BackgroundThe pain of childbirth is arguably the most severe pain that most women will endure in their lifetime. Epidural analgesia is widely used as an effective method of pain relief in labor. It provides almost complete relief of pain if administered timely, and does not affect the progress of the first stage labor.ObjectivesThe objective of this study was to determine the awareness and utilization of epidural analgesia in labor in pregnant women attending the antenatal clinic at Federal Teaching Hospital, Abakaliki (FETHA).MethodologyThis is a cross-sectional study involving 350 women attending the antenatal clinic between April 2016 and July 2016. A total of 335 questionnaires were correctly completed, and used for analysis.ResultsThe average age and parity of the respondents were 27.6±8.2 years and 2.4±1.8, respectively. About 58.2% of respondents were civil servants, 98.5% were married, and 74.6% had a tertiary level of education. About 43.3% of the respondents are aware of the use of epidural analgesia in labor, but only 7.5% had used it; 95% of these were satisfied and desired to use it again. The reasons responsible for the poor uptake were desire to experience natural labor, cost, and fear of side effects. However, 70% of those who had not used it expressed the desire to use it.ConclusionEpidural analgesia is one of the most effective methods of pain relief in labor. However, the present study indicates that knowledge and practice of epidural analgesia among parturients are low. Efforts should be made to raise awareness, dispel misconceptions, and subsidize the cost of providing this invaluable care in modern day obstetrics.

Background Female genital mutilation (FGM) is an assault on womanhood. Objective To compare the obstetric outcome between parturient with genital mutilation with a cohort that has no genital mutilation. Materials and methods This cross-sectional prospective study was done in the labour ward of Federal Teaching Hospital Abakaliki between 1st January 2013 and 31st December 2013. The obstetrics outcome of 260 consenting healthy parturients with FGM in the 1st stage of labour was compared with 260 cohorts with no FGM and also in labour. Data were obtained with a structured questionnaire and analysed using IBM SPSS Statistic version 20. Simple percentage odd ratio and Chi-square were used for data analysis at a p-value of < 0.05. Results The mean age and gestational age of the women were 27.9 ± 4.8 years and 38.9 ± 1.5 weeks respectively. Majority of the women, 308 or 77.0%, belonged to social class 4 and 82.0% had Type 2 FGM. More than 90.0% of the women had a vaginal delivery and the 2nd stage of labour lasted more than 2 h in 13.4% of the women (OR = 0.78 95% CI 0.64-0.97). Parturient with FGM had increased odd of perineal tear (OR = 0.76 95% CI 0.63 - 0.91) and episiotomy (OR = 1.69 95% CI 1.17–2.45). The mode of delivery and neonatal Apgar scores were not significantly influenced by the presence of FGM (P > 0.05). Conclusion The study has shown that FGM in labour increases the odds of developing perineal trauma which may be associated with a host of short- and long-term complications. We recommend continued awareness creation to stop FGM.

BackgroundDetecting and treating asymptomatic bacteriuria (ASB) prevents urinary tract infection and its consequences. The cost-effectiveness of routine screening for ASB in pregnancy is controversial. In populations with high prevalence, however, it is worthwhile and justifiable.AimTo determine the profile, prevalence, microbiological isolates, and risk factors of ASB among booking antenatal clinic attendees in Abakaliki, Nigeria.Materials and methodsThis was a cross-sectional study involving booking antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, who met the inclusion criteria. This study occurred between January and December, 2012. The midstream urine samples of these women were subjected to microscopy, culture, and sensitivity.ResultsA total of 300 randomly selected booking antenatal clinic attendees participated in the study; 74 of them had ASB, giving a prevalence of 24.7%. With the exception of rural residence, sociodemographic and obstetric characteristics did not influence the risk of ASB among the participants in this study. Staphylococcus aureus was the commonest organism isolated. The majority of the organisms were sensitive to ofloxacin and ceftriaxone.ConclusionThere is a high prevalence of ASB among pregnant women in Abakaliki. With the exception of rural dwelling, sociodemographic and obstetric characteristics did not significantly influence the risk of ASB among these pregnant women. Therefore, routine ASB screening of pregnant women is recommended in our environment.

The clinical diagnosis of fetal distress is accurate in 29.1% of the cases. However, it has led to an unnecessary caesarean section in the remaining 70.9% of the parturients. In order to reduce this high trend of unnecessary caesarean sections due to clinical diagnosis of fetal distress in this environment, antepartum fetal assessment with non-stress test or biophysical profile and intrapartum use of continuous electronic fetal monitoring should be used to confirm or refute the fetal distress before any surgical intervention. Fetal blood sampling and fetal pulse oximetry should be performed in event of non- re-assuring or abnormal cardiotocography.

Background: The application of invasive obstetric procedures has an end point of reducing the Caesarean section rate. The declining rate of use of these procedures is one of the reasons for increasing Caesarean section rates in our environment. Objective: The aim of the study was to determine the practice of operative vaginal deliveries among obstetricians practicing in Nigeria and to evaluate the reasons for non-use of these procedures. Methodology: It was a questionnaire based study. The questionnaires were administered to practitioners of Obstetrics in the various centres in Nigeria. Data was collated and analyzed with Epi-Info statistical software version 7.0 (Center for Disease Control and Prevention, USA), and conclusions were drawn by means of descriptive statistics. Results: A total of 1200 questionnaire were distributed but 1104 were returned and used for analysis. This gave a response rate of 92%. The age distribution of the respondents showed that the 20-30 year age group had the least number of respondents 22 (2%) while 41-50 age group had the highest number of respondents 486 (4%). The majority of the respondents were males 839 (76%). In terms of duration of practice, 449 (40.7%) of the respondents had more than 6 years duration of practice while 256 (23.2) had practiced for less than 3 years. Tertiary centres had highest number of respondents 71.8%. The distribution of the respondents according to the geopolitical zones in Nigeria are; SouthEast (57.6%), South-South (19.6%), South West (11.4%), NorthWest (4.9%), NorthEast (3.8%), North-Central (2.7%).

BackgroundLow utilization of health facilities for delivery by pregnant women poses a public health challenge in Nigeria.AimTo determine the factors that influence the choice of birth place among antenatal clinic attendees.MethodologyThis was a cross-sectional study of the eligible antenatal clinic attendees recruited at Mater Misericordiae Hospital, Afikpo and Saint Vincent Hospital, Ndubia in Ebonyi State from February 1, 2016 to June 30, 2016. Analysis was done using EPI Info 7.21 software (CDC Atlanta Georgia).ResultsA total of 397(99.3%) completely filled questionnaires were collated and analysed. Approximately 71% of the health facilities closest to the respondents had maternity services. It took at least 1 hour for 80.9% of the respondents to access health facilities with maternity services. Most (60.2%) of the respondents had at least one antenatal clinic attendance and majority of them did so at public hospitals. Approximately 43.8% of the respondents were delivered by the skilled birth attendants. The respondents’ age and the couple’s educational level, history of antenatal clinic attendance, distance of the health facility and availability of transport fare had a significant effect on delivery by skilled birth attendants. The common determinants of birth place were nearness of the health facilities, familiarity of healthcare providers, improved services, sudden labour onset and cost. Also 61.7% of the respondents chose to deliver in public health facilities due to favourable reasons but this could be hampered by the rudeness of some healthcare providers at such facilities. A significant proportion of private health facilities had unskilled manpower and shortage of drugs.ConclusionA greater proportion of women will prefer to deliver in health facilities. However there are barriers to utilization of these facilities hence the need to address such barriers.

Background. In recent times, it has become a common practice to discharge a woman early after an uncomplicated caesarean section (CS), to satisfy their wishes, reduce cost, and maximize efficient use of healthcare system resources. Objective. To conduct a comparative analysis of maternal and neonatal outcomes following day two hospital discharge versus day 5 or 7 discharge after an uncomplicated CS. Materials and Methods. Eligible parturient (228) who met the inclusion criteria were randomized into two groups between 1st October 2018 and 30th September 2019 in two different maternity centers in Ebonyi state. The study group (114) was discharged two days after an uncomplicated CS while the control group (114) was discharged on the 5th or 7th postoperative day. Their satisfaction, cost, morbidities, and breastfeeding practices were evaluated using a pretested questionnaire. Data were analyzed using IBM SPSS version 22. Results. Day 2 discharge was not associated with a higher rate of readmission as compared with day 5-7 discharge ( χ 2 = 0.95 , P = 0.329 ). There were no statistically significant differences in cost incurred by patients discharged on day 2 after uncomplicated CS compared to the control group ( χ 2 = 1.65 , P = 0.649 ). Maternal satisfaction was high following day 2 discharge compared with day 5-7 discharge ( χ 2 = 16.64 , P = 0.0001 , OR = 0.857 , 95 % CI = 0.59 – 1.25 ). The majority of mothers (79.6%) discharged on day 2 were able to initiate and sustain breastfeeding with no statistically significant difference in the initiation and sustenance of breastfeeding with those discharged on days 5-7 ( χ 2 = 4.45 , P = 0.108 ). Early hospital discharge did not have any significant negative impact on neonatal health ( χ 2 = 1.063 , P = 0.303 ). Conclusion. Early discharge of patients after an uncomplicated CS is not associated with increased rate of readmission. It is associated with good maternal satisfaction, adequate initiation and sustenance of breastfeeding, and good neonatal wellbeing. We advocate early discharge of women following uncomplicated CS.

Objectives: Globally, caesarean section (CS) has immensely contributed to improved obstetric outcome in circumstances where vaginal delivery is not feasible. However, in some low-income countries, there is aversion to the procedure. The aim of this study was to determine the level of awareness and socio-cultural barriers to the acceptance of CS. Materials and Methods: A cross-sectional study was conducted among 344 parturients at Federal Teaching Hospital in Abakaliki, from October 1 to November 30, 2016. Data were collated using a self-administered questionnaire and was analyzed using SPSS version 20.0 and conclusions were drawn by means of descriptive statistics. Results: All the respondents were aware of CS as an operative abdominal procedure for delivery; of these, over one-tenth (14.0%; 48/344) had experienced the procedure previously. Over four-fifths (82.3%; 283/344) of those who have had a previous CS were wellinformed about the indications. About one-fifth (20.3%; 70/344) did not accept CS for any reasons. The major barriers to acceptance were being considered by peers as a reproductive failure (29.2%; 7/24), high cost (20.8%; 5/24) and religious beliefs (12.5%; 3/24). Conclusions: Majority of antenatal attendees had a significant awareness of CS and the indications. Moreover, a vast majority had morbid aversion towards it; due to numerous, non-evidence based socio-cultural reasons. Therefore, adequate health education, female empowerment, access to free or affordable antenatal care service, elimination of harmful, religious/cultural beliefs and myth regarding caesarean delivery are necessary to curb this ugly trend if we hope to achieve the sustainable development goals related to maternal health.