Olabisi M. Loto

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.

Poor obstetric performance of teenagers: is it age- or quality of care-related?

We studied prospectively the effect of antenatal care on the obstetric performance of teenagers seen at a university teaching hospital over a 14-month period. When the obstetric complications among the teenagers were compared to their older counterpart, there were significantly higher complication rates, especially anaemia, preterm delivery, low birth weight and neonatal admission. After controlling for utilisation of antenatal care, significant differences were observed only in the incidence of low birth weight babies. In conclusion, this study has shown that the poor obstetric outcome of teenage pregnancy is related to non-utilisation of prenatal care rather than their biological age.

Influence of multiple antenatal counselling sessions on modern contraceptive uptake in Nigeria

Abstract Objective To determine the influence of multiple contraceptive counselling sessions during antenatal care on use of modern postpartum contraception. Method A total of 216 eligible pregnant women were randomised into antenatal and postnatal counselling groups. The ‘Antenatal group’ received one-to-one antenatal contraceptive counselling on several occasions while the ‘Postnatal group’ received a single one-to-one contraceptive counselling session at the sixth week postnatal check, as is routinely practised. All participants were contacted six months postpartum by telephone or personal visit, and questioned about their contraceptive use, if any. Results More women who had multiple antenatal contraceptive counselling sessions used modern contraceptive methods than those who had a single postnatal counselling session (57% vs. 35%; p = 0.002). There was also a significantly more frequent use of contraception among previously undecided patients in the Antenatal group (p = 0.014). Conclusion Multiple antenatal contraceptive counselling sessions improve the use of modern postpartum contraception.

A randomized comparative study of prophylactic oxytocin versus ergometrine in the third stage of labor

To compare the effect of prophylactic use of oxytocin and ergometrine in management of the third stage of labor.

Active management of third stage of labour: a survey of providers’ knowledge in southwest Nigeria

BackgroundThe disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers’ knowledge on the subject.ObjectiveTo assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL.MethodsQuestionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria.ResultsFemale nurses at different cadres accounted for most of the respondents. Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13 potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identified the components of AMTSL as defined by FIGO/ICM. Many procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being in administrative position (adjusted OR: 2.68; CI 1.19–6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21–5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI 0.05–0.39), matron (adjusted OR: 0.25; CI 0.08–0.79) or intern (adjusted OR: 0.07; CI 0.01–0.29) compared to postgraduate resident doctors reduced the odds of having accurate knowledge of AMTSL.ConclusionAMTSL was a familiar but poorly understood intervention among obstetric care providers in this region. Improvement in healthcare quality and practitioners’ adherence to recommended guidelines on AMTSL urgently requires educational interventions that target those who provide routine delivery care and organisation of the health care delivery system in such a way that enables providers to act on acquired knowledge.

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.

Cesarean section in relation to self-esteem and parenting among new mothers in southwestern Nigeria

Background. Maternal psychopathology and self‐esteem during childbirth may have an effect on maternal parenting self‐efficacy. Objective. This study aimed to asses the self‐esteem of newly delivered primiparous mothers who had cesarean section (CS) in relation to their parenting self‐efficacy. Methods. A total of 115 primiparous women who delivered by CS were compared with 97 matched controls who had vaginal delivery during the same period. They completed the Rosenberg self‐esteem scale prior to discharge. They also completed the parent–child relationship questionnaire at six weeks postpartum, together with the Rosenberg self‐esteem scale. Results. The mean score on the Rosenberg self‐esteem scale was significantly lower for the CS group, both prior to discharge (p = 0.006) and at six weeks (p < 0.001), than the vaginal delivery group. The mean score on the parent–child relationship questionnaire was also lower in those who had CS compared with those who had vaginal delivery (p < 0.001, OR 4.71, 95% CI 1.75–14.71). Conclusion. CS in Nigerian women is associated with lowered self‐esteem and predicts poor parenting self‐efficacy in the postnatal period. Psychological support and techniques to improve self‐esteem and parenting should be incorporated into the management of women having CS.

Post‐partum urinary retention in a teaching hospital in southwestern Nigeria

This study was undertaken to determine the prevalence of post‐partum urinary retention after vaginal delivery and to examine the associated risk factors.

A randomised controlled trial of uterine exteriorisation and non-exteriorisation at caesarean section

Background: There is not enough information to evaluate the routine use of exteriorisation of the uterus for repair of the uterine incision and further studies are needed to examine the value of exteriorisation of the uterus at caesarean section as against non‐exteriorisation.

A randomized trial of artesunate-amodiaquine versus artemether-lumefantrine for the treatment of acute uncomplicated malaria in pregnancy

To compare the artesunate‐amodiaquine and artemether‐lumefantrine combinations in the treatment of acute uncomplicated falciparum malaria during pregnancy.