Background Inappropriate and excessive use of surgical antibiotic prophylaxis are associated with the emergence of antibiotic resistance. Antibiotic prophylaxis malpractices are common in obstetrics and gynecology settings and antibiotic stewardship is used to correct such malpractice. Objective To evaluate the impact of antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis practice in obstetrics and gynecology surgeries. Method A prospective pre- and post-intervention study was conducted in two tertiary hospitals between May and December 2016. The duration of the each period was 3 months. Antibiotic stewardship interventions including development of a protocol, educational meeting and audit and feedback were implemented. Data were collected using the patient records and analyzed with SPSS version 23. Results A total of 226 and 238 surgical procedures were included in the pre- and post-intervention periods respectively. Age, length of stay and estimated blood loss were similar between the two groups. However, specialty and surgical procedures varied significantly. There was a significant increase in compliance with timing (from 14.2% to 43.3%) and duration (from 0% to 21.8%) of surgical antibiotic prophylaxis after the interventions. The interventions significantly reduced the prescription of third generation cephalosporin (-8.6%), redundant antibiotic (-19.1%), antibiotic utilization (-3.8 DDD/procedure) and cost of antibiotic prophylaxis (-$4.2/procedure). There was no significant difference in the rate of surgical site infection between the two periods. Post-intervention group (OR: 5.60; 95% CI: 3.31–9.47), elective surgery (OR: 4.62; 95% CI: 2.51–8.47) and hospital attended (OR: 9.89; 95% CI: 5.66–17.26) were significant predictors of compliance with timing while elective surgery (OR: 12.49; 95% CI: 2.85–54.71) and compliance with timing (OR: 58.55; 95% CI: 12.66–270.75) were significantly associated with compliance to duration of surgical antibiotic prophylaxis. Conclusion The interventions improve compliance with surgical antibiotic prophylaxis and reduce antibiotic utilization and cost. However, there is opportunity for further improvement, particularly in non-elective surgical procedures.

Background Audit of antibiotic prophylaxis is an important strategy used to identify areas where stewardship interventions are required. Objectives To evaluate compliance with surgical antibiotic prophylaxis in obstetrics and gynaecology surgeries and determine the Defined Daily Dose (DDD) of antibiotic. Settings Three public tertiary hospitals located in Northern Nigeria. Methods This prospective study included women who had obstetrics and gynaecology surgeries with no infection at the time of incision. Appropriateness of antibiotic prophylaxis was determined by a clinical pharmacist. DDD of antibiotics was determined using ATC/DDD index 2017 from the World Health Organization Collaborating Centre for Drugs Statistics Methodology. Main outcome measure Compliance with antibiotic prophylaxis and DDD of antibiotic per procedure. Results A total of 248 procedures were included (mean age: 31.7 ± 7.9 years). Nitroimidazole in combination with either beta-lactam/beta-lactamase inhibitor or third generation cephalosporin were the most prescribed antibiotics. Redundant anaerobic antibiotic combination was detected in 71.4% of the procedures. Timing of antibiotic prophylaxis was optimal in 16.5% while duration of prophylaxis was prolonged in all the procedures (mean duration was 8.7 ± 1.0 days). The DDD of antibiotics prophylaxis was 16.75 DDD/procedure. Antibiotic utilisation was higher in caesarean section and myomectomy (17.9 DDD/procedure) than hysterectomy (14.5 DDD/procedure); P < 0.001. Redundant metronidazole represents one-third of total DDD and 87% of the DDD for metronidazole. Conclusion Excessive and inappropriate use of antibiotic prophylaxis was observed in women who had obstetrics and gynaecology surgeries. These observations underline the need for antimicrobial stewardship interventions to improve antibiotic use.

This is a prospective non-randomised study to determine the fertility performance and pregnancy outcome in pregnant females who had caesarean myomectomy at last delivery. A total of 29 females were studied and they had a mean age of 37.3 years. Of these, 22 (75.9%) of the females were para 1 and 25 (86.2%) had had one previous caesarean section. Only six (20.7%) of them had fertility treatment before the attainment of the index pregnancy. The common antenatal complications recorded were abnormal lie/malpresentation (10.3%), placenta praevia (10.3%) and threatened abortion (10.3%); 17 patients were eligible for trial of scar; 13 (44.8%) had successful vaginal birth after caesarean myomectomy, while 16 (55.2%) had repeat caesarean section including a caesarean hysterectomy. Postoperative morbidity was recorded in four (25%) of the 16 patients that had abdominal delivery. There was no maternal or perinatal mortality recorded. The future fertility and or subsequent pregnancy outcome in patients is unaffected by caesarean myomectomy.

Background: Involuntary infertility is a tragedy in most African setting. This is due to premium placed on fertility as a result of roles children fulfill in the family and the society. Aetiologic factors of infertility in sub-Saharan Africa are mostly infection related and they are mainly associated with poor treatment outcome to conventional non assisted conception technique. Objective: To evaluate the level of awareness and perception of assisted conception treatment among women attending fertility clinic. Methods: A descriptive cross-sectional study. Results: One hundred and ninety six women attending fertility clinic were interviewed. Mean age was 34.8 years and mean duration of infertility of 4.1 years. Of the 196 infertile women interviewed, 150 (76.5%) have heard of Assisted Reproductive Technology treatment. Sources of information were mainly family relation (46%) and friends (28.7%). Knowledge on some of Assisted Reproductive Technology practices showed that 50.7% were aware that the treatment could fail, 36.8% knew it could be applied for male infertility treatment, 9.3% and 18.7% respectively are aware that donor oocyte and sperm could be used for treatment. Perception on babies conceived from assisted conception treatment revealed that 52% of patients interviewed could not comment if they are normal and natural babies. Majority of patients could not affirm if they will agree to the use of donor gamete or zygote for their treatment. Conclusion: Awareness of assisted conception treatment was high, however knowledge on specifics of treatment was low and perception on some of the practices was unfavorable. Sensitization of the public will help overcome some beliefs that may be at tangent to some practices of assisted conception.