This study affirms previous suspicion that a significant proportion of antenatal clients are averse to C/S and the negative cultural perception of the people to C/S reinforced this aversion.

The rate of 50% missed diagnosis in this study highlights the need for a high index of suspicion in the diagnosis of abdominal pregnancies as the clinical features are varied. It calls for vigilance on the part of the obstetrician. The maternal and fetal outcomes relate to early diagnosis and skilled management.

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This study evaluated the rate and factors influencing male uptake of infertility investigations. Infertility constituted 11.2% of all new gynaecological consultations in the centre during the study period. A total of 61 (70.1%) males consented to seminal fluid studies without much hesitation, 12.4% after much persuasion, while the remainder (17.5%) refused. Obliging doctor's recommendation was the primary motivation for those who willingly had seminal fluid studies while the claim to be healthy and not being responsible for infertility were the commonest barriers for reluctance or refusal to be investigated. Fears of exposure of semen so obtained to witchcraft and rituals were also contributory. Gynaecologists working in rural South-east Nigeria should through systematic public enlightenment dispel misconceptions of necessary medical intervention.

This study aimed at determining the knowledge and perception of physicians in Nigeria on abortion related deaths, and also to find out if they will support the liberalization of abortion as a means of reducing deaths from unsafe abortion. Physicians' willingness to offer abortion services was also explored. A self-administered questionnaire was distributed to a convenience sample of physicians in Delta state of Nigeria. Physicians were equally divided on whether legal liberalization of abortion would significantly reduce maternal mortality in Nigeria. Only 13.4% of the doctors were willing to offer abortion services if legally liberalized. The majority of the doctors considered promoting abstinence from pre-marital sex and contraceptive use as best effective strategies for reducing abortion-related deaths. However, liberalization of abortion law in Nigeria was not considered a very effective strategy.

BackgroundA vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day) urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day) urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service.Methods/DesignThis study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT) comparing the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repair surgery over the course of 24 months at each site.DiscussionIf no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia.Trial registrationClinicalTrials.gov Identifier NCT01428830.

One thousand and thirteen (1013) symphysiotomies were performed and 27,477 deliveries were conducted during the period. The symphysiotomy rate in the study period was 3.7%. Fifty-six percent (56%) of the patients who had symphysiotomy were aged 39 years and below, and the mean age was 27.94 +/- 7.16 years. Mothers with maternal age greater than 40 years were at a higher risk for symphysiotomy. Thirty-eight percent (38%) of those who had symphysiotomy were nulliparae, 35% were multiparae, while grandmultiparae accounted for 27%. Cephalopelvic disproportion was the leading indication for symphysiotomy (88%), while arrest of the after-coming head of the breech and previous caesarean section with mild cephalopelvic disproportion were other indications for symphysiotomy. Transient post-operative pelvic and leg pain was the leading maternal complication in the study, while stress incontinence, para urethra/vagina lacerations and vesico-vagina fistula were the other complications highlighted. In the study, 69% of the symphysiotomies performed were for babies with birth weight between 3.0 and 3.9 kg. The record of one maternal death was available and was from massive pulmonary embolism on the third day postpartum. There were 104 perinatal deaths with a perinatal mortality rate of 108.7 per 1000 total births.

Objective. Fistula has always been thought to be a scourge of the Northern region of Nigeria only. This study was aimed at providing data on the prevalence, profile and obstetric experience of fistula patients in Abakaliki, Southeast Nigeria and to demonstrate that fistula is also a burden in the southern parts of Nigeria. Materials and Methods. This was a prospective descriptive study conducted between 2003 and 2009. Sample size and sampling method. Four hundred and sixty-two fistula patients who were operated at the Fistula Unit of the Teaching Hospital and later at the Southeast Fistula Centre was consecutively recruited and interviewed during the study period. Results. The prevalence of fistula was 4.3%, the mean age was 35±9.5 years and 8.4% was less than 20 years, majority of them had no formal education. A quarter had no occupation and majority had no regular monthly income. Twenty percent were married by the age of 14 years and majority were multiparous. In about 40%, the fistula occurred during the first child birth. About 34% were still sexually active and 30% of the married clients had achieved childbirth after development of fistula. The average height and weight were 1.47m±0.08 and 46.4kg±7.2 respectively. Majority had fistula following prolonged obstructed labour, though 42.6% eventually had caesarean section for prolonged obstructed labour. Majority of the patients were older, had a longer urine leakage and presented latter for corrective surgery than those reported from other parts of Nigeria. Conclusions. There is a high prevalence (43.6/1000 deliveries) of obstetric fistula in this Centre, and majority of the vesico-vaginal fistula (VVF) was due to prolonged obstructed labour. Majority of the patients were older, had a longer urine leakage and presented latter for corrective surgery than those reported from other parts of Nigeria. However, 30% of the married patients achieved a pregnancy and delivered vaginally even in the presence of the fistula