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Papers by Eric Nwogu-ikojo

Research paper thumbnail of Uterine packing in the management of complete placenta praeuvia

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria

Complete (type 4) placenta praevia is a major cause of haemorrhage in Obstetrics. Uterine packing... more Complete (type 4) placenta praevia is a major cause of haemorrhage in Obstetrics. Uterine packing is an effective but underutilized life-saving intervention in situation of uncontrolled haemorrahage due to major placenta praevia. To reappraise the effectiveness of uterine packing in the management of complete placenta praevia in order to popularize the practice. Seven case series of complete placenta praevia were managed with uterine packing in Enugu, Nigeria between January 2, 2012 and February 28, 2013. Previous Caesarean delivery (85.71%) was the commonest identified risk factor for complete placenta praevia. Uterine packing was effective in preventing blood transfusion in 57.14% of the cases, and further post-operative intervention in 85.71%.Peripartum hysterectomy and maternal death were 100% avoidable. Uterine packing is an effective life-saving intervention in management of complete placenta praevia. The technique should be considered whenever there is uncontrollable haemorra...

Research paper thumbnail of Bladder-only Repair Of Vesicovaginal Fistula: Twelve Years Experience In South-eastern Nigeria

Sorry, before using webmedcentral.. You need to have javaScript activated in your web browser. ..... more Sorry, before using webmedcentral.. You need to have javaScript activated in your web browser. ...WebmedCentral OBSTETRICS AND GYNAECOLOGY 2010;1(10):WMC001030. Submitted on: 18 Oct 2010 04:36:08 PM GMT. Published on: 18 Oct 2010 06:02:44 PM GMT. Abstract ...

Research paper thumbnail of Avoidable maternal mortality in Enugu, Nigeria

Public Health, 2008

, were studied to identify maternal characteristics and avoidable factors for maternal mortality.... more , were studied to identify maternal characteristics and avoidable factors for maternal mortality. Booked women were those who received formal prenatal care in a medical facility. Abortion-related deaths were not included in the study. Results: There were 49 maternal deaths, 2131 deliveries and 2044 live births during the study period, giving a maternal mortality ratio of 2397.3 maternal deaths per 100,000 live births. The average age of the women was 29.8 years. Twelve women (25.5%) booked in the UNTH, 23 (48.9%) booked elsewhere and 12 (25.5%) were unbooked. Ten women (21.3%) were nulliparous, 15 (31.9%) were Para 1-2, 17 (36.2%) were Para 3-4 and five (10.6%) were Para 5 or above. Twenty-one women (44.7%) first sought medical attention at a private medical clinic, six (12.8%) at the general/mission hospital, five (10.6%) at maternity/health centres, one (2.1%) from a traditional birth attendant and 14 (29.8%) at the UNTH. Fourteen women (39.8%) died within 24 h of admission, 12 (25.5%) between 24 and 48 h, seven (14.9%) between 48 and 96 h and 14 (29.8%) after 96 h. Two women (4.3%) delivered at home, eight (17.0%) in private medical clinics, 23 (48.9%) in the UNTH and 14 (29.8%) died undelivered. Major avoidable factors were substandard care (27.7%), delay in seeking care (19.1%), financial constraints (8.4%), delay in recognizing a problem (6.4%), lack of blood (4.3%), lack of drugs (2.1%) and industrial strike action by health workers (2.1%). No major avoidable factor was identified in 14 women (29.8%). Conclusion: Avoidable factors are still prevalent in maternal deaths in Nigeria.

Research paper thumbnail of Juxtacervical vesicovaginal fistulae: Outcome by route of repair

Journal of Obstetrics & Gynaecology, 2006

Vesicovaginal fistula is a major public health problem in Nigeria with diverse medical, psycholog... more Vesicovaginal fistula is a major public health problem in Nigeria with diverse medical, psychological and social consequences for the patient. This study compared the outcome of vaginal vs abdominal repair of juxtacervical vesicovaginal fistulae. It was a retrospective review undertaken at the University of Nigeria Teaching Hospital, Aghaeze Hospital and Mbanefo Hospital, all in Enugu, Nigeria, from 1 January 1992 to 31 December 2004. The outcome measures were primary repair success rate, blood transfusion, postoperative urinary tract infection rate and duration of hospital stay. Abdominal repair of juxtacervical vesicovaginal fistula was associated with a significantly higher need for blood transfusion when compared with vaginal repair. Both routes of repair had similar primary repair success rates, postoperative urinary tract infection rates and duration of hospital stay. It was concluded that the route of repair of juxtacervical vesicovaginal fistula should be determined by accessibility of the fistula and whenever possible, the vaginal route should be preferred.

Research paper thumbnail of Sterilization by minilaparotomy in south-eastern Nigeria

African journal of reproductive health, 2009

The study aimed to assess the trend in acceptance and characteristics of acceptors of female ster... more The study aimed to assess the trend in acceptance and characteristics of acceptors of female sterilization between January 1999 and December 2006 at the University of Nigeria Teaching IHospital, linugu, South-Eastern Nigeria. There were a total of 20,485 new clients, with 212 (1.0%) accepting sterilization between January 1999 and December 2006. There was an initial rise in acceptance from 0.4% in 1999 to 3.0% in 2004, then a decline. 108 (50.9%) were between 35-39 years. 169 (79.7%) had more than five living children. 69 (32.5%) and 76 (35.9%) had secondary and higher education respectively. Health workers were the main source of information. Completed family size was the reason for choosing sterilization in 185 clients (87.3%). 120 (56.6%) were in occupational social class 3.106 (50.0%) did not practice any form of family planning prior to the procedure. 184 (86.8%) had interval sterilization and the rest (13.2%) postpartum. Acceptance of tubal sterilization is still low in our co...

Research paper thumbnail of Morbidity and mortality following higher order caesarean section in a developing country

Journal of the Pakistan Medical Association

Research paper thumbnail of Maternal and Fetal Outcome of Elective Caesarean Section at 37 – 38 Weeks versus 39 Completed Weeks of Gestation in Enugu, Southeast Nigeria

Journal of Clinical Medicine Research

OKEKE TC1,*, ONAH N1, IKEAKO LC2, EZENYEAKU CCT2, NWOGU-IKOJO E1 1Department of Obstetrics & Gyna... more OKEKE TC1,*, ONAH N1, IKEAKO LC2, EZENYEAKU CCT2, NWOGU-IKOJO E1 1Department of Obstetrics & Gynaecology, Uuniversity of Nigeria Teaching Hospital (Unth), Enugu, Nigeria 2Department of Obstetrics and Gynaecology, Anambra State University Teaching Hospital Awka, Nigeria *Corresponding author: ubabiketochukwu@yahoo.com Received January 15, 2013; Revised April 19, 2013; Accepted April 23, 2013 Abstract A retrospective study comparing maternal and neonatal outcome of singleton fetuses delivered at 37–38 weeks of completed gestation with those delivered at 39 completed weeks of gestation or longer by elective caesarean section at the University of Nigeria Teaching Hospital, Enugu between January 1, 2004 and December 31, 2008. There were 164(21.3%) elective caesarean deliveries during the study period. 117 (71.3%) were performed between 37–38 weeks of completed gestation and 47(28.7%) at 39 completed weeks of gestation. Elective caesarean births at 37-38 weeks were associated with signifi...

Research paper thumbnail of Morbidity and mortality following high order caesarean section in a developing country

Journal of the Pakistan Medical Association

To determine the morbidity and mortality associated with multiple (four and higher order) caesare... more To determine the morbidity and mortality associated with multiple (four and higher order) caesarean section. A group of 92 women who had undergone four or more caesarean sections was compared with another group of 184 women who had three or less such procedures at the obstetric unit of the University of Nigeria Teaching Hospital, Enugu, Nigeria, between January 1, 1999 and December 31, 2007. The record were retrieved by trained staff and data was extracted using pre-tested forms. SPSS 15 and Z test were used for statistical analysis. There were a total of 1,755 caesarean sections out of which 92 (5.24%) were higher order repeat caesarean. Three women had the 6th caesarean section, while one had her seventh. Women in the study group were three times more likely to have primary postpartum haemorrhage (p = 0.001); to spend more time on the operation table; and to receive blood transfusion (p = 0.001) compared to the control group. More neonatal morbidities were observed among the contr...

Research paper thumbnail of Unbooked obstetric emergencies at ESUT Teaching Hospital, Enugu, Nigeria

Research paper thumbnail of Childbirth expectations of pregnant women in Enugu

Research paper thumbnail of The Effect of Gravidity on Anthropometric Indices of Pregnant Women in Enugu, South East, Nigeria

Anthropometry in pregnancy is a comparative measure of size, proportion and composition of the bo... more Anthropometry in pregnancy is a comparative measure of size, proportion and composition of the body in relation to pregnancy. Anthropometric indices are useful in the assessment of nutritional status of pregnant women and predicting pregnancy outcome. To determine the effect of gravidity on anthropometric indices of pregnant women in Enugu, South East Nigeria. This was a prospective cross sectional survey of 578 pregnant women drawn from the general population of Enugu metropolis of Nigeria. These women were randomly selected from antenatal care attendees from four peripheral hospitals in Enugu. A self-administered structured pretested questionnaire was designed. The data were analyzed by descriptive and inferential statistics using SPSS version 12, and P value less than 0.05 was considered statistically significant. The mean values of the weight, body mass index (BMI), mid upper arm. Circumference (MUAC), calf circumference (CC), waist circumference and hip circumference of pregnan...

Research paper thumbnail of Infant Feeding Practices among HIV-Positive Women in Enugu, Nigeria

British Journal of Medicine and Medical Research, 2015

Objective: To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Ta... more Objective: To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Tanzania. These data then served as a proxy to evaluate the adequacy of current infant feeding counselling. Design: A cross-sectional survey of infant feeding behaviours. Setting: Four clinics in greater Dar es Salaam in early 2008. Subjects: A total of 196 HIV-positive mothers of children aged 6-10 months recruited from HIV clinics. Results: Initiation of breast-feeding was reported by 95?4 % of survey participants. In the entire sample, 80?1 %, 34?2 % and 13?3 % of women reported exclusive breast-feeding (EBF) up to 2, 4 and 6 months, respectively. Median duration of EBF among women who ever breast-fed was 3 (interquartile range (IQR): 2?1, 4?0) months. Most non-breast-milk foods fed to infants were low in nutrient density. Complete cessation of breast-feeding occurred within 14 d of the introduction of non-breast-milk foods among 138 of the 187 children (73?8 %) who had ever received any breast milk. Of the 187 infants in the study who ever received breast milk, 19?4 % received neither human milk nor any replacement milks for 1 week or more (median duration of no milk was 14 (IQR: 7, 152) d). Conclusions: Infant feeding practices among these HIV-positive mothers resulted in infants receiving far less breast milk and more mixed complementary feeds than recommended, thus placing them at greater risk of both malnutrition and HIV infection. An environment that better enables mothers to follow national guidelines is urgently needed. More intensive infant feeding counselling programmes would very likely increase rates of optimal infant feeding.

Research paper thumbnail of Trend in the use of intra-uterine contraceptive device (IUCD ,TCU 380A), in Enugu, Nigeria

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria

To estimate the acceptance rate and trend of Intrauterine Contraceptive Device (IUCD) use in Enug... more To estimate the acceptance rate and trend of Intrauterine Contraceptive Device (IUCD) use in Enugu, Nigeria A review of all new acceptors of intrauterine contraceptive device (IUCD) over a nine year period (1999-2007). A total of 133,375 clients were seen at the UNTH family planning clinic between 1999 and 2007. Out of 6,947 users of IUCD, during the period, 1,659 were new acceptors. The IUCD acceptance rate was 5.21%. Majority of the clients (29.7%) were aged 40 years and above. Eight hundred and forty seven (51.4%) had attained post secondary education. Majority of the clients (99.4%) were married . Twenty-six percent (26.0%) had completed their desired family size. Majority 1,359 (82.4%) did not use any method contraception prior to IUCD insertion. The commonest complication was menorrhagia (5.8%) and this was responsible for removal in 3.0% of cases. Eight (0.5%) and nine (0.6%) requested for removal for fear of causing cancer and migration to the brain or heart respectively. Tw...

Research paper thumbnail of Copper and selenium status of healthy pregnant women in Enugu, southeastern Nigeria

Nigerian Journal of Clinical Practice, 2011

Background: Copper and selenium are important trace elements in man. They function as antioxidant... more Background: Copper and selenium are important trace elements in man. They function as antioxidants and play roles in oxido-reductase reactions. Several imported multivitamin preparations are given to our women during pregnancy and lactation to correct possible deficiencies. Objective: The aim of the study is to determine the serum level of these micronutrients (selenium and copper) in a cross section of pregnant women in Enugu, southeastern Nigeria. Materials and Methods: A cross section of 130 healthy pregnant women at different trimesters of pregnancy and 30 non-pregnant controls were selected from two health facilities in Enugu, southeastern Nigeria. Serum from the samples collected was assayed for copper and selenium using atomic absorption spectrophotometer. Results: The mean copper level increased (P = 0.018), while the selenium level decreased (P < 0.0001) as pregnancy advanced. Conclusion: High copper levels indicate that supplementation should not be undertaken during normal pregnancy. Dietary intake should be modified to ensure optimal selenium levels during pregnancy.

Research paper thumbnail of Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria

Nigerian Journal of Clinical Practice, 2014

Context: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute ... more Context: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA (HbAA) genotype subjects. Materials and Methods: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. Results: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. Conclusions: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.

Research paper thumbnail of Multiple antenatal bookings among pregnant women in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2010

Maternal morbidity and mortality has been associated with anaemia in pregnancy and is the cause o... more Maternal morbidity and mortality has been associated with anaemia in pregnancy and is the cause of low birth weight in infants and other complications. The contribution of malaria infection to maternal anaemia in pregnancy has been well-documented in most other countries. This study, therefore, investigated the incidence of antenatal malaria parasitaemia and haemoglobin profile of pregnant women in Enugu East Local Government Area, Enugu, Nigeria. Seven hundred (700) capillary blood samples were collected from women that were made up of 210 primiparae, 390 multiparae and 100 non-pregnant (that served as the control group), and tested for presence of malaria parasites and haemoglobin profile using microscopy and a portable β-haemoglobin photometer (HamoCue, Hemo Cue AB, Angelholm, Sweden) respectively. The result showed that majority of the malaria positive participants were anaemic with haemoglobin (HB) below 11g/dl. There were more positive cases among primigravidae (first pregnancy) and there were also downward gradation in the intensity of malaria from primiparae to control group. Prevalence of malaria parasitaemia was found to be 55.56% at Annunciation hospital and 60.06% at Park lane hospital which was higher than prevalence of 22.00% and 16.00%% among non pregnant women used as control. The results showed a significant difference (P<0.05) between the primigravidae, and multigravidae (more pregnancies). Women between the age ranges of 18-28 were most infected. The findings of this study have proven that primiparae have high susceptibility to malaria in endemic regions. Also, anaemia was associated with malaria in pregnancy. There is need to intensify effort in malaria prevention on pregnant women. Educational campaign is recommended at all levels to improve the awareness of malaria and preventive measures. Attack on malaria by provision of access to effective treatment and reduction of access with the vector is as well recommended.

Research paper thumbnail of Obstructed labour in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2008

Obstructed labour is an important cause of maternal death in developing countries. Obstructed lab... more Obstructed labour is an important cause of maternal death in developing countries. Obstructed labour also causes significant maternal morbidity mainly due to infection and hemorrhage and foetal death from asphyxia is also common. Objectives are to reduce maternal and newborn complications by early detection and rapid interventions and to reduce maternal and perinatal morbidity and mortality. This Hospital-based prospective cross-sectional study was conducted from June 2013 to June 2014 in Sylhet, MAG Osmani Medical College Hospital. 100 obstructed labour cases were selected those who were admitted in Inpatient department of Obstetrics and Gynaecology, SOMCH. 100 obstructed labour cases were recorded. The majority (80%) were residents of rural areas in which transportation were difficult, the occupation of the women were housewives mostly (90%) and remaining (10%) were tea-garden worker.75% of the obstructed labour cases did not have any antenatal follow-up. Most of the cases (70%) were visited Osmani Medical College Hospital by their attendant. 70% Visited at 12-24 hours of labour, (80%) came from a distance of 10-50 kilometers. Cepholo-pelvic disproportion was the major cause of obstructed labour (78%) and cesarean section was the main way of delivery (95%). PPH (4%), puerperal sepsis (4%), rupture uterus (2%), VVF (2%), rupture uterus with shock (1%), were the main complications and maternal death (1%). Obstructed labour was the major causes of poor perinatal outcome and perinatal death (7%). This study revealed high incidence of maternal morbidity and perinatal morbidity and mortality.

Research paper thumbnail of Vesico-vaginal fistula in Eastern Nigeria

Journal of Obstetrics and Gynaecology, 2005

Our objective was to examine the epidemiological determinants of vesico-vaginal fistula in Easter... more Our objective was to examine the epidemiological determinants of vesico-vaginal fistula in Eastern Nigeria, and maternal characteristics and sociocultural factors predisposing to vesico-vaginal fistula. The case-records of 74 patients with vesico-vaginal fistula were reviewed. The mean age of the patients was 34.1 years and the mean age at occurrence of fistula was 30.1 years. A total of 24 women (32.4%) presented within 6 months of fistula formation. They were mainly multipara, housewives, subsistence farmers and still living with their husbands. A total of 68 (91.9%) developed a fistula following prolonged obstructed labour. Juxta-cervical fistula was the most common, 33 (44.6%) followed by juxta-urethral 11 (14.9%). The other associated morbidity included chronic vulval excoriation, cervical damage and amenorrhoea. Fetal wastage was high with 53 (77.9%) stillbirths and four (5.9%) early neonatal deaths. Vesico-vaginal fistula is still a major problem in the developing countries and a reflection of standard of obstetric care currently available to our women.

Research paper thumbnail of Abortion-related mortality in a tertiary medical centre in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2007

This study reviewed abortion-related maternal deaths, from January 2000 to December 2005 at the U... more This study reviewed abortion-related maternal deaths, from January 2000 to December 2005 at the University of Nigeria Teaching Hospital, Enugu, Nigeria, to identify maternal characteristics, abortion types, provider characteristics, complications and causes of death. Abortion was defined as termination of pregnancy before 28 completed weeks of pregnancy. There were 93 pregnancy-related deaths, and 11 were abortion-related. Abortion-related mortality accounted for 11.8% of all maternal deaths. Nine (81.8%) had induced abortions; three (27.3%) were teenagers; five (45.5%) were married; and six (54.5%) were unmarried. Five (45.5%) of the women were nulliparous. Six (54.5%) of the procedures were in private medical clinics. The cause of death was sepsis and haemorrhage in eight (72.7%) and three (27.3%) of the women, respectively. Abortion-related mortality is a major contributor to maternal mortality in our institution, with induced unsafe abortion constituting the bulk of the burden. Improved access to family planning and reproductive health services may reduce abortion-related maternal deaths.

Research paper thumbnail of Trends in uterine rupture in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2005

Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to... more Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to determine any change in pattern of presentation, management and outcome of such patients. The birth register of 4,333 deliveries at the University of Nigeria Teaching Hospital Enugu from January 1997 and December 2000 were reviewed. Forty-one cases of ruptured uterus were identified and analysed. The incidence of uterine rupture was 1 in 106 deliveries with a mean maternal age of 31.2 years. The majority (75.6%) of the patients were multiparous and had some form of antenatal care (61%) with 19.5% of the total booked at the Teaching Hospital. Many (78.1%) of the patients were in labour for 24?hours or less and 22.0% had oxytocin to augment or induce labour. The majority (68.3%) had a previously scarred uterus and many (53.6%) had lower segment ruptures. At laparotomy 31.7% had repair alone, 29.2% had repair with tubal ligation, 22.0% subtotal hysterectomy and 17.1% total hysterectomy. Perinatal mortality was high (87.8%) and maternal mortality rate 48.8 per 1,000 deliveries. Labour in a previously scarred uterus was the most common aetiological factor followed by obstructed labour in a multiparous woman. The incidence of ruptured uterus is still rising at Enugu, Nigeria but maternal mortality, due to uterine rupture continues to fall. The most commonly performed surgery is repair with or without sterilisation rather than hysterectomy.

Research paper thumbnail of Uterine packing in the management of complete placenta praeuvia

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria

Complete (type 4) placenta praevia is a major cause of haemorrhage in Obstetrics. Uterine packing... more Complete (type 4) placenta praevia is a major cause of haemorrhage in Obstetrics. Uterine packing is an effective but underutilized life-saving intervention in situation of uncontrolled haemorrahage due to major placenta praevia. To reappraise the effectiveness of uterine packing in the management of complete placenta praevia in order to popularize the practice. Seven case series of complete placenta praevia were managed with uterine packing in Enugu, Nigeria between January 2, 2012 and February 28, 2013. Previous Caesarean delivery (85.71%) was the commonest identified risk factor for complete placenta praevia. Uterine packing was effective in preventing blood transfusion in 57.14% of the cases, and further post-operative intervention in 85.71%.Peripartum hysterectomy and maternal death were 100% avoidable. Uterine packing is an effective life-saving intervention in management of complete placenta praevia. The technique should be considered whenever there is uncontrollable haemorra...

Research paper thumbnail of Bladder-only Repair Of Vesicovaginal Fistula: Twelve Years Experience In South-eastern Nigeria

Sorry, before using webmedcentral.. You need to have javaScript activated in your web browser. ..... more Sorry, before using webmedcentral.. You need to have javaScript activated in your web browser. ...WebmedCentral OBSTETRICS AND GYNAECOLOGY 2010;1(10):WMC001030. Submitted on: 18 Oct 2010 04:36:08 PM GMT. Published on: 18 Oct 2010 06:02:44 PM GMT. Abstract ...

Research paper thumbnail of Avoidable maternal mortality in Enugu, Nigeria

Public Health, 2008

, were studied to identify maternal characteristics and avoidable factors for maternal mortality.... more , were studied to identify maternal characteristics and avoidable factors for maternal mortality. Booked women were those who received formal prenatal care in a medical facility. Abortion-related deaths were not included in the study. Results: There were 49 maternal deaths, 2131 deliveries and 2044 live births during the study period, giving a maternal mortality ratio of 2397.3 maternal deaths per 100,000 live births. The average age of the women was 29.8 years. Twelve women (25.5%) booked in the UNTH, 23 (48.9%) booked elsewhere and 12 (25.5%) were unbooked. Ten women (21.3%) were nulliparous, 15 (31.9%) were Para 1-2, 17 (36.2%) were Para 3-4 and five (10.6%) were Para 5 or above. Twenty-one women (44.7%) first sought medical attention at a private medical clinic, six (12.8%) at the general/mission hospital, five (10.6%) at maternity/health centres, one (2.1%) from a traditional birth attendant and 14 (29.8%) at the UNTH. Fourteen women (39.8%) died within 24 h of admission, 12 (25.5%) between 24 and 48 h, seven (14.9%) between 48 and 96 h and 14 (29.8%) after 96 h. Two women (4.3%) delivered at home, eight (17.0%) in private medical clinics, 23 (48.9%) in the UNTH and 14 (29.8%) died undelivered. Major avoidable factors were substandard care (27.7%), delay in seeking care (19.1%), financial constraints (8.4%), delay in recognizing a problem (6.4%), lack of blood (4.3%), lack of drugs (2.1%) and industrial strike action by health workers (2.1%). No major avoidable factor was identified in 14 women (29.8%). Conclusion: Avoidable factors are still prevalent in maternal deaths in Nigeria.

Research paper thumbnail of Juxtacervical vesicovaginal fistulae: Outcome by route of repair

Journal of Obstetrics & Gynaecology, 2006

Vesicovaginal fistula is a major public health problem in Nigeria with diverse medical, psycholog... more Vesicovaginal fistula is a major public health problem in Nigeria with diverse medical, psychological and social consequences for the patient. This study compared the outcome of vaginal vs abdominal repair of juxtacervical vesicovaginal fistulae. It was a retrospective review undertaken at the University of Nigeria Teaching Hospital, Aghaeze Hospital and Mbanefo Hospital, all in Enugu, Nigeria, from 1 January 1992 to 31 December 2004. The outcome measures were primary repair success rate, blood transfusion, postoperative urinary tract infection rate and duration of hospital stay. Abdominal repair of juxtacervical vesicovaginal fistula was associated with a significantly higher need for blood transfusion when compared with vaginal repair. Both routes of repair had similar primary repair success rates, postoperative urinary tract infection rates and duration of hospital stay. It was concluded that the route of repair of juxtacervical vesicovaginal fistula should be determined by accessibility of the fistula and whenever possible, the vaginal route should be preferred.

Research paper thumbnail of Sterilization by minilaparotomy in south-eastern Nigeria

African journal of reproductive health, 2009

The study aimed to assess the trend in acceptance and characteristics of acceptors of female ster... more The study aimed to assess the trend in acceptance and characteristics of acceptors of female sterilization between January 1999 and December 2006 at the University of Nigeria Teaching IHospital, linugu, South-Eastern Nigeria. There were a total of 20,485 new clients, with 212 (1.0%) accepting sterilization between January 1999 and December 2006. There was an initial rise in acceptance from 0.4% in 1999 to 3.0% in 2004, then a decline. 108 (50.9%) were between 35-39 years. 169 (79.7%) had more than five living children. 69 (32.5%) and 76 (35.9%) had secondary and higher education respectively. Health workers were the main source of information. Completed family size was the reason for choosing sterilization in 185 clients (87.3%). 120 (56.6%) were in occupational social class 3.106 (50.0%) did not practice any form of family planning prior to the procedure. 184 (86.8%) had interval sterilization and the rest (13.2%) postpartum. Acceptance of tubal sterilization is still low in our co...

Research paper thumbnail of Morbidity and mortality following higher order caesarean section in a developing country

Journal of the Pakistan Medical Association

Research paper thumbnail of Maternal and Fetal Outcome of Elective Caesarean Section at 37 – 38 Weeks versus 39 Completed Weeks of Gestation in Enugu, Southeast Nigeria

Journal of Clinical Medicine Research

OKEKE TC1,*, ONAH N1, IKEAKO LC2, EZENYEAKU CCT2, NWOGU-IKOJO E1 1Department of Obstetrics & Gyna... more OKEKE TC1,*, ONAH N1, IKEAKO LC2, EZENYEAKU CCT2, NWOGU-IKOJO E1 1Department of Obstetrics & Gynaecology, Uuniversity of Nigeria Teaching Hospital (Unth), Enugu, Nigeria 2Department of Obstetrics and Gynaecology, Anambra State University Teaching Hospital Awka, Nigeria *Corresponding author: ubabiketochukwu@yahoo.com Received January 15, 2013; Revised April 19, 2013; Accepted April 23, 2013 Abstract A retrospective study comparing maternal and neonatal outcome of singleton fetuses delivered at 37–38 weeks of completed gestation with those delivered at 39 completed weeks of gestation or longer by elective caesarean section at the University of Nigeria Teaching Hospital, Enugu between January 1, 2004 and December 31, 2008. There were 164(21.3%) elective caesarean deliveries during the study period. 117 (71.3%) were performed between 37–38 weeks of completed gestation and 47(28.7%) at 39 completed weeks of gestation. Elective caesarean births at 37-38 weeks were associated with signifi...

Research paper thumbnail of Morbidity and mortality following high order caesarean section in a developing country

Journal of the Pakistan Medical Association

To determine the morbidity and mortality associated with multiple (four and higher order) caesare... more To determine the morbidity and mortality associated with multiple (four and higher order) caesarean section. A group of 92 women who had undergone four or more caesarean sections was compared with another group of 184 women who had three or less such procedures at the obstetric unit of the University of Nigeria Teaching Hospital, Enugu, Nigeria, between January 1, 1999 and December 31, 2007. The record were retrieved by trained staff and data was extracted using pre-tested forms. SPSS 15 and Z test were used for statistical analysis. There were a total of 1,755 caesarean sections out of which 92 (5.24%) were higher order repeat caesarean. Three women had the 6th caesarean section, while one had her seventh. Women in the study group were three times more likely to have primary postpartum haemorrhage (p = 0.001); to spend more time on the operation table; and to receive blood transfusion (p = 0.001) compared to the control group. More neonatal morbidities were observed among the contr...

Research paper thumbnail of Unbooked obstetric emergencies at ESUT Teaching Hospital, Enugu, Nigeria

Research paper thumbnail of Childbirth expectations of pregnant women in Enugu

Research paper thumbnail of The Effect of Gravidity on Anthropometric Indices of Pregnant Women in Enugu, South East, Nigeria

Anthropometry in pregnancy is a comparative measure of size, proportion and composition of the bo... more Anthropometry in pregnancy is a comparative measure of size, proportion and composition of the body in relation to pregnancy. Anthropometric indices are useful in the assessment of nutritional status of pregnant women and predicting pregnancy outcome. To determine the effect of gravidity on anthropometric indices of pregnant women in Enugu, South East Nigeria. This was a prospective cross sectional survey of 578 pregnant women drawn from the general population of Enugu metropolis of Nigeria. These women were randomly selected from antenatal care attendees from four peripheral hospitals in Enugu. A self-administered structured pretested questionnaire was designed. The data were analyzed by descriptive and inferential statistics using SPSS version 12, and P value less than 0.05 was considered statistically significant. The mean values of the weight, body mass index (BMI), mid upper arm. Circumference (MUAC), calf circumference (CC), waist circumference and hip circumference of pregnan...

Research paper thumbnail of Infant Feeding Practices among HIV-Positive Women in Enugu, Nigeria

British Journal of Medicine and Medical Research, 2015

Objective: To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Ta... more Objective: To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Tanzania. These data then served as a proxy to evaluate the adequacy of current infant feeding counselling. Design: A cross-sectional survey of infant feeding behaviours. Setting: Four clinics in greater Dar es Salaam in early 2008. Subjects: A total of 196 HIV-positive mothers of children aged 6-10 months recruited from HIV clinics. Results: Initiation of breast-feeding was reported by 95?4 % of survey participants. In the entire sample, 80?1 %, 34?2 % and 13?3 % of women reported exclusive breast-feeding (EBF) up to 2, 4 and 6 months, respectively. Median duration of EBF among women who ever breast-fed was 3 (interquartile range (IQR): 2?1, 4?0) months. Most non-breast-milk foods fed to infants were low in nutrient density. Complete cessation of breast-feeding occurred within 14 d of the introduction of non-breast-milk foods among 138 of the 187 children (73?8 %) who had ever received any breast milk. Of the 187 infants in the study who ever received breast milk, 19?4 % received neither human milk nor any replacement milks for 1 week or more (median duration of no milk was 14 (IQR: 7, 152) d). Conclusions: Infant feeding practices among these HIV-positive mothers resulted in infants receiving far less breast milk and more mixed complementary feeds than recommended, thus placing them at greater risk of both malnutrition and HIV infection. An environment that better enables mothers to follow national guidelines is urgently needed. More intensive infant feeding counselling programmes would very likely increase rates of optimal infant feeding.

Research paper thumbnail of Trend in the use of intra-uterine contraceptive device (IUCD ,TCU 380A), in Enugu, Nigeria

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria

To estimate the acceptance rate and trend of Intrauterine Contraceptive Device (IUCD) use in Enug... more To estimate the acceptance rate and trend of Intrauterine Contraceptive Device (IUCD) use in Enugu, Nigeria A review of all new acceptors of intrauterine contraceptive device (IUCD) over a nine year period (1999-2007). A total of 133,375 clients were seen at the UNTH family planning clinic between 1999 and 2007. Out of 6,947 users of IUCD, during the period, 1,659 were new acceptors. The IUCD acceptance rate was 5.21%. Majority of the clients (29.7%) were aged 40 years and above. Eight hundred and forty seven (51.4%) had attained post secondary education. Majority of the clients (99.4%) were married . Twenty-six percent (26.0%) had completed their desired family size. Majority 1,359 (82.4%) did not use any method contraception prior to IUCD insertion. The commonest complication was menorrhagia (5.8%) and this was responsible for removal in 3.0% of cases. Eight (0.5%) and nine (0.6%) requested for removal for fear of causing cancer and migration to the brain or heart respectively. Tw...

Research paper thumbnail of Copper and selenium status of healthy pregnant women in Enugu, southeastern Nigeria

Nigerian Journal of Clinical Practice, 2011

Background: Copper and selenium are important trace elements in man. They function as antioxidant... more Background: Copper and selenium are important trace elements in man. They function as antioxidants and play roles in oxido-reductase reactions. Several imported multivitamin preparations are given to our women during pregnancy and lactation to correct possible deficiencies. Objective: The aim of the study is to determine the serum level of these micronutrients (selenium and copper) in a cross section of pregnant women in Enugu, southeastern Nigeria. Materials and Methods: A cross section of 130 healthy pregnant women at different trimesters of pregnancy and 30 non-pregnant controls were selected from two health facilities in Enugu, southeastern Nigeria. Serum from the samples collected was assayed for copper and selenium using atomic absorption spectrophotometer. Results: The mean copper level increased (P = 0.018), while the selenium level decreased (P < 0.0001) as pregnancy advanced. Conclusion: High copper levels indicate that supplementation should not be undertaken during normal pregnancy. Dietary intake should be modified to ensure optimal selenium levels during pregnancy.

Research paper thumbnail of Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria

Nigerian Journal of Clinical Practice, 2014

Context: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute ... more Context: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA (HbAA) genotype subjects. Materials and Methods: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. Results: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. Conclusions: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.

Research paper thumbnail of Multiple antenatal bookings among pregnant women in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2010

Maternal morbidity and mortality has been associated with anaemia in pregnancy and is the cause o... more Maternal morbidity and mortality has been associated with anaemia in pregnancy and is the cause of low birth weight in infants and other complications. The contribution of malaria infection to maternal anaemia in pregnancy has been well-documented in most other countries. This study, therefore, investigated the incidence of antenatal malaria parasitaemia and haemoglobin profile of pregnant women in Enugu East Local Government Area, Enugu, Nigeria. Seven hundred (700) capillary blood samples were collected from women that were made up of 210 primiparae, 390 multiparae and 100 non-pregnant (that served as the control group), and tested for presence of malaria parasites and haemoglobin profile using microscopy and a portable β-haemoglobin photometer (HamoCue, Hemo Cue AB, Angelholm, Sweden) respectively. The result showed that majority of the malaria positive participants were anaemic with haemoglobin (HB) below 11g/dl. There were more positive cases among primigravidae (first pregnancy) and there were also downward gradation in the intensity of malaria from primiparae to control group. Prevalence of malaria parasitaemia was found to be 55.56% at Annunciation hospital and 60.06% at Park lane hospital which was higher than prevalence of 22.00% and 16.00%% among non pregnant women used as control. The results showed a significant difference (P<0.05) between the primigravidae, and multigravidae (more pregnancies). Women between the age ranges of 18-28 were most infected. The findings of this study have proven that primiparae have high susceptibility to malaria in endemic regions. Also, anaemia was associated with malaria in pregnancy. There is need to intensify effort in malaria prevention on pregnant women. Educational campaign is recommended at all levels to improve the awareness of malaria and preventive measures. Attack on malaria by provision of access to effective treatment and reduction of access with the vector is as well recommended.

Research paper thumbnail of Obstructed labour in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2008

Obstructed labour is an important cause of maternal death in developing countries. Obstructed lab... more Obstructed labour is an important cause of maternal death in developing countries. Obstructed labour also causes significant maternal morbidity mainly due to infection and hemorrhage and foetal death from asphyxia is also common. Objectives are to reduce maternal and newborn complications by early detection and rapid interventions and to reduce maternal and perinatal morbidity and mortality. This Hospital-based prospective cross-sectional study was conducted from June 2013 to June 2014 in Sylhet, MAG Osmani Medical College Hospital. 100 obstructed labour cases were selected those who were admitted in Inpatient department of Obstetrics and Gynaecology, SOMCH. 100 obstructed labour cases were recorded. The majority (80%) were residents of rural areas in which transportation were difficult, the occupation of the women were housewives mostly (90%) and remaining (10%) were tea-garden worker.75% of the obstructed labour cases did not have any antenatal follow-up. Most of the cases (70%) were visited Osmani Medical College Hospital by their attendant. 70% Visited at 12-24 hours of labour, (80%) came from a distance of 10-50 kilometers. Cepholo-pelvic disproportion was the major cause of obstructed labour (78%) and cesarean section was the main way of delivery (95%). PPH (4%), puerperal sepsis (4%), rupture uterus (2%), VVF (2%), rupture uterus with shock (1%), were the main complications and maternal death (1%). Obstructed labour was the major causes of poor perinatal outcome and perinatal death (7%). This study revealed high incidence of maternal morbidity and perinatal morbidity and mortality.

Research paper thumbnail of Vesico-vaginal fistula in Eastern Nigeria

Journal of Obstetrics and Gynaecology, 2005

Our objective was to examine the epidemiological determinants of vesico-vaginal fistula in Easter... more Our objective was to examine the epidemiological determinants of vesico-vaginal fistula in Eastern Nigeria, and maternal characteristics and sociocultural factors predisposing to vesico-vaginal fistula. The case-records of 74 patients with vesico-vaginal fistula were reviewed. The mean age of the patients was 34.1 years and the mean age at occurrence of fistula was 30.1 years. A total of 24 women (32.4%) presented within 6 months of fistula formation. They were mainly multipara, housewives, subsistence farmers and still living with their husbands. A total of 68 (91.9%) developed a fistula following prolonged obstructed labour. Juxta-cervical fistula was the most common, 33 (44.6%) followed by juxta-urethral 11 (14.9%). The other associated morbidity included chronic vulval excoriation, cervical damage and amenorrhoea. Fetal wastage was high with 53 (77.9%) stillbirths and four (5.9%) early neonatal deaths. Vesico-vaginal fistula is still a major problem in the developing countries and a reflection of standard of obstetric care currently available to our women.

Research paper thumbnail of Abortion-related mortality in a tertiary medical centre in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2007

This study reviewed abortion-related maternal deaths, from January 2000 to December 2005 at the U... more This study reviewed abortion-related maternal deaths, from January 2000 to December 2005 at the University of Nigeria Teaching Hospital, Enugu, Nigeria, to identify maternal characteristics, abortion types, provider characteristics, complications and causes of death. Abortion was defined as termination of pregnancy before 28 completed weeks of pregnancy. There were 93 pregnancy-related deaths, and 11 were abortion-related. Abortion-related mortality accounted for 11.8% of all maternal deaths. Nine (81.8%) had induced abortions; three (27.3%) were teenagers; five (45.5%) were married; and six (54.5%) were unmarried. Five (45.5%) of the women were nulliparous. Six (54.5%) of the procedures were in private medical clinics. The cause of death was sepsis and haemorrhage in eight (72.7%) and three (27.3%) of the women, respectively. Abortion-related mortality is a major contributor to maternal mortality in our institution, with induced unsafe abortion constituting the bulk of the burden. Improved access to family planning and reproductive health services may reduce abortion-related maternal deaths.

Research paper thumbnail of Trends in uterine rupture in Enugu, Nigeria

Journal of Obstetrics and Gynaecology, 2005

Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to... more Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to determine any change in pattern of presentation, management and outcome of such patients. The birth register of 4,333 deliveries at the University of Nigeria Teaching Hospital Enugu from January 1997 and December 2000 were reviewed. Forty-one cases of ruptured uterus were identified and analysed. The incidence of uterine rupture was 1 in 106 deliveries with a mean maternal age of 31.2 years. The majority (75.6%) of the patients were multiparous and had some form of antenatal care (61%) with 19.5% of the total booked at the Teaching Hospital. Many (78.1%) of the patients were in labour for 24?hours or less and 22.0% had oxytocin to augment or induce labour. The majority (68.3%) had a previously scarred uterus and many (53.6%) had lower segment ruptures. At laparotomy 31.7% had repair alone, 29.2% had repair with tubal ligation, 22.0% subtotal hysterectomy and 17.1% total hysterectomy. Perinatal mortality was high (87.8%) and maternal mortality rate 48.8 per 1,000 deliveries. Labour in a previously scarred uterus was the most common aetiological factor followed by obstructed labour in a multiparous woman. The incidence of ruptured uterus is still rising at Enugu, Nigeria but maternal mortality, due to uterine rupture continues to fall. The most commonly performed surgery is repair with or without sterilisation rather than hysterectomy.