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  Citation statistics : Table of Contents
   2017| January-April  | Volume 34 | Issue 1  
    Online since May 26, 2017

 
 
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CASE REPORTS
Quadruplet pregnancy following transfer of 3 embryos: A case report
OM Loto, AJ Akindojutimi, DE Emmanuel, PB Kuti
January-April 2017, 34(1):61-64
DOI:10.4103/TJOG.TJOG_23_17  
Multiple pregnancy is a known complication of in-vitro fertilization and embryo transfer (IVF-ET). It is usually associated with serious perinatal morbidity and/or mortality as well as significant maternal morbidity and efforts to reduce these has led to the concept of elective single embryo transfer (ESET) in developed countries, this concept has not been entrenched in the practice in Nigeria. We report a case of quadruplet pregnancy following the transfer of three embryos following IVF and reviewed the relevant literature.
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Oropharyngeal fetus-in fetu in Ilero Nigeria: A case report
AO Adebiyi, TO Shorunmu, T Owoeye, OE Amoran, AA Ojeleke
January-April 2017, 34(1):65-68
DOI:10.4103/TJOG.TJOG_20_17  
Fetus-in-fetu is a rare congenital condition in which a malformed parasitic twin is found within the body of its partner. Although a few had been documented worldwide, none has been reported in Nigeria. In this report, we document the history of a concoction of drugs of an indeterminate nature taken in pregnancy, the wrong diagnosis by the rural based sonographer and the presence of polyhydraminos. Our finding of a previously misdiagnosed oropharyngeal fetus-in fetu with dichorionic and cardiac features calls for a revision of the current definition of fetus-in fetu. It also raises an important hypothesis of the likely associations between drugs, infections, pregnancy induced hypertension and fetus-in-fetu.
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Vesicouterine fistula: A case report of successful repair
TO Shorunmu, OE Jagun, BD Osuolale, OAO Oloyede, OL Odusoga, KM Ogunsowo, OO Ogunsemi, OO Toyobo
January-April 2017, 34(1):69-72
DOI:10.4103/TJOG.TJOG_14_17  
The increasing rate of cesarean deliveries especially in previous scars is a major cause of vesicouterine fistula (VUF). The incidence of VUF is on the rise because of the increasing incidence of cesarean deliveries. VUF is a pathological communication between the uterus and the bladder. VUF presents in various ways, the main symptoms are urinary incontinence with or without hematuria. There could be depression or psychological distress, which may culminate in reduction in quality of life. The precise and early diagnosis of vesicouterine fistula may be difficult; thus necessitating myriad of investigations such as retrograde cystography, cystoscopy, contrast-enhanced CT scan, MR urogram, and transvaginal ultrasound with or without Doppler. Examination under anaesthesia (EUA) is crucial to the diagnosis of VUF and this includes methylene blue test. We report a case of VUF.
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Intramyometrial gestation: A rare localization of ectopic pregnancy
Ravikanth Reddy
January-April 2017, 34(1):73-75
DOI:10.4103/TJOG.TJOG_2_17  
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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LETTER TO EDITOR
Biomarkers in uterine leiomyomas and their clinical significance
Seema Dayal
January-April 2017, 34(1):76-77
DOI:10.4103/TJOG.TJOG_46_16  
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ORIGINAL ARTICLES
Impact of maternal DNA contamination of fetal DNA in chorionic villi on prenatal diagnosis of sickle cell anemia
OA Oloyede, OA Taiwo, J Minari, K Adekoya, M Lamina
January-April 2017, 34(1):11-15
DOI:10.4103/TJOG.TJOG_22_17  
Objective: The study aim was to determine the hemoglobin genotypic and allelic distributions in fetal population, and to quantitatively evaluate the effect of heterozygous maternal DNA contamination of homozygous fetal DNA in chorionic villi, on fetal hemoglobin genotypes. Materials and Methods: A descriptive, cross sectional study of amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) analysis of fetal hemoglobin genotype using DNA from chorionic villi and maternal venous blood. The primary fetal hemoglobin genotypes were obtained in the first phase and the secondary hemoglobin genotypes after contaminating homozygous primary genotypes (HbAHbA and HbSHbS) with varying proportions of heterozygous maternal DNA (HbAHbS). Data analysis was done with Micosoft Excel 2010 statistical package and Chi-square (goodness-of-fit). Results: There was no statistically significant deviation in the hemoglobin genotypic and allelic counts between the observed and the expected counts in the fetal population based on Mendelian expectation. Contaminating homozygous fetal DNA with >11.1% (0.5 μl) of heterozygous maternal DNA produced significant change in fetal hemoglobin genotype results. Homozygous hemoglobin genotypes HbAHbA were affected more than HbSHbS. Conclusion: Study established Mendelian distribution in the fetal population and the levels of heterozygous maternal contamination of homozygous fetal DNA that resulted in significant risk of misdiagnosis.
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An analysis of postdural puncture headache in obstetric patients: A study from Kano, Nigeria
AD Mohammed, R Ayyuba, I Salisu, AU Nagoma, LF Owolabi, A Ibrahim
January-April 2017, 34(1):16-20
DOI:10.4103/TJOG.TJOG_61_16  
Background: One of the complications of spinal anesthesia is postdural puncture headache. Many risk factors have been identified which when addressed could reduce the incidence. Objectives: This was a prospective study that analyzed the incidence, onset and severity of postdural puncture headache among pregnant women who had cesarean section under a subarachnoid block in Aminu Kano Teaching Hospital, Kano, Nigeria. Patients and Methods: Spinal anesthesia was performed on 146 patients using size 25- or 26-gauge Quincke, Whitacre, or Sprotte needles. Patients were followed up to determine the incidence, onset, and severity of post spinal headache. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 18.0 (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Demographic variables were presented using tables while summary was done using means, standard deviation, and percentages. Test of association was done using Fisher's Exact test. A P value < 0.05 was considered statistically significant. Results: The overall incidence of postdural puncture headache was 15.8% with all cases presenting within the first 24 hours. Most patients rated their headache as mild to moderate on a 10-cm visual analogue scale. Conclusion: Traumatic Quincke spinal needle is associated with high incidence of postdural puncture headache and therefore we recommend the use of atraumatic pencil tip needle especially in obstetric anesthesia.
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Feto-maternal outcome of induced versus spontaneous labour in a Nigerian Tertiary Maternity Unit
OY Abisowo, AJ Oyinyechi, FA Olusegun, OY Oyedokun, AF Motunrayo, OT Abimbola
January-April 2017, 34(1):21-27
DOI:10.4103/TJOG.TJOG_59_16  
Background: Induction of labour may be associated with postpartum haemorrhage, instrumental delivery, blood transfusion, longer hospital stay and admission to the neonatal intensive care unit. Objective: To assess the feto-maternal outcome of induced labour compared to spontaneous onset labour. Materials and Methods: Prospective comparative study involving 440 participants divided into induction (study) and spontaneous labour (control) groups. Data were collected on socio-demographic data, maternal complications, blood transfusion and neonatal outcomes. Results: A total of 1540 deliveries occurred during the study period, out of which 257 had induction of labour. Successful induction rate was 16.47%. Vaginal delivery was 67.6% in the study group compared to 83.4% in the control group. Postdated pregnancy and hypertensive diseases accounted for 56.8% and 28% of the indications for induced labour, respectively. Induced labour was associated with a significantly higher caesarean section rates (P < 0.001). Cephalo-pelvic disproportion was the most common indication for caesarean section (P = 0.038). Maternal complications include primary postpartum haemorrhage, perineal lacerations and endometritis. The study group had longer duration of hospital stay compared to the control (P < 0.001). Five perinatal mortality occurred among the study group compared to three in the control (P = 0.848). Conclusion: Induction of labour is associated with increased risk of caesarean delivery and postpartum haemorrhage compared with spontaneous labour, however, overall rates remain low.
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Maternal contribution to ultrasound fetal measurements at mid-pregnancy
IA Taiwo, TK Bamgbopa, MA Ottun, F Iketubosin, AO Oloyede
January-April 2017, 34(1):28-33
DOI:10.4103/TJOG.TJOG_18_17  
Background: Maternal variables are known contributors to fetal variables and can be assessed during pregnancy. Objective: To assess maternal contribution to some mid-pregnancy fetal ultrasound measurements. Materials and Methods: A prospective study involving 87 pregnant women scanned at 18–23 weeks of pregnancy was carried out. The fetal measurements were head circumference (HC), abdominal circumference (AC), femur length (FL), and biparietal diameter (BPD) while the maternal variables were age, parity, height, weight, and BMI. Results: There were intercorrelations between some maternal and fetal variables respectively. Parity correlated significantly with all the ultrasound fetal measurements (P < .05), but the association vanished with partial correlation (P > .05). Significant correlation between parity and age remained the same with simple and partial correlations (P < 0.01). Canonical correlation analysis gave four sets of canonical variables; however, none was statistically significant. Regressing fetal parameters against parity through parent-fetus regression procedure gave significant model fit (P < 0.05), but low r2value suggesting that variations in parity did not explain much of the variations observed in the fetal ultrasound measurements (3.9% < r2 > 6.7%). The generated models revealed HC having the highest standardized regression coefficient (b = 5.07;P < .05) while FL had the least (b = 1.08;P < .05). Conclusion: The results suggested that parity contributed significantly to fetal ultrasound measurements at mid-pregnancy while maternal height, weight, and BMI made no significant impact.
  - 2,417 225
Cesarean section in Ahmadu Bello University Teaching Hospital Zaria, Nigeria: A five-year appraisal
SM Adelaiye, A Olusanya, PI Onwuhafua
January-April 2017, 34(1):34-38
DOI:10.4103/TJOG.TJOG_58_16  
Objective: In 1985, the WHO recommended an optimum Cesarean section (CS) rate of 10–15% and stated that there was no justification for any region to have higher rates. The global increase in CS rate is causing concern and it is a major public health issue. Our objective is to appraise the CS intervention, observe trend, and proffer solutions. Materials and Methods: All relevant clinical data from the patients delivery records in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria over the period 2010–2014 were pooled and used to analyze the clinical information. Results: There were a total of 9,388 deliveries during the period out of which 2,254 were CS, giving a rate of 24.5%. The mean age and parity of the study groups were 30.6 ± 4.8 years and 1.9 ± 1.6, respectively. A total of 288 (12%) of them were done as elective. Most of the CS was done due to previous scar, pre-eclamsia/eclampsia. The maternal mortality rate (MMR) during this period was 870/100000 live births, the CS-related mortality was 339/100,000, and the perinatal mortality (PM) was 43.9/1000 live births. Conclusion: The CS rate, the MMR, and PM are all high and the indications show that alternative interventions can be used to reverse the ugly trend but there is a need for training.
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Determinants of neonatal survival following preterm delivery at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
B Bako, A Idrisa, MA Garba, S Pius, HI Obetta
January-April 2017, 34(1):39-44
DOI:10.4103/TJOG.TJOG_49_16  
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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Obesity and preeclampsia: Role of fibrinogen andC-reactive protein
OA Babah, AA Oluwole, OS Ayanbode, EO Ohazurike
January-April 2017, 34(1):45-48
DOI:10.4103/TJOG.TJOG_15_17  
Objective: This study aimed at ascertaining the relationship between obesity and preeclampsia and the role of fibrinogen and C-reactive protein (CRP). Study design: This was a case-control study involving 200 pregnant women, 100 of whom were healthy pregnant women, and 100 preeclamptic women, matched for age, parity, and gestational age. Information about their sociodemographic characteristics was obtained and body mass index (BMI) calculated using their height and weight at recruitment. Their plasma fibrinogen and CRP levels were assayed using enzyme-linked immunosorbent assay (ELISA) technique. All data collected were subjected to statistical analysis using Epi Info. Results: The mean (±SD) age of subjects was 31.1 ± 4.51 years. The preeclamptic subjects were found to have higher BMI (30.04 ± 6.06 kg/m2) compared to the normotensive pregnant women (28.08 ± 2.97 kg/m2). However, this was not statistically significant. Using mean arterial blood pressure as an indicator of disease severity, with a cut-off of 125 mmHg, it was found that severe preeclamptics had higher BMI (30.18 ± 6.49 kg/m2) compared to women with mild form of the disease (29.83 ± 5.48 kg/m2) but this difference was not statistically significant (P = 0.2131). There was also statistically significant association between BMI and high-sensitivity C-reactive protein (hsCRP) (P = 0.0000), and between BMI and plasma fibrinogen levels (P = 0.0000). Conclusion: It can thus be inferred from this study that obesity elicits inflammatory response which might predispose to the development of preeclampsia. Lifestyle modifications such as dietary control, exercise, and pre-pregnancy weight reduction may help in reducing the incidence of preeclampsia.
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Gynecological laparoscopic surgeries: A 4-year audit at the University of Ilorin Teaching Hospital, Nigeria
LO Omokanye, AWO Olatinwo, S Ibrahim, KA Durowade, SA Biliaminu, IF Abdul
January-April 2017, 34(1):49-53
DOI:10.4103/TJOG.TJOG_1_17  
Background: In addition to a shorter hospital stay and better cosmetic results, laparoscopic surgery also offers patients fewer postoperative complications compared to conventional open gynecological surgeries. With expertise and better facilities, it has come to stay as an alternative surgical approach to gynecological diagnosis and treatment. Aims and Objectives: The aim of this study was to assess the indications, intraoperative findings, and types of laparoscopic surgeries performed at the University of Ilorin Teaching Hospital, Ilorin. Materials and Methods: A retrospective observational study of 150 patients who underwent laparoscopic procedures between January 1, 2012 and December 31, 2015, at the Assisted Reproduction Technology (ART) unit of the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. Results: Within the period of our review, there were 1,256 gynecological operations and 150 laparoscopies, thus giving a period prevalence of 11.2%. The patients were aged 20–59 years with a mean age of 32.1 ± 3.9 years. Of the 150 laparoscopies, 30 (20%) had diagnostic laparoscopies while 120 (80%) had therapeutic laparoscopies. Of the 30 patients who had diagnostic laparoscopies, 5 (16.7%) presented with primary infertility and 12 (40%) with secondary infertility. The commonest indication for therapeutic laparoscopy was clomiphene-resistant polycystic ovary syndrome (PCOS) and was found in 81 (67.5%). One (0.7%) was converted to open surgery due to technical difficulties. There was a case of iatrogenic sigmoid colon injury and no mortality recorded. Conclusion: Laparoscopic surgery offers patients a novel choice of intervention that affords establishing definitive diagnosis, shorter hospital stay, better cosmetics, and reduced morbidities/mortalities compared to open gynecological surgeries.
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Fertility desire and utilization of family planning methods among HIV-positive women attending a tertiary hospital in a suburban setting in Northern Nigeria
AO Ashimi, TG Amole, MY Abubakar, EA Ugwa
January-April 2017, 34(1):54-60
DOI:10.4103/TJOG.TJOG_8_17  
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.
  - 3,156 373
Ebola virus disease and pregnancy outcome: A review of the literature
Iliyasu Garba, Lamaran M Dattijo, Abdulrazaq G Habib
January-April 2017, 34(1):6-10
DOI:10.4103/TJOG.TJOG_3_17  
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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REVIEW ARTICLE
Adolescent and pre-pregnancy nutrition in Nigeria
JIB Adinma, OS Umeononihu, MN Umeh
January-April 2017, 34(1):1-5
DOI:10.4103/TJOG.TJOG_12_17  
Good nutrition during adolescent and pre-pregnancy period is critical towards a healthy pregnancy and normal birth weight infant. This article is a review of Adolescent and pre-pregnancy nutrition in Nigeria. Undernutrition in adolescent girls aged 15–19 years in Nigeria has been variously reported to range between 23% and 57.8%. Undernutrition was more prevalent among the rural compared to the urban adolescent, and was attributable more to socio-economic, and dietary factors. A high proportion of energy amongst adolescent, was derived from carbohydrates such as rice, yam, and cassava. Proteins were derived mainly from legumes and pulses, while fats were derived mainly from palm and vegetable oil. Iron was mainly of plant origin and had low bioavailability due to the presence of absorption inhibitors– tannins and phytates. A high levels of vitamin A was prevalent due to consumption of red palm oil. Undernourished adolescent girl and pre-pregnant women are likely to give birth to undernourished infants with the risk of transmitting undernutrition to the future generation. The recommendation towards the implementation of adolescent and pre-pregnancy nutrition in Nigeria include– The establishment of a country-wide school-based nutrition programme; Integration of Nutritional counselling with primary health care services, targeting out of school adolescents; Development of dietary guidelines and IEC materials on nutrition; and Establishment of Preconception clinic to counsel women on family planning and appropriate diet as well as monitor their body weight prior to pregnancy.
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