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: Myomectomy during pregnancy is rare, however, for patients with failed response to conservative management (and are ardent at preservation of pregnancy) the need for surgery becomes imperative. This scenario may be common in a dedicated fertility treatment centre; hence the need for proficiency in gravid myomectomy. Objective: To document our experience with myomectomy during pregnancy. Methods: Report of three cases of gravid myomectomy is presented. The format of the case series included clinical presentation and surgical management. Conclusion: Our experience shows that scrupulous adherence to basic surgical principles of good exposure, minimal tissue handling, speed but careful closure/hemostasis in addition to judicious post operative care can guarantee a successful pregnancy sparing myomectomy.

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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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Context: Dysmenorrhea is common and can be severe, hampering women's quality of life. Aims: This study aimed to assess the prevalence and factors associated with dysmenorrhea in a population of young females and to explore the impact on routine activity and proven relief measures experienced by this group. Settings and Design: This is a cross-sectional, observational study among female medical and nursing students at a tertiary health care facility in South-Western Nigeria. Subjects and Methods: It was a questionnaire study carried out among 360 female students. Explanatory variables were age, parity, use of combined oral contraception, and first-degree family history of dysmenorrhea. The main outcome variable was the presence of dysmenorrhea. Statistical Analysis Used: Data were analyzed by Chi-square test and logistic regression (P < 0.05). Results: All respondents had attained menarche at 12.4 ± 1.2 years; 299 (83.1%) reported dysmenorrhea. Primary dysmenorrhea constituted 63.6%; secondary was 19.4%. Younger respondents (teenagers) and married females were significantly less likely to suffer dysmenorrhea, while nonusers of oral contraceptives were more likely to. Period pain precluded usual activity in 48.8% of sufferers; 39.5% had missed classes on account of it; however, only 10% had sought medical care. The most effective treatment used was piroxicam (an antiprostaglandin drug). On multivariate analysis, increasing age (Odds ratio-10.6 [95% Confidence Interval: 3.4-34.0]) was significantly associated with dysmenorrhea. Conclusions: Dysmenorrhea is a highly prevalent problem among this population. Women should be encouraged to seek medical care to limit the debility that arises from dysmenorrhea. Some women may benefit from investigations and definitive treatment.

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Background: Gynaecological emergencies are common causes of morbidity and mortality worldwide and patients' characteristics are important determinants of gynaecological emergencies. Objectives: This study was conducted to determine the pattern and management outcome of gynaecological emergencies in Aminu Kano Teaching Hospital (AKTH), Kano. Materials and Methods: A 3-year retrospective review of all gynaecological emergencies seen in AKTH between January 2012 and December 2014 was done. Results: A total of 3050 gynaecological consultations were done within the period under review, 1337 of which were gynaecological emergencies giving an institutional prevalence of 43.8%. The highest (44.5%) frequency was seen in the 21–30-year age group. Ten different types of gynaecological emergencies were seen with abortion being the leading (59.3%) gynaecological emergency. Incomplete abortion is the most common form of miscarriage in age's ≥ 20 years; in the Parous; and amongst married women. Sexual assault occurred in 5% of the patients, with 47.8% occurring in individuals aged below 10 years. The least common gynaecological emergency was coital laceration which accounted for 0.5%. The prevalence of mortality from gynaecological emergencies was 3.7%. The most common cause of mortality from a gynaecological emergency was bleeding gynaecological malignancy and carcinoma of the cervix accounting for 41.2%. Conclusion: Gynaecological emergencies are common and abortions are the most common emergency at AKTH. Patient characteristics play a significant role in their pattern of presentation, while outcomes of these emergencies are related to their cause and manner of presentation. Increased surveillance and advocacy of policies that strongly punish individuals convicted of sexual assault should be encouraged, and increased awareness and utilization of Pap smear should be encouraged for early detection of premalignant and early stage carcinoma of the cervix. Further research is required to identify the possible risk factors/causes of abortion in this environment.

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Introduction: There has been a tremendous increase in the use of transvaginal ultrasound (TVS) in pregnancy. With the use of high-resolution transducers, the transvaginal probe has proved to be particularly useful for finding the location and dating of early pregnancies when compared with transabdominal sonography (TAS). It has also been shown to be a reliable method for confirming complete miscarriage. This study aims at determining the perception and acceptability of TVS in pregnancy. Materials and Methods: This is a descriptive cross-sectional study of 424 consenting pregnant women attending the antenatal clinic at the University College Hospital, Ibadan. Using a self-administered questionnaire, we obtained information on their socio-demographic characteristics, awareness of ultrasound and TVS and opinion about TVS including acceptability and perceived complications. Results: The mean age of the respondents was 31.6 ± 4.7 years. Majority (410; 96.7%) had heard about ultrasound scanning, and 395 (93.2%) had undergone at least one type. Approximately two-fifth (177; 41.7%) had heard about TVS, mostly from antenatal clinic, with two-third having a good knowledge. Only 90 (21.2%) had personal experiences, and 144 (34%) believed it is harmful; however, about three-fifths (256; 60.4%) were willing to do TVS if indicated. Perceived complications of TVS included abortion, infection and bleeding. Awareness and perception were strongly associated with acceptability of TVS but not with education or previous experience. Conclusion: This study shows that the perception and acceptability of TVS by pregnant women is dependent on their level of awareness. There is an urgent need for proper information dissemination on the usefulness, safety and advantages of TVS in pregnancy.

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Background: Uterine fibroids are responsible for significant morbidity in a large proportion of the female population of the reproductive age worldwide. Hence, there is a need to determine the levels of oestrogen and progesterone receptors in relation to the growth and symptomatology in a purely African population noted for high incidence of uterine fibroids. Objectives: To determine the levels of oestrogen and progesterone receptors in normal myometrium and uterine fibroids and ascertain whether there are any significant clinical associations. Materials and Methods: This was a prospective study conducted at the Obstetrics and Gynaecology Department in collaboration with the Morbid Anatomy Department, both at the University of Benin Teaching Hospital (UBTH). Tissue specimens obtained from uterine fibroids and normal myometrium during surgeries performed on patients with a pre-operative diagnosis of uterine fibroids were histologically examined. The concentrations of oestrogen and progesterone receptors were histochemically determined for the selective tissue slides. The results and the socio-demographic characteristics of the patients were used to generate a database for analysis. Results: A total of 262 cases of uterine fibroids were analysed. Those presenting with lower abdominal mass had more oestrogen receptors in uterine fibroids (57.0%, P = 0.014), whereas more progesterone receptors were found in those presenting with menorrhagia (P = 0.001). A comparison of oestrogen and progesterone receptors in uterine fibroids and normal myometrium showed significantly higher levels of oestrogen and progesterone receptors in fibroids than in normal myometrium (P = 0.000). Conclusion: The concentrations of oestrogen and progesterone receptors in uterine fibroids were significantly higher than those in normal myometrium. The steroid dependence of the growth and symptomatology of uterine fibroids may be related to the steroid receptor level. Identification and quantification of the concentrations of oestrogen and progesterone receptors will be useful in the prognostication and the development of newer treatment modalities for uterine fibroids. Further research in this area is clearly warranted.

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Background: Labor is generally considered to be a very painful experience. Epidural analgesia which is the gold standard for labor pain relief is not widely available, affordable, or feasible, especially in our environment. Parenteral opioid analgesics, which are more commonly used, can cause nausea and vomiting in the patient and respiratory depression in the neonate; hence, they cannot be used in all stages of labor. There is thus the need for an alternative analgesic with similar or superior analgesic effect to opioids but without their fetomaternal side effects. Objectives: The objective of this study was to compare the efficacy of intramuscular (IM) pentazocine and intravenous (IV) paracetamol infusion in relieving labor pain at Aminu Kano Teaching Hospital, Kano. Study Design: It was a randomized controlled study. Methodology: One hundred women with singleton uncomplicated pregnancies and spontaneous labor at term were randomly assigned to the study group or control group. Women in the study group received an IV infusion of 1000 mg of paracetamol while women in the control group received a single dose of 30 mg of pentazocine intramuscularly. Labor pain perception was assessed using visual analog scale (VAS) scores at presentation and after delivery while maternal satisfaction assessed using Likert scale, and maternal and fetal complications were recorded after delivery. Statistical analysis was done using computer software SPSS Version 20.0. Chi-square, Fisher's exact test, t-test, and Mann–Whitney U-tests were used to compare means and proportions as appropriate for statistically significant differences, setting the level of significance (P value) at <0.05. Results: There were no statistically significant differences between the two groups in their sociodemographic characteristics, obstetric characteristics, and labor characteristics. There was also no statistically significant difference in the VAS pain scores between the two groups before administration of the analgesics (P = 0.968) and after administration of the analgesics (P = 0.225). The maternal satisfaction with pain relief among the patients in the two groups was also found to be similar (P = 0.341). Nausea (P = 0.002), vomiting (P = 0.012), and drowsiness (P < 0.001) were significantly higher in the pentazocine group when compared with the paracetamol group. None of the patients in the two groups developed dyspnea during labor, skin rashes, or persistently low systolic blood pressure of <90 mmHg, and none had persistent fetal heart rate abnormalities during labor or appearance, pulse, grimace, activity, and respiration (APGAR) scrores <7 at the 1^st or 5^th min after delivery. However, the mean APGAR score of the neonates at 1 min was significantly higher in the paracetamol group (P = 0.033), while there was no difference in the mean APGAR scores of the neonates in the two groups at 5 min after delivery (P = 0.152). Conclusion: The analgesic efficacy of IV paracetamol was similar to that of IM pentazocine in labor, with similar levels of maternal satisfaction with pain relief, but IV paracetamol was associated with significantly lower rates of adverse effects.

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Background: About 6.8% of Indian women consume tobacco and only 21.0% receive 'full' antenatal care. Thus, there are chances that women who consume tobacco during the non-pregnant state will continue to use tobacco during pregnancy. Materials and Methods: A cross-sectional study was conducted across nine health centres in three districts of Madhya Pradesh, India. A total of 3,839 women admitted in the post-partum ward of selected hospitals were interviewed about tobacco consumption during pregnancy. Adjusted odds ratios were calculated to determine the predictors of tobacco consumption during pregnancy. Results: The prevalence of tobacco consumption during pregnancy was 13.1%. Only 4.4% of women who consumed tobacco and 1.6% of women who did not use tobacco were advised against tobacco consumption by frontline health workers. The strongest predictors of tobacco consumption were tobacco consumption by husband [AOR = 36.16 (CI = 22.89–68.86)], neighbor/female friend consuming tobacco [AOR = 22.29 (CI = 13.11–31.82)], and female family members consuming tobacco [AOR = 5.63 (CI = 4.39–7.53)]. Conclusion: Awareness among women about adverse effects of tobacco consumption during pregnancy was low. Health system intervention in the form of health education and advice against tobacco consumption was virtually non-existent.

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Context: Pre-labour rupture of membranes (PROM) is a common obstetric complication which presents a diagnostic challenge, especially in equivocal cases. Standard methods of diagnosis are limited by high false positives and negatives. This study compared the accuracy of a biomarker placental alpha microglobulin-1 (PAMG-1) with the traditional methods of diagnosis. Objective: To compare the accuracy of PAMG-1 in cervicovaginal secretions with other standard methods in the diagnosis of PROM. Materials and Methods: A longitudinal prospective study was conducted among women with symptoms and signs of PROM at the Lagos State University Teaching Hospital. Standard tests and PAMG-1 assay were compared with the reported final diagnosis at delivery. Descriptive analysis was done using the Statistical Package for Social Sciences (SPSS) version 19. Results: A total of 140 consenting pregnant women were recruited in the study. An initial diagnosis of PROM was made in 67 patients (47.9%) using the standard methods of diagnosis whereas PAMG-1 immunoassay using Amnisure ROM test diagnosed PROM in 86 patients (61.4%). Upon review of patients' clinical records, 88 women (62.8%) had a final diagnosis of PROM. In the final analysis, PAMG-1 assay had a sensitivity of 97.7%, specificity 100%, PPV 100% and NPV 96.7%. The standard methods had a sensitivity 76.1%, specificity 92.2%, PPV 90.1% and NPV 70.4%. PAMG-1 had a highest accuracy of 98.6%, followed by nitrazine test 89.3%, pooling of liquor 83.5% and fern test 51.4%. Conclusion: The immunoassay of PAMG-1 had a higher diagnostic accuracy and is recommended for the diagnosis of PROM.

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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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Introduction: Benign lesions of the cervix such as hyperplasia, endometriosis, cervicitis and endocervical polyps are health concerns for women globally. Meanwhile, Cervical cancer is the fourth most common cancer among women in the world, with developing countries bearing the brunt of the burden in terms of morbidity and mortality. This study examines the histopathological pattern of cervical biopsies in a tertiary health institution in Lagos, Nigeria. Materials and Methods: This was a retrospective study of all cervical biopsies received in a government-owned tertiary health institution and a private pathology laboratory both in Ikeja over an 8-year period. All the slides were retrieved and reviewed while socio-demographic and clinical details were obtained from request and clinical notes. Data analysis was conducted using the Statistical Package for Social Science version 20. Results: A total of 901 biopsies were retrieved, representing 4.8% of the total biopsies conducted. The age range of patients was 19–87 years with a mean age of 49 ± 13.0 years. The benign tumours accounted for 58.8% of the cases, with a benign to malignant ratio of 1.5:1. Squamous cell carcinoma (SCC), endocervical polyps, and cervical intraepithelial neoplasm accounted for 36.1%, 30.9%, and 15.1% of the total cervical biopsies, respectively. The benign tumours were statistically related to the younger age groups (P = 0.00), however, malignant tumours showed no relationship with age group (P = 0.325). Conclusion: SCC and endocervical polyps were the most common malignant and benign cervical biopsies, respectively. The benign tumours were seen more in the younger age group. Early detection of some of these benign conditions may provide an opportunity for appropriate interventions to prevent further complications.

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Background: Brucellosis in animals has been identified as a common cause of miscarriage. It is the most common zoonotic disease that leads to considerable morbidity in humans. It is rarely diagnosed in hospitals in Nigeria, and debate exists as to whether it is a more common cause of miscarriage in humans compared to other infective agents, especially with the finding of antibrucella activity in human amniotic fluid. Brucellosis in humans is a treatable disease and risk factors for transmission are prevalent in Zaria. Objective: The objective of this study was to determine the seroprevalence of brucellosis among women with miscarriage. Materials and Methods: This was a descriptive cross-sectional study involving 121 women aged between 15 and 49 years with miscarriage who presented to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria from August 2014 to May 2015. Information on socio-demographic characteristics, reproductive profile, and risk factors for contracting Brucella infection were obtained using a questionnaire. Blood samples were obtained and analysed for Brucella IgG and IgM using indirect enzyme-linked immunosorbent assay kits. The data was analysed with SPSS, version 20.0. Results: The mean age of the participating women was 29.07 years [standard deviation (SD) ±6.74]. The seroprevalence of brucellosis was 19.0%; 17.4% of the women had a recent infection, and 1.7% had a chronic infection. Age, history of previous miscarriage, consumption of milk products and consumption of roasted meat/barbecue had positive relationships with recent Brucella infection (χ² = 9.706, P = 0.046; χ² = 7.300, P = 0.026; χ² = 3.169, P = 0.049; χ² = 3.012, P = 0.050, respectively). Chronic Brucella infection had a positive relationship with number of pregnancies (χ² = 8.036, P = 0.018). Regression analyses showed that age, history of previous miscarriage and history of recent miscarriage in animals reared were positively correlated with Brucella seropositivity and miscarriage (χ² = 13.200, P = 0.022; χ² = 9.795, P = 0.007; χ² = 7.890, P = 0.005, respectively). Conclusion: There is a high prevalence of brucellosis among women with miscarriage in Zaria. The burden of the disease should be appreciated and routinely tested to prevent reoccurrence.

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Background: Screening and treatment of pre-cancerous lesions is important for prevention of cervical cancer. Currently, most available screening tests for cervical cancer are limited by low sensitivity, prohibitive costs, logistics and technical concerns. This study evaluates the role of multimodal hyperspectroscopy (MHS) as a cost-effective, sensitive and user-friendly point-of-care machine for early detection in women at risk of pre-cancer lesions. Materials and Methods: Multimodal hyperspectroscopy of the cervix using the LuViva^® Advanced Cervical Scan was performed first in a 1-minute procedure among 100 previously screened for cervical cancer using either visual inspection after application of acetic acid (VIA) or cytology within the last 120 days. This was then followed by obtaining human papilloma virus (HPV) samples and biopsies from women for histology. Results: Of the 22 women with abnormal Pap tests of at least low-grade squamous intraepithelial lesion, 3 had CIN2+, 6 had CIN1, 4 were free of dysplasia at histopathology while 9 had cervicitis. All 3 of the CIN2+ recorded high likelihood of CIN2+ by MHS. However, HPV was negative for all 3 women. The machine classified 1 of 1 CIN1s and 7 of the 13 women without dysplasia or cervicitis as low or moderate risk for CIN2+ (40% specificity); of the 37 women who were VIA+, 81% were classified as high risk, and 66% of 37 women with normal Pap tests and biopsy were either at moderate or low risk. Conclusions: The findings from this pilot study show that MHS reduced the percentage of unnecessary colposcopy and biopsy by 37.5%. It was also able to differentiate between VIA+ and Pap negative women suggesting its potential of being a point-of-care primary and objective screening test.

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Most gynecologists may not encounter a case of nonpuerperal uterine inversion in their practice. We present the case report of a 35-year-old grand multipara who presented with 2 years history of a protrusion per vaginum that was complicated by profuse vaginal bleeding and hemorrhagic shock. A diagnosis of complete infected nonpuerperal uterine inversion was made. The patient was resuscitated with intravenous fluids, blood transfusion, and antibiotic therapy. She had vaginal hysterectomy. Nonpuerperal uterine inversion can pose a diagnostic dilemma to the unwary physician and its management can be challenging.

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