Background Puerperal period is an important and thought-provoking period for puerperal mothers. Surprisingly, reports have indicated that there is increasing number of women resuming menstruation within six weeks of childbirth (puerperal menstruation). To the best of knowledge, there is no prior study on predictors of puerperal menstruation. Objective To determine frequency and predictors of puerperal menstruation. Methods This was a single tertiary health institution cross-sectional study at ESUT Teaching Hospital, Parklane, Enugu, Nigeria that included data from May 2015 to December 2018. Women were interviewed at the end of the first six weeks of their childbirth. Women with HIV positive or had uterine rupture or peripartum hysterectomy were excluded. Bivariate analysis was performed by the chi-squared test and conditional logistic regression analysis was used to determine variables associated with puerperal menstruation. Statistical significance was accepted when P-value is <0.05. Results A total of 371 women met the inclusion criteria. The return of menses within 6 weeks was present in 118(31.8%) women versus 253 (68.2%) women without puerperal menstruation, given a ratio of 1:3. Of the 371 women, 249 (67.1%) were on exclusive breastfeeding. The significant associated risk factors were age (p = 0.009), parity (p<0.001), early use of family planning (p = 0.001), socioeconomic status (p<0.001) and manual removal of placenta (p = 0.007). At conditional logistic regression analysis, early use of family planning (p = 0.001),

<abstract><sec> <title>Background</title> <p>Abdominal pregnancy is very rare, with only a few gynecologists being fortunate to encounter it all through their professional careers. It makes up only 1% of all ectopic pregnancies but has very high perinatal and maternal mortality of 95% and 18% respectively. Hemorrhagic and infectious complications account for these. Removal of the placenta at laparotomy is a big dilemma as torrential bleeding may ensue.</p> </sec><sec> <title>Case</title> <p>We report the case of an undergraduate teenager who was referred with features of septicemia and anemia following unsafe vaginal instrumentation by a patent medicine dealer (a person without formal training in pharmacy but sells orthodox medications on retail basis) in a bid to terminate an extrauterine pregnancy. Ultrasonography confirmed a nonviable abdominal pregnancy of 20 weeks.</p> </sec><sec> <title>Result</title> <p>She had exploratory laparotomy with the evacuation of the dead fetus and successful complete removal of the placenta. Her postoperative recovery was uneventful.</p> </sec><sec> <title>Conclusion</title> <p>In view of the grave complications like a pelvic abscess, disseminated intravascular coagulation and bowel obstruction that may accompany retention of the placenta in advanced abdominal pregnancy, optimal placental removal at surgery is recommended whenever feasible.</p> </sec></abstract>