International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology ISSN 2736-1594 Vol. 8 (11), pp. 001-004, November, 2020. © International Scholars Journals

Full Length Research Paper

Prevalence and pattern of intra-abdominal adhesions seen at diagnostic laparoscopy among infertile women with prior open appendicectomy in Nnewi, south-east Nigeria

*Ikechebelu JI, Eleje GU, Umeobika JC, Eke NO, Eke AC, Mbachu II

*Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi; PMB 5025, Nnewi, Anambra State, Nigeria.

Accepted 06 September, 2020

Abstract

Black women are predisposed to the formation of adhesions, which may be a contributing factor in female infertility. Laparoscopic approach in contrast to open abdominal operations militates against intra-abdominal adhesion formation and may be beneficial to African women where available. To determine the prevalence and pattern of intra-abdominal adhesions in women with prior histories of open appendicectomy being investigated for infertility using laparoscopy and dye test in Nnewi between 1^st January 2007 and 31^st December, 2008.This was a prospective survey at a private specialist hospital in Nnewi, South-east Nigeria over a two-year period. Data was collected with a pre-designed proforma which included the socio-demographic characteristics and laparoscopic findings in various abdomino-pelvic organs among infertile women that underwent laparoscopy and dye test. A total of 212 patients met the inclusion criteria. The data was analyzed using SPSS package. During the study period, a total of 517 patients had laparoscopy and dye tests, of which 212 (41.0%) patients had prior histories of open appendicectomy. Out of the 212 patients, 86 had adhesions at the previous appendicectomy site. This gave a prevalence rate of 40.6%. The mean age was 35.8± 5.7 years and all the patients were Nigerians (black). Of the 86 patients, 11 (12.8%) had adhesions involving their reproductive organs: right fallopian tube (8/11) and right ovary (3/11). Seventy five (87.2%) patients had adhesions affecting other organs excluding the reproductive organs. Intra-abdominal adhesions were common among infertile women with prior history of open appendicectomy and reproductive organs were affected. There is need to recommend laparoscopy in the treatment of appendicitis in young women in particular to minimize the risks of adhesion and its sequalae. Efforts should be made to make laparoscopy available and affordable in our surgical practice.

Key words: Appendicectomy, adhesions, infertility, women, laparoscopy.

International Journal of Obstetrics and Gynecology ISSN 2736-1594 Vol. 8 (11), pp. 001-005, November, 2020. © International Scholars Journals

Full Length Research Paper

Vaginal birth after one caesarean section: A review of the practice at Nnewi, southeast Nigeria

¹Ikechebelu J.I, ¹Mbamara S.U and ²Afuba A.N.

¹Department of Obstetrics/Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

²Faculty of Medicine, Nnamdi  Azikiwe University Nnewi Campus,Nnewi, Nigeria.

Accepted 14 September, 2020

Abstract

This study was carried out to determine the incidence, predictive factors, and the outcome of the practice of vaginal birth after one previous caesarean section at Nnamdi Azikiwe University Teaching Hospital, Nnewi Southeast Nigeria. Data was retrieved from case records of patients who underwent trial of vaginal birth after caesarean section from January 2001 to December 2005. There were 2062 deliveries out of which 379 were caesarean sections thereby giving a caesarean section rate of 18.4%. A total of 105 patients had trial of vaginal birth after one previous caesarean section and 56 (53.3%) ended in repeat caesarean section while 49 (46.7%) had successful vaginal birth. The indications for the repeat caesarean section include poor progress in labour (43.1%), fetal distress (17.2%) and scar dehiscence/ruptured uterus (10.4%). Spontaneous onset of labour (56.0%), patient age of between 25-29 (51.6%), low social class (57.90%) and non recurrent indication in the previous caesarean section like malpresentation (62.5%) were the factors with positive predictive value on the out-come of trial of vaginal birth after one previous caesarean section. There was poor outcome in women above 35 years and higher (44% vs 20%) success rate among women who went into spontaneous labour compared to those who had induction of labour. No maternal or perinatal death was recorded. Trial of vaginal birth after one previous caesarean section is possible in low resource areas. The outcome would be improved with proper patient selection.

Keywords: Vaginal birth, caesarean section, morbidity, outcome, Nnewi, Nigeria.

International Journal of Obstetrics and Gynecology ISSN 2736-1594 Vol. 8 (11), pp. 001-006, November, 2020. © International Scholars Journals

Full Length Research paper

Rate and correlates of HIV serostatus disclosure among HIV positive pregnant women in Nnewi southeastern Nigeria

Igwegbe A.O and Ugboaja J.O

Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

Accepted 03 August, 2020

Abstract

This is a cross sectional survey of 280 HIV positive pregnant women attending a PMTCT clinic in Nnewi, southeastern Nigeria to determine the rate, pattern, outcome, and barriers to HIV serostatus disclosure. All the women had known their status for more than three months. Two hundred and seventy two (97.1 %.) of the women had disclosed their HIV status. Out of this number, 90.0% disclosed to their husbands; 23.5% to a priest/pastor and 11.4% to a close family member. The only reason for non disclosure to husbands was the fear of divorce. The partner’s reaction was supportive and understanding in all cases. Being single (x²=11.46; p= 0.00), low educational status (x²=7.64; p= 0.02), Anglican Christian denomination (x²=84; p=0.00) and non membership of a support group(x²=7.66; p= 0.00) significantly increased the likelihood of non disclosure. There was no significant association between age, parity, knowledge of partner’s HIV status, duration of illness and the likelihood of serostatus disclosure. We conclude that the rate of serostatus disclosure among HIV positive pregnant women in Nnewi is high and the outcome is supportive. However, the fear of divorce should be addressed during post test counseling on serostatus disclosure.

Keywords:  Serostatus disclosure, rates, barriers, Nigerian pregnant women, PMTCT

International Journal of Obstetrics and Gynecology ISSN 2736-1594 Vol. 8 (10), pp. 001-004, October, 2020. © International Scholars Journals

Case Report

A woman presenting rheumatic cardiopathy in pregnancy: a case report

Ambrogio P Londero¹*, Alessandra Citossi¹*, Serena Bertozzi²*, Lorenza Driul¹, Giorgia Poloni¹, Omar Anis¹, Diego Marchesoni¹

¹Clinic of Obstetrics and Gynecology, AOU “Santa Maria della Misericordia”, Udine, Italy.

²Clinic of Surgical Semeiotics, AOU “Santa Maria della Misericordia”, Udine, Italy.

Accepted 08 June, 2020

Abstract

A 37 year old Asian pregnant woman referred to our outpatients facility at the 31st gestational week with a few days history of asthenia, dyspnea by walking and tachycardia in the early morning by waking up. The objective examination revealed elevated heart rate (80beats/min), arrhythmia and abnormal respiratory rate (20 breaths/min).The urgent haemogram showed hypochromic anaemia (Hb 10.0 g/dL), erithrocytopenia (3.79 x 10⁶/µL) and normal leukocytes (8.06 x 10³/µL) . The cardiology evaluation with echocardiography found severe atrial fibrillation, mitral stenosis and pulmonary hypertension associated with severe bi-atrial dilatation. In relation to the patient conditions, an intensive heart monitoring was started. The patient was treated for respiratory distress syndrome prophylaxis (Betametasone 12 mg i.m. x2) and Low Molecular Weight Heparin prophylaxis (Seleparine 6000 UI tid). Initially, there was a successful pharmacological cardioversion, but after some days atrial fibrillation reappeared (150 bpm). At the 33 gestational week, after a multidisciplinary discussion, cesarean section was performed. Five days after delivery the patient developed anaemia, fever, leukocytosis and C-reactive protein increase. Active treatment included haemotransfusion, wide spectrum antibiotics and dicumarolic prophylaxis, and forty days after delivery the patient was successfully discharged with good health conditions.

Keywords: Chronic rheumatic heart disease, mitral stenosis, pulmonary hypertension, atrial fibrillation arrhythmia, pregnancy.

International Journal of Obstetrics and Gynecology ISSN 2736-1594 Vol. 8 (10), pp. 001-008, October, 2020. © International Scholars Journals

Full Length Research paper

Pregnancy outcome and neonatal health by mothers aged 40 years and over

Lorenza Driul^1*, Ambrogio P Londero^1*, Serena Bertozzi^2*, Laura Peressini¹, Michele Vanin¹, Vito D’Aietti¹, Arrigo Fruscalzo³, Anna Biasioli¹, Stefania Salvador¹, Riccardo Furlan⁴, Maria Maddalena Petrovec¹, Diego Marchesoni¹

¹Clinic of Obstetrics and Gynecology, AOU "S M della Misericordia", 33100 Udine, Italy

²Clinic of Surgical Semeiotics, AOU "S M della Misericordia", 33100 Udine, Italy

³Department of Obstetrics and Gynecology, Gesundheitszentrum Rheine - Mathias-Spital, Rheine, Germany

⁴Neonatology Department, AOU "S M della Misericordia", 33100 Udine, Italy

Accepted 04 July, 2020

Abstract

This study was carried out to investigate obstetric outcomes in single pregnancies conceived by women older than 40 compared to those of their younger counterparts in a low natality setting with high mean age at first pregnancy. Data were collected about women who delivered in our Clinic between January and July 2005, excluding multiple pregnancies. Statistical analysis was performed using R (version 2.10.1), considering significant a p<0.05.We selected 688 women: 50 of them are 40 years or older and 638 are younger. Advanced age correlates with higher BMI (p=0.056) and seems to increase the risk of gestational hypertension (p<0.05) and gestational diabetes (p<0.05), cesarean sections (p<0.05) and vacuum extraction (p0.089), neonatal clavicle fracture (p<0.05) and perinatal mortality (p<0.05).Advanced age women have an increased risk of pregnancy complications, such as gestational hypertension and diabetes, neonatal clavicle fracture and perinatal death, and undergo more frequently cesarean sections.

Keywords: Advanced maternal age, pregnancy outcome, neonatal outcome, pregnancy related hypertensive disorders.

International Journal of Obstetrics and Gynecology ISSN 2736-1594 Vol. 8 (10), pp. 001-011, October, 2020. © International Scholars Journals

Full Length Research Paper

The comparison of low-risk women’s birth outcomes and experiences in different sized midwifery practices in The Netherlands

Yvonne Fontein

Midwifery, School of Health Studies, Glasgow Caledonian University, Govan Mbeki, room A306 Cowcaddens Road, Glasgow G4 0BA, Scotland, United Kingdom. E-mail: [email protected]. Tel: +44 (0)141 331 8376.

Accepted 03 September, 2020

Abstract

To examine maternal birth outcomes and birth experiences of low-risk women in the Netherlands in different sized midwifery practices. Descriptive study was using postal questionnaires six weeks after the estimated due date. Women were recruited from urban, semi-rural and rural areas from small-sized practices (1-2 midwives), medium-sized practices (3-4 midwives) or large-sized practices (5 or more). 718 Dutch speaking women with uncomplicated pregnancies, a representative sample of women in 143 midwifery practices in the Netherlands who had given birth in the period between 20 April and 20 May 2007. Distribution of place of birth categories and intervention categories, birth experience, woman-midwife relationship and presence of own midwife after referral. Data were analyzed with Statistical Package for Social Sciences (SPSS). Women in practices with a maximum of two midwives were significantly more likely to experience lower rates of referral, interventions in general and specifically pain relief by means of pethidine, CTG registration and unplanned caesarean sections. Women with a maximum of two midwives were significantly more likely to know their midwife or midwives and were more frequently supported by their own midwife after referral in comparison to women in practices with more than two midwives. The presence of the woman’s own midwife added value to the birth experience. Women with a maximum of two midwives had higher levels of a positive birth experience than women in practices with more than two midwives. Midwifery practices with a maximum of two midwives contribute to non-interventionist birth and a positive birth experience. Awareness of the study results and further study is recommended to discuss re-organisation of care in order to achieve significant reductions on referral and interventions during childbirth and positive maternal birth experiences.

Key words: Midwifery, birth interventions, referral, practice size.