1Department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Maternity Wing, P.M.B 1339 and ²Department of Community Health and Epidemiology, University of Ilorin Teaching Hospital, P.M.B 1459, Ilorin, Nigeria .

Context: Public health measures suggested to curb the menace of unsafe abortions in developing countries include liberalization of abortion law, family life education and family planning. However public acceptability of these solution options are poor.

Objective: To examine the efficacy of information, education and communication (IEC) on the public acceptability of unsafe abortion solution options of contraception, family life education including sex education and liberalization of abortion laws. Our aim was to use IEC to improve public acceptability of the recommended solutions.

Methods: Trained questionnaire administrators interviewed randomly selected civil servants in Ilorin, Nigeria to asses the level of their acceptability of the various options. There were 95 respondents for the baseline interviews and 93 respondents for the post IEC interviews. The responses were compared pre- and post-IEC to assess the effectiveness of the IEC.

Results: Contraception for adults was the most acceptable solution to the public both pre- and post-IEC, the acceptability doubling (46.3% to 93.4%) after IEC. Contraception for adolescents, and family life education showed appreciable improved acceptability post IEC (25.3% to 40.2% and 40% to 67.4%) respectively Liberalization of abortion law also appreciated marginally in the amount of yes answers (14.8% to 18.5%). Ironically, the percentage of rejecters also appreciated from 78.9% to 79.3%, giving a very weak correlation coefficient of 0.42.

Conclusion: IEC is effective in improving public acceptability of unsafe abortion solutions. The need for an extension and sustenance of this intervention strategy to all segments of the society for effective advocacy is an imperative

Key Words: Unsafe Abortions, Information, Counselling, Education [Trop J Obstet Gynaecol, 2002, 19: 12-16].

Department of Obstetrics and Gynaecology, University College Hospital, P. M. B 5117, Ibadan, Nigeria.

Context: Obesity constitutes a health hazard and the greater the degree of obesity, the greater the health risks. This is especially so in obstetric practice where complications of pregnancy are reportedly greater in obese patients.

Objectives: To determine the prevalence of obesity and to compare the outcome of pregnancy between obese and non-obese patients.

Material and Methods: A review of the case records over a five-year period at a Nigerian teaching hospital to identify obese patients who delivered babies was done. Outcome of pregnancy in the 205 obese patients identified (using a weight of 90 kg and above as cut-off) was compared with 206 controls.

Results: The incidence of obesity in pregnancy was 7.4%. The obese patients were older than the controls (p<0.05). There was no significant difference in socio-economic status in the two groups. More of the obese patients were multiparous (p <0.01). Preeclampsia was significantly more common in the obese group (p<0.001). The caesarean section rate was also higher in the obese group (p<0.001). The incidence of fetal macrosomia was higher in the obese group (p<0.001).

Conclusion: Obesity increased the risk of preeclampsia and fetal macrosomia and operative deliveries. The risk of birth asphyxia and perinatal mortality were not increased by obesity.

Key Words: Obesity, Parturient, Maternal, Neonatal, Outcome. [Trop J Obstet Gynaecol, 2002, 19: 17-20].

Departments of Paediatrics ¹, and Obstetrics & Gynaecology ², University of Ilorin Teaching Hospital, Ilorin, Nigeria

Abstract

Background: Knowledge of the maternal factors predisposing to preterm deliveries should affect the anticipatory care of mothers at risk of delivering preterm babies and improve perinatal outcome.

Objective: To determine the maternal socio-biological characteristics associated with the delivery of early spontaneous singleton preterm babies in a sample of Nigerian Women.

Methods: The study was conducted at a teaching hospital in the Guinea savannah belt of Nigeria. Two groups of patients were recruited. Group A consisted of women who delivered babies prior to a gestational age of ² 34 weeks, while Group B were mothers who delivered at 37 or more weeks. Data collected on each subject included maternal post-partum weight, height, obstetric data and social characteristics.

Results: A total of 171 mothers were studied; 69 in Group A and 102 in Group B. There was no significant difference between the socio-demographic profiles of the two groups. Factors significantly associated with preterm delivery were body mass index (BMI) ² 20.0 [Odds Ratio (OR) 14.6; 95% CI: 3.2-66.1]; previous preterm delivery [OR: 4.5; 95% CI: 1.5-13.3]; parity 1-2 [OR: 2.1; 95% CI: 1.1-4.0] and previous abortion [OR: 1.6; 95% CI: 1.2-2.4]. These associations were still demonstrable after adjusting for confounding variables, with BMI being the strongest determinant of preterm delivery. Maternal height alone and previous uterine curettage were not significantly associated with preterm delivery.

Conclusion: Low BMI, low parity, previous preterm delivery and previous abortions were the maternal factors associated with early spontaneous singleton preterm delivery in a sample of Nigerian women.

Key Words: Maternal, Labour, Preterm Births, Prematurity, Perinatal [Trop J Obstet Gynaecol, 2002, 19: 32-35]

Department of Obstetrics and Gynaecology, University College Hospital, P. M. B 5117, Ibadan, Nigeria.

Context: Twinning being a very important high-risk condition in our environment requires detailed study. There are several studies reviewing factors in twin perinatal mortality in our environment but there is a need to ascertain the relative contributions of each of these factors.

Objectives: To assess the relative contributions of maternal and fetal factors to perinatal mortality in twins.

Materials and Methods: Data was extracted from the birth register of a Nigerian tertiary health institution to identify maternal and fetal factors associated with a higher risk of perinatal mortality.

Outcome Measures: Perinatal deaths among twin pairs (ranked).

Results: The twinning rate was 32.3/1000(3.2%). Risk of perinatal death had linear correlation with birth asphyxia (r = 0.412, p < 0.01), birth weight of the second twin (r = 0.358, p < 0.01), birth weight of the smaller twin (r = -0.344, p < 0.01), presence of birth weight discordance (r = 0.278, p < 0.01), gestational age at delivery (r = -0.211, p < 0.05), birth weights of first and larger twins (r = -0.275, p < 0.01) and (r = -0.206, p < 0.05) respectively. The maternal age and parity showed no significant correlation with risk of perinatal death.

Conclusion: Birth asphyxia was the greatest predictor of perinatal death in twins among the variables studied.

Key Words: Twins, Birthweight Discordance, Perinatal Mortality [Trop J Obstet Gynaecol, 2002, 19: 36-38].

1Departments of Chemical Pathology & Haematology and ³Obstetrics & Gynaecology, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria; ²Department of Human Nutrition, University of Ibadan, Ibadan, Nigeria; and ⁴Centre for Research in Reproductive Health, C/10 Cinema Road, Sagamu , Ogun State, Nigeria.

Context: Breastfeeding patterns, ethnic variation and nutrition have been shown to influence the return of menstruation after childbirth, but the role played by nutritional status requires further elucidation, particularly in a place like Nigeria where undernutrition is common.

Objectives: To determine the effects of nutrition and breastfeeding pattern on the duration of lactational amenorrhoea in Nigerian women.

Subjects and Methods: Marginally malnourished mothers (162) were randomised into two groups [A & B] for comparison with a third group [C] of well-nourished mothers. Mothers in Group A (83 subjects) received supplements in the form of specially formulated biscuits while those in Group B (79 women) & Group C (85 women) received none. The subjects were visited 3 times a week to ensure compliance with the supplements and to collect information on breastfeeding pattern and duration of lactational amenorrhoea.

Results: There were no significant differences in the duration of postpartum amenorrhoea in the three groups of mothers, being 270, 220 and 234 days for Groups A, B and C respectively. Wide individual variations were observed in the duration of amenorrhoea in each group of mothers despite the fact that they generally had similar patterns of breastfeeding. The energy expenditure patterns in the supplemented and unsupplemented mothers were similar.

Conclusion: Nutritional status and supplementation do not seem to influence the duration of lactational amenorrhoea in this group of Nigerian women. Subtle physiological differences between individual women may account for the wide individual variations observed in the time of resumption of menstruation after childbirth in the subjects.

Key Words: Breastfeeding, Lactational Amenorrhoea, Nutritional Status, Menstruation. [Trop J Obstet Gynaecol, 2002, 19: 39-43].

The Use of the Foley Catheter in Controlling Severe Uterine Haemorrhage in Gynaecological

Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH), Enugu.

Three patients with severe uterine bleeding were managed successfully by intracavitary insertion and distension of Foley catheter balloons. Blood transfusion was averted in the first patient and reduced to 2 units in the second, while imminent maternal death was prevented in the third case. The availability of the Foley catheter and minimal requirements for its use, coupled with lack of untoward effects in cases managed, make the procedure a useful one.

Key Words: Uterus, Haemorrhage, Foley Catheter. [Trop J Obstet Gynaecol, 2002, 19: 44-46]

Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.

A case of ruptured uterus in a 30 year-old primigravida is presented. The patient went into labour at term and reported to a local maternity where it was discovered that the fetus had a breech presentation. The attending midwife decided to attempt an external cephalic version. Soon afterward, the patient developed generalized abdominal pains, dizziness and fainting attacks. Prompt referral, immediate resuscitation and urgent laparotomy saved the patient although it meant the end of her reproductive career.

Key Words: Uterus, Rupture, Haemorrhage, Primigravida. [Trop J Obstet Gynaecol, 2002, 19: 47-48]

Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Uterine rupture is a life threatening complication in pregnancy in developing countries. While multiparity is a commonly associated factor, primigravida are said to be ‘immune’ to uterine rupture. We present a case of uterine rupture in an unbooked primigravida who had massive bolus doses of intravenous oxytocin in the presence of prolonged obstructed labour and pelvic contraction. Operative findings include a male fresh stillbirth weighing 3.8 kg. and a transverse uterine rupture at the lower segment. Peritoneal lavage and repair of the rupture without bilateral tubal ligation were done.

Key Words: Uterus, Rupture, Haemorrhage, Primigravida. [Trop J Obstet Gynaecol, 2002, 19: 49-50]

Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria.

A case of a preterm neonate with congenital thyrotoxicosis is reported. Her mother had thyrotoxicosis which was diagnosed at 27 weeks gestation, and was treated with propranolol and carbimazole. The diagnosis of thyrotoxicosis in the neonate was confirmed by an elevated serum tri-iodo-thyronine (T3) level of 6.7 nmol/L, a thyroid stimulating hormone (TSH) level of less than 0.3 mu/L, and advanced bone age of between 3-6 months, at birth. The baby was treated with propranolol and Lugol’s iodine, with a favourable outcome.

Key Words: Thyrotoxicosis, Maternal, Congenital, Neonate [Trop J Obstet Gynaecol, 2002, 19: 51-53].