Background:Ectopic pregnancy has remained a significant cause of maternal morbidity and mortality especially in the sub Saharan Africa. A periodic appraisal of its management is paramount.Aim:To determine the incidence and associated risk factors, for ectopic pregnancy, review available treatment modalities and suggest interventions to reduce its prevalence, morbidity and mortality.Materials and Methods:A cross sectional study with retrolective data collection of all cases of ectopic pregnancy managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria between 1st January, 2002 and 31st December, 2011 was undertaken. Analysis was carried out using Epi-info 2008 version 3.5.1.Results:During the study period, there were a total 98 cases of ectopic pregnancies out of 8,811 deliveries and 1884 gynecological admissions, giving an incidence of 0.9% of all attendants or 1 in 90 deliveries and 5.2% of all gynecological admissions. Only 94.9% (93/98) case files were retrieved and were used in the final analysis. The mean age of the patients was 30.1 (0.7) years while the mean gestational age at presentations was 7.4 weeks. Previous induced abortion, 37.5% (36/93) was the commonest associated risk factor, followed by pelvic infections, 35.5% (33/93). The recurrence rate was 6.5% (6/93). Majority, 80.6% (75/93) presented with abdominal pain and 35.8% (33/93) presented with vaginal bleeding. Up to 88.2% (82/93) had salpingectomy while only 2.5% (2/93) were successfully managed medically with methotrexate therapy following diagnosis with transvaginal ultrasound Missed diagnosis of ectopic pregnancy occurred in 16.1% (15/93). There was no maternal death.Conclusion:Ectopic pregnancy has remained an important gynecological condition in our center. The common identifiable risk factors were induced abortion and pelvic infection. Early first trimester transvaginal ultrasound should be offered to all women for early diagnosis.

There is very low-certainty evidence that RRSO may increase overall survival and lower HGSC and breast cancer mortality for BRCA1 and BRCA2 carriers. Very low-certainty evidence suggests that RRSO reduces the risk of death from HGSC and breast cancer in women with BRCA1 mutations. Evidence for the effect of RRSO on HGSC and breast cancer in BRCA2 carriers was very uncertain due to low numbers. These results should be interpreted with caution due to questionable study designs, risk of bias profiles, and very low-certainty evidence. We cannot draw any conclusions regarding bone fracture incidence, quality of life, or severe adverse events for RRSO, or for effects of RRSO based on type and age at risk-reducing surgery. Further research on these outcomes is warranted to explore differential effects for BRCA1 or BRCA2 mutations.

Background: COVID-19 was first reported on 31 December 2019 and has so far claimed over 2,000 lives in Nigeria. Through global and national efforts, about 4 million doses of the AstraZeneca vaccine was distributed and used in Nigeria from March 2021. Vaccine hesitancy could pose a serious problem for COVID-19 prevention and control. Objectives: To estimate the proportion of the Nnamdi Azikiwe University community that is willing to be vaccinated against COVID-19; level of hesitancy and its associated factors. Methods: A cross-sectional survey was conducted using online Google form distributed to staff and students of the university via different WhatsApp groups. The outcome measures were the proportion of persons willing to be vaccinated, vaccine hesitancy rates and reasons for this hesitancy. Data were analyzed using SPSS version 23 and Minitab version 19. Bivariate analysis was performed by the chi-square test, Odds Ratios (ORs) and statistical significance was accepted when p-value is < 0.05. Results: Only 349 of the survey responses were analyzed in the survey. Results show that 34.70 ± 5.00% of the university community were willing to receive the COVID-19 vaccine when it is offered to them. The COVID-19 hesitancy rate among staff and students was 65.04 ± 5.00%. It was discovered that marital status (OR = 2.06), age (OR = 0.802) and christian denominational affiliation (OR = 0.366) influenced respondents’ perception of COVID-19 vaccination. Gender, occupation, previous vaccination experience, awareness of COVID-19 and previous symptoms of COVID-19 did not significantly ( p = 0.05) influence respondents’ willingness to be vaccinated. Conclusion: COVID-19 vaccine hesitancy is high among staff and students in a Nigerian university and is significantly influenced by marital status, respondents’ age and christian denominational affiliation.

APM reduces the incidence of episiotomy and increases the incidence of women with an intact perineum after vaginal delivery. It also reduces the risk of flatus incontinence after childbirth without increased maternal or neonatal complications. Women should therefore be counseled on the likely benefits of APM and the information provided during antenatal care. Obstetricians should consider the technique as routine prenatal care for nulliparous women so as to reduce the incidence of perineal trauma during vaginal birth.

BackgroundInduction of labour is the artificial initiation of labour in a pregnant woman after the age of fetal viability but without any objective evidence of active phase labour and with intact fetal membranes. The need for induction of labour may arise due to a problem in the mother, her fetus or both, and the procedure may be carried out at or before term. Obstetricians have long known that for this to be successful, it is important that the uterine cervix (the neck of the womb) has favourable characteristics in terms of readiness to go into the labour state.ObjectivesTo compare Bishop score with any other method for assessing pre-induction cervical ripening in women admitted for induction of labour.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies to identify randomised controlled trials (RCTs).Selection criteriaAll RCTs comparing Bishop score with any other methods of pre-induction cervical assessment in women admitted for induction of labour. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and studies using a cross-over design were not eligible for inclusion. Studies published in abstract form were eligible for inclusion if they provided sufficient information.Comparisons could include the following.Bishop score versus transvaginal ultrasound (TVUS).Bishop score versus Insulin-like growth factor binding protein-1 (IGFBP-1).Bishop score versus vaginal fetal fibronectin (fFN).However, we only identified data for a comparison of Bishop score versus TVUS.Data collection and analysisTwo review authors independently assessed the trials for inclusion, extracted the data and assessed trial quality. Data were checked for accuracy.Main resultsWe included two trials that recruited a total of 234 women. The overall risk of bias was low for the two studies. Both studies compared Bishop score withTVUS.The two included studies did not show any clear difference between the Bishop score and TVUS groups for the following main outcomes: vaginal birth (RR 1.07, 95% CI 0.92 to 1.25, moderate quality evidence), caesarean delivery (RR 0.81, 95% CI 0.49 to 1.34, moderate quality evidence), neonatal admission into neonatal intensive care unit (RR 1.67, 95% CI 0.41 to 6.71, moderate quality evidence). Both studies only provided median data in relation to induction-delivery interval and reported no clear difference between the Bishop and TVUS groups. Perinatal mortality was not reported in the included studies.For the review's secondary outcomes, the need for misoprostol for cervical ripening was more frequent in the TVUS group compared to the Bishop score group (RR 0.52, 95% CI 0.41 to 0.66, two studies, 234 women, moderate quality evidence). In contrast, there were no clear differences between the Bishop scope and TVUS groups in terms of meconium staining of the amniotic fluid, fetal heart rate abnormality in labour, and Apgar score less than seven. Only one trial reported median data on the induction-delive...