respectively. The patients presented with obstetric complications such as obstructed labour (24.2%), postpartum haemorrhage (21.1%), puerperal sepsis (24.2%), imminent eclampsia and eclampsia (15.5%), retained second twin (9.3%). Three maternal deaths occurred (MMR 1467/100 000 births) and the perinatal mortality rate was 290/1000 total births. The adduced reasons for late presentation included, financial constrains (85.1%), poor access to hospital/transportation difficulties (33.5%), objection to hospital admission by relatives (23.0%), aversion to caesarean section (21.7%) and attitude to hospital staff (8.1%). The patients were of the opinion that reducing the economic burden associated with hospital fee, provision of transportation, encouraged family support and reduction of operation rate would lead to reduction in late presentation.This study examines the socioeconomic barriers to safe motherhood in booked patients in the Ife-Ijesha health administrative zone, Nigeria. During the period of study (January 1998 to December 1998), 161 booked patients of Ife State Hospital, Ile-Ife and Wesley Guild Hospital, Ilesha presented with an avoidable obstetric emergency, Seventeen (10.6%) presented during the antenatal period, while 89 (55.3%) and 55 (34.2%) presented in labour and postpartum respectively. The patients presented with obstetric complications such as obstructed labour (24.2%), postpartum haemorrhage (21.1%), puerperal sepsis (24.2%), imminent eclampsia and eclampsia (15.5%), retained second twin (9.3%). Three maternal deaths occurred (MMR 1467/100 000 births) and the perinatal mortality rate was 290/1000 total births. The adduced reasons for late presentation included, financial constrains (85.1%), poor access to hospital/transportation difficulties (33.5%), objection to hospital admission by relatives (23.0%), aversion to caesarean section (21.7%) and attitude to hospital staff (8.1%). The patients were of the opinion that reducing the economic burden associated with hospital fee, provision of transportation, encouraged family support and reduction of operation rate would lead to reduction in late presentation.

Emergency peripartum hysterectomy in a Nigerian hospital: a 20-year review.

Postpartum haemorrhage is a major cause of maternal morbidity and mortality and occasionally severe enough to warrant hysterectomy to prevent maternal death. Hysterectomy often is fraught with danger and regular audit is necessary to assist in the reduction of these dangers. A 20-year audit of all emergency peripartum hysterectomies, performed at Havana Specialist hospital Lagos, Nigeria, is reported. Of the 6599 deliveries and peripartum referrals seen during the period, 22 had an emergency hysterectomy as a result of severe postpartum haemorrhage (0.33%). The aetiological factors associated with the postpartum haemorrhage included uterine atony (45.5%), placenta praevia (27.3%), pathologically adherent placenta (18.2%) and ruptured uterus (9.1%). The majority of the procedures were subtotal hysterectomy (81.8%) and the mean operative time was significantly shorter than for total hysterectomy (P < 0.05). The postoperative complications included postoperative anaemia (28.6%), febrile morbidity (36.9%), wound infection (19.0%) and urinary tract infection (9.5%), together with three maternal deaths. In conclusion, emergency peripartum hysterectomy, although life-saving, is associated with severe morbidity and mortality and subtotal hysterectomy is usually the operation of choice.

Delivery outside hospital after antenatal care: prevalence and its predictors.

Over a period of 5 years (1994 - 1998), of 9519 women who booked for antenatal care at the two tertiary hospitals of the Obafemi Awolowo University Teaching Hospital Complex, Ile Ife,-Nigeria,12.8% (1220) defaulted from hospital delivery. The casenotes of these patients were retrieved from the medical records department and were sorted into two groups of defaulters and non-defaulters from hospital delivery. Information obtained from the casenotes includes sociodemographic characteristic, past obstetric and present obstetric history. Bivariate analysis revealed six potential predictors; however, following adjustment by multiple logistic regression, only history of previous delivery outside the hospital (OR = 3.13, CI = 2.06 - 4.67), planned elective caesarean section in current pregnancy (OR = 2.03, 1.66 - 2.75), caesarean section in last delivery (OR = 1.93, CI = 1.57 - 2.76) and objection to admission in the current pregnancy (OR = 1.33, CI = 1.04 - 1.65) remained as significant predictors.

Risk factors for preterm delivery in South Western Nigeria

This was a case–control study to determine the risk factors of preterm delivery among Nigerian women seen at Obafemi Awolowo University teaching hospital, Ile-Ife, Nigeria over a period of 9 months. All women delivering preterm were recruited into the study, with two consecutive term deliveries after each preterm delivery serving as controls. Information obtained from the women includes socio-demographic characteristics, past reproductive and present pregnancy history and outcome. Laboratory investigations were conducted as necessary. Bivariate analysis revealed 21 potential risk factors, however, following adjustment by multiple logistic regression only previous preterm delivery (OR 4.68, 2.24–6.31), previous second trimester spontaneous abortion (OR 4.48, 2.32–8.54), heavy and stressful occupation (OR 3.56, 1.05–6.45), premature rupture of fetal membrane (OR 3.46, 1.04–6.45), maternal medical disorders (OR 3.13, 1.56–5.16), body mass index at delivery of less than 23 (OR 3.01, 1.56–5.43), antepartum haemorrhage (OR 2.73, 1.18–6.34), maternal febrile illness (OR 2.84, 1.32–4.52), intrauterine growth retardation (OR 2.14, 0.98–2.34) and multiple pregnancy (OR 1.98, 1.02–2.68) remained as significant factors.

Vaginal misoprostol induction of labour: a Nigerian hospital experience

We reviewed our experience with vaginal misoprostol induction of labour in 339 consecutive women with a live fetus and intact fetal membrane using 100 mcg 12-hourly until labour was established. The labours were monitored using the WHO partograph protocol. Two hundred and sixty-five women had a successful induction while 74 had an emergency caesarean section because of cephalopelvic disproportion (63.5%), fetal distress (14.9%), prolonged labour (12.2%), antepartum haemorrhage (6.8%) and other indications (2.8%). The induction delivery interval among the women who had successful induction ranged from 3 hours 42 minutes to 26 hours 15 minutes with a mean of 9 hours 23 minutes (SD 2 hours 41 minutes). Most (73.6%) of these patients delivered within 12 hours of starting induction, the majority (95.3%) requiring only 100 mcg to go into established labour. Complications recorded in this series include fetal distress in 32 (9.4%), postpartum haemorrhage in 23 (6.8%), hyperstimulation in six (1.8%), uterine rupture in one (0.3%), birth asphyxia in eight (2.5%), admission in neonatal intensive care ward in five (1.5%), neonatal death in one (0.3%) and maternal death in one (0.3%) patient. In conclusion, misoprostol was found not only to be efficacious but relatively safe in comparison to other methods of induction in use in our hospital.

Illegal Induced Abortion in Nigeria: An Examination of Its Consequences and Policy Implications for Social Welfare and Health Policy Makers

Abstract In this case study - based research, using the conceptual underpinnings of the subject-matter of public policy as our analytical point of departure, we examined the issue of illegal induced abortion in Nigeria. In the process, we highlighted its consequences and implications for the policy makers in the areas of responsive policy outputs as they concerned the issue of induced abortion. Along the same analytical plane, we examined the concept of illegal induced abortion per se relying on empirical evidences across the globe vis-a-vis its problems to society and, lack of adequate utilization or payment of attention to them by the government. With these background analyses, and, using purposive sampling technique which falls within the matrix of Non-probability sampling design, we sourced our data through the technique of content analysis, from the archival records of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife. From the data, the incidence of illegal induced abortion to the total gynaecological admission was established as does the prevalence of the medico-socio-cultural and, political phenomenon - (i.e. illegal induced abortion) - in question, among our younger women under the age of 20 years. The resultant discussion of the data showed that induced abortion has caused a lot of reproductive health problems among the Nigerian women. This discussion equally revealed the paucity of our policy makers by ways of concrete policy or policies on illegal induced abortion in Nigeria and, that this was largely due to the heterogeneity of the Nigerian environment on one side and, lack of understanding by government of the real issues involved coupled with the government’s inadequate utilization or payment of attention by ways of policy initiation, formulation and implementation to the available empirical evidence on the consequences of illegal induced abortion on the other hand. Consequent on this, we recommended some concrete measures needed to reduce the rising tide of this sociopolitical and medical malaise with the provision that the achievement of the latter is contingent on the effective adoption of the offered solutions by the social welfare and health policy makers and other stakeholders in Nigeria.