Nigerian Obstetric Population Research Articles

Post-operative Experience following Caesarean Section in a Nigerian Obstetric Population

Background: Caesarean section is the most significant obstetrics operative intervention globally. Good postoperative experience after caesarean section is important because there is need for the mother to recover from surgery and take care of her baby. The aim of this study was to assess the experience of women that had caesarean section in the first 24 hours postoperatively. Materials/methods: This was a cross-sectional study conducted among women that had elective and emergency caesarean section. They were followed up to 24 hours post-operative. The primary outcome measures were pain score and satisfaction. Secondary outcome measures were time of mobilization, time of commencement of oral feeds and time of initiation of breastfeeding. Data analysis was carried out using Statistical Package for Social Sciences version 22. Results: The median pain scores among those that had emergency and elective caesarean section ranged between 2 and 3 at all points of pain assessment. The satisfaction was good among 66.1% that had emergency caesarean section and 71.2% among those that had elective caesarean section. However, the difference was not statistically significant (χ2 = 0.546, p = 0.761). More than 90% of the participants that had either emergency or elective caesarean section did not ambulate within the first 24 hours after caesarean section and there was no association between the time of ambulation and the type of caesarean section (χ2 = 0.005, p = 0.941). Conclusion: The participants had adequate pain relief and majority were satisfied with the pain relief. However, the optimum satisfaction was not achieved. The participants did not ambulate early and did not initiate breast-feeding early. Recommendation: Further research is recommended to assess other factors that affect patient's satisfaction and ambulation so as to improve on patient's postoperative care.

Reference charts of fetal biometric parameters in a group of healthy Nigerian women with singleton pregnancies

Background: Fetal biometric assessment is critical for optimal obstetric management as fetal growth abnormalities are associated with perinatal morbidity and mortality. We sought to ascertain normal third trimester fetal biometric parameters and develop growth charts in a Nigerian obstetric population. Methods: A third trimester cross-sectional assessment of fetal biometric parameters at 2-weekly intervals from 28 -36 weeks and thereafter, weekly to 41 weeks’ gestation. At each gestational age, 50 women were recruited and had ultrasound scan where fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were assessed and estimated fetal weight (EFW) calculated using Hadlock algorithm. SPSS version 20 was used to calculate the mean values and percentiles (5th, 10th, 50th, 90th, and 95th) for the parameters and corresponding reference charts developed using Microsoft Excel.Results: The mean values and ranges of BPD and HC respectively among preterm fetuses were 81.6 ±2.1 mm (68.4 – 95.5) and 29.3 ± 0.7 cm (24.6 – 33.7) while that of term fetuses were 94.0 ± 2.8 mm (82.9 – 101.0) and 33.5 ± 0.8 cm (31.8 – 35.8). Mean values and ranges of AC, FL and EFW for preterm fetuses were 29.1 ± 1.1 cm (23.3 – 35.4), 63.0 ± 1.9 mm (51.4 – 74.7), 2.1 ± 0.2 Kg (1.10 – 3.48). Mean values and ranges of AC, FL and EFW for fetuses at term were 35.2 ± 1.2 cm (32.7 – 41.3), 74.4 ± 1.9 mm (69.6 – 79.5) and 3.6 ± 0.3 Kg (3.02 – 4.85). Reference charts for normal fetal growth were derived from 28 – 41 weeks’ gestation.Conclusion: Reference third trimester fetal growth charts were established and are useful tools for clinical management in this obstetric population.

Intimate partner violence and associated factors in an obstetric population in Jos, North-central Nigeria

Background: Intimate partner violence (IPV) during pregnancy is a human right and public health concern, often life-threatening to both the mother and fetus. This study sought to ascertain the prevalence of IPV, pattern, and associated factors in a Nigerian obstetric population. Materials and Methods: This is a cross-sectional study among 338 pregnant women at term between January and July 2015 using pretested self-administered questionnaires to ascertain their sociodemographic and obstetric characteristics as well as partners' features. IPV was assessed using the hurt, insult, threaten, and scream validated screening tool. Data were analyzed using SPSS version 20 for windows (SPSS Inc., Chicago, IL, USA). Multivariate analysis was done to ascertain associated factors for IPV and P < 0.05 was considered statistically significant. Results: Prevalence of IPV among women was 14.8% (50/338). One hundred and twenty-seven respondents (37.6%) suffered verbal abuse, 28.4% had physical violence, while 5.3% reported sexual abuse. Most of the women, i.e., 72.0% (36/50) did not report violence and 76.0% (38/50) disclosed that they still felt safe in their marital relationship. Independent risk factors for IPV were duration of marriage of 6.8 years (P = 0.04, odds ratio [OR] =8.8, 95% confidence interval [CI] =7.8–9.9), maternal primary educational status (P = 0.02, OR = 10.7, 95% CI = 1.1–103.1), and male partner cigarette smoking (P = 0.003, OR = 3.1, 95% CI = 3.0–316.0). Conclusion: IPV during pregnancy is common in this obstetric population. Screening for IPV should be a part of routine antenatal care, especially among women with long marriage duration, primary educational status, and those whose husbands smoking cigarettes is recommended.

Validity of common ultrasound methods of fetal weight estimation in late pregnancy among women in Kwale, Niger Delta region, Nigeria.

Accuracy of some ultrasound equations used in our locality for fetal weight estimation is doubtful. To assess the accuracy of common ultrasound equations used for fetal weight estimation. A longitudinal study was conducted on selected Nigerian obstetric population at Central Hospital, Kwale between March, 2009 and January, 2011. Sonography was performed on 412 women with advanced singleton cyesis and measurements of BPD, HC, AC, and FL were obtained and figured into 12 common ultrasound equations for the estimation of fetal weight. The actual birth weight at delivery was recorded. The highest intraclass correlation coefficient was generated by the Hadlock 5 and Hsieh 2 equations. The least mean absolute percent error was obtained with Hsieh 2 equation, followed by Woo 3, and Hadlock 5. These equations also had the least percentage error and the least range of limits of agreement in the same order with no significant difference between their mean fetal weight estimates and that of the actual birth weight (p > 0.05). All twelve equations had strong positive correlation with the actual birth weight with Nzeh 2 equation the least. Hsieh 2 equation has the best accuracy in fetal weight estimation studied.

Correlation Between Maternal Obesity, Progress of Labour and Risk of Caesarean Delivery in a Cohort of Nigerian Parturients

Background: Maternal obesity is associated with adverse obstetric outcomes including labour complications.This study aimed at assessing the relationship between maternal obesity and course of first stage of labour and risk of caesarean delivery among women in active first stage of labour. Methods: This retrospective cohort study was a secondary analysis of data collected to assess the impacts of maternal obesity on pregnancy outcomes in a Nigerian obstetric population. We compared progress of labour and risk of caesarean delivery in 170 obese [Body mass index (BMI = ≥ 30 Kg/m2)] and 170 normal weight women (BMI = 18.5 – 24.9 Kg/m2) who were in spontaneous labour at term. They were matched for age and parity and exclusion criteria included women with height less than 1.52 metres, medical disorders, previous caesarean section, those that had augmentation of labour and infant weight > 4.0 Kg. Statistical analysis was done using SPSS version 16 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered significant. Results: Mean age and parity of the women were 30.6 ± 4.8 years and 1.9 ± 1.6 respectively. There was no significant difference between mean cervical dilatation at presentation between the two study groups (4.9 ± 1.8 versus 5.0 ± 1.7, P = 0.64). Cervical dilatation rate per hour was significantly slower in obese group compared to the controls (0.87 ± 0.4 versus 1.2 ± 0.5 cm/hr, P = 0.001). The mean duration of labour was the same in both groups (7.5 ± 3.9 versus 6.2 ± 3.4 hours, P = 0.57). Caesarean section rate increased from 8.8% in the controls to 23.5% among obese women. Obese women had three times higher risk of caesarean delivery compared to the controls (P = 0.002, OR 3.2, 95% CI 1.15 – 8.62) and this was mainly due to failure to progress in labour (P = 0.03). Conclusion: Among women in active phase of labour, maternal obesity was associated with slower rate of cervical dilatation and increased risk of caesarean delivery.

Risks associated with subsequent pregnancy after one caesarean section: A prospective cohort study in a Nigerian obstetric population.

Aversion for cesarean delivery is common in our practice and risks associated with caesarean section may contribute to this phenomenon. The objective of this study was to estimate the risks associated with subsequent pregnancies in women with one previous cesarean section in a low resource setting. A prospective cohort study carried out at two major tertiary maternity centers in Enugu. Maternal and perinatal outcomes were compared between women with one previous caesarean and women who had only previous vaginal deliveries. Analysis was performed with SPSS statistical software version 17.0 for windows (IBM Incorporated, Armonk, NY, USA) using descriptive and inferential statistics at 95% of the confidence level confidence. A total of 870 women were studied. These were divided into 435 cases and 435 controls. The absolute risk of cesarean section in a subsequent pregnancy in women with one previous cesarean was 75.8% (95% confidence interval [CI]: 72.0, 80.0). Cesarean section was significantly commoner in women with one previous cesarean compared with those who had previous vaginal delivery (Relative risk [RR] =3.78; 95% CI: 1.8, 6.2). Placenta praevia (RR = 5.0; 95% CI: 2.6, 7.2.), labor dystocia (RR = 6.4, 95% CI: 3.2, 11.2) intrapartum hemorrhage (RR = 5.0, 95% CI: 2.1, 9.3) primary postpartum hemorrhage (RR = 5.0, 95% CI: 1.5, 4.3.), blood transfusion (RR = 6.0, 95% CI: 3.4, 10.6) and Newborn special care admission (RR = 2.5; 95% CI: 1.1, 4.9) were significantly more common in women with one previous cesarean compared with those with previous vaginal deliveries. The absolute risk of failed trial of vaginal birth after a cesarean was 45% (95% CI: 38.5, 51.5). Women who have one previous C-section face a markedly increased risk of repeat caesarean sections and feto-maternal complications in subsequent pregnancies. There is a need for doctors in Nigeria to be mindful of these risks while offering primary cesarean section in this low resource setting.

Profile of Women Seeking To Know Fetal Sex at Ultrasoun in a Nigerian Obstetric Population

Background/Objectives: It Is Possible That Not All Women Would Want The Disclosure Of Fetal Sex Or Gender By The Sonologist During An Antenatal Or Perinatal Scan. The Objective Of This Study Was To Determine The Proportion Of Women That Wanted To Know Fetal Sex At Ultrasound, Group Them And Document Their Reasons For Wanting To Know. Methodology: This Was Descriptive Study Of Pregnanat Women Who Presented At Our Facility For Antenatal Ultrasound Diagnosis In Makurdi From June 1st To December 31st 2013. Results: One Hundred And Eighty (180) Women Were Studied Within This Period. Most Of The Women (55%) Were Of The Tiv Ethnic Group. Ibo And Idoma Women Accounted For 15% And 13.3% Respectively. Majority Of The Women Were Christians (93.3%). Ninety Six Percent (96%) Of The Women Consent To Disclosure Of Fetal Gender, While Four Percent (4%) Decline. The Main Reason For Wanting To Know Fetal Gender Was So That They Will Know What To Buy Before Delivery. Conclusion: Most Of The Women (96%) Would Want Fetal Gender Disclosure At Prenatal Ultrasound Scan. Only 4% Of The Women Did Not Want Fetal Gender Disclosure Because They Were Satisfied With Anyone. It Is Therefore Advisable For Any Sonologist To Be Careful On Fetal Gender Disclosure To Pregnant Women

Prevalence and Risk Factors for Obesity in a Nigerian Obstetric Population

Background: An obese pregnant woman is at increased risk of pregnancy complications with resultant adverse pregnancy outcomes. This study was undertaken to ascertain the magnitude of this nutritional disorder and its predictive factors among an obstetric population in Nigeria. Materials and methods: A descriptive study of pregnant women who registered for antenatal care within the first trimester in a private University Teaching Hospital over a 7-month period. They were interviewed to document the requisite data, their weights and heights were also taken. Body mass index obesity and obesity were classified based on the WHO criteria. Data was analyzed using SPSS version 16 for windows (SPSS Inc., Chicago, IL, USA). Results: The mean weight and height of the women were 71.2 ± 14.9 Kg and 1.59 ± 0.06 meters respectively. The prevalence of obesity was 33.1%. Thirty two women (60.4%) had mild obesity, 16 (30.2%) had moderate obesity while 5 (9.4%) had severe or morbid obesity. Also, 32.5% (52/160) of the study population were overweight while 34.4% (55/160) had normal BMI. Maternal age > 35 years (P = 0.04, OR 3.9, 95% CI 1.01 – 8.15), history of previous delivery (P = 0.03, OR 4.8, 95% CI 1.08 – 5.55) and self-reported satisfactory income (P = 0.03, OR 4.6, 95% CI 1.11 – 8.86) were significant independent predictive factors of obesity among the study population. Conclusion: Obesity is common in this obstetric population and older women, previous delivery and self-reported satisfactory income were its predictive factors. The need for prenatal health awareness about obesity and identification of these women aimed at instituting early antenatal surveillance and identification of complication(s) is advocated.

First trimester sonographic dating formula for the Nigerian obstetric population

Objective: The main purpose of this study is to derive a dating formula for the Nigerian obstetric population, quantify its prediction error, and compare its performance with existing published formulae. Materials and Methods: The crown-rump length (CRL) of 322 fetuses without risk for fetal growth restriction were plotted against menstrual age to obtain a scatter plot from which we derived the best-fit fractional polynomial regression model for estimating gestational age (GA). The accuracy of the formula was compared with that of existing formula in another data set of 88 fetuses. Results: The scatter plot yielded a best-fit equation for the estimation of GA (in weeks) from CRL (in mm) as GA=−0.0008 (CRL2) + 0.168 CRL + 5.397, (R2=0.8017). The mean prediction error was 0.13 for our formula, and 0.16 and 0.20 for Nelson's, and Robinson's formulae, respectively. Conclusion: Our dating formula locally derived was more favorably applicable for the Nigerian population. This has implication for prenatal diagnosis in Nigeria.

O377 CD4 count in a healthy Nigerian obstetric population

O377 CD4 count in a healthy Nigerian obstetric population

Profile of Women Seeking Fetal Gender at Ultrasound in a Nigerian Obstetric Population

Objective: To determine the proportion of women that wanted to know fetal gender at ultrasound, characterize them and document reasons for wanting to know fetal gender. Methodology: A cross-sectional study on consecutive pregnant women at 20 weeks or more gestation that presented for prenatal ultrasound at a private hospital in Nigeria from May to December 2005. Results: Of the 1135 women, 167 (14·7%) sought to know the fetal gender. Significant independent factors included ethnic group, as women from the predominant Hausa–Fulani were less likely when compared to those of other ethnic groups (OR: 0·4, 95% CI: 0·2–0·7). Women with tertiary education were 6·6 times (OR: 6·6, 95% CI: 3·3–13·2) more likely. Women with a previous male baby were 30·6 times more likely (OR: 30·6, 95% CI: 13·6–68·5), while those with previous female baby were 54·3 times more likely (OR: 54·3; 95% CI: 23·4–125·8) to seek fetal gender. Main reasons for seeking fetal gender were preference for a particular fetal gender (57%); what wears to buy for the baby (24%) and curiosity (18%). Conclusion: About 15% of the study group requested to know fetal gender and it was associated with ethnic group, maternal educational level and gender of the previous baby. The most common reason for wanting to know fetal gender was the desire for a particular gender.

Risk factors for hepatitis B infection during pregnancy in a Nigerian obstetric population

SummaryWe aimed to assess the risk factors for hepatitis B infection among pregnant women in Enugu, southeast Nigeria. This was a prospective case-control study of risk factors for hepatitis B surface antigen positivity among pregnant women seen in two tertiary health institutions in Enugu, southeast Nigeria. It was carried out over an 8-month period, January – August 2005. Of the 1,499 pregnant women attending the antenatal clinic, 4.6% (n = 69) were seropositive for hepatitis B surface antigen. A total of 35 (50.7%) HBsAg positive women and 71 negative controls were interviewed. The risk factors for HBsAg were present in 71% (n = 25) of the positive cases, while only 27% (n = 19) of the negative cases had risk factors. The significant risk factors for HBsAg positivity were higher mean parity, higher number of sexual partners since sexual debut, polygamy and previous positive history of sexually transmitted diseases (STD) (p < 0.05). The two groups did not differ with respect to presence of tattoo or scarification marks, positive history of jaundice or contact with a jaundiced patient, previous blood transfusion or contact with blood products, intravenous drug abuse or sharing personal instruments (p > 0.05). Screening pregnant women for hepatitis B infection on the basis of presence of risk factors may not effective. Universal antenatal screening for HBsAg, health education aimed at reducing risk factors and immunisation of all newborn and those at risk of hepatitis B is advocated.

An evaluation of the shock index in predicting ruptured ectopic pregnancy

SummaryIn order to evaluate the shock index in predicting a ruptured ectopic pregnancy in a Nigerian obstetric population, a prospective observational study of consecutive pregnant women presenting to the emergency room of the University of Nigeria Teaching Hospital, Enugu with complaints of abdominal pain and/or vaginal bleeding in the first trimester of pregnancy over a 23-month period (1 February 2003 to 31 December 2004) was carried out. A total of 152 subjects were studied. Of these, 15 (9.9%) of the women had ruptured ectopic pregnancy while the rest had other causes of bleeding in early pregnancy. The mean shock index for ruptured ectopic pregnancy was significantly different from that for threatened abortion (p < 0.001), incomplete abortion (p = 0.022) and inevitable abortion (p < 0.001) but not from that for unruptured ectopic pregnancy and septic abortion (p > 0.05 for both categories). The areas under the relative operating characteristic (ROC) curves for shock index and heart rate were statistically significant (p < 0.001 for both variables) but those under the curves for systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were not statistically significant (p > 0.05 for the three variables). From the curves, the cut-offs that combined highest sensitivity with lowest false positivity (1-specificity) were 0.935 for the shock index and 99 bpm for heart rate. On univariate logistic regression, the odds ratio (OR) for predicting ruptured ectopic pregnancy was 52.9 (95% CI = 10.9 – 257.3, p < 0.001) for shock index ≥0.935 and 26.4 (95% CI = 6.8 – 102.8, p < 0.001) for heart rate ≥99/min. On multivariate logistic regression using both shock index ≥0.935 and heart rate ≥99/min, only shock index ≥0.935 was statistically significant with an OR of 4.5 (95% CI = 1.8 – 11.6, p = 0.002). We conclude that when faced with the possibility of ruptured ectopic pregnancy, shock index has a high predictive value in the Nigerian population studied and is a useful addition to the currently available diagnostic armamentarium in ruptured ectopic pregnancy.

Preferences for cesarean section or symphysiotomy for obstructed labor among Nigerian women

In developed countries there is a low prevalence of obstructed labor and little aversion to cesarean delivery. In fact delay in performing a cesarean section often results in lawsuits. For these reasons symphysiotomy is rarely necessary and has been abandoned in those countries. However developing countries are characterized by a high prevalence of obstructed labor (from cephalopelvic disproportion—CPD) poor obstetric services and a cultural dislike for cesarean delivery. Because of the dislike for cesarean delivery and the higher mortality and morbidity associated with cesarean section than symphysiotomy for obstructed labor symphysiotomy has been advocated for the management of obstructed labor from CPD in resource-poor settings. Despite this we have observed surprisingly that indigenous Nigerian obstetricians rarely offer symphysiotomy as a therapeutic option for obstructed labor because they consider it dangerous compared with cesarean section. Currently we do not know whether Nigerian women prefer symphysiotomy or cesarean section for obstructed labor. The objective of this study was to determine the preferences for either symphysiotomy or cesarean section for obstructed labor in a Nigerian obstetric population. (excerpt)

Effect of prolongation of pregnancy on perinatal mortality

Objectives: (1) To determine the distribution of singleton and twin births according to gestational age in a Nigerian obstetric population; and (2) to compare their perinatal outcomes according to gestational age. Methods: A 10-year retrospective comparative study of twin and singleton births at a tertiary care center in Enugu, Nigeria. The variables analyzed were: the proportion of deliveries occurring at each gestational age, the gestational age-specific rates for stillbirths, cesarean section, babies with 1-min Apgar scores less than 4 and those whose birthweights were below the 10th percentile for gestational age. The trends in these rates were determined by finding the best fitting polynomial regression curve for each variable. Tests of statistical significance for trends in proportions were carried out by means of the χ 2-test at the 95% confidence level. Results: Of the 496 twin births, 3.6% compared with 17.3% of the 496 singleton births went beyond 40 weeks’ gestation while 1.2% of the twin and 4.4% of the singleton deliveries occurred at 42 weeks’ gestation or beyond. For twins as well as singletons, there was a consistent and significant decline in the stillbirth rate and the proportion of babies with 1-min Apgar scores less than 4 up to 42 weeks ( P=0.0000). Among the twins, the proportion of babies with birthweights below the 10th percentile (i.e. those with impaired growth) significantly rose from 28 weeks and above ( P=0.0000) while among the singletons, a declining trend with gestational age was observed ( P=0.0003). However, among the twins with impaired growth, the stillbirth rate neither differed between the first and second twins at each gestational age nor did it increase with gestational age in both the first and second twins. While the cesarean section rate for singletons remained almost stable at approximately 13%, there was a significant rise in the cesarean section rate with gestational age among the twin births. Conclusions: There were 1.2% of twin deliveries compared with 4.4% of singleton deliveries which occurred at 42 weeks’ gestation or beyond. In the Nigerian population studied, the perinatal outcomes in twins did not differ from those of singletons up to 42 weeks’ gestation suggesting that the 42-week cut-off for prolonged pregnancy applies equally well to twins as to singletons.

Prognostic Value of Absolute versus Relative Rise of Blood Pressure in Pregnancy

This study evaluated the prognostic value of absolute versus relative rise in blood pressure during pregnancy at the Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria from 17th December 1997 to 31st March 1999. The study sample consisted of 515 consecutive healthy antenatal subjects of the hospital who satisfied the inclusion criteria. The study involved a longitudinal measurement of variables such as blood pressure and anthropometric data of the subjects as well as the maternal mortality rate, caesarean section rate, incidence of eclampsia and proteinuria, perinatal mortality rate, incidence of severe asphyxia and low birth weight, mean birth weight, birth length, ponderal index and gestational age at delivery. Differences in these indices between different groups of the subjects were compared using the chi-square test for categorical variables and one way ANOVA for continuous variables. Grouping was based on the absolute systolic/diastolic blood pressure (SBP/DBP) and relative rise in SBP/DBP from mind-pregnancy until delivery at term. The absolute blood pressure of 140/90 mmHg was a better predictor of feto-maternal outcome than a relative rise in the systolic/diastolic blood pressure from mid pregnancy, which did not reach this absolute level. We conclude that in the Nigerian obstetric population, the practice of diagnosing pregnancy hypertension on the basis of a relative blood pressure rise of 30/15 mmHg alone without reference to the absolute blood pressure level needs to be reviewed.

A Review of Rhesus Iso-Immunization in a Nigerian Obstetric Population

Context : Haemolytic disease of the newborn, a problem that has not been sufficiently investigated in the Nigerian population, leads to significant perinatal morbidity and mortality. Objectives : To determine the incidence of Rhesus (Rh) isoimmunization and the utilisation rate of Rh-immunoprophylaxis in our population. Methods : A review of the clinical records of all Rh-negative pregnancies, booked at the Federal Medical Centre, Abeokuta between July, 1996 and June, 2000. The mothers' and infants' records were analysed for age, parity, ante-natal antibody status and some selected characteristics in the infant. Results : Seventy-seven Rh-negative pregnancies were managed, accounting for 2.6% of the total obstetric population. Those who received immuno-prophylaxis following previous abortions and deliveries were 15.4 % and 38.2% respectively. Initial testing, at booking, for sensitization was not done in 36.5% of the women, while 63.4% had no follow-up testing. The incidence of ante-natal sensitization was 1.3%. The time of onset of neonatal jaundice was 26.5 + 14.6 hours (mean + SD) in Rh-positive infants, compared to 44.4 + 17.8 hours in Rh-negative infants (p = 0.07). The haematocrit of both groups of infants were similar [42.8 + 5.8 versus 44.5 + 5.3; p = 0.6]. There was no perinatal death. The partners' Rh-status was determined in 59.7% and the infants' Rhesus group in 71.6%. Immunoprophylaxis rate was poor (44.8%). The majority of those who declined immunoprophylaxis did so for financial reasons. Conclusion : The risk of haemolytic disease of the newborn with its attendant perinatal morbidity and mortality is real in our community, yet the rate of Rh-immunoprophylaxis remains quite low in our obstetric population. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2):69-72)