Tropical Journal of Obstetrics and Gynaecology

Incidental Finding of Bicornuate Uterus at Repeat Caesarean Section in a Woman with Recurrent Abnormal Presentation

2025-02-08T21:33:09-07:00

The bicornuate uterus is one of the most common uterine anomalies and is often associated with adverse pregnancy outcomes. It is asymptomatic in some cases; but can cause abnormal lie and presentation in advanced pregnancy.

This patient was an unbooked 39-year-old G7P2+4(1A) woman with two previous caesarean sections and a poor obstetric history. The previous surgeries were due to breech presentations. She presented at a gestational age of 33 weeks and 6 days with preterm drainage of liquor and developed labour pain with the baby in transverse lie. She subsequently had an emergency caesarean section with incidental findings of a bicornuate uterus, which was not previously identified in her previous deliveries. She delivered a live male neonate with a birth weight of 2.3kg and an APGAR score of 6 in one minute and 9 at the fifth minute of life. Her post-operative state was satisfactory until discharge and at the postnatal clinic review.

Uterine anomalies are associated with various abnormal obstetric conditions; as seen in the case presentation. Therefore, recurrent abnormal presentation requires a high index of suspicion for uterine anomalies for which the uterus should be meticulously examined at or after delivery.

Ruptured Caesarean Section Scar Ectopic Pregnancy: A Rare Case Report And First to be Reported at Alex Ekwueme Federal University Teaching Hospital Abakaliki.

2024-12-19T05:37:23-07:00

Caesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, characterized by blastocyst implantation in a previous caesarean scar. The incidence is approximately 1:2000 pregnancies and with increasing incidence of caesarean section worldwide, more and more cases are diagnosed and reported. Very few cases have been documented in Africa, and this is the first case to be reported in Nigeria. Misdiagnosis or a delay in diagnosis or treatment can lead to life-threatening complications such as uterine rupture, haemorrhage and significant maternal morbidity and mortality. Diagnosis of CSP remains a challenge in sub-sahara Africa where early ultrasound are rarely done among majority of pregnant women who are either unbooked or registered for antenatal care in a maternity home supervised by unskilled birth attendant. Even where first trimester ultrasound is done, the availability of high resolution ultrasound and the skill for such sonography may be lacking. We present a case of 38 year old G3P2⁺⁰A2 with history of two previous caesarean section scars who had emergency exploratory laparotomy and uterine repair on account of slow leaking ectopic pregnancy from ruptured CSP and highlight the complications associated with late diagnosis of such case.

Keywords: Cesarean scar pregnancy, ectopic pregnancy, uterine rupture, uterine repair

Reviving The Vanishing Art of Instrumental Vaginal Delivery in Tropical Obstetric Practice

2026-02-12T10:54:31-07:00

Dear Editor-in-Chief,

Our attention was drawn to a recent publication in the Tropical Journal of Obstetrics and Gynaecology TJOG) by Alu et al titled “Instrumental Vaginal Delivery in Abuja, Northcentral Nigeria: A 5-Year review”. We wish to commend the authors of this very illuminating manuscript, as it touches on a topical issue that is relevant to obstetric practice, not only in Nigeria, but globally.

The authors reported an instrumental delivery rate of 0.65% and cited other references that were published from different parts of Nigeria within the last decade.¹ These references reported IVD rates ranging between 0.4 to 2%.^2,3These rates are quite low, compared to other countries globally such as the UK (up to 23%),⁴ and especially other sub-Sahara African countries (around 8%).⁵ These indices point to a low performance of this key skill in obstetric practice within the country. As a consequence, Caesarean section rates have increased geometrically in the country, further emphasizing the relevance of the skills for IVD as life-saving measures.

The implications of the low rates of IVD can be considered to be two-sided: first is the ongoing deprivation of the benefits of these life-saving procedures for women and babies who may benefit from them as a very crucial determinant of the outcome of their labour. This may also have resultant implications on the outcomes of future pregnancies. Secondly there is a high possibility that this trend will continue in the foreseeable future, as the currently low rates of IVD suggests that many specialists and their trainees would have neither observed nor performed enough of the procedures to achieve competence for independent practice. There is therefore the need to reverse the trends, in order to improve the intrapartum care of parturients in Nigeria to a level that is comparable to what obtains in order climes.

As doctors with clinical experience in both settings, we would like to propose practical approaches to a safe, improved and sustainable performance of IVD. There is a dire need for regular simulation training at local (Institutional) and national (Postgraduate Colleges) levels. For example, in the UK, the RCOG Operative Birth Simulation Training (ROBUST) is a mandatory requirement from early stage of specialty training in Obstetrics that provides a uniform training template for IVD.⁶ Furthermore, to achieve competence, a minimum number of workplace-based structured assessments should be a mandatory requirement for residents at different training levels, with formative and summative feedback to guide and improve proficiency. This could be structured into non-rotational IVD for junior residents and rotational deliveries for senior residents, as obtainable in other training programmes globally.

One may ask how the already qualified specialists who are not fully equipped with the practical skills for IVD would teach the specialist trainees? This calls for a collaborative drive with the more-skilled colleagues. As the learning curve is expected to be steep, a hands-on training on the labour ward through partnership and exchange programmes will be more realistic than occasional training courses which are mostly manikin-based simulation drills.

Once achieved, consultant-led or consultant-delivered care at the teaching hospitals is the only way to sustain transfer of skills. The availability of consultants on the floor of the labour ward at all or most times of the day will provide the necessary support for specialty trainees to receive the experiential training and maintain the skills. Until these are considered, we will at best, regrettably continue to substitute IVDs with avoidable caesarean sections in the nation’s tertiary hospitals.

Acceptability of Child Adoption as a Management Option for Infertility Among Women of Reproductive Age Group in Ogbomoso, South-West, Nigeria: A Cross-Sectional Study

2025-04-01T05:09:35-06:00

Introduction: Child adoption refers to the processes by which a child is brought into a family by one or more adults, not biological parents, but recognized by law as such. Infertility has become the main reason parents seek child adoption. This study aimed to assess the knowledge, perception, acceptability and factors influencing child adoption as a management option for infertility among women of reproductive age in Ogbomoso.

Methodology: This was a cross-sectional descriptive study. The instrument of study was interviewer-administered questionnaires. A total of 404 women of reproductive age group from different communities in the five local government areas of Ogbomoso were selected through a multistage sampling technique. The data was analyzed using SPSS version 26.

Result: Majority of the respondents 133(32.92%) were within the age range 21-25 years; up to 185(45.79%) were married; 171(42.33%) had tertiary education. The knowledge score of respondents on Child Adoption ranges between 0.00% and 85.71% with mean score of 53.96% ± 19.898.

Sixty two of the respondents had Good Knowledge. About 50% of the respondents had Good Perception. Three hundred and twelve (77.2%) of respondents were willing to accept child adoption if infertile. This study showed an increasing level of knowledge of child adoption and acceptability with increasing level of education.

Conclusion: The study shows high acceptance rate of child adoption practices. A significant association exists between good knowledge on child adoption and the inclination towards accepting child adoption as a management option of infertility.

Keywords: Child adoption, Infertility, Women, reproductive age, Nigeria.

Comparing the Complications of the Intrauterine Device Insertion in The Postpartum and Interval Periods at the Jos University Teaching Hospital

2024-12-12T08:34:57-07:00

Background: An unmet need for family planning exists among women, particularly in the postpartum period. This is however, an emerging form of contraception and concerns regarding its complications as opposed to the interval insertion may affect its uptake and acceptability. Objective: This study aimed to assess the acceptability and complications of postpartum intrauterine device (IUD) insertion and compare them with interval insertion at the Jos University Teaching Hospital (JUTH).

Methodology: Conducted over one year (January to December 2021) at JUTH, this prospective parallel cohort study included 174 women who received CuT380A IUDs. Of these, 87 underwent postpartum insertion, and 87 received interval insertion. Follow-up occurred at 2, 6, and 26 weeks post-IUD insertion, focusing on outcomes like abnormal uterine bleeding (AUB), pelvic pain, expulsion, missing strings, abnormal vaginal discharge, discontinuation, and continuation rates.

Results: At the 2-week mark, complete expulsion (8.1%) and missing IUD strings (33.7%) were more common in the postpartum IUD (PPIUD) group, with statistically significant p-values of 0.002 and <0.001, respectively. Abnormal vaginal discharge (10.5%) was more frequent in the interval group, statistically significant (p=0.029). At 6 weeks, AUB (15.5%) and abnormal vaginal discharge (15.5%) were more common in the interval group, both statistically significant (p=0.041). However, at 26 weeks, there were no statistically significant differences in complications between the groups.

Conclusion: While both groups experienced early complications, long-term complications were comparable and not statistically significant. Thus, PPIUD insertion should be encouraged as a viable contraception option for women during the postpartum period, supporting the promotion of long-acting reversible contraception.

Keywords: Postpartum IUD, Contraception, Long-acting Reversible Contraception

Prevalence and Sociodemographic Correlates of Anxiety Disorder in Pregnancy Among Adolescents Attending a Teaching Hospital in Northern Nigeria.

2025-06-23T14:08:59-06:00

Background: Adolescent pregnancy is a common occurrence world-wide despite some societal reservations against it. In predominantly Muslim society of Northern Nigeria, early marriage and the resultant teenage motherhood abound. There is paucity of study on anxiety disorders among adolescents in pregnancy. This study aims to determine the prevalence and socio-demographic correlates of anxiety disorders among adolescents in late pregnancy attending a tertiary hospital in northern Nigeria. Materials and Methods: It was a cross-sectional study in which one hundred and fifty adolescents aged 14 – 19 years in their third trimester of pregnancy selected via systematic random technique participated. All the participants completed socio-demographic, clinical, social support and GHQ-12 questionnaires by self-report. Those that screen positive for emotional distress at cut-off point of 3 and few of those that screened negative were interviewed with anxiety module of Structured Clinical Interview for DSM-IV Disorders (SCID). Results showed the prevalence of anxiety disorders among the adolescents was 11.3%. Primigravida (OR = 1.32. 95% CI 0.21 – 8.20), Previous history of Still birth (OR = 6.06, 95% CI 1.33 – 27.53 and Poor social support (OR = 3.15, 95% CI 0.12 – 81.50) were associated with anxiety among the participants. Conclusion: Anxiety disorders are prevalence in late pregnancy among adolescents as found in this study. Routine screening for anxiety disorders during the antenatal care using GHQ-12 will help in early detection and management, thereby limiting the potential harmful effect on the women and their newborns.

Prevalence and Predictors of Intimate Partner Violence Among Pregnant Women Accessing Antenatal Care in Lagos.

2025-04-01T05:51:02-06:00

Background: Intimate partner violence (IPV) among pregnant women is a critical human rights and public health issue, affecting both mothers and their unborn children. This study aimed to assess the prevalence of IPV among pregnant women accessing antenatal care in Lagos State and identify potential predictors.

Methods: A descriptive cross-sectional study was conducted involving pregnant women of all gestational ages from randomly selected health facilities within a senatorial district of Lagos. Data were collected through a structured, interviewer-administered questionnaire and analyzed using IBM SPSS version 25 with a significance threshold of p<0.05.

Results: Out of 460 participants, complete data was gathered from 417, with a mean age of 31.1 years. The findings revealed that approximately 22.5% of women experienced IPV in the year before pregnancy, with a prevalence of 19.7% reported during the current pregnancy. Psychological abuse was the most frequently encountered type of IPV. Key risk factors identified included unplanned pregnancies, exposure to violence during childhood, and a history of abuse in the past year. Women who had previously faced IPV were 96 times more likely to experience it during pregnancy (p<0.001). Additionally, controlling behavior exhibited by male partners increased the odds of IPV by 5 times.

Conclusion: This study highlights the high prevalence of IPV among pregnant women and emphasizes the urgent need for increased awareness, advocacy, and integrated surveillance programs within antenatal care to combat this pressing public health concern.

Utilisation of the Labour Care Guide: Experiences of Health Workers in the Southern Part of Nigeria – A Qualitative Study

2025-05-10T04:00:35-06:00

Background: The World Health Organization (WHO) Labour Care Guide (LCG) is a standardized tool designed to enhance the quality of maternal care by systematically monitoring labour progression, maternal and fetal well-being, and supportive care.

Aim- This study explores the awareness, utilization, challenges, experiences and potential modifications of LCG implementation among healthcare providers in Nigeria’s South-South and South-East zones.

Methodology: The study employed qualitative methods, conducting interviews with 11 physicians from nine states: Ebonyi, Enugu, Abia, Anambra, Imo, Akwa Ibom, Cross River, Rivers, and Bayelsa.

Result: Findings reveal that while LCG is recognized as a valuable tool for improving maternal care, its implementation remains limited, with full adoption observed only in Ebonyi State. Most respondents were aware of the LCG but awaited directives on usage from higher authorities. Barriers to adoption included insufficient training, resistance to transitioning from the traditional partograph, and resource limitations. Despite these challenges, non-users expressed optimism about future adoption, though no definitive timeline was provided. To enhance LCG implementation, the study recommends staff training, policy enforcement, active monitoring by the Society of Gynaecology and Obstetrics of Nigeria (SOGON), public awareness campaigns, and integration into electronic health records.

Conclusion: While the LCG holds significant potential for improving labour management and maternal outcomes, addressing these barriers is crucial for its successful and widespread adoption.

Prevalence and Risk Factors of Asymptomatic Malaria Diagnosed Using Rapid Diagnostic Kits Among Pregnant Women Attending Antenatal Clinic at Benue State University Teaching Hospital, Makurdi

2025-04-27T04:07:04-06:00

ABSTRACT

Background: Malaria in pregnancy is of significant public health concern in sub-Saharan Africa. Pregnant women residing in areas of stable malaria transmission are at a higher risk of experiencing the adverse effects of malaria infection. Unfortunately, most of these infections are asymptomatic, and remain overlooked and untreated, which can be detrimental to both the mother and the foetus.

Objective: To determine the prevalence and risk factors associated with asymptomatic malaria in pregnancy among pregnant women attending antenatal clinic in a tertiary hospital in Nigeria.

Methodology: This cross-sectional study included 357 pregnant women who were screened for malaria infection using Rapid Diagnostic Test (RDT). Data were collected using a structured questionnaire and analyzed using descriptive statistics and logistics regression analysis.

Results: The prevalence of malaria infection was 11.8%. Level of education, employment status, parity, and gestational age of participants were significantly associated with malaria in pregnancy. Additionally, use of Sulphadoxine-Pyrimethamine as chemoprophylaxis, indoor spraying with insecticides, and the use of long-lasting insecticide-treated nets were also associated with the likelihood of malaria in pregnancy. Logistics regression analysis revealed that increased literacy, use of intermittent preventive treatment with Sulphadoxine-Pyrimethamine, and indoor spraying with insecticides were associated with reduced likelihood of malaria in pregnancy.

Conclusion: The study highlights the need for effective malaria prevention and control strategies among pregnant women in Nigeria, including the use of IPTp-SP and indoor spraying with insecticides. The findings emphasize the importance of addressing socioeconomic factors, such as education in malaria prevention programs.

Utilisation of Preconception Care among Pregnant Women in Dar es Salaam, Tanzania

2025-04-30T23:46:27-06:00

Background: Various strategies have been applied to reduce the burden of maternal and child morbidity and mortality, but the rates remain unacceptably high. Efforts have been made in antenatal, intrapartum, and postnatal care, although little emphasis has been placed on preconception care, especially in developing countries, including Tanzania. Therefore, this study aimed to assess the utilization of preconception care in Dar es Salaam, Tanzania.
Methods: This was a cross-sectional study conducted among 312 pregnant women attending Temeke and Mwananyamala Regional Referral Hospitals, Dar es Salaam, Tanzania, using interviewer-administered structured questionnaires. Descriptive and inferential statistics were applied to the data, including bivariate and multivariable logistic regression analysis. To declare a statistically significant association, a p-value of <0.05 was used.
Results: Forty-seven (15.1%) participants utilized preconception care with HIV counselling, testing and ART initiation being the most utilized (21.3%). Logistic regression analysis revealed unplanned pregnancy (p = <0.001) and not having a history of previous infertility or subfertility (p = <0.001) as statistically significant factors influencing preconception care utilization.
Conclusion: The study revealed that the utilization of preconception care is low. It also identified the factors influencing the use of preconception care, therefore, implementing strategies to increase uptake of preconception care, such as opportunistic provider-initiated preconception care counseling during health visits may be helpful.

Keywords: Preconception care, Utilization, Pregnant Women, Factors, Dar Es Salaam

Incidence and Risk Factors of Stillbirth at a Nigerian Tertiary Health Care Centre

2025-05-10T05:07:32-06:00

Abstract

Context: Stillbirths are often unregistered and are not seen as major public health problem. It is an important indicator of the quality of antepartum and intrapartum care of any given obstetric unit.

Aims: This was to determine the incidence and aetiologic factors associated with stillbirth at a tertiary health care centre.

Study design and setting: A prospective cross-sectional study of women who had stillbirths at the Obstetric unit of Federal Medical Centre, Bida, North-central Nigeria.

Methods and Material: A purposive sampling of cases of stillbirths from 28weeks gestation or birth weight of at least 1000g was carried out from 1^st July, 2021 to 31^st December, 2022. Data collection was done using proforma.

Statistical analysis used: Data were analyzed using Statistical Package for Social Sciences version 22 and level of significance was set at p < 0.05.

Results: The stillbirth rate was 55/1000 deliveries during the period under review. Majority of the cases had aetiologic factors (79%). The commonest cause of stillbirth from this study was abruptio placenta (21.1%), followed by hypertensive disorders of pregnancy (14.9%). Unexplained stillborn occurred in about 22.1% of cases.

Conclusions: Pregnant women should receive quality affordable antenatal care and intrapartum care in order to reduce this unacceptable stillbirth rate.

Keywords: stillbirth, rate, incidence, aetiology, factors

Advancing Reproductive Health Through Comprehensive Care and Evidence-Based Practice

2026-07-11T23:27:23-06:00

Nil