We studied a 17-year-old female P0 + 0 who presented with menorrhagia and cyclic thrombocytopenia (CTP). Cyclic changes were observed in platelet count in phase with menstruation with a nadir of 4–30 × 10⁹/L and a rise of above 600 × 10⁹/L noted over the 4 months period of the observation. Thrombocytopenia was associated with menorrhagia, gum bleeding and epistaxis, followed about 14 days later by normal or elevated platelet counts. Presenting packed cell volume (PCV), platelet count, and white blood cell (WBC) count were, 0.25 L/L, 4 × 10⁹/L, and 6.8 × 10⁹/L respectively, WBC and PCV all remain stable all through the period of study; antinuclear antibody, direct and indirect antiglobulin test was negative while flow cytometry for Gp IIb/IIIa and Ib were not done. Bone marrow examinations performed at the time of reduced platelet counts showed increased megakaryopoiesis. The patient was monitored and observed with only hematinics prescribed over the follow-up period, and menstrual suppression with combined oral contraceptives. CTP should always be suspected when a diagnosis of idiopathic thrombocytopenic purpura is entertained especially when there is a history of menorrhagia, thrombocytopenia, and rebound thrombocytosis.

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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.

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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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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 4^th 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.

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Context: The optimal mode of delivery for breech presentation remains an issue of debate among obstetricians. The care during labor, delivery methods used, and the skills of the birth attendant influence outcome of fetuses in breech presentation. Objectives: The objective of this study is to determine the incidence, mode of delivery, and outcome of singleton breech deliveries in a secondary health facility in South-South Nigeria. Materials and Methods: The case notes of all patients who had singleton breech delivery from January 1, 2009, to December 31, 2014, were studied. Data extracted were age, parity, booking status, mode of delivery, indication for cesarean section (CS), birth weight, Apgar score at 5 min and fetal outcome. The data were analyzed using SPSS Version 20 statistical package.P < 0.05 was considered statistically significant. Results: There were 172 singleton breech deliveries and a total of 5736 deliveries during the study, giving an incidence of 3%. The mean age of the patients was 27 ± 5.4 years. About 36% of the patients were nulliparous, and over half (54.7%) of the patients were booked. About 55.2% of the patients had CS, most (67.4%) of whom were booked. The most common (26%) indication for CS was for breech presentation in primigravida. There were 122 live births (70.9%) and 50 stillbirths of which 36 (20.9%) were fresh stillbirths. The stillbirth rate was 290.7/1000 compared with 54/1000 births for singleton cephalic presentation for the same period. The mean birthweight was 2.96 ± 0.76 kg. Fetuses that weighed ≥3.5 kg had significantly poorer outcomes (P < 0.0001). The babies delivered by CS had better Apgar scores at 5 min compared to those that had vaginal breech delivery. Conclusion: CS offers a better fetal outcome for singleton breech presentation and fetuses weighing ≥3.5 kg have a poorer outcome at delivery in our facility.

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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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Introduction: Contraception use is low in sub-Saharan Africa where women have a high burden of HIV. Most of these women are in their childbearing age and require access to safe and effective contraception. The objectives of this study were to determine the use and pattern of contraceptive uptake among HIV-infected clients registered for antiretroviral therapy (ART) services at an HIV outpatient clinic in South-West Nigeria; factors influencing contraceptive uptake among HIV-infected clients; and the contraceptive failure and/or discontinuation rates among the cohort of clients. Methods: A database review was conducted on a cohort of clients registered at the family planning (FP) clinic from 2009 to 2013. Data management and descriptive statistics were with IBM SPSS software version 20. Results: The number of FP clients in the 5 years is 537, constituting 7.7% of the ART population. Most were female, 531 (98.9%); with an average age of 32.3 years. Majority of them were married, i.e., 524 (97.6%) with 322 (60.0%) in serodiscordant marriages. Two hundred and fifty-six clients (45.8%) chose and used injectable contraceptives. One hundred and thirteen (21.0%) clients chose condom only. Dual method of hormonal contraception and consistent condom was accepted and used by 73 (13.6%) clients. Two hundred and seventy-four (51.0%) discontinued their chosen contraceptive method. Reasons for discontinuation include desired conception in 54 (16.6%), menstrual irregularities in 45 (13.8%), and spouse disapproval in 11 clients (2%). Clients referred out for intrauterine contraceptive device and implant were 47 (14.5%). Twenty-one (3.9%) clients reported pregnant within the first 2 months of use. Conclusion: Contraceptive use is low (7.7%) with 51% discontinuation rate. Several reasons were given for discontinuation. Contraceptive failure rate was 3.9%. There is a need to find reasons for failed contraception and provide interventions to improve contraceptive success.

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Objective: The aim of this study was to study the pattern of care offered to patients with ovarian cancer, as well as to evaluate patients' compliance to chemotherapy in our centre. Materials and Methods: Theatre records and case files of patients who underwent surgery for ovarian cancer from January 2011 to December 2014 at our hospital were retrieved and analyzed. Results: During the study period, 68 patients were admitted with malignant ovarian tumors. Sixty-five percent of the patients presented with advanced stages (either stage III or IV). Complete surgical staging was done in 48 (66%) patients. Only 18 (25.5%) had optimal cytoreduction during surgery. Compliance to chemotherapy was poor, as out of the 58 patients that were recommended to have chemotherapy, only 28 had it; giving a compliance rate of 48.3%. Conclusion: Management of malignant ovarian tumor is still not optimal at our centre due to late presentation and poor compliance to chemotherapy. Training of gynaecologic oncologist and creation of Gynaecologic Oncology centres in our hospitals as well as provision of subsidized chemotherapy drugs will improve management and survival.

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Objectives: To organise an indigenous, cost-effective, short, intensive fetal ultrasound training programme in a low-resource setting, in order to improve the quality and quantity of skilled professionals in the field of obstetric sonography in a low-income country. Methods: The course was implemented in two stages namely the pre-workshop preparations and workshop proper. The former stage involved achieving international accreditation, publicising the programme as well as participant registration. The latter stage was focused on the workshop training activities which included lectures, practical sessions, discussions and hands-on sessions. Results: A high level of satisfaction with the programme was demonstrated by participants following a questionnaire assessment. Registration process and communication before the workshop were mostly rated as excellent and good. Other parameters such as lectures, practical sessions, coverage of objectives, knowledge improvement and others, followed the same pattern. Conclusion: Short, indigenous, cost-effective training programmes can be successfully carried out in a low-resource setting and the simple model allows for easy imitation at other relevant locations.

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Background: Bacterial vaginosis (BV) is associated with adverse pregnancy outcomes, especially preterm birth (PTB). Unfortunately, there is a dearth of evidence on the link between BV and PTB occurring in sub-Saharan Africa to inform preventive interventions targeting BV associated with PTB. Objectives: The objective of this study was to evaluate the association between genital tract colonization with BV and PTB. Methods: In this prospective case–control study design, 82 women with spontaneous PTB (cases) or term birth (TB) (controls) were screened for BV. The diagnosis of BV was based on the Nugent scoring system. The association between BV and PTB was evaluated using multivariate logistic regression analysis. Results: BV was significantly higher in women with PTB compared with those with TB (17 [41.5%] vs. 5 [12.2%]; P= 0.005). Furthermore, the odds of BV with PTB were higher among women who had PTB compared with TB after adjusting for a known factor, marital status, which differed significantly between women with preterm and TB (adjusted odds ratio 4.5, 95% confidence interval [1.4–14.4]). Conclusion: Women with BV in pregnancy have increased odds of having PTB. Given the challenge of preterm labor and PTB, screening and treatment of women for BV early in pregnancy may be a veritable strategy to prevent PTB and its consequences.

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Introduction: Preeclampsia is a common complication of pregnancy and a major cause of maternal morbidity. Pathogenetic explanations for preeclampsia include: Maladaptation of the immune system to paternal antigens and exaggerated maternal inflammatory response to trophoblastic tissue. Immune deficiency, induced by human immunodeficiency virus (HIV) or any other cause, could, therefore, inhibit a tendency to immune hyper-reactivity and thus theoretically prevent the development of preeclampsia. The study aims to explore the role of the immune theory of preeclampsia by comparing the prevalence of preeclampsia among HIV-positive and HIV-negative pregnant women. Materials and Methods: The study was a cross-sectional survey of pregnant women, beyond 28 weeks gestation, who delivered at the University College Hospital, Ibadan between 1^st October 2011 and 31^st December 2011. Data was collected using a prespecified proforma. The analysis was performed using SPSS version 17.0 and P value was set at <0.05. Results: A total of 766 women who gave birth during the study met the inclusion criteria. Among the cohort, HIV prevalence rate was 7.2% whereas preeclampsia was 10.7%. None of the HIV-positive women had preeclampsia. Conclusion: This study suggested that the prevalence and perhaps, risk of developing preeclampsia is reduced among HIV positive women. This is similar to other studies done in various countries in the world. There is a need for further study as it may prove valuable in the management and prevention of preeclampsia.

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Background: Ovarian cyst accidents constitute about 3%–5% of gynecological emergencies. They are commonly benign and are of sudden onset. A retrospective study of this nature became necessary because benign diseases of the ovary have not received attention compared to their malignant counterparts. Methodology: A review of the operation register and patients' case folders was undertaken from January 2008 to October 2015 that underwent laparotomy. Information on the sociodemographics, symptomatology, signs, significant investigation results, findings at laparotomy, and histology was extracted and analyzed using percentages, ratio, and demographic parameters. Results: Ovarian cyst accidents formed 5.6% of emergency gynecological surgeries. The age range was 19–55 years with a mean 36.2 ± 10.2 years, 42.9% participants were Hausas, 50% Muslims, 71.4% multiparous, and 57.1% amenorrheic. The most common presenting symptom/sign was lower abdominal pains/adnexal tenderness (100%) and none presented with anemia or deranged blood chemistry. Most (66%) had the cyst on the right. The average diameter of the cysts was 9.7 cm, cystectomy was done in 42.9%, and the histology was benign in 100% of the cases. Conclusion: Most of the cases of ovarian cyst accidents were in the reproductive age group, in multiparous women, benign on histology and were not long-standing sufficiently to alter blood parameters such as the hematocrit and blood chemistry as they presented early due to the acute nature of manifestation.

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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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Context: The benefit of antenatal care is no longer in doubt, but the ideal number of encounters to achieve those benefits has been the subject of discussion among maternity care stakeholders. Objective: To study the effect of frequency of antenatal visits on pregnancy outcome. Materials and Methods: This is a prospective study of 228 pregnant women attending the antenatal clinic of the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 3-month period. Maternal and fetal outcome were compared against the frequency of antenatal visits. Results: The mean frequency of visits was 6.77. Majority of the women 124 (54.4%) attended less than seven times. Compliance with antenatal drugs and mean hemoglobin level at delivery increased with increasing frequency of visits reaching 93.7% and 11.44 g/dl, respectively, in the moderate attendees (4–6 visits). Prevalence of anemia was high (56.7%) among the unbooked but lowest (9.5%) with moderate attendees. Thereafter, there was no significant improvement. Delivery mode, malaria parasitemia, and gestational age at delivery were fairly uniform in all the groups. The prevalence of low birth weight was 20% in the unregistered and decreased from 22% in the low frequency (1–3 visits) group, to 4.8% in the moderate attendees, and to 0% in the very high-frequency (ten and above visits) group. Mean Apgar scores at 1 and 5 min were also best (7.1/8.1) in the moderate attendees and worst in the unregistered. Conclusion: More than six visits conferred no significant advantage on fetomaternal outcome. Therefore, the new WHO recommendation on reduced antenatal visits can be satisfactorily implemented in Kaduna.

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Background: Trichomonas vaginalis infection is the most common curable sexually transmitted infection worldwide with about 160–180 million people affected annually. Pregnant women with trichomoniasis are at a risk of adverse pregnancy outcomes such as premature rupture of membranes, preterm labor, low birth weight as well as neonatal infection with human immunodeficiency virus (HIV), and T. vaginalis. There is a paucity of knowledge of prevalence of T. vaginalis infection among HIV-seropositive antenatal clinic attendees in northwestern Nigeria. Objectives: The objective of this study was to determine the prevalence of T. vaginalis vaginitis among HIV-seropositive antenatal clinic clients in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Design: The study was a descriptive cross-sectional study. Setting: The study was conducted at the Antenatal/Prevention of Mother to Child Transmission clinic of ABUTH, Zaria, between May 6 and September 5, 2013. Materials and Methods: One hundred and two HIV-seropositive pregnant women were recruited into the study. Sociodemographic, clinical, and obstetric information were obtained using a pro forma. Vaginal swabs were collected from each woman and examined using wet mount microscopy for T. vaginalis and cultivated in Trichomonas OXOID culture media enriched with horse sera. Results were analyzed with SPSS software Version 16. Results: The mean age of the participants was 31 years with a standard deviation of 4.9 years. Out of the 102 participants examined for T. vaginalis, 6 were positive using both wet mount microscopy and culture giving a prevalence rate of 5.9% and about 60% of the positive clients were symptomatic. Conclusion: The prevalence of T. vaginalis vaginitis among HIV antenatal clinic attendees in ABUTH, Zaria, was 5.9%. About 40% of the trichomonad-positive participants were asymptomatic. Routine screening of HIV-seropositive antenatal clients for T. vaginalis is cost-effective.

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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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