Studies on twin pregnancy are uniquely important to Africa and particularly Nigeria where the highest incidence in the world exists. This study was designed to determine the trend, rate, and obstetric outcomes of twin deliveries in the University of Abuja Teaching Hospital, Gwagwalada. This was a retrospective study of twin deliveries in the hospital over a period of 10 years. During the study period, there were 349 twin births out of 10,739 deliveries, giving an overall twining rate of 32.5 per 1,000 deliveries. Preterm delivery occurred in 39.7% cases and was, therefore, the most common complication. Mode of delivery was vaginal in 72.7% while 27.3% were delivered by caesarean section. Emergency caesarean section for delivery of both the babies was carried out in 22.3% while elective caesarean section for both the babies accounted for 1.0 %. Combined vaginal and abdominal delivery occurred in 4.0% of deliveries. The stillbirth rate was 102 per 1,000 births. There were 24 (8.0%) and 37 (12.3%) stillbirths among the first and the second baby respectively. The mean foetal weight was 2.395±0.63 kg while the female-to-male ratio was 1:1.1. The rate of twin deliveries in our centre is high. Successful vaginal delivery of twins is high when the mothers are booked and the presentations of the twins are favourable. The use of antenatal care services and good intrapartum management will help improve outcome in twin pregnancies.

Introduction: Uterine leiomyomas, commonly called fibroids are benign tumors of uterine myometrium composing of smooth muscle with variable amount of connective tissue and common gynecological problem among women of reproductive age. It is the commonest tumor of the female pelvic organ. Objective: To determine the incidence of uterine fibroids, socio-demographic, clinical characteristics and outcome of uterine leiomyoma management. (83.3%) had myomectomy, 23 (11.6%) had total abdominal hysterectomy and 9 (4.6%) myomectomy and tuboplasty. Anaemia 41 (20.7%) was the commonest morbidity, followed by wound infection 12 (6.1%) and wound dehiscence 4 (2.0%). No mortality was recorded during the period under review. Conclusion: Uterine fibroid is common in our environment and usually presents with menorrhagia, abdominal mass, infertility, pelvic pain, and re-

Objective To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals.Design Secondary analysis of a nationwide cross-sectional study.Setting Forty-two tertiary health facilities.Population Women admitted with complications during pregnancy, childbirth or puerperium.Methods All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria.Main outcome measures Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). ResultsOf 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe nonobstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO.Conclusion Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications. Tweetable abstract Non-obstetric causes are important contributors to maternal deaths and life-threatening morbidities in Nigerian hospitals. Please cite this paper as: Adeniran AS, Ocheke AN, Nwachukwu D, Adewole N, Ageda B, Onile T, Umezulike AC, Aboyeji AP, Oladapo OT, for the Nigeria Near-miss and Maternal Death Surveillance Network. Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 (S3): 41-48.

Background: Intrauterine adhesion is a cause of menstrual abnormalities and infertility, which are leading complaints in gynaecological practice in Nigeria. Determining the aetiology and management option would help reduce this problem. The objective of this study was to determine the aetiology, mode of presentation, management option and outcome of intrauterine adhesionsMethods: A retrospective analysis of intrauterine adhesions at the University of Abuja Teaching Hospital over a five-year period from 2012 to 2016 was carried out. The case notes of the patients were retrieved from the records department and information extracted from these case notes using a questionnaire included the age, level of education, marital status, parity, complaints, predisposing factors, method of diagnosis, treatment method and outcome. Additional information was obtained from the theatre registered. The least follow up period was one year.Results: There were 82 patients diagnosed with Intrauterine Adhesion over the study period giving an incidence of 1.6%. Fifty-nine case notes were available for analysis. The case note retrieval rate was 72%. Majority of the patients were between the age range of 30-34 years (21, 35.6%). Those with tertiary level of education constituted the majority (34, 57%). Nullipara constituted 54.2% (32) of the total population. Menstrual abnormalities were the most common complaint with 93.2% and this includes those with menstrual abnormalities and other complaints. The commonest predisposing factor identified was a history of dilatation and curettage or uterine evacuation (28, 47.5%). Majority of the patients had partial intrauterine adhesions (51, 86.4%). All patients were treated with adhesiolysis, Foleys catheter insertion and hormonal therapy for 3 cycles. There was not statistical significance between those who had blind adhesiolysis and hysteroscopic adhesiolysis in terms of outcome. Restoration of menstrual flow was in 25, (42.4%) while 3, (5.1%) had miscarriges and an equal no of patients had term delivery.Conclusions: Dilatation and curettage is still a major predisposing factor in the development of intrauterine Adhesions. Blind adhesiolysis still has its place in the management of intrauterine adhesion in developing countries.

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