Omololu Adegbola

Determinants of perinatal mortality in Nigeria

To determine risk factors for perinatal mortality among hospital‐based deliveries in Nigeria.

Comparative effectiveness and acceptability of home-based and clinic-based sampling methods for sexually transmissible infections screening in females aged 14-50 years: A systematic review and meta-analysis

BACKGROUND Home-based sampling is a strategy to enhance uptake of sexually transmissible infection (STI) screening. This review aimed to compare the screening uptake levels of home-based self-sampling and clinic-based specimen collection for STIs (chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and trichomoniasis) in females aged 14-50 years. Acceptability and effect on specimen quality were determined. METHODS Sixteen electronic databases were searched from inception to September 2012. Randomised controlled trials (RCTs) comparing the uptake levels of home-based self-sampling and clinic-based sampling for chlamydia, gonorrhoea and trichomoniasis in females aged 14-50 years were eligible for inclusion. The risk of bias in the trials was assessed. Risk ratios (RRs) for dichotomous outcomes were meta-analysed. RESULTS Of 3065 papers, six studies with seven RCTs contributed to the final review. Compared with clinic-based methods, home-based screening increased uptake significantly (P=0.001-0.05) in five trials and was substantiated in a meta-analysis (RR: 1.55; 95% confidence interval: 1.30-1.85; P=0.00001) of two trials. In three trials, a significant preference for home-based testing (P=0.001-0.05) was expressed. No significant difference was observed in specimen quality. Sampling was rated as easy by a significantly higher number of women (P=0.01) in the clinic group in one trial. CONCLUSIONS The review provides evidence that home-based testing results in greater uptake of STI screening in females (14-50 years) than clinic-based testing without compromising quality in the developed world. Home collection strategies should be added to clinic-based screening programs to enhance uptake.

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.

The epidemiology and management of gynatresia in Lagos, southwest Nigeria

To document data from patients presenting with gynatresia at 2 tertiary health centers in Lagos, southwest Nigeria.

Uterine rupture at Lagos University Teaching Hospital

Background: Uterine rupture remains a major life-threatening obstetric disaster encountered in many developing countries and is associated with a high maternal and perinatal mortality and morbidity. Objectives: The objective of this study was to determine the incidence, associated risk factors, trend, clinical presentation, management as well as maternal and fetal outcome of uterine rupture at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Materials and Methods: This was a retrospective study of patients with uterine rupture at the LUTH, Idi-Araba, Lagos, Nigeria, from June 1, 2005 to May 31, 2013. The case records of patients in this period were retrieved from the medical health records department. The relevant data of sociodemographic characteristics, clinical presentation, management as well as maternal and perinatal outcome were collated using a structured questionnaire. Results: Of the 13,138 deliveries during the study period, there were eighty cases of uterine rupture giving a hospital incidence of 6.1/1000 deliveries. Patients with parities of 1 (28.36%) and 2 (38.81%) were identified to be at higher risk of uterine rupture. Previous caesarean section (46.28%), obstructed labor (26.87%), and injudicious use of oxytocin (16.42%) were the common associated factors. Rupture along previous anterior scar was the most common site affected in 32.84%; repair with bilateral tubal ligation was the surgical procedure in most of the cases (47.76%). The case fatality rate for ruptured uterus was 11.94% for the mothers and the perinatal mortality rate of 791/1000 babies. Conclusion: Uterine rupture is a major cause of maternal and perinatal death in Lagos, Nigeria.

Maternal serum interleukin 6 levels and fetomaternal outcomes in women with preterm premature rupture of membranes in Lagos, South-western Nigeria

Abstract Objective: This study was done to assess the relationship between maternal serum IL-6 levels and fetomaternal outcome following PPROM. Methodology: This was a prospective cohort study comprising 45 cases of PPROM and 45 controls of similar age, parity, and gestational age. Five milliliters of maternal serum was collected after obtaining informed consent. They were followed up till delivery and records of the delivery and neonatal outcomes were obtained. Serum IL-6 levels were determined by standard enzyme-linked immunosorbent assay [ELISA]. PPROM patients were categorized into two groups using a threshold of 14 pg/ml. Chi-square (χ2) test was used to compare categorical outcomes. p values of < 0.05 were taken as significant. Results: The mean serum IL-6 level for the women with PPROM was (20.2 ± 11.0 pg/ml), which was significantly greater than for the control subjects (13.9 ± 5.8 pg/ml, p < 0.001). Fetomaternal outcomes were all worse in those with IL-6 ≥ 14 pg/ml. Nevertheless, only the difference in early neonatal deaths was statistically significant. Conclusion: Measurement of maternal serum IL-6 can help to indicate hostile intrauterine environments to the fetus as well as identify patients who may benefit from pregnancy prolongation or intervention.

The incidence, risk factors and determinants of perinatal outcome of umbilical cord prolapses in Lagos, Nigeria

Background: Umbilical cord prolapse is an obstetric emergency which is associated with significant perinatal mortality and morbidity as well as long-term handicap. Objectives: The objective of this study was to determine the incidence of cord prolapse, elucidate the risk factors as well as the fetal outcome at the Lagos University Teaching Hospital (LUTH). Design and Setting: A retrospective study at a tertiary care center in Lagos, Nigeria. Materials and Methods: A descriptive retrospective study of all pregnancies complicated by prolapse of the umbilical cord in LUTH from January 1, 2001 to December 31, 2010. Results: A total of 13,592 deliveries were conducted during the study period and 52 of which were complicated by cord prolapse at various cervical dilatations, thus giving an incidence of 3.8/1000 deliveries. Umbilical cord prolapses occurred commonly in women with multiple parities (51.9%), pregnancies with abnormal presentations (breech precisely) in 42.3%, abnormal lie in 30.8% with majority of the cord prolapse occurring after spontaneous membrane rupture (73.1%) while 26.9% occurred following amniotomy. Twenty-nine (55.8%) cases occurred outside the hospital setting; 69.2% of the children affected were term. The mean diagnosis–delivery interval was 53.3 ± 25.5 min, and cesarean section was the mode of delivery in 84.6%. Twenty-five percent of the children had Apgar score of ≥7 at the 1st min of life increasing to 69.2% at 5 min. The perinatal mortality was however 19.2%. Conclusion: Umbilical cord prolapse is associated with a significant perinatal mortality in this study, especially in those with spontaneous rupture of membranes that occurred outside the hospital setting.

Evaluation of maternal serum levels of dehydroepiandrosterone sulphate and its association with successful labour outcome among parturients undergoing spontaneous labour at term

Abstract This study evaluated maternal serum levels of dehydroepiandrosterone sulphate (DHEAS) in spontaneous labour and its association with successful labour at term. A cross-sectional observational study was carried out on 140 parturients. Their blood samples were collected in active labour; allowed to clot, centrifuged, separated and stored at −20 °C before analysis for DHEAS was done using the ELISA method. Labour was termed successful when vaginal delivery was achieved. Serum DHEAS levels were higher among parturients with successful labour compared to women with unsuccessful outcome (p = 0.001). DHEAS level was also higher among parturients who did not require oxytocin augmentation compared with those who required it (p = .001). The odds ratio and incidence of successful labour increased significantly as DHEAS level increased above a critical value of 1.5 μg/ml (p = .001). The association between serum DHEAS level and successful labour remained significant after adjusting for other variables (p = .002).

The influence of male partners on contraceptive usage in sub-Saharan Africa-Lagos experience

Background: Family planning programs, researches, and studies have focused mainly on women with little attention to men′s role in the contraceptive choices by the couple. Men′s exclusion from these programs has serious implications on the acceptance and use of contraceptives by the couple. Objective: To determine the influence of male partners on contraceptive use of their spouses. Subjects and Methods: This was a cross-sectional descriptive study at a Tertiary Care Centre in Lagos, Nigeria. It was conducted from January 1 to April 30, 2010, where all consecutive consenting pregnant women were given structured questionnaires to give to their partners so as to evaluate the contribution of the male partners to contraceptives use in their spouses as well as assess their awareness and knowledge of contraception. Categorical variables were analyzed using Chi-square test or Fisher′s exact test as appropriate while continuous variables by t-test. P < 0.05 was considered significant. Results: Of the 370 respondents, only 51.9% (192) knew about female contraceptive methods, while 50% (185) were willing to allow their wives to use contraception. Barrier method (17.3%) and periodic abstinence (15.7%) were the leading preferred choice for their wives. However, bilateral tubal ligation was the least preferred method (1.6%). Previous counseling of male partner significantly influenced their decision to allow their wives to use contraceptives (P = 0.001). Conclusion: Involving the male partner in family planning counseling plays an important role in increasing the acceptance and use of contraceptives by the couple.

Response to fifty grams oral glucose challenge test and pattern of preceding fasting plasma glucose in normal pregnant Nigerians

Background: Diabetes mellitus in pregnancy has profound implications for the baby and mother and thus active screening for this is desirable. Method: Fifty grams oral glucose challenge test was administered after obtaining consent to 222 women in good health with singleton pregnancies without diabetes mellitus at 24 to 28 weeks gestation after an overnight fast. Venous blood sample was obtained before and 1 hour after the glucose load. A diagnostic 3-hour 100 g oral glucose tolerance test was subsequently performed in all. Results: Two hundred and ten women had a normal response to oral glucose tolerance test i.e. venous plasma glucose below these cut-off levels: fasting 95 mg/dl (5.3 mmol/l), 1 hour 180 mg/dl (10.0 mmol/l), 2 hours 155 mg/dl (8.6 mmol/l) and 3 hours 140 mg/dl (7.8 mmol/l), while 12 were found to have gestational diabetes mellitus and were subsequently excluded from the study. They were appropriately managed. The mean maternal age was 30.9 ± 4.1 years (range 19 to 45 years) and the mean parity was 1.2 ± 1.1 (range 0 to 5). The mean fasting plasma glucose was 74.5 ± 11.5 mg/dl (range 42 to 117 mg/dl), while the mean plasma glucose 1 hour after 50 g glucose challenge test was 115.3 ± 19.1 mg/dl (range 56 to 180 mg/dl). Conclusions: The mean fasting plasma glucose in normal pregnant Nigerians was 74.5 ± 11.5 mg/dl (range 42 to 117 mg/dl). There is a need to re-appraise and possibly review downwards the World Health Organization fasting plasma glucose diagnostic criteria in pregnant Nigerians for better detection of gestational diabetes mellitus. Pregnant women with venous plasma glucose greater than 153.5 mg/dl (8.5 mmol/l) 1 hour after 50 g glucose challenge test are strongly recommended for diagnostic test of gestational diabetes mellitus.