The effect of short interpregnancy interval on birthweight and other pregnancy outcomes in Enugu, Southeast Nigeria

The time interval between one pregnancy and the next is a modifiable risk factor, and has an effect on pregnancy outcomes. This study compared the effects of short interpregnancy interval (IPI) on fetal birthweight and selected pregnancy outcomes amongst parturients in Enugu, Nigeria. Group A (Subjects) consisted of parturients with short IPI (IPI < 18 months), while group B (Controls) consisted of parturients with normal IPI (IPI ≥ 18 months). Relevant obstetric data were collected at delivery. Mean birthweight was 2664.13 ± 339.25g vs 3670.63 ± 452.69g in women with short IPI and normal IPI respectively (p < .0001). Women with short IPI were more likely to have low birthweight babies compared to those with normal IPI (OR = 7.331, p < .001). Maternal anaemia, preeclampsia and caesarean delivery were significantly more associated with short IPI. Women with short IPI are at greater risk of delivering newborn babies with significantly lower mean birthweight and other associated pregnancy complications than women with normal IPI.Impact StatementWhat is already known on this subject? Short interpregnancy interval has an adverse effect on pregnancy outcomes as shown in studies from Europe and the Americas.What do the results of this study add? This study adds to the body of evidence of the deleterious effects of inadequately spaced pregnancies and draws attention to this in West Africa, sub-Saharan Africa, and an area with low contribution to studies on the effect of short IPI on pregnancy outcomes.What are the implications of these findings for clinical practice and/or further research? With evidence from our own environment, it will further boost evidence for proper education of our mothers on the need for adequate birth spacing to avoid the adverse effects of a short IPI on the next pregnancy.

Impact of perceptions of body size on obesity and weight management behaviour: a large representative population study in an African setting

BACKGROUND

Perception of body size is an important psycho-cultural cause of obesity with wide racial and ethnic variations.

METHOD

Cross-sectional household survey using multistage cluster-randomised sampling. Prevalence estimates were weighted. Logistic regressions were done to determine the impact of perception of large body size on obesity and the impact of perception of own body size on weight-management behaviour. Adjusted odds ratios (AOR) were reported.

RESULTS

The survey involved 6628 adults from 2843 households. More than a quarter of the population is either obese or overweight. Nearly half, 44.07% (95% confidence interval [CI]: 42.48-45.66%) of the population perceive large body size as desirable. Positive perception of large body size significantly increases the odds of obesity by 1.5 (AOR: 1.45; 95% CI: 1.09-1.9). Some 42.03% (95% CI: 35.52-48.55%) obese persons misperceive their weight to be normal. Perceiving own body size as normal decreases the odds of weight-losing behaviour (AOR: 0.019; 95% CI: 0.014-0.026).

CONCLUSION

There is a high level of veneration of large body size in southeast Nigeria, and this has a significant impact on obesity burden. Perception of own body size has a significant impact on weight-management behaviour. Health-promotion policies aimed at changing the social desirability of large body size and misperception of body size are recommended.

Association between obesity and abnormal Papanicolau(Pap) smear cytology results in a resource-poor Nigerian setting

Background

Though obesity is associated with some malignancies, its association with cervical cancer is still inconclusive. This study was aimed at determining if there was an association between obesity and cervical epithelial cell abnormalities (CEA).

Methods

This was a cross-sectional comparative study of obese and non-obese women at the Cervical Cancer Screening Clinic, University of Nigeria Teaching Hospital (UNTH), Enugu between January, 2012 and June, 2013. The participants whose body mass index (BMI) were ≥ 30 kg/m² were classified as obese (200 women) while those whose BMI were < 30 kg/m² were classified as non-obese (200 women) and the two groups were consecutively recruited at the ratio of 1:1. Pap smear cytology, random blood sugar (RBS) and human immune-deficiency virus (HIV) screening was done for all the participants. Data was analyzed with SPSS version 20. Categorical variables were analyzed using McNemar’s test and Chi-squared test. Logistic regression analysis was used to determine the influence of socio-demographic characteristics on cervical epithelial cell abnormalities. The level of significance was set at ≤0.05.

Results

Among the obese women, 152(76%) had negative for intra-epithelial lesion or malignancy (NILM) while 48(24%) had cervical epithelial cell abnormalities (CEA). Also 182(91%) non-obese women had NILM while the remaining 18(9%) had CEA. The prevalence of CEA among all the study participants was 16.5%. There was an association between obesity and CEA[OR (95%CI) = 1.353(1.013–1.812); P-value = 0.04].CEA were significantly more common among women who were 40 years and above and single/separated women as well as widows (P-value = < 0.05).

Conclusion

There was an association between obesity and CEA. This underscores the need for a positive behavioural change among women in order to stem the tide of this public health problem.

Vulvovaginal candidiasis in reproductive age women in Enugu Nigeria, clinical versus laboratory-assisted diagnosis

Background

Clinical diagnosis of acute vulvovaginal candidiasis (VVC) depends on evidence of clinical symptoms, but symptomatic treatment widely practiced in low-resource area may lead to overdiagnosis and treatment.

Objective

The objective of the study is to determine the prevalence of VVC among women attending gynecological clinic in University of Nigeria Teaching Hospital (UNTH) Enugu and the accuracy of clinical-based diagnosis versus laboratory test supported diagnosis and patients' characteristics that affect accuracy.

Materials and Methods

This study surveyed patients seen in a gynecologic clinic for VVC using a semi-structured, pretested, and interviewer-administered questionnaire. Vaginal examination was done on each patient and findings documented. A pair of swabs was taken from the vagina and cervical os and cultured for Candida species using Sabouraud Dexttose Agar. Data were analyzed using statistical software, SPSS version 15 (SPSS Inc., Chicago IL, USA). P ≤ 0.05 were considered to be statistically significant.

Results

The mean age of 209 women surveyed was 35.9 (standard deviation [SD] ±9.0) years. Their mean parity was 2 (SD ± 3). The prevalence of VVC was 17.7% based on symptoms and laboratory test. Clinically based diagnosis had a sensitivity of 70.3% and specificity of 83.7%. Forty-one (19.6%) of the study population had good knowledge of VVC. More than 44% of the women had self-reported and treated VVC within the year. Young women of 24 years or less (54.5%) and those who had reported other episodes of VVC within the past year (41.1%) were most commonly associated with inaccurate clinical diagnosis.

Conclusion

Clinically based diagnosis of VVC has an unacceptably high false-positive rate which may encourage continued presumptive treatment with its attendant risks. Clinical evaluation and laboratory culture of vulvovaginal specimen should be the standard diagnostic method.

Prevalence and sociodemographic determinants of adult obesity: a large representative household survey in a resource-constrained African setting with double burden of undernutrition and overnutrition

BACKGROUND

The obesity epidemic has continued to spread across the globe involving even poor nations of the world.

METHOD

Household population survey of adults aged 20-60 years. Multistage stratified cluster randomised sampling involving both urban and rural statewide representative population samples. Anthropometric measurements were taken using standard methods. Prevalences were weighted and multinomial regression analyses were done.

RESULTS

A total of 6628 individuals from 2843 households were surveyed. The weighted overall prevalence for underweight was 9.1% (95% CI 8.1 to 10.1), 65.1% (95% CI 63.6 to 66.6) for normal weight, 19.0% (95% CI 17.8 to 20.3) for overweight and 6.8% (95% CI 6.0 to 7.5) for obese. Men were less likely to be overweight (adjusted OR (AOR) 0.79; 95% CI 0.68 to 0.92) and obese (AOR 0.24; 95% CI 0.19 to 0.31) than women. Urban residents were more likely to be overweight (AOR 1.42; 95% CI 1.18 to 1.71) and obese (AOR 2.09; 95% CI 1.58 to 2.76) than rural residents. Each additional 1-year increase in age increased the risk of overweight by 1.012 (AOR 1.012; 95% CI 1.005 to 1.018) and that of obesity by 1.03 (AOR 1.03; 95% CI 1.02 to 1.04). The low-income class was less likely to be overweight (AOR 0.694; 95% CI 0.507 to 0.951) and obese (AOR 0.44; 95% CI 0.28 to 0.67).

CONCLUSION

The prevalence of obesity and overweight in Enugu Nigeria is high and fast approaching that of underweight. Women, urban dwellers, older adults and high-income earners are at higher risk for obesity and overweight. The study provides robust information for public health policies towards the prevention of obesity in Nigeria.

Perinatal outcome of preterm cesarean section in a resource-limited centre: a comparison between general anaesthesia and subarachnoid block

BACKGROUND

The relationship between perinatal outcome and anesthetic technique for preterm cesarean sections has not been explored in South Eastern, Nigeria.

OBJECTIVE

The objective of the following study is to evaluate perinatal outcome in preterm cesarean sections conducted under general anesthesia (GA) and subarachnoid block (SAB) with the aim to ascertain any difference in outcome between the two methods.

MATERIALS AND METHODS

A retrospective observational study of consecutive preterm cesarean deliveries at the University of Nigeria Teaching Hospital from May 1999 to April 2008. Data entry and statistical analysis utilized the SPSS statistical package for the social sciences, 2008 version 15.0 for windows (SPSS Inc, Chicago IL, USA). Chi-square test was done to determine statistical significance and P ≤ 0.05 were considered to be significant at 95% confidence interval. The delivery characteristics were compared by logistic regression analysis to ascertain any associated confounding effect on perinatal outcome in those exposed to either anesthetic technique.

RESULTS

There were 7568 deliveries and 1961 cesarean sections giving a cesarean section rate of 25.9%. A total of 236 cesarean sections were for preterm deliveries giving a preterm cesarean section rate of 3.1%. Of these, 151 women delivered under GA while SAB was used in 85 cases. The mean gestational ages for preterm cesarean sections were 33.2 ± 2.6 weeks and 33.8 ± 2.2 weeks for those who had GA and SAB respectively. The mean Apgar scores were 6.4 ± 3.1 and 7.6 ± 3.1 at 5 min for GA and SAB respectively. There were 24 stillbirths (15.9%) in cesarean deliveries done under GA and 7 stillbirths (8.2%) in women who had SAB ( P = 0.09). Twenty-two (14.6%) babies delivered through GA and 14 (16.4%) delivered under SAB, died within 1 week of delivery ( P = 0.7). There were more babies with low Apgar scores in parturient delivered under GA ( P = 0.0004). More preterm babies delivered under SAB were discharged from the New Born Special Care Unit within 10 days of delivery ( P = 0.006). Hypertensive disorders, though not statistically significant was the most common indication for preterm cesarean delivery among those with GA and SAB. No maternal death occurred during the study period.

CONCLUSION

The study infers a strong association between anesthetic technique and immediate Apgar scores and outcome of resuscitation following preterm cesarean section. This however, failed to translate into higher differences in perinatal mortality.

Pregnancy outcome and factors affecting vaginal delivery of twins at University of Nigeria Teaching Hospital, Enugu

OBJECTIVE

The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy.

MATERIALS AND METHODS

An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium.

RESULTS

There were 5298 deliveries within the study period, out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 ± 5.9 years. Twenty-five (21.4%) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 ± 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 ± 9.1 days. Other pregnancy complications observed were severe hypertension (14.5%, anemia (9.4%), postpartum hemorrhage (8.5%), puerperal fever (5.1%), abruptio placentae, and diabetic mellitus (2.7%). Fifty-nine women (50.4%) had vaginal deliveries, 5 (4.3%) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3%) were delivered by caesarean section. Forty-eight (41%) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26, 95%CI:0.93-5.53) and those that had cephalic presentation of the leading twin, P = 0.0002 (OR = 4.7 95% CI:2.6-8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg, P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two-hundred and seventeen (92.7%) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3%) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6%) than those delivered vaginally (29.7%). Indications for admissions into the special baby care units were; prematurity 33 (40.2%), birth asphyxia 15 (18.3%), low birth weight 12 (14.6%), neonatal jaundice 10 (12.2%), and twin-twin transfusion 4 (4.9%). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4%) and twin 2 (11.9%) than those delivered by Caesarean section, 3.8 and 3.5%, respectively.

CONCLUSION

Cephalic presentation of the leading twin, birth weight less than 2.5 kg, and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women.

Percutaneous injuries and accidental blood exposure in surgical residents: awareness and use of prophylaxis in relation to HIV

OBJECTIVE

To determine the occurrence of percutaneous injuries (PI) and accidental exposure to patients' blood (AEPB) in surgical residents in Enugu, Nigeria, their awareness of universal precautions (UP), and use of post-exposure prophylaxis (PEP).

MATERIALS AND METHODS

Self-administered semi-structured pre-tested questionnaires were administered to 230 consenting trainee surgeons.

RESULTS

The rate of exposure to PI/ABE was 67.5%. The number of exposures ranged from 1 to 5 with a mean of 1.9 ± 0.99. Senior registrars had the highest rate of exposure (76.9%). In 89 exposures (63.6%) needle-prick injuries were reported. Adequate knowledge of the UP and PEP to HIV virus was only 41%. In most cases (72.1%) respondents subsequently disregarded the exposure.

CONCLUSION

The high rate of exposure to PI/ABE, inadequate knowledge and poor practice of UP/PEP seen in this study underscore the need for creating high level of awareness about UP/PEP, the development of clear institutional guideline and the provision of adequate materials and supervision to ensure adherence with the guideline. The practice of UP and PEP in PI and AEPB are life saving and should be emphasized in residency training.

Knowledge attitudes and practices of cervical cancer screening among urban and rural Nigerian women: a call for education and mass screening

The incidence of cervical cancer has declined in developed nations due to routine use of cervical cancer screening services. In developing nations opportunistic screening is the practice, and many women present with late-stage disease. This study was designed to ascertain the knowledge of the women in Nigeria to cervical cancer, their practice of cervical cancer screening and factors hindering the use of available screening services. A cross-sectional study was done with interviewer-administered questionnaire. Only the consenting women attending an annual Christian religious meeting in 2007 in three towns in Enugu, South Eastern Nigeria participated. Only 15.5% of the respondents were aware of availability of cervical cancer screening services. The awareness significantly varied with the level of educational attainment (P<0.0001). Only 4.2% had ever done Pap smear test and all were referred for screening. The most important factors hindering the use of available cervical cancer screening services were lack of knowledge (49.8%) and the feeling that they had no medical problems (32.0%). There is very poor knowledge and practice of cervical cancer screening among Nigerian women. Effective female education and free mass screening are necessary for any successful cervical cancer screening programme in Nigeria.

Menstrual disorders in adolescent school girls in Enugu, Nigeria

STUDY OBJECTIVE

To determine the prevalence, pattern of menstrual disorders, treatment practices, and the effect of menstrual disorders on school attendance in adolescent school girls in Enugu, Nigeria.

DESIGN

Cross-sectional survey.

SETTING

Randomly selected secondary schools.

PARTICIPANTS

Postmenarcheal adolescent school girls aged 10-19 years.

METHODOLOGY

Pretested, semi-structured questionnaires were used to survey 500 consenting students. The main outcome measures were menstrual disorders. Data was analyzed using SPSS for windows version 15. Data was compared using chi-square test and P ≤ 0.05 was regarded as statistically significant.

RESULTS

Four hundred ninety-five students responded giving a response rate of 99%. The mean age of the girls was 14.9 ± 1.7 years. Most were Christians (99.2%) and their mean age of menarche was 12.7 ± 1.3 years. The prevalence of menstrual disorders was 69.4% and dysmenorrhea, premenstrual dysphoric disorder, and short menstrual cycles were the commonest disorder. Being older, later age of menarche, and being domiciled in the boarding house were significantly associated with menstrual disorders (P < 0.05). Dysmenorrhea was responsible for the greatest number of school abscences. The mean days of school absenteeism was 1.8 ± 1.2. In 80% of cases paracetamol, aspirin, or piroxican were the drugs used for symptom relief. Only 16.3% of respondents ever consulted a doctor for their menstrual disorders.

CONCLUSION

There was a high prevalence of menstrual disorders as well as a high rate of non-expert treatment of the disorders. This underscores the need for awareness creation. Parents and adolescents should consult trained practitioners when significant menstrual disorder occurs in order to rule out or treat associated or underlying medical conditions.

Women's perception as a barrier to focused antenatal care in Nigeria: the issue of fewer antenatal visits

The attitude of pregnant women to a new antenatal care model with four antenatal visits (focused antenatal care) is examined using a cross-sectional survey in Enugu, Nigeria. Only 20.3% of the parturients desired a change to the new model. Parturients who defaulted from antenatal care three or more times, those dissatisfied with their current antenatal care, senior civil servants and parturients who received secondary school education or less most commonly desired a change to the new model (P < 0.05). Default from antenatal care and dissatisfaction with current antenatal care were most predictive of the desire for change in multiple logistic regression analysis. The most common reasons for desiring the change were convenience (65.1%) and cost considerations (24.1%). Reasons given for the rejection of the new model were: fear of inadequate learning during antenatal care (45.7%), the suspicion that four visits were inadequate for familiarization with care providers (12.9%), the need for early detection of disease (6.7%) and social satisfaction from antenatal visits (6.7%). These concerns are amenable to change by health education and social mobilization.

Knowledge and beliefs about exclusive breastfeeding among rural Nigerian men in Enugu, Southeast Nigeria

AIM

This study evaluated the knowledge, beliefs, and attitude of rural Nigerian men to exclusive breastfeeding.

SUBJECTS AND METHODS

A sample of 200 men drawn from a rural community in Enugu, Nigeria was studied.

RESULTS

One hundred fifty-four (82.4%) respondents had heard of exclusive breastfeeding. Only 29.9% knew the correct time for initiation of exclusive breastfeeding, while 30.5% believed that breastmilk alone was sufficient for the first 6 months of life of an infant. One hundred six (56.7%) accept the practice of exclusive breastfeeding, while 38.5% accepted that colostrum is safe for a child. Reasons for rejecting colostrum were chiefly because it is perceived as poisonous, dirty milk and culturally unacceptable. Educational status and age significantly affected knowledge and acceptance of exclusive breastfeeding among the respondents.

CONCLUSION

There is a critical need to target men for intensive breastfeeding education.

Awareness and practice of cervical cancer screening among female undergraduate students in a Nigerian university

Cervical cancer screening enhances early detection which reduces morbidity and mortality. The objective of this study is to assess awareness and practice of cervical cancer screening amongst female students in a Nigerian university. A cross-sectional survey of 394 students was done. About 23.1% identified the Pap smear as a screening test. Only 5.2% of respondents had ever been screened and 52.8% reported willingness to be screened. The major reason for unwillingness to get a Pap smear was absence of symptoms (31.7%). There is a critical need to improve cervical cancer screening participation amongst female undergraduate students in Nigeria.

Knowledge, perceptions and practices of lifestyle-modification measures among adult hypertensives in Nigeria

Hypertension remains the most rapidly rising cardiovascular disease in Africa. This study was designed to evaluate the perception, knowledge and practices of Nigerian hypertensive patients regarding hypertension and lifestyle modification measures. Consecutive hypertensive patients attending the cardiac clinics of the University of Nigeria Teaching Hospital, Enugu, Nigeria, were recruited. A pre-tested structured interviewer-administered questionnaire was used to collect data. Questions were categorised to elicit patients' demographic characteristics, knowledge, perception and practice of various lifestyle-modification measures. chi(2) tests were performed. More than half (54.2%) of the 260 respondents had no formal, or just primary, education. About 25% were no longer taking their antihypertensive medication. Fifty per cent of the patients thought that hypertension was caused by stress. Most knew about the lifestyle measures through health personnel. More than 50% adopted the lifestyle-modification measures once they became aware of their effects. This study has shown a poor level of perception of hypertension and awareness of the lifestyle-modification measures through the mass media, but a high level of willingness to adopt the lifestyle measures. Concerted strategies are required to change the perception of hypertension and increase the awareness of the lifestyle-modification measures in this part of the world.

HIV/AIDS-related knowledge, sexual practices and predictors of condom use among long-distance truck drivers in Nigeria

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A risk assessment for pregnancy using the World Health Organization classifying form in primary health-care facilities in Enugu, Nigeria

We present a cross-sectional survey of the pattern of high-risk pregnancies in randomly selected primary health-care facilities in Enugu, Nigeria, using the World Health Organization's classifying form. None of the 10 maternity homes studied had a standard risk screening tool. The age of the 299 women studied ranged from 16 to 42 years with a mean of 27.8 +/- 6.7 years. Eighty-eight (29.4%) of them were nulliparous, 160 (53.5%) were multiparous and 51 (17.1%) grandmultiparous. One hundred and twenty (40.1%) respondents were in the high-risk category. Rhesus D-negative blood group parturients (42, 35.0%), previous perinatal deaths (29.2%) and multiple pregnancies (9.2%) were the most common risk factors. The prevalence of high-risk pregnancies significantly increased with maternal age and parity and was not influenced by an improved maternal educational attainment. The institution of screening for high-risk pregnancies is vital at the primary health-care level and must be emphasized and must be regularly audited.

Adoption practices in Enugu, Nigeria

OBJECTIVE

The study of the pattern and outcome of adoptions in Enugu, Nigeria in order to determine the challenges in the emerging adoption practice in the state.

MATERIALS AND METHODS

A retrospective analysis of adoption practices in Enugu Nigeria based on data from the National women's Commission. The National Women's Commission is the statutory body responsible for the documentation and follow-up of adoption in Enugu State. The characteristics of adopters and adoptees, types of adoption, prevalence and outcome of the adoptions between January 1991 and December 2001 were examined. Percentages were used for descriptive statistics and student's t-test for comparing means at 5% significance levels.

RESULTS

There were sixty-one adoptions in the eleven-year period giving a prevalence of 5.5 adoptions per year. Eighteen (29.5%) kinship adoptions and 43 (70.5%) adoptions of abandoned babies and children were recorded. The mean age of the adoptees was 4.2 years and 33.3% of them were 5 years and above. All adopters were Nigerians but 32.0% of them resided overseas. The commonest age range at adoption was 4-49 years and the peak duration of marriage prior to adoption was 15-19 years. Most adopters (84.9%) had at least secondary school education. No adoption was annulled and there was no recorded death of adoptees. Post care monitoring was found to be incomprehensive.

CONCLUSION

The growing practice of adoption in Enugu is laudable but post adoption care is poor. Emphasis on post adoption care is vital in developing countries where complex social and logistic factors militate against it. In infertility management early institution of counseling on adoption would allow couples ample time for decision making and preparation for adoption, as well as encourage adoption when couples are still young.

Symphyseal diastasis following vaginal deliveries: a report of two cases

BACKGROUND

Rupture of the symphysis pubis and separation of the pubic rami of more than one centimeter in pregnancy and following vaginal delivery or symphyseal diastasis is uncommon.

OBJECTIVE

To report the clinical characteristics, management and outcome of cases of symphyseal diastasis treated conservatively.

METHODS

Symptomatic symphyseal diastasis follows rupture of the pubic symphysis and may recur in subsequent pregnancies. Subsequently the asymptomatic residual symphyseal diastasis is usually an incidental radiological finding. Examination of a recent case and a twenty-year review of symptomatic symphyseal diastasis in the University of Nigeria Teaching Hospital Enugu were done.

RESULTS

Two cases are reported separated by a seven year interval. The first case occurred intrapartum and the second case occurred in the puerperium. Manipulative vaginal delivery and fundal pressure were associated with the first case. In the second case a partial intrapartum rupture completed spontaneously post partum was suspected. Both cases were managed conservatively with good outcome.

CONCLUSION

Symphyseal diastasis is uncommon in Obstetrics and its diagnosis and effective treatment hinge on anticipation and proper evaluation.

Retained second twins in Enugu, Nigeria

OBJECTIVES

To review our experience with retained second twin in Enugu, Nigeria, over a 10-year period.

METHODS

The second twin is retained when a delay of 30 min occurs after the delivery of the first twin. The case notes and records of all twin deliveries at the University of Nigeria Teaching hospital Enugu between January 1991 and December 2000 were retrieved and analyzed.

RESULTS

Retained second twin occurred in 1/6 twin deliveries with a resultant perinatal mortality rate of 288.5 per 1000 deliveries which was 1.7 times that of first twin. Malpresentation (54%) and uterine atony (39%) were the principal causes of retained second twins. The place of delivery of the first twin, prolonged birth intervals, oxytocin augmentation of labor and breech extraction affected perinatal outcome.

CONCLUSIONS

Early recourse to vacuum extraction and cesarean deliveries of retained second twin, effective health education and adequate supervision of primary health care facilities are advocated to reduce this preventable condition.