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CASE REPORTS
Recurrent Bartholin's gland abscess in pregnancy: An uncommon presentation
Zubaida G Abdullahi, Aminatu M Umar, Afolabi K Koledade, Bilkisu K Lawal, Tokunbo O Adeoye, Oladapo S Shittu
May-August 2016, 33(2):246-249
DOI:10.4103/0189-5117.192239  
Bartholin's gland cysts and abscesses are the most common cystic swelling of the vulva in women of reproductive age and are usually small in size, as the discomfort associated with it necessitates early consultations. Huge Bartholin's abscesses are uncommon and even fewer cases have been reported were among non-pregnant women. This case involved a 25-year old grandmultipara, who presented at a gestational age of 24 weeks with a huge vulval swelling measuring 14cm x 10cm, following failure of its resolution from self-medicated antibiotics. She had experienced similar but smaller vulvar enlargements in her two preceeding pregnancies that had resolved following similar medical treatment. She was treated successfully with marsupialization, without any adverse effect on the pregnancy. This case illustrates the likelihood of huge Bartholin's abscess complicating pregnancy and that there should be no hesitation to apply marsupialization in its treatment. The recurrence of the abscess in three successive pregnancies in this woman, who kept using self-prescribed antibiotics is a worrying trend that will require the education of women at various reproductive health care clinics about vulvar swellings and warn against antibiotics abuse.
  18,694 276 -
REVIEW ARTICLE
Maternal nutrition in Nigeria
JIB Adinma, OS Umeononihu, MN Umeh
May-August 2017, 34(2):79-84
DOI:10.4103/TJOG.TJOG_25_17  
Introduction: Nutrition refers to intake of food necessary for optimal growth, function, and health. A well-nourished mother is likely to have healthy infants with appropriate birth weight. Objective: To review nutrition including the dietary habit of the pregnant and postpartum women in Nigeria. Materials and Methods: Review involving Internet and literature search. Results: Undernutrition in women aged 15–49 years decreased from 15% (2003) to 11% (2013), while overnutrition increased from 21% (2003) to 25% (2013). Inadequate intake of calories and micronutrient is a major feature of studies on the dietary pattern of Nigerian pregnant women. Multinutrient malnutrition and micronutrient deficiencies are a consequence of low content of macronutrients and micronutrients in diet and staple foods in Nigeria. Food restriction/taboos occur in association with primigravidity; teenage pregnancy; lack of formal education; low household income, signifying low socio-economic status and a low body mass index. Food restrictions/taboos are common with proteins and vegetable. Commonly consumed vegetable contain adequate mineral and vitamins. Poor food preparation habit e.g blanching of vegetable and parboiling of rice occur. Postpartum mother has poor dietary intake–malnutrition, overweight, and obese body mass index. Caloric intake is high with low intake of protein and fat. There is intake of spices and peppery food believed to flush out lochia, and consumption of palm wine believed to assist breast flow. Consequences of anemia include–folic acid and iron deficiency, malaria, hookworm infestation, and urinary tract infections. Conclusion: Dietary habit on nutrition in pregnancy and postpartum women in Nigeria is poor. Recommendation: Recommended measures to improve maternal nutrition in Nigeria include development of dietary guideline for pregnancy and postpartum; health education on nutrition in pregnancy, using information, education and communication materials; provision of adequate rest and reduction of workload; counselling of pregnant women on intake of diversified food, and provision of treatment supplement; encouraging exclusive breastfeeding; and micronutrient supplementation/food fortification for postpartum mothers.
  5,102 390 -
ORIGINAL ARTICLES
Awareness and perception of preconception care among health workers in Ahmadu Bello University Teaching University, Zaria
O Adeoye Tokunbo, O Kolawole Abimbola, I Onwuhuafua Polite, O Adeoye Gbemiga
May-August 2016, 33(2):149-152
DOI:10.4103/0189-5117.192215  
Background: Preconception care (PCC) has been found to improve fetomaternal outcome but it is not widely practiced in Nigeria. Objective: To obtain information concerning the level of awareness, perception and practice of PCC among health workers with the view of providing recommendation for a framework for its implementation in Ahmadu Bello University Teaching Hospital. Materials and Methods: A descriptive cross-sectional study was conducted among 280 health workers (doctors and nurses) using pretested self-administered, semi-structured questionnaires between November 2013 and January 2014. Analysis was done using the Statistical Package for the Social Sciences version 16.0. Chi-square test was used to determine relationships between variables. Results: The response rate was 85.0% with 130 (54.2%) doctors and 109 (45.8%) nurses. Most (83.3%) of the respondents had heard of PCC, and 91.6% defined it correctly. Only 55 (23%) knew more than 75% of the components of PCC. The difference in knowledge of PCC between doctors and nurses and based on years of experience was statistically significant (c2 = 0.014). Only 114 (47.7%) had ever offered some form of PCC. The most common intervention was preconception folic acid administration in 33% of the respondents. The perceived obstacles to assessing PCC were poor information (88.3%), poor health seeking behaviour (68.6%) and unplanned pregnancies (60.7%). Majority 182 (76.2%) felt obstetricians should handle PCC followed by family physicians. Opportunistic delivery was cited as the best mode of delivery. Conclusion: The level of awareness of PCC is high among health workers, especially doctors. It can be offered opportunistically until full integration into the health care system. Training of health workers will improve its implementation.
  3,265 258 1
Effect of Implanon (etonogestrel) implant on serum lipids and lipoproteins
AO Aisien, SE Idogun
September-December 2016, 33(3):257-262
DOI:10.4103/0189-5117.199812  
Background: Since derangements of lipids and lipoproteins are associated with steroidal contraceptives and could be a consequent of cardiovascular diseases, it is important to study the association with Implanon implant. Objective: Evaluation of serum lipids and lipoproteins of Implanon users after 24 months of use. Materials and Methods: The longitudinal study of 46 women who had Implanon inserted was evaluated at preinsertion, 6, 12, and 24 months for serum lipids and lipoproteins. Results: The mean age and parity of the users were 34.3 ± 4.9 years and 3.0 ± 2.0. The mean weight and blood pressure were 72.2 ± 11.9 kg and 118.3 ± 13.2/76.8 ± 8.6 mmHg. The serum cholesterol and triglycerides were 136.5 ± 16.9 mg/dl and 49.6 ± 14.7 mg/dl at preinsertion. At 6 months, the serum cholesterol rose without significant changes at 6 months, i.e., 138.6 ± 5.4 mg/dl (P = 0.06) and at 12 months, i.e. 137.9 ± 14.3 mg/dl (P = 0.44) of the study. The mean value showed an insignificant reduction at 24 months, i.e., 133.9 ± 12.5 mg/dl (P = 0.24). The serum triglycerides did not change significantly at 6 months -50.8 ± 11.9 (P = 0.42), 12 months -48.9 ± 9.2 (P = 0.66), and 24 months of the study -48.8 ± 10.1 mg/dl (P = 0.73) when compared with the preinsertion mean value. The high-density lipoprotein cholesterol was 52.9 ± 6.3 mg/dl at preinsertion. The serum value reduced significantly at 12 months of the study to 51.1 ± 5.9 mg/dl (P = 0.03) without any significant changes at 6 months, i.e., 51.4 ± 7.4 mg/dl (P = 0.09), and at 24 months of the study, i.e., 51.4 ± 7.9 mg/dl (P = 0.38). The low-density lipoprotein cholesterol was 73.3 ± 14.9 mg/dl at insertion. The mean value significantly increased at 6 months, i.e., 77.2 ± 13.2 mg/dl (P = 0.01), 12 months, i.e., 77.2 ± 13.2 mg/dl (P = 0.05) of study with an insignificant reduction at 24 months, i.e., 72.7 ± 12.7 mg/dl (P = 0.79). Conclusion: The observed changes in the serum lipids and lipoproteins which are expected to dissipate with time were within normal values.
  1,252 1,833 -
The prevalence of anemia in pregnancy at booking in Abakaliki, Nigeria
Chidi OU Esike, Okechukwu B Anozie, Robinson C Onoh, Uchechi C Sunday, Okechukwu S Nwokpor, Odidika UJ Umeora
September-December 2016, 33(3):332-336
DOI:10.4103/0189-5117.199818  
Background: Anemia is the most common hematologic abnormality diagnosed in pregnancy. It continues to be a major health problem in many developing countries and is associated with increased rates of maternal and perinatal morbidity and mortality. We do not know the prevalence of anemia in our pregnant population at booking in Abakaliki despite the aforementioned devastation of anemia in pregnancy, hence the need for this study. Materials and Methods: This is a retrospective study of 501 pregnant women who attended antenatal care at the Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Their antenatal case records were retrieved from the records department and the antenatal records unit of the hospital. All the relevant information were retrieved and analyzed. Results: Using the World Health Organization criterion of 11 g/dl to define anemia in pregnancy, majority of our pregnant women at booking, 283 (56%) were anemic at booking with 196 (69.3%) being mildly anemic and 87 (30.7%) being moderately anemic. None of our patients was severely anemic. However, using the Lawson definition of anemia in pregnancy as a hemoglobin of below 10 g/dl as the cutoff, 16% of the pregnant women were anemic at booking with 75 (14.9%) being mildly anemic and 5 (6.3%) moderately anemic. None was severely anemic. Conclusion: Anemia in pregnancy has an unacceptably high prevalence in our pregnant population at booking, and all efforts must be made to correct this widespread problem as early as possible using the most appropriate and expeditious means to avoid preventable calamities.
  2,810 257 -
Prevalence and predictors of menopausal symptoms among postmenopausal Ibo and Hausa women in Nigeria
N Ameh, NH Madugu, D Onwusulu, G Eleje, A Oyefabi
September-December 2016, 33(3):263-269
DOI:10.4103/0189-5117.199819  
Background: Menopause is an important part of the life of a woman. The perception and reaction to these symptoms vary from woman to woman and among different tribes and races. Nigerian women are becoming more aware of menopause and its associated problems through the media and other sources. This has important implications including health and financial burden of treatment and loss of work hours. Objective: To determine the pattern of menopausal symptoms and factors affecting them among Ibo women in southeast and Hausa women in northeast geopolitical zones of Nigeria. Methods: A descriptive cross-sectional study involving 261 randomly selected postmenopausal women from the southeast and northeast geopolitical zones of Nigeria. Results: The mean age of the respondent was 52.68 ± 5.76. Major complaints were joint and body pains (74%), reduction in scalp hair volume (57%), internal heat (51.7%), and vulvar pruritus (47.1%). Most of them had multiple symptoms with moderate severity (58.6%). Vulva vagina dryness was observed in age group of 50–54 years while underweight women presented more with forgetfulness. Women with tertiary education were more likely to experience severe symptoms and to seek medical help, and Ibo women were more likely to have their daily functions affected by menopause (P < 0.05). Only 7.9% of the respondents had knowledge of treatment for menopausal symptoms. Conclusion: There is an increased awareness of menopause among women in this population. Menopausal women mainly experienced body and joint pains and reduction in scalp hair volume, contrary to commonly held view that dark-skinned women mainly experience vasomotor symptoms. Menopausal clinics will address these problems.
  1,908 563 1
CASE REPORTS
Oropharyngeal fetus-in fetu in Ilero Nigeria: A case report
AO Adebiyi, TO Shorunmu, T Owoeye, OE Amoran, AA Ojeleke
January-April 2017, 34(1):65-68
DOI:10.4103/TJOG.TJOG_20_17  
Fetus-in-fetu is a rare congenital condition in which a malformed parasitic twin is found within the body of its partner. Although a few had been documented worldwide, none has been reported in Nigeria. In this report, we document the history of a concoction of drugs of an indeterminate nature taken in pregnancy, the wrong diagnosis by the rural based sonographer and the presence of polyhydraminos. Our finding of a previously misdiagnosed oropharyngeal fetus-in fetu with dichorionic and cardiac features calls for a revision of the current definition of fetus-in fetu. It also raises an important hypothesis of the likely associations between drugs, infections, pregnancy induced hypertension and fetus-in-fetu.
  2,279 79 -
ORIGINAL ARTICLES
Awareness and utilization of emergency contraception among female undergraduates in a Nigerian University
Bilkisu Isa, Sanusi M Ibrahim, AA Kullima, Babagana Bako
May-August 2016, 33(2):196-200
DOI:10.4103/0189-5117.192224  
Background: Many women are not aware of emergency contraception, which limits its use. Because increased risk of unwanted pregnancy and subsequent unsafe abortion have been well-documented, research on the knowledge and usage of emergency contraception is appropriate. Materials and Methods: The present study was a descriptive cross-sectional study conducted among 450 female undergraduate students of a University in northeast Nigeria from November to December 2014. Results: The age range of the respondents was 19-30 years, with a mean age of 21.4 ± 2.1 years. Most of them, 308 (68.4), were between the ages of 20 and 24 years. Majority of the students, 321 (71.3%), were single. Overall, 295 (65.5%) students were aware of emergency contraception, and 211 (71.5%) had utilized them. Among those who had utilized them, 174 (82.4%) were singles. The most common source of initial information about emergency contraception was health personnel, 148 (50.1%), followed by friends, 107 (36.3%). School, 11 (3.7%), and parents, 4 (1.4%), were the least utilized sources of information. Information from health personnel, news media and schools were the major influences of emergency contraceptive utilization. Levonorgestrel only pills (Postinor-2 R ) and combined pills (Yuzpe) were the most commonly utilized emergency contraception by 91 (43.1%) and 85 (40.3%) of the respondents, respectively. Conclusion: There was good level of awareness and utilization of emergency contraception among female undergraduates. However, there is a need to educate the parents, students and staff or counselors at the family clinic section of the university health clinic on its importance to improve the awareness of the students.
  1,794 211 -
Predictors of successful induction of labour at a tertiary obstetric service in Southwest Nigeria
Folasade A Bello, Oriyomi O Akinyotu
May-August 2016, 33(2):143-148
DOI:10.4103/0189-5117.192213  
Context: Induction of labour is a useful obstetric intervention, yet it is underutilized in Africa. Recommendations for practice may reduce its unmet need. Objective: This study aims to determine labour induction success rates and identify predictors of outcome. Study Design, Setting and Patients: This was a retrospective, descriptive, cross-sectional study of 104 women who had induction of labour at the University College Hospital, Nigeria. Main Outcome Measures: Primary outcomes were vaginal delivery within 24 hours and caesarean delivery. Analyses were done by Chi-square tests, t-tests and logistic regression. Results: Labour induction rate was 12.7%; most were performed on account of post-dated pregnancies and pre-labour rupture of membranes. Forty-six, (44.2%) had vaginal delivery within 24 hours whereas induction failed (i.e. caesarean delivery) in 38 (36.5%). The mean duration of the process was 12.0 ± 6.6 hours with misoprostol, 8 hours less than with oxytocin (P < 0.01). Misoprostol was significantly more likely to result in delivery within 24 hours in comparison to extra-amniotic transcervical catheter for ripening (P = 0.02, OR = 5.1, 95% CI = 1.2-21.1), and to oxytocin for induction (P = 0.03, OR = 6.5, 95% CI = 1.2-36.3), respectively. Adverse effects were infrequent and comparable with either method. Conclusion: Success rate needs to be improved upon. Higher parity, later gestation and misoprostol ripening or induction are associated with successful outcomes. It is recommended that clients' experience may be improved by commencing misoprostol cervical ripening the night before induction and administering the medication orally rather than vaginally.
  1,755 233 -
REVIEW ARTICLES
Postgraduate medical education in Nigeria: Past, present, and future
Friday E Okonofua
January-April 2018, 35(1):1-13
DOI:10.4103/TJOG.TJOG_54_16  
Postgraduate Medical Education (PME) in Nigeria: Past, Present and Future was a solicited paper delivered at the Annual Scientific Conference of Society of Obstetrics and Gynaecology of Nigeria held in Abuja in November 2015 in honour of Professor L. N. Ajabor, the doyen of medical practice and a foremost practitioner and researcher in Obstetrics and Gynaecology whose several achievements and influences on professional practice in undergraduate and postgraduate medical education span over 40 years within and outside Nigeria. This lecture was a befitting tribute to a hero, mentor and benefactor, who with several of his colleagues championed the development and implementation of PME in Nigeria in the 70s, the assessment undertaken in this paper suggests that while the main purpose of PME have largely being achieved in Nigeria, a lot remains to be done in propelling it beyond its original vision to enable it compare favourably with similar medical post graduate training in other parts of the world. This lecture is organized in four main areas: Professor Linus Ajabor autobiography, The history, origin and intention of postgraduate medical training from the international perspectives, the history of postgraduate medical education in Nigeria, status of residency training in Nigeria, challenges facing medical education in Nigeria. The PhD versus fellowship controversy in Nigeria and the future of postgraduate medical education in Nigeria.
  1,729 237 1
REVIEW ARTICLE
Cervical cancer screening and practice in low resource countries: Nigeria as a case study
Oluwaseun O Sowemimo, Opeyemi O Ojo, Olusola B Fasubaa
September-December 2017, 34(3):170-176
DOI:10.4103/TJOG.TJOG_66_17  
Cervical cancer is the most common female genital tract malignancy in Nigeria and majority of the patients present with advanced disease. It is a preventable cancer as there are well-defined treatable premalignant phases. The objective of the study is to review the burden of cervical cancer, its screening modalities, and practice of screening and treatment in low resource countries with emphasis on Nigeria. This is a review involving internet and literature search. While developed countries have recorded significant reduction in the incidence of cervical cancer owing to organized screening programs, treatment of premalignant cervical lesions, and follow-up of treated cases, developing countries including Nigeria are yet to optimally utilize screening services due to lack of organized population-based screening programs with only pockets of screening services which are at best opportunistic. This has not reduced the incidence of cancer because only a fraction of the target population is covered. Apart from this, loss to follow-up is rampant. The level of awareness of cervical cancer and its preventive strategies are low among the population and policymakers in Nigeria. There is no organized screening program, and the few services available are only opportunistic with little or no impact. Development of cervical cancer screening policy and institution of organized screening program targeted at covering ≥80% of population at risk is fundamental. There is also a need for widespread education of the populace on the burden of cervical cancer and the public health importance of the disease using the mass media, counseling at antenatal clinics, and the involvement of men will contribute immensely to reduction in the incidence of cervical cancer. Decentralization of services by incorporation of cervical screening and treatment in primary health care programs will ensure adequate rural-urban coverage.
  1,468 448 -
ORIGINAL ARTICLES
An analysis of postdural puncture headache in obstetric patients: A study from Kano, Nigeria
AD Mohammed, R Ayyuba, I Salisu, AU Nagoma, LF Owolabi, A Ibrahim
January-April 2017, 34(1):16-20
DOI:10.4103/TJOG.TJOG_61_16  
Background: One of the complications of spinal anesthesia is postdural puncture headache. Many risk factors have been identified which when addressed could reduce the incidence. Objectives: This was a prospective study that analyzed the incidence, onset and severity of postdural puncture headache among pregnant women who had cesarean section under a subarachnoid block in Aminu Kano Teaching Hospital, Kano, Nigeria. Patients and Methods: Spinal anesthesia was performed on 146 patients using size 25- or 26-gauge Quincke, Whitacre, or Sprotte needles. Patients were followed up to determine the incidence, onset, and severity of post spinal headache. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 18.0 (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Demographic variables were presented using tables while summary was done using means, standard deviation, and percentages. Test of association was done using Fisher's Exact test. A P value < 0.05 was considered statistically significant. Results: The overall incidence of postdural puncture headache was 15.8% with all cases presenting within the first 24 hours. Most patients rated their headache as mild to moderate on a 10-cm visual analogue scale. Conclusion: Traumatic Quincke spinal needle is associated with high incidence of postdural puncture headache and therefore we recommend the use of atraumatic pencil tip needle especially in obstetric anesthesia.
  1,678 130 -
The social class and reasons for grand multiparity in Calabar, Nigeria
CI Emechebe, CO Njoku, EM Eyong, K Maduekwe, JT Ukaga
September-December 2016, 33(3):327-331
DOI:10.4103/0189-5117.199808  
Background: Grand multiparity is a high-risk pregnancy, and it is a common phenomenon in this part of the world, and when added to low socioeconomic status, it significantly increases obstetrics risk to mother and fetus. Objective: To determine the social class and reasons for grand multiparity in Calabar. Materials and Methods: This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of the University of Calabar Teaching Hospital, Calabar. The study comprised 150 grand multiparous women who were admitted for delivery and consented to the study during the period. The social class, educational level, and reasons for grand multiparity were determined. The data obtained were collated and analyzed using SPSS version 18. Results: The incidence of grand multiparity in this study is 8.7%, and most grand multiparous women belong to low social class 63 (42.0%). Grand multiparity was higher among women with primary education, polygamous marriage, and traders. Gender desirability (31.3%) was the most common reason for grand multiparity followed by desire for more offspring to maintain large family size (16.7%). Conclusion: This study showed that the incidence of grand multiparity is still high in our environment, and the reasons were complex, multiple, interrelated but preventable. Health awareness on the dangers of grand multiparity, reorientation of our long-held culture of gender preference, female education, and economic empowerment will help women to discard wrong sociocultural and religious beliefs.
  1,660 130 -
Vaginal hysterectomy using local anesthesia and analgesics
O Onafowokan, O Asemota
September-December 2016, 33(3):270-273
DOI:10.4103/0189-5117.199806  
Context: Vaginal hysterectomy for pelvic organ prolapse is often performed under general or regional anesthesia. However, the performance of this operative procedure under local anesthetic has potential benefits, especially in resource-poor settings. Aims: The aim of this study was to review the outcome of vaginal hysterectomy and pelvic floor repair using local anesthesia and supplementary analgesia. Settings and Design: The study was retrospective and the setting was a cottage hospital in the northern Nigeria. Subjects and Methods: A review of the case records of women who underwent a vaginal hysterectomy and pelvic floor repair for uncomplicated 4th degree (Stage III) uterovaginal prolapse, using local lidocaine infiltration and supplemental pentazocine injection. Statistical Analysis Used: Descriptive statistics and frequencies were used to describe the population and outcomes of surgery. Results: Eighteen women successfully had vaginal hysterectomy and pelvic floor repair using local anesthesia with supplemental pentazocine intramuscular injection. Four (22.2%) of the women required supplemental pentazocine injection. The mean duration of surgery was 101.67 (± 14.14) min and the average hospital stay was 36.22 (± 17.16) h. Thirteen (72.2%) women were satisfied with the surgery, anesthesia, and early ambulation while the others desired a totally painless surgery in addition to the early ambulation and short hospitalization. Conclusions: The use of local anesthesia for vaginal hysterectomy and pelvic floor repair was successful in patients with severe uterovaginal prolapse. A larger, randomized controlled study is recommended.
  1,593 108 -
Expectant mothers' perception of prenatal sonography in a South-Eastern population in Nigeria
AC Ugwu, HC Elugwu, OA Onyegbule
May-August 2016, 33(2):190-195
DOI:10.4103/0189-5117.192222  
Background: Prenatal sonography is very important for quality patient management and effective service delivery in diagnostic radiology during the antenatal period. Aim: The study was conducted to assess the perception of pregnant women to prenatal sonography and to investigate the factors affecting maternal satisfaction to prenatal sonography in some tertiary institutions in south-eastern Nigeria. Materials and Methods: The study was a cross-sectional study that involved 150 patients. It was conducted by administering semi-structured questionnaires. The questionnaire contained a total of 17 questions consisting of 16 close-ended questions and 1 open-ended question. The respondents were pregnant women who presented for obstetric sonography in Federal Teaching Hospitals and Federal Medical Centers in south-eastern Nigeria. The data were analyzed descriptively using frequency tables and percentages. Results: There was a high indication of clinical use of obstetric ultrasound such as the health and well-being of the foetus (35.3%), foetal age determination, and the expected date of delivery (24.7%). Most respondents (84.6%) perceived prenatal sonography as being necessary, and 66.7% of the patients considered the result of obstetric sonography to be reliable. Majority of the respondents (88.7%) considered the services rendered during their sonographic scan to be satisfactory. Conclusion: Most of the women perceived prenatal sonography as necessary and reliable. The services rendered during sonography were also considered satisfactory by most women; however, most pregnant women did not know about diagnostic ultrasound safety during the prenatal period.
  1,493 179 -
Gestational trophoblastic disease in Abuth Zaria, Nigeria: A 5-year review
Abimbola O Kolawole, John K Nwajagu, Adekunle O Oguntayo, Marliya S Zayyan, Sunday Adewuyi
May-August 2016, 33(2):209-215
DOI:10.4103/0189-5117.192228  
Gestational trophoblastic diseases (GTD) includes a spectrum of diseases (tumor or tumor-like conditions) characterised by aberrant growth and development of the trophoblasts that may continue even beyond the end of pregnancy. It encompasses the benign trophoblastic disease (complete and partial moles), and the malignant trophoblastic diseases including the invasive mole (chorioadenoma destruens), choriocarcinoma, and Placental Site Trophoblastic Tumor (PSTT). This study was to determine the prevalence, risk factors, clinical presentation, diagnosis, treatment options and outcomes of GTD in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. A five-year retrospective study of patients with GTD managed at ABUTH, North-west Nigeria, from 1 st January 2008 to 31 st December, 2012 was undertaken. Data of all cases of GTD in the hospital over the 5 year period were obtained. The gynaecology ward and labour ward registers also provided information on the total number of gynaecological admissions and deliveries respectively. The data processing and analysis were carried out using the SPSS software version 16. The data obtained were expressed in percentages, means, and standard deviations. During the period of study there were 8,138 deliveries and 2,453 gynaecological admissions. There were 59 cases of GTD with 41 having choriocarcinoma, 18 molar pregnancies and no case of invasive mole or PSTT. Out of the 41 case folders retrieved, 23 were choriocarcinoma and 18 of molar pregnancies. The prevalence of GTD was 7.2 per 1000 deliveries (0.72% or 1 in 138 deliveries) and constituted 2.4% of gynaecological admissions. Hydatidiform mole (HM) occurred in 1 in 452 deliveries and choriocarcinoma occurred in 1 in 198 deliveries. Ages ranged from 19-49 years with mean of 32.5+ 5.0 years. Most (66.7%) cases of HM were 19-29years while 60.9% of choriocarcinoma cases were 30-39years. Majority of cases were multiparous. The antecedent events predating choriocarcinoma were Hydatidiform mole (31.7%), abortions (29.3%) and 2.4% followed term pregnancy. History of amenorrhea was present in all cases while vaginal bleeding occurred in 97.6%, pallor (87.8%), hyperemesis gravidarum (48.8%) and 4.9% came in shock. Consequently, common complications reported were haemorrhage (90.2%), anemia (87.8%) and shock (12.2%). Pregnancy test was positive in 90.2% of cases and serum beta hCG was done in 24.4% with more than half having a level >12,000miu/ml. All patients had pelvic ultrasound scan and snowstorm appearance occurred in 41% of benign GTD cases. Histology was used to confirm 56.1% cases of choriocarcinoma and 43.9% of molar gestation. Most (94.4%) of HM had suction evacuation while 95.6% of choriocarcinoma cases had chemotherapy, one case (2.4%) had Total Abdominal Hysterectomy. Contraception was used in 78% and common methods were male condom (41.5%) and 36.6% used combined oral contraceptive pills. Less than half (43.9%) had follow up for 6 months and 9.8% were seen for more than a year. Eight patients had subsequent pregnancies and there was one death in the series giving a case fatality of 2.4%. Gestational trophoblastic disease is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.
  1,405 157 -
Determination of coagulopathy complicating severe preeclampsia and eclampsia with platelet count in a University Hospital, South-South, Nigeria
OO Awolola, NO Enaruna
May-August 2016, 33(2):179-184
DOI:10.4103/0189-5117.192220  
Background: Pre-eclampsia is a multisystemic disorder complicating pregnancy. It is associated with a significant burden on maternal and perinatal health, especially when complicated by coagulation abnormalities. Objective: The objective of the study was to determine the level of thrombocytopenia that predicts a risk of abnormalities of coagulation indices in severe preeclampsia and eclampsia. Materials and Methods: Haemostatic factors including platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT) and plasma fibrinogen were done for a cohort of 90 patients with severe preeclampsia and eclampsia at the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City. Their demographic and laboratory data were analysed using the Statistical Package for Social Sciences version 20.0 and GraphPad InStat 3 software. Results: Twenty-one (23.3%) of the 90 patients had eclampsia. Mean age was 29.78 ± 4.7 years, parity was 2.54 ± 1.6 and gestational age was 36.14 ± 2.9 weeks. Thrombocytopenia was found in 13 (14.4%) patients, whereas biochemical coagulopathy was found in 6 (6.7%) patients. Thrombocytopenia was 43% more likely with eclampsia than severe preeclampsia (47.6% vs 4.3, P = 0.001). Abnormal PT, APTT and plasma fibrinogen were more likely with platelet count below 80000 cell/µl (P = 0.046, P = 0.014 and P = 0.001, respectively). Eclampsia complicated with thrombocytopenia was associated with the most severe biochemical coagulopathy. Conclusion: Thrombocytopenia frequently complicates eclampsia more than severe preeclampsia at platelet count levels below 80000 cell/µl. This level is discriminatory for biochemical coagulopathy, and it should prompt coagulation studies and warrant clinical vigilance.
  1,334 185 -
Feto-maternal outcome of induced versus spontaneous labour in a Nigerian Tertiary Maternity Unit
OY Abisowo, AJ Oyinyechi, FA Olusegun, OY Oyedokun, AF Motunrayo, OT Abimbola
January-April 2017, 34(1):21-27
DOI:10.4103/TJOG.TJOG_59_16  
Background: Induction of labour may be associated with postpartum haemorrhage, instrumental delivery, blood transfusion, longer hospital stay and admission to the neonatal intensive care unit. Objective: To assess the feto-maternal outcome of induced labour compared to spontaneous onset labour. Materials and Methods: Prospective comparative study involving 440 participants divided into induction (study) and spontaneous labour (control) groups. Data were collected on socio-demographic data, maternal complications, blood transfusion and neonatal outcomes. Results: A total of 1540 deliveries occurred during the study period, out of which 257 had induction of labour. Successful induction rate was 16.47%. Vaginal delivery was 67.6% in the study group compared to 83.4% in the control group. Postdated pregnancy and hypertensive diseases accounted for 56.8% and 28% of the indications for induced labour, respectively. Induced labour was associated with a significantly higher caesarean section rates (P < 0.001). Cephalo-pelvic disproportion was the most common indication for caesarean section (P = 0.038). Maternal complications include primary postpartum haemorrhage, perineal lacerations and endometritis. The study group had longer duration of hospital stay compared to the control (P < 0.001). Five perinatal mortality occurred among the study group compared to three in the control (P = 0.848). Conclusion: Induction of labour is associated with increased risk of caesarean delivery and postpartum haemorrhage compared with spontaneous labour, however, overall rates remain low.
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Pain relief in labor: A randomized controlled trial comparing intramuscular tramadol with intramuscular paracetamol at the University College Hospital, Ibadan, Nigeria
CO Aimakhu, OO Saanu, O Olayemi
May-August 2017, 34(2):91-98
DOI:10.4103/TJOG.TJOG_17_17  
Background: Labor is considered to be one of the most painful experiences in life. Several efforts have been made over the years, particularly in the developed world, to relieve pain in labor. Unfortunately, the same attention has not been given to obstetric analgesia in most of Africa. Aim: To compare the analgesic efficacy, patient satisfaction, and side effects of intramuscular tramadol and paracetamol as pain relief among women in labor at University College Hospital (UCH), Ibadan, Nigeria. Materials and Methods: This was a prospective double-blind randomized controlled trial that recruited 142 parturients into two groups of 71 women. One group received intramuscular 600 mg paracetamol and the other 100 mg tramadol at recruitment with rescue dose at least 3 h apart. Maternal vital signs were monitored and labor pain was assessed using the numerical rating scale. Neonatal conditions were assessed by the use of APGAR scoring system and the need for admission into the Special Care Baby Unit. The parturients overall satisfaction with the analgesia were assessed 24 h postpartum. Results: The sociodemographic characteristics of the pregnant women in the two groups were similar, with the mean ages being 30.89 ± 3.50 and 30.93 ± 3.82 years, respectively. The study showed that intramuscular paracetamol was as effective as intramuscular tramadol for providing moderate pain relief during active phase of labor. Neither drug caused significant changes in maternal vital signs, with favorable neonatal outcome and good safety profile. Conclusions: This study showed that 600 mg intramuscular paracetamol provides similar and modest pain relief in labor when compared to 100 mg intramuscular tramadol. It also has fewer maternal adverse effects and favorable neonatal outcome such as tramadol. It is concluded that intramuscular paracetamol is simple, cost-effective, readily available, and feasible option as labor analgesics, especially for resource poor settings.
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Experiences in the use of misoprostol in the management of first trimester missed abortion in a low resource setting
MA Abdul, HO Palmer, B Aminu, H Ismail, A Kadas
May-August 2016, 33(2):201-204
DOI:10.4103/0189-5117.192225  
Background: The use of misoprostol in the management of first trimester abortion is an evolving clinical practice in most parts of sub-Saharan Africa. Objective: To determine the effectiveness and acceptability of misoprostol in the evacuation of the uterus in first trimester missed abortion. Study Design: This was a non-randomized trial. Setting: This study was conducted in the Gynecologic Unit, Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Nigeria. Materials and Methods: Consented consecutive patients with first trimester missed abortion were recruited in the study. Each patient was given sublingual misoprostol 600 µg to be repeated after 6 hours if abortion process was not initiated. They were followed-up after two weeks and offered contraceptive counseling. However, if active vaginal bleeding persisted, patients were reviewed after 1 week, scanned and offered surgical evacuation (manual vacuum aspiration) on confirmation of residual products of conception. Telephone review was conducted for patients who defaulted follow-up. Data were analyzed using the Statistical Package for the Social Sciences version 16. P value was considered significant at a < 0.05 at 95% CI. Results: Sixty-one patients with missed abortion were managed between 1 st January and December 2013 with a mean age, parity and gestational age of 27.6 ± 5.6 years, 3.6 ± 2.3 and 7.6 ± 2.0 weeks, respectively. Fifty-six patients (92%) achieved complete evacuation. Mean interval between the first dose of misoprostol and abortion was 5.1 ± 2.2 hours and mean duration of vaginal bleeding was 5.9 ± 1.6 days (range: 3-14 days). Side effects were minor mainly nausea/vomiting, and all the patients with complete evacuation showed satisfaction with the method and preferred it to surgical evacuation. Conclusion: Misoprostol is very effective in the management of first trimester missed abortion in our setting and should be the treatment method of first choice.
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Pattern of breast cancer risk factors among pre and post-menopausal women at a Primary Care Clinic in Nigeria
Ajayi O Ikeoluwapo, Ogunbode M Adetola, Adeniji-Sofoluwe T Adenike, Mosuro A Olushola, Ladipo MA Modupe, Oluwasola O Abideen, Afolabi B Nathaniel, Obajimi O Millicent
May-August 2016, 33(2):220-227
DOI:10.4103/0189-5117.192232  
Context: The incidence of breast cancer is increasing worldwide. In black women, breast cancer is associated with aggressive features and poor survival. Objective: Identification of risk factors such as early age of menarche, obesity and family history of breast cancer may permit preventive strategies. Study Design: A cross-sectional comparative study design was used and questionnaires were administered to 400 adult women at a tertiary health centre in Nigeria. The data was analyzed with the Statistical Package for the Social Sciences version 17; the level of significance set at alpha = 0.05. Results: There was significant association between pre-menopausal and post-menopausal women with positive family history of breast cancer with P = 0.010. Majority of the respondents with a positive family history of breast cancer were menopausal (P = 0.010). There was a statistically significant association between menopausal status and ever consuming alcohol-based herbal concoctions (P = 0.010) and in those whose partners smoked cigarettes (P = 0.001). Majority of respondents were not currently on any form of contraceptives. Parity, breastfeeding and use of hormonal contraceptives were all statistically significant (P < 0.001, P < 0.001 and P = 0.004, respectively). Almost all the women in our study, 97%, had never had a mammogram. There was a significant association between pre-menopausal and post-menopausal women with positive family history of breast cancer (P = 0.010). Conclusion: With increasing incidence of breast cancer worldwide and late presentation in developing countries with high morbidity and mortality, effective screening for risk factors will go a long way in reducing the incidence of breast cancer.
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Labour outcome in patients admitted in the second stage of labour at Jos University Teaching Hospital, Jos, Nigeria
Michael T Maanongun, Patrick H Daru, Victor C Pam, Terrumun Z Swende, Augustine O Ojabo, Peter O Eka
May-August 2016, 33(2):165-171
DOI:10.4103/0189-5117.192218  
Context: Unsupervised or poorly monitored labour is associated with increased maternal and neonatal complications. Late presentation in labour is common place in this part of the world. Objective: To determine the reasons for coming in second stage of labour and compare the labour outcome with those admitted in the first stage of labour. Materials and Methods: This was a case control study conducted at the Jos University Teaching Hospital between September and November 2012. Results: Of the 617 total deliveries, 156 (25.3%) were admitted in second stage of labour. Majority of women (38.57%), (10.00%), (8.57%) stated transportation difficulties, fast progress of labour and husband not around respectively as the reason for coming in second stage of labour. Maternal complications like lower genital laceration (25.7% vs 8.6%), postpartum haemorrhage (7.1% vs 2.1%), and ruptured uterus (2.1%) were more common amongst the cases than the control. The total mean blood loss was similar in both groups. Complications of sickle cell crises, eclampsia, and anaemia including chorioamnionitis were found only among the cases. There were more spontaneous vagina deliveries amongst the cases while caesarean section and use of episiotomy were more amongst the control (P < 0.01). Instrumental delivery was similar in the two groups. Perinatal complications like fresh stillbirths (5.0%), early neonatal deaths (2.10%), birth asphyxia (5.4% vs 3.6%) and the need for admissions in special care baby unit (3.4% vs 0.7%) were more amongst the cases than the control. Conclusions: This study identified transportation problems, fast progress of labour, absence of husband at home when labour starts as major reasons for presenting in second stage of labour. Presenting in second stage of labour was associated with worse labour outcome.
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Cervical intraepithelial neoplasia: Prevalence, risk factors, and utilization of screening services among an urban population in Nigeria
BT Utoo, PM Utoo, SD Ngwan, SA Anzaku, MA Daniel
September-December 2016, 33(3):279-283
DOI:10.4103/0189-5117.199810  
Background: Cervical intraepithelial lesion is a precursor lesion for cancer of the cervix. It is usually asymptomatic and can only be detected through screening. Purpose: This study was designed to determine the prevalence, risk factors, and utilization of screening services for cervical intraepithelial neoplasia among the women. Methods: It was a cross-sectional study during an organized screening program for cervical intraepithelial neoplasia (CIN) using Pap smear among women in July 2013 at the University Teaching Hospital, North Central Nigeria. Results: Out of the 286 women interviewed, 208 agreed to be screened giving a response rate of 72.7%. Most (72.1%) of them were 31–50 years, 78.4% were married, and 65.4% had a tertiary level of education. Approximately, 77% became sexually active as teenagers. CIN 1 and CIN 2/3 accounted for 4.8% and 2.9%, respectively. Overall, low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion amounted to 7.7%. The risk of intraepithelial lesion is higher among those with multiple sexual partners, early coitarche, and ever use of oral contraceptive pills (odds ratio 1.76, 0.8, and 1.4). Only 9.8% of the total population interviewed had ever screened at least once in the past. Even among those with a positive result for CIN, only 18.8% had ever screened. Conclusion: Organized screening programs for early detection and treatment of CIN, modification of risky social behaviors, and vaccination of teenage women should be promoted as crucial steps to preventing cancer of the cervix.
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REVIEW ARTICLE
Adolescent and pre-pregnancy nutrition in Nigeria
JIB Adinma, OS Umeononihu, MN Umeh
January-April 2017, 34(1):1-5
DOI:10.4103/TJOG.TJOG_12_17  
Good nutrition during adolescent and pre-pregnancy period is critical towards a healthy pregnancy and normal birth weight infant. This article is a review of Adolescent and pre-pregnancy nutrition in Nigeria. Undernutrition in adolescent girls aged 15–19 years in Nigeria has been variously reported to range between 23% and 57.8%. Undernutrition was more prevalent among the rural compared to the urban adolescent, and was attributable more to socio-economic, and dietary factors. A high proportion of energy amongst adolescent, was derived from carbohydrates such as rice, yam, and cassava. Proteins were derived mainly from legumes and pulses, while fats were derived mainly from palm and vegetable oil. Iron was mainly of plant origin and had low bioavailability due to the presence of absorption inhibitors– tannins and phytates. A high levels of vitamin A was prevalent due to consumption of red palm oil. Undernourished adolescent girl and pre-pregnant women are likely to give birth to undernourished infants with the risk of transmitting undernutrition to the future generation. The recommendation towards the implementation of adolescent and pre-pregnancy nutrition in Nigeria include– The establishment of a country-wide school-based nutrition programme; Integration of Nutritional counselling with primary health care services, targeting out of school adolescents; Development of dietary guidelines and IEC materials on nutrition; and Establishment of Preconception clinic to counsel women on family planning and appropriate diet as well as monitor their body weight prior to pregnancy.
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ORIGINAL ARTICLES
Transfusion syndromes in monochorionic multiplets: An overview
Dominic O Osaghae, Jacob A Unuigbe
May-August 2016, 33(2):135-142
DOI:10.4103/0189-5117.192211  
The west Africa sub-region, notably Nigeria, records the highest twin and triplet birth rates globally. Therefore, the time has come for attention to be focused on an area of gemellology, feto-fetal transfusion syndromes in multiplets, in order to attend to what the authors consider a yet-to-be-explored major significant contributor to the overall unacceptably high fetal, perinatal and neonatal losses in the region. This review examines the genetics, embryology and pathophysiology of twinning in general to provide the background to the spectrum of clinical presentations of feto-fetal transfusion syndromes. Twin-to-twin transfusion syndromes (TTTS) are unique prenatal complications of monochorionic multiplets and manifest as twin oligohydramnios polyhydramnios sequence (TOPS), twin anaemia polyhydramnios sequence (TAPS) and twin reversed arterial perfusion syndrome (TRAPS). These grave complications are associated with fetal malformations and early miscarriages as well as fetal weight and haemoglobin discordances, discordant haemodynamic changes in addition to intrauterine deaths, perinatal asphyxia, cerebral palsy and brain damage. Most importantly, the management of TTTS requires highly skilled interventions, expensive equipment, rare expertise and costly treatment options that are currently not available in Nigeria and other developing countries. Moreover, these management options are unavailable in Nigeria because considerable attention of the health system is directed at the burden of high levels of maternal, perinatal, and childhood morbidity and mortality. Regardless of these overwhelming obstetric and paediatric challenges, there is still urgent need to develop feto-maternal medicine units in the country to focus attention on the management of TTTS because of high twinning rate and attending fetal, perinatal and neonatal wastages. Furthermore, Nigeria is now witnessing an increased incidence of twin births from the rapidly developing assisted reproductive therapy centres in the country. All these provide justification for devoting attention to this unique area of perinatal care that will, on balance, be robustly cost effective. Hence, this review of transfusion syndromes in monochorionic multiplets aims to sensitize health workers and researchers in Nigeria, particularly perinatologists and feto-maternal physicians, neonatal paediatricians, as well as policy makers and other stakeholders, on the need to focus attention on the problem.
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