Solomon O. Ogunniyi

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.

Occupational health hazards among health care workers in an obstetrics and gynaecology unit of a Nigerian teaching hospital

The occupational health hazards among health-care workers in an obstetrics and gynaecology unit were investigated. A total of 78 pretested questionnaires were administered to the doctors, nurses and ward orderlies in the unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. The common occupational health hazards were work-related stress (83·3%), needle-stick injuries (75·6%), bloodstains on skin (73·1%), sleep disturbance (42·3%), skin reactions (37·2%) assault from patients (24·3%) and hepatitis (8·9%). Nearly half of the staff used diazepam, lexotan or alcohol to cope with the stress of work. A greater percentage of doctors compared to nurses and ward orderlies used safety precautions such as gloves, facemasks and aprons. All the staff employed regular handwashing after various procedures. However no category of staff adopted regularly proper disposal of needles and sharps into separate puncture-resistant containers. About 59% of the staff recap used needles. The implications of the findings were discussed and recommendations made appropriately.

Ureteric injuries associated with gynecologic surgery

We conducted a review of eight ureteric injuries associated with major gynecologic surgery in seven patients over an 11‐year period. Our low incidence of 0.36% is comparable with other reports. Diagnosis was made either intra‐operatively or postoperatively. Immediate ureteric repair is advocated for all injuries discovered intra‐operatively. Attention to preventive measures both before and during gynecological operations will reduce the incidence of ureteric injuries.

A prospective randomized clinical trial of urethral catheter removal following elective cesarean delivery

To compare immediate and 24‐hour postoperative removal of urethral catheters for elective cesarean delivery.

Ectopic pregnancy in a defined Nigerian population

All cases of ectopic pregnancy in the Ile‐Ife teaching hospital between 1977 and 1987 were reviewed. The incidence per 1000 births was 4.76, and this condition accounted for 2.75% of all gynecological admissions. The associated mortality was low (0.5%). An increasing incidence was observed during the study period, as was an increasing proportion of nulliparous patients. Tubal damage from pelvic infections might account for the trends.

A randomised controlled trial of early initiation of oral feeding after cesarean section

Objective. To evaluate the safety and efficacy of early oral feeding after cesarean delivery. Methods. Two hundred women who had cesarean section were randomly assigned to early feeding or routine feeding. Women in the early feeding group were encouraged to take sips of water 8 h post-operatively, followed by oral tea of 100 mL at the time of supervision. Women in the routine feeding group were managed by restricting oral intake for the first 24 h and administration of sips of water 24–48 h post-operatively. The outcome measures include the rate of ileus symptoms, post-operative time interval to presence of bowel sounds, passage of flatus and bowel movement, time interval to return to regular diet, length of hospital stay, post-operative complications, acceptability and benefit of early oral feeding. Results. The early feeding group had a shorter mean post-operative time interval to bowel sounds 18.90 ± 4.17 h versus 36.21 ± 3.52 h (p < 0.001), passage of flatus 44.81 ± 3.73 h versus 60.58 ± 4.40 h (p < 0.001) and bowel movement 58.30 ± 5.91 h versus 72.76 ± 4.25 h (p < 0.001). There was no significant difference in paralytic ileus symptoms. Early feeding group had a shorter mean hospital stay 4.80 ± 0.59 days versus 6.69 ± 0.71 days (p = 0.001). Early feeding group required less intravenous fluid 7.14 ± 1.34 bottles versus 11.8 ± 1.32 bottles (p < 0.001). Conclusions. Early feeding after cesarean section was well tolerated and safe and can be implemented without an increase in adverse outcome.

Comparison of ceftriaxone versus triple drug regimen in the prevention of cesarean section infectious morbidities

Objective. To compare the effectiveness of single dose ceftriaxone versus multiple doses of ampiclox, gentamicin, and metronidazole to prevent infectious morbidity at elective cesarean section. Methods. This was a randomized clinical trial involving 200 pregnant women who had an elective cesarean section for various reasons during the study period. Outcome measures included endometritis, urinary tract infections, febrile morbidities, wound infections, duration of hospital stay, and cost of antibiotic therapy. Data were managed using SPSS. Results. There was no statistically significant difference in the mean duration of hospital stay between the two groups, but a significant statistical difference was found in the mean cost of antibiotic treatment (

Mortality and morbidity associated with misdiagnosis of ectopic pregnancy in a defined Nigerian population.

15 for the combination and

Rate of increase in oxytocin dose on the outcome of labor induction.

9 for ceftriaxone; p = 0.000), with the group of patients taking a single dose of ceftriaxone (ROPHEX) having a lower mean cost of treatment than those taking a combination of ampiclox, gentamicin, and metronidazole. The study groups did not differ significantly in the incidence of endometritis (14% versus 15%), urinary tract infection (11% versus 15%), wound infections (7% versus 8%), febrile morbidity (7% versus 6%), and peritonitis (0% versus 0%). Conclusion. Single dose ceftriaxone was as effective as a combination of ampiclox, gentamicin, and metronidazole in preventing post-elective cesarean section complications.

A comparative study between intramuscular iron dextran and oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy.

Ectopic pregnancies can be very difficult to diagnose at initial admission. This paper reviewed the morbidity and mortality associated with misdiagnosis of ectopic gestation over a 15-year period (1985-99) at Ile-Ife, Nigeria. There were 380 confirmed ectopic pregnancies of 35 857 live births, giving an incidence of 10.5 per 1000 live births. Of the 380 cases, 38 (10%) were misdiagnosed initially at presentation. Mistaken diagnoses include pelvic inflammatory diseases, cholera, acute appendicitis, typhoid enteritis, incomplete septic abortion, uterine fibroid with menorrhagia, malaria, gastroenteritis, peptic ulcer and intestinal obstruction. There were five maternal deaths among the 38 misdiagnosed cases compared to two maternal deaths among the 342 initially correctly diagnosed cases. Significant morbidity included prolonged hospital stay, increased hospital costs and an enterocutaneous fistula. To improve the chances of correct diagnosis at initial admission, accurate menstrual and sexual history should be obtained. Facilities for improved diagnosis such as serum beta HCG and transvaginal ultrasonography should be provided. Colleagues from other specialities should be educated to increase their suspicion of ectopic pregnancy in any woman of childbearing age and perform the appropriate investigations.