Background: Twin pregnancy is as fascinating as it is high risk and its epidemiology is globally more dynamic in the recent times. It is associated with increase maternal morbidities, fetal wastage and neonatal morbidities and mortality. Objectives: To determine the current incidence, assess the trend and investigate maternal and perinatal outcomes and influencing factors of twinning. Methods: For this case control study, data was collected on twin pregnancies; the study group and singleton pregnancies; the control group between January 2009 and December 2016 at a missionary Hospital in southsouth Nigeria. EPI INFO and INSTAT statistical software were used for analyses and Fisher's exact test for tests of statistical associations setting the statistical significance at <.05. Results: Among 8769 deliveries were 207 pairs of twins, a twinning incidence of 2.4% or 1 in 42 with an upward trend in incidence. Twin mothers were relatively older with those aged 30-34 years (41.2%) as the modal age group, less literate and less likely to have prenatal care. They were more prone to anemia, caesarean birth, Postpartum hemorrhage, gestational hypertension and blood transfusion (P<0.05). Mean gestational age and birth weight of twins were 35.5±3.8 weeks and 2352.9±746.4gm respectively. The twins were associated with increased preterm births (OR 28.1, P<0.001), Low birth weight (OR 15.6-24.1, P<0.001), perinatal death (OR 3.6, P<0.001), birth asphyxia (OR 2.9-5.9, P<0.01) and Special Care Baby Unit admission (OR 9.8-12.5, P<0.001). About 7 (66.2%) and 3 (31.4%) of every 10 first twins were in cephalic and breech presentation respectively with cephalic/cephalic (44.0%) the leading paired presentations. Conclusion: There was high and increasing incidence of twinning in this population. Twin pregnancy is associated with increased maternal morbidity and perinatal morbidity and mortality. To improve twinning outcome will require quality obstetric and perinatal care.

Abstract:Background: The Total Fertility Rates have declined below the replacement rates globally and in the industrialized countries. The rates are still high in Nigeria and most other poorer countries. Too much childbirth is associated with increased adverse obstetric outcomes and socioeconomic implications. There has been profuse literature on high parity but limited data on the reasons for high parity. We set out to explore the reasons the women have for high parity in Nigeria. Aim: To investigate the reasons women have for high parity in order to improve reproductive health services. Methods: This was a cross-sectional descriptive study on 288 grandmultiparas (para≥5) in South-south Nigeria between 2012 and 2016. EPI INFO software was used for analysis with statistical significance set at P<.05. Results: The mean age of respondents was 35.3±4.2 years. About 85% and 12% were in first marriage and remarried relationship respectively. The mean parity was 5.95±1.3 and ranged 5-11births. Respondents leading reasons for high parity were mistake (unplanned) 30.9%, desire for specific gender 22% (male child 15.6%) and personal desire for more children 15.3%. Over 90% was aware of contraception, only 29.2% ever used any method. The younger (OR=4.9, P=0.02), less educated (OR=0.39, P=0.01) and employed (OR=0.23, P=0.02) and (OR=6.9, P= 0.04) respondents significantly cited spouse desire, desire of male child, child loss and contraception failure for high parity respectively. Conclusion: Mistake, desire for male child and large family were the leading reasons women gave for high parity. Maternal age, education and employment significantly influenced the reasons for high parity. There was high contraceptive awareness but poor utilization among the respondents; a huge unmet need of contraception in this population.

Background: There is an increased aversion to caesarean birth and high premium to vaginal birth especially in developing countries. Trial of vaginal birth after caesarean is therefore readily accepted and successful vaginal birth highly celebrated especially in sub Saharan Africa. This reduces both the caesarean section rate and repeat caesarean morbidities yet optimal conduct of trial of vaginal birth after caesarean remains a compelling obstetric challenge. This study therefore appraised the correlates of successful trial of vaginal birth after caesarean to contribute data to the increasing evidence for optimal trial of vaginal birth after caesarean. Methods: This was a case series observational study of 334 women who had trial of vaginal birth after a primary caesarean section at a mission hospital between June 2009 and April 2016. Results: Successful VBAC rate in this study was 53.3%. The predictors from the primary CS were non-recurrent indications (OR 2.0, P: 0.01), primary CS at tertiary health facility (OR 2.1, P: 0.045) and obstetrician surgeon (OR 1.8, P: 0.02). Others were previous vaginal delivery (OR.3.2, P <0.001), previous VBAC (OR 2.6, P: 0.02), spontaneous labor (OR 1.6, P: 0.06) and induced labor (OR. 0.5, P: 0.01). Conclusion: Trial of vaginal birth after caesarean is a viable option to reduce the increasing caesarean section rate and its associated morbidity especially in high parity settings. It only requires quality management particularly strict selection criteria and conscious labor supervision to optimize its benefits.

Background: Though most pregnant women tend to deliver around their expected date of confinement, quite a significant number deliver preterm and postterm.  The variation of delivery timing can result from obstetrics complications, genetic or demographic factors. Objective: The objective of this study is to determine the influence of demographic factors of pregnant Ijaw women on gestational age at delivery, like: maternal age, parity, occupation, educational level, gestational age at booking, maternal height, and body mass index, on gestational age at delivery. It also intends to determine the effects of birth weight and fetal sex. Materials and Methods: It was an observational cross-sectional study of 1484 booked pregnant women of Ijaw ethnic group, who delivered in the labour ward of the Niger Delta University Teaching Hospital. Their case notes were retrieved and relevant information such as maternal age, parity, educational level, and occupation was obtained. Others include maternal height and weight at booking, gestational age at booking, gestational age at delivery and birth weight. Body mass index was calculated from height and weight and categorized. Data was analyzed with Chi square, Pearson’s correlation coefficient, simple linear regression, and multivariate analysis Results: The prevalence of preterm birth (PTB) among Ijaw women was 9.7%, and the prevalence of PTB was significantly associated with underweight, Odd ratio = 7.79[3.12, 19.50], low educational level, Odd ratio =2.27[1.40, 3.68], and late booking for antenatal care P = 0.004. Delivery postterm was significantly associated with class 1 obesity, Odd ratio =16.0[4, 59, 55.8], and delivery of male babies Odds ratio = 6.76[2.41, 18.96]. Demographic factors from multivariate analysis could only account for 15.9% of the factors responsible for gestational age at delivery, of which the most important were birth weight, educational level and maternal height at booking. Conclusion: Though maternal and fetal demographic factors significantly affects birth weight, the bulk of the determinants (84.1%) are outside these factors, and it could be from obstetrics, genetic, or other factors.

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