Adetokunbo O. Fabamwo

Efficacy of visual inspection of the cervix using acetic acid in cervical cancer screening: A comparison with cervical cytology

Summary Screening programmes for the early detection of premalignant lesions of the cervix are expensive and technically difficult, especially in resource-challenged settings. There is a need for cheaper and equally effective alternative screening methods. This study compared the efficacy of visual inspection of the cervix using acetic acid (VIA) with the Pap smear method. A total of 186 subjects had a Pap smear followed by visual inspection of the cervix using 3 – 5% acetic acid with biopsies taken from suspicious acetowhite positive lesions. Cases of abnormal cytology were recalled for biopsies. A total of 150 subjects were negative for both tests; 30 (16.2%) were positive for VIA, while six were positive for both VIA and Pap smear. VIA detected one lesion missed by Pap smear on biopsy. The sensitivity of VIA was 100%, while that of Pap smear was 85.7%. The negative predictive value of VIA was 100%, while the positive predictive value was 20%. The sensitivity of VIA equals the reported rates for Pap smear. VIA is proposed as a credible alternative to Pap smear in resource-challenged settings.

Assessment of the effect of psychosocial support during childbirth in Ibadan, south-west Nigeria: A randomised controlled trial

Objective: To assess the effect of psychosocial support on labour outcomes.

Uterine artery ligation for management of uterine fibroids

To determine the efficacy of uterine artery ligation by the vaginal route for the management of symptomatic uterine fibroids. A pilot study had suggested that the procedure was effective.

Caesarean section – an appraisal of some predictive factors in Lagos Nigeria

BackgroundSeveral maternity units in the developing world lack facilities for caesarean section and often have to transfer patients in extremis. This case controlled study aimed to appraise predictive factors for caesarean section.MethodsOne hundred and fifty two consecutive women with singleton pregnancies who had caesarean section were studied. The next parturient with normal delivery served as control. Variables such as age, parity, marital status, booking status, past obstetric history, weight, height, infant birth weight were assessed. Data obtained were analysed using SPSS 16.0 Windows package.ResultsDuring the study period, there were 641 deliveries with 257 of them by caesarean section (40.1%).Logistic regression analysis showed that parity, booking status, maternal height; maternal weight, birth weight, previous caesarean section and ante-partum bleeding were significant predictive factors for caesarean section while maternal age was not.ConclusionsThese predictive factors should be considered in antenatal counseling to facilitate acceptance by at risk women and early referral.

Nurses in low resource settings save mothers' lives with non-pneumatic anti-shock garment.

Purpose:To discuss the role of nurses and nurse-midwives in preventing and treating postpartum hemorrhage (PPH) from uterine atony in developing countries and examine the role of a new device, the Non-pneumatic Anti-Shock Garment (NASG), in improving the outcomes for these patients. Study Design and Methods:In this subanalysis of a larger preintervention phase/intervention phase study of 1,442 women with obstetric hemorrhage, postpartum women with hypovolemic shock (N = 578) from uterine atony (≥750 mL blood loss; systolic blood pressure <100 mmHg and/or pulse >100 beats per minute) were enrolled in two referral facilities in Egypt and four referral facilities in Nigeria. The study had two temporal phases: a preintervention phase and an NASG-intervention phase. Women with hemorrhage and shock in both phases were treated with the same evidence-based protocols for management of hypovolemic shock and hemorrhage, but women in the NASG-intervention phase also received the NASG. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated for primary outcomes—measured blood loss, incidence of emergency hysterectomy, and mortality. Results:Women in the NASG-intervention phase had significantly better outcomes, 50% lower blood loss, reduced rates of hysterectomy (8.9% vs. 4%), and mortality decreased from 8.5% to 2.3% (RR = 0.27, 95% CI: 0.12–0.60). Clinical Implications:In low-resource settings nurses have few resources with which to stabilize women with severe PPH. With training nurses and nurse-midwives can stabilize hemorrhaging women with the NASG, a low-technology first-aid device that shows promise for reducing blood loss, rates of hysterectomy, and mortality.

Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria

BackgroundHaemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies.MethodsCase records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed.ResultsThere were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units).ConclusionEven though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.

Uterine artery ligation for the treatment of fibroids

Objective. To determine the efficacy of bilateral uterine artery ligation in the treatment of symptomatic uterine fibroids. Design. A descriptive study. Setting. Tertiary care gynecological clinic, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Sample. Fifty women who had trans‐vaginal bilateral uterine artery ligation for the treatment of uterine fibroids between January 2003 and January 2006. Methods. Pre‐operative baseline ultrasonic measurements of uterine and dominant fibroid volumes were carried out and repeated at two, six, and 12 weeks, then three monthly for a period of three years. Severity of menstrual blood loss, changes in pain symptoms and patients’ satisfaction were also assessed. Main outcome measures. Changes in uterine and fibroid volumes, hemoglobin values, menstrual pain ratings, and patients’ satisfaction ratings. Results. The mean fibroid volume, mean uterine volume, and mean menstrual pain rating showed statistically significant reductions at six, 12, and 36 months. The mean hemoglobin level and patients’ satisfaction rating showed a statistically significant increase after six, 12, and 36 months. Conclusion. Trans‐vaginal bilateral uterine artery ligation is a safe and effective method for the treatment of symptomatic uterine fibroids especially in areas where access to high level medical technology is restricted.

The understanding and acceptability of assisted reproductive technology (ART) among infertile women in urban Lagos, Nigeria

This descriptive study was carried out to assess the awareness and acceptability of Assisted Reproductive Technology (ART) among infertile women in Lagos, Nigeria. Self-administered questionnaires on the knowledge of ART in the women were used. After a brief exposé on ART, questions relating to their attitude were answered. A total of 166 women were studied. Only 51.8% had any knowledge of ART and most of these had poor knowledge. A total of 137 women would embrace ART if offered but 29 would not, for reasons such as religion, fear of side-effects, failure and unaffordable costs. There is a paucity of good knowledge of ART. A significant number of the women would consider ART if offered. There is thus a need to create more awareness about the possibilities offered by ART, as well as instituting low cost ART strategies in developing world countries.

Assessment of sublingual misoprostol as first-line treatment for primary post-partum hemorrhage: results of a multicenter trial.

The study investigated the effectiveness of sublingual misoprostol when used as primary treatment of primary post‐partum hemorrhage (PPH) in a low‐income country.