Good clinical practice advice for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria.

The impact on healthcare services in settings with under-resourced health systems, such as Nigeria, is likely to be substantial in the coming months due to the COVID-19 pandemic, and maternity services still need to be prioritized as an essential core health service. The healthcare system should ensure the provision of safe and quality care to women during pregnancy, labor, and childbirth, and at the same time, maternity care providers including obstetricians and midwives must be protected and prioritized to continue providing care to childbearing women and their babies during the pandemic. This practical guideline was developed for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria and other low-resource countries.

Hysterosalpingographic findings in infertility - what has changed over the years?

BACKGROUND: Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 - 50% of female infertility, with as high as 80% reported in some studies. With improved access to contraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered. OBJECTIVE: To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally. METHOD: A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables. RESULTS: Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency. CONCLUSION: Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency.

The predictive value of serum cancer antigen 125 (CA125) levels on pregnancy outcome in threatened miscarriages.

Background Spontaneous miscarriages are common pregnancy complications which result in psychological and emotional burden in the affected women. It is therefore necessary to identify biomarkers that can predict pregnancy outcome in women with threatened miscarriages so as to assist in their counselling and management. Methods The study compared levels of maternal serum CA125 in 65 pregnancies with threatened miscarriages (study group) with 65 normal intrauterine pregnancies (control group) between 6 weeks and 19 weeks + 6 days gestation using an enzyme linked immunosorbent assay (ELISA) technique. Results The mean age of the study and control groups were 29.5 ± 0.14 years and 30.1 ± 0.14 years, respectively. The mean serum CA125 in the study group was 30.1 ± 1.1 IU/mL while that of the control group was 22.9 ± 1.2 IU/mL and this was statistically significant (P = 0.0001). The mean serum CA125 level in the women whose pregnancies were aborted (aborters) was 34.8 ± 1.4 IU/mL while the mean value among those whose pregnancies continued till term (non-aborters) was 27.3 ± 1.2 IU/mL. This was statistically significant (P = 0.001). Further analysis using CA125 ≥36.2 IU/mL (mean value of serum CA125 among aborters + 1 standard deviation) as a threshold for intrauterine pregnancies that eventually got aborted showed a sensitivity of 66.7%, specificity of 83.3%, positive predictive value of 55.6%, negative predictive value of 88.9% and the diagnostic effectiveness (accuracy) was 79.4%. Conclusion The measurement of serum CA125 is a useful predictor of pregnancy outcome in threatened miscarriages.

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.

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).

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

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.

Fetal Macrosomia at a Tertiary Care Centre in Lagos, Nigeria.

BACKGROUND: Large babies have attracted immense attention as they present obstetric problems with associated increase in perinatal morbidity and mortality. The major risk of fetal macrosomia is trauma to the fetus and mother during vaginal delivery. OBJECTIVE: To compare the outcome of macrosomic babies with babies of normal birth weights. METHODS: This was a retrospective comparative study of deliveries over a period of two years from 1 "August 2005 to 31st July 2007. RESULTS: There were 198 macrosomic babies (6.9%) out of a total of 2,879 deliveries that occurred within the study period. Majority of the mothers were multiparous; para 2 to 4 (47.5% in the study group and 33.7% in the control group). Emergency Caesarean Section (EMCS) rate in the study group was 44.4% while it was 25.3% in the control group and this was statistically significant (p value <0.001). In this study the maternal injuries in the study group were not significantly higher than the control group. The fetal morbidity and mortality in the study group was significantly higher than the control group both with p values <0.001. CONCLUSION: Fetal macrosomia is associated with high morbidity and mortality in this centre, there is a need to identify pregnant women at risk as well as adequate counseling of possible interventions and outcomes.

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.

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.

Twin pregnancies in Sub-Saharan Africa - Lagos experience.

A total of 2,879 deliveries were conducted within 2 years and 92 were twin deliveries constituting 3.2% or 1 in 31 deliveries. The mean age and parity was 30.4 ± 3.9 years and 1.3 ± 1.4 respectively. Male infants constituted 54.4% of the twins with a sex ratio of 1.2 boys to 1.0 girl. Among twin deliveries, presentation of cephalic-cephalic was the commonest. Caesarean section rate was 65.2% in the overall twin pregnancies. Commonest indication for perinatal admission was prematurity. None of the twins delivered before 28 weeks gestation survived whereas survival was almost certain from 32 weeks gestation. There was generally no significance difference in the outcome of the babies with respect to chorionicity. Perinatal mortality was high compared with that of singleton with prematurity being the leading cause of death.

The epidemiology and management of gynatresia in Lagos, southwest Nigeria.

OBJECTIVE: To document data from patients presenting with gynatresia at 2 tertiary health centers in Lagos, southwest Nigeria. METHODS: In a prospective, descriptive study, clinical history and physical examination data were collected for women who presented with gynatresia between January 2004 and January 2011. Ultrasonography results and abnormality at surgery were also documented. Where possible, the severity of stenosis and surgical outcome were assessed by published scales. RESULTS: Forty-seven patients were included in the study. Eight patients (17.0%) presented with congenital gynatresia, the commonest cause of which was Mayer-Rokitansky-Küster-Hauser syndrome (4 patients, 50%). Thirty-nine patients (83.0%) presented with acquired gynatresia, the main cause of which was herbal pessaries (30 patients, 76.9%). Herbal pessaries were used to treat fibroids (23 patients, 76.7%), uterovaginal prolapse (3, 10.0%), and infertility (2, 6.7%); and to procure abortion (2, 6.7%). The ages of the patients who used herbal pessary ranged from 18 to 50 years (mean 36.10 ± 1.24 years). Other causes of acquired gynatresia were birth injuries (6 patients, 15.4%), and female genital mutilation (2, 5.1%). CONCLUSION: Acquired gynatresia was more common in Lagos than congenital gynatresia. The causes of acquired gynatresia are preventable and could be eliminated by health education.

Determinants of perinatal mortality in Nigeria.

OBJECTIVE: To determine risk factors for perinatal mortality among hospital-based deliveries in Nigeria. METHODS: The WHO Global Maternal and Perinatal Health Survey was implemented in Nigeria as a first step in establishing a global system for monitoring maternal and perinatal health. Twenty-one health facilities with more than 1000 deliveries annually were selected by a stratified multistage cluster sampling strategy. Information was recorded on all women who delivered and their neonates within a 3-month period. RESULTS: Overall, there were 9208 deliveries, comprising 8526 live births, 369 fresh stillbirths, 282 macerated stillbirths, 70 early neonatal deaths, and 721 perinatal deaths. The stillbirth and perinatal mortality rates were, respectively, 71 and 78 per 1000 deliveries; the early neonatal death rate was 8 per 1000 live births. Approximately 10% of all newborns weighed less than 2500 g, and 12.3% were born at less than 37 weeks of gestation. Predictors of perinatal mortality were mother's age, lack of prenatal care, unbooked status, prematurity, and birth asphyxia. CONCLUSION: The perinatal mortality rate remains unacceptably high in Nigeria. Fresh stillbirth accounted for most perinatal deaths. Interventions to improve the utilization and quality of prenatal care, in addition to the quality of intrapartum care, would considerably reduce perinatal death.

Active management of third stage of labor: evidence versus practice.

OBJECTIVE: To determine the correct use of active management of third stage of labor (AMTSL) (using the full complement of existing standard definitions) and compare the outcomes of third stage of labor in women who received AMTSL (according to these definitions) with those who did not. DESIGN: Observational, cross-sectional survey. SETTING: Seven tertiary centers in southwest Nigeria. POPULATION: Women undergoing non-instrumental vaginal deliveries. METHODS: Prospective direct observations of childbirth procedures. AMTSL was defined according to Cochrane review, ICM/FIGO (International Confederation of Midwives/International Federation of Gynecology and Obstetrics), and WHO (World Health Organization) recommendations. Main outcome measures. Use of AMTSL and its components and outcome of third stage of labor. RESULTS: There was a high rate of compliance with most of the individual components of AMTSL. The use of AMTSL varied widely with the definition applied and tended to decrease with increasing strictness of the criteria (Cochrane review: 88.9%; ICM/FIGO: 42%; WHO: 1.8%). The frequencies of adverse labor outcomes were generally low (postpartum hemorrhage (PPH): 4.9%; severe PPH: 0.8%; retained placenta: 1.9%; uterine inversion: 0.0%). Frequencies of PPH, postpartum anemia, and mean blood loss among women who received AMTSL according to the Cochrane review definition were significantly lower than for those who did not (p < 0.05). There was no significant difference between any of the outcomes for women who received AMTSL according to the ICM/FIGO definition and those who did not. CONCLUSIONS: The survey reveals substantial definition-dependent variation in the providers' adherence to recommended AMTSL practices. The clinical implications of the current practice in this population suggest the need for randomized comparison of various AMTSL packages to determine their comparative effectiveness in the prevention of PPH.

Intended postpartum contraceptive use among pregnant and puerperal women at a university teaching hospital.

OBJECTIVE: To assess the intention to use postpartum contraceptives and factors influencing use. METHOD: A total of 423 consecutive consenting women attending the pregnancy and puerperal clinics at a university teaching hospital were interviewed using structured questionnaire. RESULTS: The prevalence of previous contraceptive use was 35.5%. Fifty-four percent of the respondents intended to use contraceptives after delivery, though 3% were yet to decide. Condoms (38.3%) followed by intrauterine contraceptive device (IUCD) 11.5%, were the most preferred choice of postpartum contraceptives. However, spermicide (0.4%) was the least preferred. Advanced age and high parity significantly predicted intention to use postpartum contraceptives (P = 0.02 and 0.01, respectively). Also high level of respondent's education and family planning counseling by doctors and nurses increased the intention to use postpartum contraceptives (P = 0.03 and 0.01, respectively). CONCLUSION: Family planning counseling and education play a vital role in increasing the use of contraceptives in the postpartum period.

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

BACKGROUND: The disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers' knowledge on the subject. OBJECTIVE: To assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL. METHODS: Questionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria. RESULTS: Female 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. CONCLUSION: AMTSL 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.

Gestational age at antenatal booking in Lagos University Teaching Hospital (LUTH).

BACKGROUND: The role of antenatal care in ensuring improved pregnancy outcome is no longer in doubt. Ensuring early booking for antenatal care can optimize this benefit. OBJECTIVE: To determine the gestational age at first antenatal attendance in pregnant women at the Lagos University Teaching Hospital (LUTH). METHODS: A cross-sectional study of all pregnant women that booked at the antenatal clinic in LUTH from November 2005 to June 2006 was undertaken to determine the gestational age at booking. RESULTS: The mean age of the women was 30.5 +/- 4.5 years (range 18-46 years) and the mean gestational age at first antenatal visit for the study was 19.1 +/- 7.8 weeks (range 6 to 40 weeks). While the nulliparous and primiparous women booked earlier (mean 18.5 +/- 8.3 and 18.4 +/- 7.4 weeks respectively), those with parity 5 booked much later, mean 25.9 +/- 8.6 weeks and this was significant statistically (p < 0.0002). Only 317 (27%) had booked as at 13 weeks, the end of first trimester while the majority 647 (55.2%) booked in the second trimester (14 to 26 weeks gestation). 70 women (6%) had their first antenatal visit at > or = 34 weeks while 22 (1.9%) first booked at > or = 37 weeks gestation. However, 3 women (0.3%) booked at 40 weeks gestation. Majority of the women belonged to social class 3 (496; 42.3%) with majority of their partners also in social class 3 (490; 41.8%). However women in social class 1 and those whose partner belong to social class 1 booked earlier than the other social classes and this also was statistically significant (p < 0.0008). CONCLUSION: Nulliparous and primiparous women as well as women in social class 1 and those whose partners are in social class 1 tend to book earlier for antenatal care services. Aggressive and extensive health education on the benefit of antenatal care and the need for early booking in the first trimester is advocated. The hospital may need to review the cost of antenatal care and delivery as well as improve on the whole service package.

Gestational age at antenatal booking in Lagos University Teaching Hospital (LUTH) (revised edition).

BACKGROUND: The role of antenatal care in ensuring improved pregnancy outcome is no longer in doubt. Ensuring early booking for antenatal care can optimize this benefit. OBJECTIVE: To determine the gestational age at first antenatal attendance in pregnant women at the Lagos University Teaching Hospital (LUTH). METHOD: A cross-sectional study of all pregnant women that booked at the antenatal clinic in LUTH from November 2005 to June 2006 was undertaken to determine the gestational age at booking. RESULTS: The mean age of the women was 30.5 +/- 4.5years (range 18-46years) and the mean gestational age at first antenatal visit for the study was 19.1 +/- 7.8 weeks (range 6 to 40 weeks). While the nulliparous and primiparous women booked earlier (mean 18.5 +/- 8.3 and 18.4 +/- 7.4 weeks respectively), those with parity 5 booked much later, mean 25.9 + 8.6 weeks and this was significant statistically (p < 0.0002). Only 317 (27%) had booked as at 13 weeks, the end of first trimester while the majority 647 (55.2%) booked in the second trimester (14 to 26 weeks gestation). 70 women (6%) had their first antenatal visit at > or = 34 weeks while 22 (1.9%) first booked at 1 37 weeks gestation. However, 3 women (0.3%) booked at 40 weeks gestation. Majority of the women belonged to social class 3 (496; 42.3%) with majority of their partners also in social class 3 (490; 41.8%). However women in social class 1 and those whose partner belong to social class 1 booked earlier than the other social classes and this also was statistically significant (p < 0.0008). CONCLUSION: Nulliparous and primiparous women as well as women in social class 1 and those whose partners are in social class 1 tend to book earlier for antenatal care services. Aggressive and extensive health education on the benefit of antenatal care and the need for early booking in the first trimester is advocated. The hospital may need to review the cost of antenatal care and delivery as well as improve on the whole service package.

Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria.

BACKGROUND: Although supported by research evidence, misoprostol for induction of labour remains contentious. OBJECTIVE: To assess perception and practice of obstetricians regarding use of misoprostol for labour induction. METHODOLOGY: Cross-sectional questionnaire-based survey of Senior Registrars and Consultant Obstetricians in southwestern Nigeria. RESULTS: One hundred and six questionnaires were completed (52.8% Consultants; 47.2% Senior Registrars). Most respondents (96, 90.6%) employ misoprostol for induction in both live and dead fetuses with majority having personally prescribed misoprostol for cervical ripening or induction of labour (97.2 and 79.3%, respectively). Fetal tachycardia, hyperstimulation and ruptured uterus were the commonly reported complications. Twenty-six respondents (24.5%) reported being aware of maternal death in relation to misoprostol use. Only 52.9% of the respondents have protocols guiding misoprostol use in their hospitals. More than half of respondents administer misoprostol 50 mug or higher 6 hourly. Most (92, 87.6%) believe that research evidence backs use of misoprostol for the indication; 89.5% of respondents support use of misoprostol. Most respondents (90, 86.5%) disagree with the notion that misoprostol is too dangerous for induction; only 26 respondents (25.1%) considered oxytocin a better choice for induction; 93 respondents (88.6%) agreed that, given cautious use, misoprostol is safe for induction, while 86 respondents (81.9%) considered misoprostol a cost-effective intervention for labour induction in developing countries. Though senior registrars and younger consultants tended to report side effects more frequently than older consultants, they were more likely to support misoprostol for induction of labour than older consultants. This differences were however not statistically significant (P>0.05). CONCLUSION: Misoprostol is widely utilized by obstetricians for induction of labour in southwestern Nigeria. Fetal and maternal side effects are commonly experienced. We recommend urgent adoption of evidence-based guidelines in every unit using the drug to prevent complications.