Background: One of the pillars of prevention of Mother to child transmission (MTCT) of Human Immunodeficiency Virus (HIV) involves prevention of pregnancy or delaying pregnancy until when it is desired in HIV-positive women. This study aimed to assess fertility desire, utilization of family planning method, and predictors for use of contraception among women living with HIV. Materials and Methods: This was a descriptive cross-sectional study, carried out at the Federal Medical Centre Birnin Kudu, Jigawa state, Nigeria. Using an interviewer-administered questionnaire, the fertility desire, utilization, and predictors of use of modern contraceptive methods was assessed among 330 HIV-positive women attending the hospital specialist clinic. Data was analyzed using SPSS. Results: Majority (n = 250; 75.8%) of the respondents desired to have more children, out of which 100 (40%) desired to have more than 6 children each while 80 women (24.2%) no longer wanted more children. Sixty-eight (20.6%) respondents had a change in fertility intention since diagnosed as HIV positive. The use of family planning methods was significantly associated with having formal education, being married, and being of the Christian faith (P < 0.05). The odds of using a family planning method was about 4 times less among women with informal education (P = 0.002, OR = 3.819; 95% CI (Confidence Interval) = 1.657–9.139); while the odds was 3 times higher among married women (P = 0.032, OR = 0.258; 95% CI = 0.075–0.888). Conclusion: Women living with HIV have different reproductive intentions with majority desirous of childbearing, hence they should be supported either to space their births or limit child bearing to reduce the risk of MTCT of HIV.

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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.

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Background: Client preference and availability of contraceptives are important determinants of uptake in developing countries. In this study, we investigated the trend of contraceptive uptake and factors associated with client choice among women accessing family planning services in an urban tertiary hospital in Northwestern Nigeria. Subjects and Methods: Time-trend analysis was performed on registry data of contraceptives dispensed between January 2000 and December 2014 at the family planning unit of Barau Dikko Specialist Hospital, Kaduna, Northwestern Nigeria. Five-year periods (2000–2004, 2005–2009, and 2010–2014) were identified, and the prevalence of contraceptive methods for each period is expressed as moving averages. Predictors of client choice were determined by logistic regression expressed as odds ratio [OR] (95% confidence interval [CI]). Results: A total of 5992 family planning consultations were made during the 15-year study period. Compared with the intermediate 5 years, there was a rise from 1723 (2000 to 2004) to 2128 (2005–2009) and a decline in the final 5 years to 1912 (2010–2014). Cumulatively, the most preferred contraceptive was injectables (40.7%). Women aged ≥35 years showed significant positive association with contraceptive uptake (OR 2.243, 95% CI = 1.489–3.380; P < 0.05) for injectables (OR 13.609, 95% CI = 6.317–29.318 and OR = 0.019, 95% CI = 0.012–0.030; P < 0.05) for oral contraceptive pills. Women who had completed secondary school or more had greater odds of using intrauterine contraceptive device or implants, OR 2.278, 95% CI = 1.869–2.776, P < 0.05 and OR 5.012, 95% CI = 2.346–10.79, P < 0.05, respectively. Conclusion: Injectable contraceptive was the most common method used. Women's age and educational attainment were the major factors influencing choice and uptake of modern contraceptives.

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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.

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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.

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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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Context: An important but little understood concept that retards the goal to reduce maternal mortality and increase universal access to reproductive health is disrespect and abuse (D&A) during childbirth. Aim: This study aims to determine the prevalence, pattern, perpetrators, and determinants of D&A during childbirth among recently parturient women in Kano, north western Nigeria. Settings and Design: Using a cross-sectional design, 332 women accessing child immunization and postnatal services at Murtala Muhammad Specialist Hospital, Kano, were selected. Subjects and Methods: Respondents were selected using systematic sampling technique and data collected using an adapted, interviewer administered tool. Statistical Analysis: Data was analysed using IBM SPSS version 21.0 and level of significance set at 0.05. Results: Respondents (n = 306) had a mean age of 27.7 ± 6.3 years and more than half (55.9%; n = 171) had experienced at least one form of D&A during childbirth. Commonest forms of abuse were abandonment and nonconfidential care (84.5%, n = 142; 67.9%, n = 114, respectively). Main perpetrators were nurses/midwives (83.0%, n = 142). The experience during the last childbirth was significantly higher among respondents of non-Hausa/Fulani ethnic group (χ² = 6.10; P = 0.014), of the Christian faith (χ² = 8.62; P = 0.003), and with formal education (χ² = 19.94; P = 0.0001). After controlling for confounders, formal education remained a predictor for experiencing abuse at childbirth (AOR = 2.43; 95% confidence interval = 1.11--5.32). Conclusions: D&A during childbirth is prevalent in our setting. Educating healthcare providers and women about their responsibilities and rights will enhance provision and utilization of quality maternal health services.

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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.

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An abdominal pregnancy can be regarded as a form of an ectopic pregnancy where the embryo or fetus is growing and developing outside the uterus but within the abdominal cavity. While it is a very rare occurrence, abdominal pregnancies have a higher chance of maternal mortality, perinatal mortality, and morbidity compared to normal and ectopic pregnancies, but on occasion, a healthy viable infant can be delivered. We presented the case of a 40-year-old gravida 8 para 4⁺³ (4 alive) woman with intra-abdominal pregnancy who was first seen at 29 weeks' gestation with a history of abdominal pain and ultrasonographic findings of a live intra-abdominal fetus. She was managed conservatively till 34 weeks' gestation and was subsequently delivered by laparotomy with favorable maternal and fetal outcomes. The case is reported to highlight the successful outcome in spite of the difficulties in diagnosis and management in a low-resource setting.

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Background: Adolescent girls often lack knowledge regarding reproductive health including menstruation that could be due to sociocultural barriers in which they grow up. Materials and Methods: The study was a cross-sectional survey conducted among adolescent girls in three secondary schools at Kano, from 1^st January to 31^st December, 2016. Ethical approval was obtained from Aminu Kano Teaching Hospital Ethics Committee and Kano State Ministry of Health. Consent/assent was obtained from all the participants/guardians. Data obtained were recorded on questionnaires and analyzed using SPSS version 18 Statistical Software. Fishers' exact test was used in this study and P value of ≤0.05 was considered significant. Result: During the study period (from January to December, 2016), 219 adolescent secondary school girls participated in the survey. The mean age (±SD) was 16.1 ± 1.34 years. There was no statistically significant association between the mean age at menarche and the socioeconomic status of their parents (P [Fishers'] = 0.817). Up to 202 (92.2%) adolescent girls had premanarcheal counseling. Most of the information on premenarcheal counseling was provided by the parents/guardians 139 (62.9%) followed by the school teachers 42 (19.0%). Sanitary pads were the most used menstrual absorbent among the adolescents 202 (92.2%). Other menstrual absorbent used by the adolescents were toilet roll 11 (5.0%) and cloth 5 (2.3%). Among the methods of disposal of menstrual absorbent, dustbin 161 (73.9%) was the most used followed by disposal in the toilet 32 (14.7%), and burning 21 (9.6%). Other methods of disposal used by the adolescents were by washing it or road side/farm/over the fence disposal 4 (1.8%). Conclusion: There was good menstrual hygiene among the adolescent school girls. Sanitary pads were the most used menstrual absorbent.

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Objective: The purpose of this study is to classify the stillbirths (SBs) in our institution and to determine the avoidable contributors using a pro forma that was developed in our perinatal unit. Materials and Method: All mothers who delivered SBs at Obafemi Awolowo University Hospitals Complex Ile-Ife, Nigeria, from April 2014 to August 2015 were the subjects of this study. At our weekly perinatal mortality meeting, every SB was reviewed in detail to determine the cause of death and identify gaps in the care. The causes of fetal death were classified using three classification systems – Simplified CODAC, ReCoDe, and our newly developed Ife Perinatal Death Classification System. Remote contributors to fetal demise were assigned using a purpose–designed “Avoidable Factor Proforma” A SB was deemed avoidable if one or more factors were identified. Results: The total number of deliveries during the study was 2,142 with 109 SBs giving a gross SB rate of 51/1000 total births. The SB rate was significantly lower among booked patients than their unbooked counterparts (15 vs. 140 per 1000; P < 0.005). Antepartum death constituted 82.6% of SB among booked patients compared to 41.2% in the unbooked. The most common cause of SB among booked mother was intrauterine growth restriction (21.7%) while obstructed labor (23.3%) was the leading cause among unbooked mothers. Using our classification system, only 3.8% of SBs were unexplained, as against 5.7% for ReCode, and 26.4% for Simplified CODAC. Majority (81.7%) of the SBs were avoidable; and the most common avoidable factor was deficiency in health care. Access to the point of care was not associated with any of the avoidable deaths. Conclusion: Our SB rate remains unacceptably high, with a preponderance of antepartum deaths among booked patients. Majority of the SBs are avoidable dictating the need for training in modern methods of fetal surveillance and improved efficiency of our health-delivery systems.

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Introduction: Ebola virus disease (EVD) is a disease of humans and other primates caused by Ebola viruses. The most widespread epidemic of EVD in history occurred recently in several West African countries. The burden and outcome of EVD in pregnant women remains uncertain. There are few reports to date on maternal and fetal outcomes among pregnant women with EVD, hence the justification for this comprehensive review of these published studies. Materials and Methods: Published literature in Englishthat reported on maternal and or fetal outcome among pregnant women with EVD up to May 2016 were searched in electronic databases (Google Scholar, Medline, Embase, PubMed, AJOL, and Scopus). Studies that did not meet the inclusion criteria were excluded. We extracted the following variables from each study: Geographical location, year of the study, settings of the study, participants, maternal and fetal outcome. Results: A total of 12 studies reported on 108 pregnant women and 110 fetal outcomes. Six of the studies were case reports, three retrospective studies, two cross-sectional studies, and one was a technical report. There were 91 (84.3%) deaths out of the 108 pregnant women, while only one (0.9%) fetal survival was reported out of 110. The survival rate among the 15 patients that had spontaneous abortion/stillbirth or induced delivery was 100%. Conclusion: There was a poor maternal and fetal outcome among pregnant women with EVD, and fetal evacuation significantly improves maternal survival.

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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.

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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.

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Background: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, yet there are no universally accepted diagnostic criteria for GDM. The International Association of Diabetes in Pregnancy Study Group (IADPSG) and World Health Organization's (WHO) diagnostic criteria are commonly used criteria, although clinical outcome data of diagnostic performance of these diagnostic criteria are limited. This study examines the IADPSG and WHO criteria for predicting adverse pregnancy outcomes. Materials and Methods: This longitudinal study involved 130 pregnant women who underwent Oral Glucose Tolerance Testing (OGTT) during 24-32 weeks of gestation. Fasting, 1-hour and 2-hour glucose were measured. Participants were classified as GDM and non-GDM women based on the IADPSG and WHO diagnostic criteria. Five pregnancy outcomes were observed, namely, pre-eclampsia, shoulder dystocia or birth injury, birth weight ≥4.0 kg, clinical neonatal hypoglycaemia and birth asphyxia. Results: Twenty-eight participants (21.5%) had GDM by the IADPSG criteria (GDM _IADPSG ) and 21 (16.2%) women had GDM by the WHO criteria (GDM _WHO ). Only 15 women (11.5%) met the criteria for GDM by both criteria. The association of GDM with macrosomia was stronger in GDM _WHO women [Odds ratio (OR) =13.1, 95% confidence interval (CI) = 3.4-50.6] compared to the GDM _IADPSG women (OR = 5.3, 95% CI 1.5-18.9). Macrosomia or at least one adverse outcome were more likely in GDM patients who met the diagnostic criteria by both the IADPSG and WHO criteria (P = 0.001). Conclusion: A diagnosis of GDM that meets both the WHO and IADPSG criteria provides stronger prediction for adverse pregnancy outcome than a diagnosis that meets only WHO or IADPSG criteria.

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Background: The advent of highly active antiretroviral therapy (HAART) in the medical management of human immunodeficiency virus (HIV) infection has modified the natural history of HIV, resulting in improvements in the quality of life and life expectancy of women living with HIV. Consequently, many HIV-positive women of reproductive age are considering the possibility of having their own biological offspring. Materials and Methods: This was a cross-sectional study conducted among HIV-positive women of reproductive age attending the adult HIV clinic at the Jos University Teaching Hospital, Jos, Nigeria. Equal numbers of HIV-positive women of reproductive age in serodiscordant and seroconcordant relationships, who met the selection criteria, were recruited using convenience sampling technique. Data were collected using a pretested questionnaire in a face-to-face interview, and were analyzed using the Statistical Package for the Social Sciences statistical software (version 17) to determine their reproductive intentions using Chi-square and t-test. Multiple logistic regressions were used to determine the relationship between independent variables and the intentions of respondents to have children. Results: A total of 500 women were recruited for the study (250 in serodiscordant relationship and 250 in seroconcordant relationship). The overall reproductive desires and intentions were 60% and 56.4%, respectively. The reproductive intentions among those in serodiscordant and seroconcordant relationships were 63.2% and 49.6%, respectively. The difference was statistically significant. Conclusion: The reproductive intentions among the HIV- positive women in this study were high, the intentions being much higher among those in serodiscordant relationship. With a compelling intention to exercise their parenthood, there is a need for us to provide appropriate reproductive and sexual health services and support for all HIV-positive women of reproductive age.

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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.

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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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Background: Placental malaria constitutes a major threat to the well-being of both the mother and fetus (es). It is a common complication of malaria in pregnancy, in areas where malaria is endemic. It is, therefore, imperative to study the prevalence as well as pregnancy and fetal outcome of placental malaria in our area. Methodology: The study was a cross-sectional study carried out over a 6-month period. A total of 300 eligible subjects were involved in the study. A pretested questionnaire was administered. Maternal peripheral blood was taken for malaria parasites while cord and placental blood samples were taken at delivery for neonatal packed cell volume and malaria parasite. Neonatal anthropometric measurements were recorded in a standardized pro forma. Data were analyzed using STATA 10. Descriptive and bivariate analyses were performed. Results: Of the 300 participants studied, 48% had placental malaria parasitemia while 57.7% had peripheral malaria parasitemia. Pregnancy and perinatal outcome that was strongly associated with placental parasitemia includes maternal anemia (P < 0.0001); low birth weight (LBW) (P < 0.0001); and congenital malaria. Conclusion: Placental parasitemia constitutes a major challenge in pregnancy as it is significantly and adversely associated with perinatal outcomes such as LBW and congenital malaria as well as with maternal anemia. Therefore, the need for adequate protection of pregnant women in malaria endemic area from the harmful effect of placental malaria is, therefore, absolutely essential.

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Introduction: The human papillomavirus (HPV) has significant public health importance because of its high prevalence, mode of transmission, major causative role in cervical cancer, and having effective vaccines. The main thrust of this study was to ascertain the level of awareness of HPV and its vaccines among students as well as their attitudes toward receiving the vaccines. Materials and Methods: A descriptive cross-sectional survey conducted among female undergraduates of the University of Ibadan using structured self-administered questionnaires. The questionnaires sought to obtain information about their awareness of HPV, their sexual behavior, previous vaccination, and willingness to access HPV vaccination. Results: A total of 489 students, with a mean age of 19.7 ± 3.2 years, satisfactorily responded to the survey. Overall, 411 (84%) had an overall good knowledge about vaccines, 218 (44.6%) recalled that they had been previously vaccinated in childhood, and 147 (30.1%) were aware of HPV. Only 66 (13.5%) were aware of HPV vaccines, and 10 (2%) had ever been vaccinated against HPV. A majority were willing to get vaccinated if the current price is further reduced. Conclusion: There is a low level of awareness of HPV and its vaccines among female undergraduates. When available, uptake is restricted by cost. There is an urgent need to support public health programs that increase awareness through adequate information dissemination on mechanisms of cancer prevention and also to strengthen policy efforts that address the barriers of HPV vaccination.

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Objectives: To assess the prevalence of unwanted pregnancies and induced abortion among female undergraduates. Methodology: A cross-sectional survey was conducted among female undergraduates in University of Ibadan, Nigeria. The survey used a structured, self-administered questionnaire. Data analysis was conducted using Statistical Package for the Social Sciences version 20 with Chi-square and t-tests. Statistical significance was set at P < 0.05. Findings: The mean age of the participants was 20.3 (±2.7) years and 80% were single at the time of the study. The prevalence of induced abortion was 51%. The overall prevalence of unwanted pregnancy was 17%, and 92.7% of students who had ever been pregnant had considered the pregnancy unwanted. Only 7.3% reported willingness to be pregnant while engaged and 58.3% were unwilling to keep pregnancy if engagement ends. Unwanted pregnancy was less among those ever married (χ² = 49.96, P < 0.001), and more of the induced abortions were found in the unmarried group albeit not statistically significant (χ² = 0.21, P = 0.640). Unwanted pregnancy occurred more during the engaged period than any other time, which was statistically significant (χ² = 20.24, P < 0.001), although no significant difference in induced abortion was found. Conclusion: The prevalence of unwanted pregnancy and induced abortion is high especially among university undergraduates. As it appears to happen more often while they are engaged, unprotected sex during the engagement period needs to be targeted.

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Objectives: To assess the knowledge and attitude of adolescent girls regarding menstruation and menstrual hygiene. Material and Methods: After approval by the ethical committee , the study was conducted on 340 adolescent girls aged 12-19 years, belonging to an urban slum area of Delhi. This was a questionnaire based cross-sectional study conducted over a period of 9 months in a tertiary hospital. Confidentiality of the subjects was ensured. Results: Out of 340 girls 69 % were between 16-19 years. Source of information about menstruation in majority of the cases was mother (60%). Only 48% girls knew menstruation before menarche and 24% girls knew uterus as the organ for menstruation. 71 % girls used sterile sanitary napkins as absorbent. Satisfactory changing of pads (>2pads/day) was done by 68 % and 77% girls cleaned the genitalia satisfactorily (>2 times/day). 41% girls were aware of the fact that unhygienic use of pad could be a source of genital infection and 8% girls had associated vaginal discharge. Social restrictions during menses in the form of religious activities, drop out from school, avoiding certain foods etc were practiced in many families. Conclusion: Although the menstrual practices appear to be satisfactory in major percentage of girls but knowledge regarding menstrual hygiene is worrisome, as maximum girls are unaware of menarche and physiology of menstruation. Inclusion of such information in the school curriculum and wider coverage in mass media will help to bridge this gap.

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Aim: To determine annual trends of maternal mortality ratio in a tertiary hospital offering free maternity services. Settings and Design: This retrospective descriptive study was conducted at the Mother and Child Hospital Akure, Ondo State, a busy purpose-built tertiary care facility premised on evidence-based protocol management of patients and offering free consultations, admissions, drugs, laboratory tests, blood transfusions and surgeries. Materials and Methods: Data were collected from available hospital records from inception on 24^th February 2010 to 31^st December 2014 and analysed using Microsoft Excel 2010 software. Statistical Analysis: Data analysis was done using descriptive statistics. Categorical variables were expressed as frequency (percentage) and continuous variables as mean, median and range. Results: In the 5-year period, antenatal registration was 49195; increasing from 7378 in 2010 to 12002 in 2013 (63% increase) before dipping to 9780 in 2014. Number of births was 30031; increasing from 3673 in 2010 to 7634 in 2013 (108% increase) before dipping to 6234 in 2014. The overall maternal mortality ratio was 383 per 100,000 births reducing from 708 in 2010 to 208 in 2014 (70% reduction). The most common causes of maternal deaths were postpartum haemorrhage (30%), eclampsia (29%) and uterine rupture (14%). Conclusions: Over 5 years, a busy tertiary maternity centre premised on evidence-based protocol management of patients and offering free services had a sustained reduction in facility-based maternal mortality ratio. It is, therefore, recommended that the model be adopted in all public maternity centres.

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Intramyometrial pregnancy is the rarest subtype of ectopic pregnancy. It poses a diagnostic and therapeutic challenge. Preoperative diagnosis is difficult, and hysterectomy is always required due to the delay in diagnosis. Misdiagnosis can lead to uterine rupture with life threatening hemorrhage. We report a rare case of intramyometrial ectopic pregnancy in a 27-year-old lady, P3L3, with no history of previous abortions. The patient was admitted at 8 weeks of gestation with pelvic pain and hemorrhage. She underwent ultrasound and magnetic resonance imaging scans of the pelvis which revealed an intramyometrial ectopic. Findings on diagnostic laparoscopy revealed an asymmetrically enlarged anterior wall of the uterus. Hysteroscopy was performed concurrently demonstrating an empty uterine cavity. Medical management was adopted with methotrexate. She was followed up until the beta-HCG levels returned to the baseline. This case report illustrates the imaging findings of an exceptional case of intramyometrial ectopic pregnancy.

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Objective: To study the determinants of neonatal survival and outcome of preterm deliveries at the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Materials and Methods: A retrospective case-control study of women who had preterm delivery (PTD) at the UMTH, Maiduguri from January 1, 2014 to December 31, 2015 was conducted. Information on socio-demographic characteristics, antenatal care and treatment, Apgar score, Special Care Baby Unit (SCBU) and Statistical Package for Social Sciences (SPSS) admission and perinatal mortality were collated. Statistical analysis was done with SPSS. Odd ratio was used to test for association and multiple logistic regression was computed to control for confounding variables at 95% confidence interval. Results: A total of 183 preterm births (with 195 babies) and 183 term births (with 184 babies) having complete information were analyzed. PTD occurred in 10.38% (19/183) of teenage mothers and 31.16% (68/183) of the PTD were before 32 weeks of gestation. Majority of the mothers have had at least basic education (63.69%). The mean duration of admission for the preterm babies was 1.9 + 8.4 days with neonatal survival and take home baby rate being 72.31% (141/195). Neonatal survival was independently associated with gestational age at delivery >32 weeks (OR = 12.24, CI: 5.67–34.76), antenatal dexamethasone (OR = 10.82, CI: 2.38–48.22), pre-labour premature rupture of membranes (OR = 7.68, CI: 1.83–34.64), and delivery after at least 24 hour of commencement of dexamethasone (OR = 5.66, CI: 1.23–45.23). However, maternal febrile illness (OR = 0.25, CI: 0.11–0.56) and polyhydramnious (OR = 0.29, CI: 0.16–0.55) adversely affected neonatal survival. Conclusions: The neonatal survival following PTD is high. Survival is more likely in babies born after 32 weeks, PPROM, and after antenatal dexamethasone. We recommend routine use of antenatal dexamethasone injection in women at risk of PTD and planned delivery at the tertiary centre with equipments to cater for the special needs of the preterm babies.

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