Ibraheem O. Awowole

Tuberculosis in pregnancy: a review.

Tuberculosis (TB) was declared a public health emergency by WHO in 2005. The disease is a significant contributor to maternal mortality and is among the three leading causes of death among women aged 15–45 years in high burden areas. The exact incidence of tuberculosis in pregnancy, though not readily available, is expected to be as high as in the general population. Diagnosis of tuberculosis in pregnancy may be challenging, as the symptoms may initially be ascribed to the pregnancy, and the normal weight gain in pregnancy may temporarily mask the associated weight loss. Obstetric complications of TB include spontaneous abortion, small for date uterus, preterm labour, low birth weight, and increased neonatal mortality. Congenital TB though rare, is associated with high perinatal mortality. Rifampicin, INH and Ethambutol are the first line drugs while Pyrazinamide use in pregnancy is gaining popularity. Isoniazid preventive therapy is a WHO innovation aimed at reducing the infection in HIV positive pregnant women. Babies born to this mother should be commenced on INH prophylaxis for six months, after which they are vaccinated with BCG if they test negative. Successful control of TB demands improved living conditions, public enlightenment, primary prevention of HIV/AIDS and BCG vaccination.

Adjunctive rectal misoprostol versus oxytocin infusion for prevention of postpartum hemorrhage in women at risk: A randomized controlled trial

Aim:  The aim of this study was to evaluate the efficacy of adjunctive rectal misoprostol compared to oxytocin infusion in the prevention of primary postpartum hemorrhage after routine active management of the third stage of labor in women with identifiable risk factors for uterine atony.

Obstetric hysterectomy: Trend and outcome in Ile-Ife, Nigeria

Worldwide, the incidence of obstetric hysterectomy is expected to be on the decline due to improvements in obstetric care. This hospital-based 10-year review (2001–10) was performed to determine its incidence and outcome in Ile-Ife, Nigeria. The trend was determined by comparing the current incidence with that from two previous studies from the same centre. There were 58 obstetric hysterectomies and 15,194 deliveries during the review period, giving a rate of 3.8/1,000 deliveries. A rising trend was observed in the obstetric hysterectomy rate in Ile-Ife over two decades (1990–2010). Uterine rupture was the commonest indication (60%). Postoperative complications such as sepsis, vesico-vaginal fistula and renal failure affected 34.5% of the patients. Maternal and fetal case fatality rates were 18.2% and 43.6%, respectively. The obstetric hysterectomy rate in Ile-Ife is high and the trend is rising. Universal access to skilled birth attendance is advocated to reduce uterine rupture and consequently obstetric hysterectomy.

Pregnancy-related acute kidney injury requiring dialysis as an indicator of severe adverse maternal morbidity at a tertiary center in Southwest Nigeria

OBJECTIVE Despite being a Critical Intervention in the WHO Near-miss concept, the indications and clinical outcomes of patients with Pregnancy-Related Acute Kidney Injury (PRAKI) requiring dialysis at the Obafemi Awolowo University Teaching Hospitals Complex, Nigeria remain unknown. This retrospective review was conducted to facilitate counselling, prognostication and introduction of preventative measures by providing contemporary data on the aetiology and clinical outcomes of women with PRAKI. STUDY DESIGN A retrospective review. The indications for dialysis and feto-maternal outcomes of women with PRAKI requiring dialysis between January 2007 and December 2016 were reviewed. Analysis was performed with IBM SPSS 21.0. RESULTS There were 43 patients with PRAKI that required dialysis and 11,242 live births, with Maternal Near Miss Ratio (MNMR) of 3.8/1000 live births. Preeclampsia/ecclampsia (40%), Sepsis (37.5%) and Haemorrhage (20%) were the leading aetiologies of kidney injury, while oligo-anuria (100%) was the commonest clinical presentation. Majority (78%) of them had ≤four dialysis sessions before recovery of renal function. The mean (±SD) gestational age and birth weight at delivery were 36 (±3.1) weeks and 2.9 (±0.6)kg, while the Maternal Mortality Index and Perinatal mortality rates were 18% and 34% respectively. Delayed referral, and lower number of dialysis sessions were the significant predictors of mortality, while four women discontinued care due to cost. CONCLUSION The high rate of Pregnancy-related acute kidney injury requiring dialysis, with its attendant morbidity and mortality are largely preventable. The prognosis is however good with standardised care. Functional emergency obstetric services, and a review of the Nigerian healthcare financing system are advocated.

Clinical correlates of leiomyoma estrogen and progesterone receptors among Nigerian women

To compare the expression of estrogen receptor α (ERα) and progesterone receptor (PR) in myometrium and leiomyomata tissue, and to correlate their expression with symptoms of uterine leiomyomata.

Maternal mortality in the last triennium of the Millennium Development Goal Era at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

Abstract The maternal mortality ratio (MMR) of Nigeria remains high. This retrospective study aims to suggest evidence-based strategies towards achieving the sustainable development goal target 3.1 at the Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria by providing contemporary data on MMR between October 2012 and September 2015. There were 86 maternal deaths and 5243 live births over the triennium, with annual MMRs of 1744, 1622 and 1512/100,000 live births, respectively. Fifty-six (65.2%) were postpartum deaths, while 44 (51.2%) occurred within 12 hours of admission. Using the WHO ICD-10 system, the causes of mortality were pregnancy-related infections; 26 (30.2%), haemorrhage; 20 (23.3%), hypertension; 13 (15.2%) and pregnancies with abortive outcomes; 11 (12.7%). Financial constraints, misdiagnosis and delayed referrals constituted the predominant contributors. The MMR at OAUTHC, Nigeria in the last triennium of the MDG was ‘Extremely High’. Improved aseptic techniques, blood transfusion services, antimicrobial sensitivity evaluation, Universal Health Coverage, training-retraining of skilled birth-attendants and effective referral systems are advocated. IMPACT STATEMENT What is already known on the subject of the paper: Nigeria now contributes the largest proportion (19%) of the burden of maternal mortality worldwide, despite constituting just 2% of the global population. Reversing this adverse trend during the sustainable development goal (SDG) period demands effective strategies, which can only be predicated on reliable data at the hospital, regional and national levels. What this study adds: This article provides the contemporary maternal mortality data of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, during the last triennium of the Millennium Development Goal era. The findings from the study revealed that the average maternal mortality ratio (MMR) of the Hospital over the three years was 1640/100,000 live births, and that pregnancy-related infection is now the leading cause of maternal death, followed by obstetric haemorrhage. What the implications are for clinical practice: Improvement in aseptic techniques, evaluation of antimicrobial sensitivity patterns and efficient blood transfusion services, as well as Universal Health Insurance coverage and Skilled Birth Attendants will improve the maternal health indices of the hospital, and ultimately the country during the SDG execution period.

Factors associated with the desire for companionship during labor in a Nigerian community

To determine preferences for companionship during labor and to identify associated factors.

Upright or dorsal? childbirth positions among antenatal clinic attendees in Southwestern Nigeria

Background: Upright childbirth positions are associated with better delivery outcomes. These positions such as kneeling and squatting were the norm for childbirth in indigenous Nigerian custom. However, westernization has largely replaced them with supine positions. Objective: This study was conducted to compare the knowledge, attitude and experience regarding childbirth positions between antenatal clinic attendees in southwest and northwest Nigeria. Materials and Methods: A mixed methods design was employed. Quantitative data were obtained using a structured questionnaire in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife (n = 201) and Federal Medical Centre, Katsina (n = 104). Knowledge was graded as poor, fair or good whereas attitude toward each position was graded as favoured, indifferent or against. The resulting proportions were compared using Chi-square. Qualitative data were obtained through key-informant interviews. Results: Knowledge of childbirth positions was generally poor. Overall, only to women (0.6%) had good knowledge, whereas 60 (19.7%) had fair knowledge and the rest (79.7%) had poor knowledge. More women in Katsina than Ile-Ife knew the squatting position (32.7% vs. 16.4%; P < 0.001) and favoured it (25.0% vs. 7.5%; P < 0.001), whereas more Ile-Ife women knew the lithotomy position (42.3% vs. 26.9%; P = 0.01). Attitudes towards the remaining positions were comparable between them. Key-informant interviews of the midwives revealed that they were trained to conduct delivery exclusively in the supine positions. They were, however, interested in learning the use of upright positions. Conclusion: Knowledge about childbirth positions was very poor. Women in northwestern Nigeria were more aware and favorably disposed to childbirth in their customary squatting position. Training of Nigerian midwives on upright childbirth positions is recommended.