INTRODUCTION
‘Abdominal massage’ is an unconventional application of pressure on the
abdominal wall of pregnant women by a traditional birth attendant (TBA) or an
unskilled birth attendant.1 It is a bad obstetric practice in
southern Nigeria, particularly age long manauvres by
the people of Niger Delta regions.1 In addition, abdominal massage
has a myriad of negative effect to the mother and baby; to the mother examples
of which are abruption placenta, uterine rupture, post-partum haemorrhage and
maternal mortality while to the baby complications such as mild to severe birth
asphyxia, birth injuries and perinatal.1,2-4,7-10 Some of the
factors that have been associated with abdominal massage among pregnant women
are ignorance, illiteracy and poverty.2-4 In addition, other factors
that have facilitated this age long practices are lack of development, poor
access to medical facilities, outdate medical equipment, present brain drain of
skilled birth attendants in these regions and lack of political will to address
the challenges mentioned as well as infrastructure development.3-7
The solutions to halting this bad obstetric practice “abdominal massage” should
be addressed holistically multi-sectoral and
multi-disciplinary.8 This involves education especially for the girl
child, including mass literacy campaign, improving the health facilities,
making the environment conducive for health care providers as to discourage
brain drain, training and re-training of skill birth attendants, enlightenment
campaign to communities to educate them on adverse effect of abdominal massage
in pregnancy to the mother and the unborn child.9 Furthermore,
religious groups should be encouraged to educate their congregation on the
negative effect of abdominal massage.5-9 The government should also
be involved in the crusade against abdominal massage by passing laws against
this harmful traditional practice.1,5-6
CASE REPORT
She was Mrs N.P 28-year old unbooked Gravida 3Para2 (all alive) at 37 weeks of gestation. She
presented with complaints of severe abdominal pains, bleeding par vaginam and absence of fetal
kicks all of 6 hours duration following ‘abdominal massage’ from the home of a
TBA who attempted to turn to breech presenting fetus
to cephalic. On examination at presentation, she was in severe painful
distress, pale, anicteric, afebrile (37.2oC) and dehydrated. Her
cardiovascular examination revealed a pulse rate of 106 beats per minute small
volume and a blood pressure of 90/60 mmHg. She had an enlarged abdomen compartible with term pregnancy, woody hard and tender, the
lie and presentations were difficult to ascertain due to severe tenderness with
absence of fetal heart tones on auscultation aided by
a hand held Doppler, There were blood clots protruding from thevulva
on inspection of the vagina. Digital vaginal examination revealed a soft
cervix, posterior and uneffaced; cervix was
2centimeters dilated with an intact membrane and vertex was at station 0-2
station. The examining gloved fingers were stained with altered blood. A
clinical diagnosis of Ante-partum haemorrhage was made secondary to abruption
placenta. Full blood count done revealed
packed cell volume of 25% and White blood cell counts and differentials were
within normal range, Obstetric ultra-sound revealed an intra-uterine fetal death with baby lying in oblique lie, with features
of abruption placenta and estimated fetal weight of
3.0 Kilograms. She was resuscitated, counselled for an emergency caesarean
section. She was resuscitated and 2 units of blood grouped and cross-matched.
Finding at surgery under general anaesthesia was a fresh still born female baby
birth weight 3.0 kg Apgar scores were 0 in the first minute and 0 at the fifth
minute with placenta was detached and delivered manually with retroperitoneal
blood clots. The estimated blood loss 1.2 Litres. She
had 2 unit s of blood transfused intra-operatively and 2 units
post-operatively. Her post-operative period was uneventful. She was discharged
on her 5th post-operative day and counselled on family planning.
DISCUSSION
This case report is depicts the adverse effects of abdominal massage in
this scenario abruptio placenta and intra-uterine fetal death. This age long unconventional practice is
common among residents in the Niger Delta region of Nigeria.1,2
Abdominal massage is also practiced in some remote countries outside Nigeria
such as Kenya and Ethiopia.4,5 Some authors are of the opinion that
is commoner among low social status as in our patient Mrs a house wife with
primary level of education whose husband a casual worker with primary level of
education.2-6 However, Ugboma and Akani reported that abdominal massage was also practiced
among those with high social class.2
There are myriads of factors that are associated with abdominal massage,
these include ignorance, low socio-cultural status, illiteracy and poverty.1,2 Our patient Mrs NP an example of these qualities.
In addition, other factors that tend to encourage patients who patronize
massage homes are lack of development, poor access to medical facilities,
outdate medical equipment, present brain drain of skilled birth attendants in
these regions and lack of political will to address the challenges mentioned as
well as infrastructure development.3-7 The patient under discussion
had abruptio placenta and intra-uterine fetal death.
The negative effects of abdominal massage in pregnancy can be broadly be classified into maternal and fetal.
For the maternal complications these include abruption placenta, uterine
rupture, post-partum haemorrhage and maternal death.1,2,8-10 The fetal complications of abruptio placenta includes – birth
asphyxia, injury to the unborn baby and intra-uterine fetal death.1,2,7-10
CONCLUSION
‘Abdominal massage’
is of public health concern in our environment. This case report revealed
abruption placenta and intra-uterine fetal death and
a near miss of maternal death following the cascade of events from this
primitive act of abdominal massage. Advocacy should be encouraged in favour of
safe motherhood cutting across all sectors and disciplines of our society. The
role of government in the prevention of abdominal massage by passing of laws
against the practice of abdominal massage cannot be ver
emphasized.
Acknowledgement
Mother, Baby and Adolescent Care Global Foundation.
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