Intravenous versus intramuscular oxytocin injection for preventing uterine atonic primary postpartum haemorrhage in third stage of labour: A double-blind randomised controlled trial.

Objectives: To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour. Methods: A double-blind randomised clinical study on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous (n = 115) and intramuscular (n = 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby's delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705. Results: The baseline socio-demographic and clinical characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml versus 249.4 ± 39.88 ml; p = 0.210), haematocrit change (2.4 (0.8%) versus 2.1 (0.6%); p = 0.412) or adverse effects (p > 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%) versus 17 (14.53%); p = 0.032). Conclusion: Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles.

Association between serum vitamin D status and uterine leiomyomas: a case-control study.

OBJECTIVE: Uterine leiomyoma is a common gynecological condition that negatively affects women's quality of life. Vitamin D plays an important role in tumor development and progression. However, clinical studies comparing serum vitamin D levels between women with and without uterine leiomyomas are limited and inconclusive. This study aimed to compare serum vitamin D levels in women with and without uterine leiomyomas. METHODS: This hospital-based case-control study included 150 women who visited a gynecological clinic. The cases included 75 women with uterine leiomyoma, whereas the controls included 75 age-and parity-matched participants without uterine leiomyoma. Serum vitamin D levels were measured in each participant and volumes of the uterine leiomyomas were determined using the water displacement method following myomectomy. The statistical significance was inferred at P<0.05. RESULTS: The mean serum vitamin D level was 15.26±4.96 ng/mL and 22.45±6.93 ng/mL for the case and control groups, respectively. The difference was statistically significant (t-value -7.302 and P<0.001). Within the fibroid group, nine (12.0%), 49 (65.33%), and 17 (22.67%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively; and in the control group, two (2.67%), 24 (45.33%), and 39 (52.0%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively. There was significant negative correlation between the fibroid volume and the serum vitamin D level (r=-0.591, P<0.001). CONCLUSION: Women with uterine leiomyoma had lower vitamin D levels than women in the control group. Lower vitamin D levels were associated with larger fibroid masses. Therefore, vitamin D supplementation may reduce fibroid growth and development.

Maternal and umbilical cord blood levels of leptin in pre-eclamptic and healthy pregnant women: A comparative cross-sectional study.

BACKGROUND: Pre-eclampsia is a multi-systemic disease with its attendant increased maternal and perinatal morbidities and mortality. It has been hypothesized that leptin contributes immensely to the natural history of pre-eclampsia. However, there is considerable disagreement in the reports of existing research work on the link between fetomaternal serum leptin levels and pre-eclampsia. OBJECTIVE: To determine and compare the maternal and umbilical cord sera levels of leptin in women with pre-eclampsia and healthy pregnant women. STUDY DESIGN: This is an analytical cross-sectional study. METHODS: The study involved consenting 120 pregnant participants (60 on each arm). Pregnant women diagnosed with pre-eclampsia constituted the investigation group, while the controls were normotensive pregnant women. They were matched for maternal age and body mass index. Venous blood specimens were obtained from the participants for assessment of the serum leptin concentration while umbilical cord blood samples were obtained following delivery of the neonate in advance of the removal of the placenta. The collected blood samples were analysed for the levels of leptin in a blinded pattern. The primary outcome measures were maternal serum leptin levels and umbilical cord serum leptin levels. RESULTS: Mean maternal serum leptin concentration in the pre-eclampsia group was significantly higher than that in the control group (24.88 ± 3.92 vs. 15.03 ± 2.98ng/mL, p < 0.001). Similarly, maternal serum leptin concentration was significantly higher in participants with severe pre-eclampsia compared with those with mild pre-eclampsia (25.91 ± 3.5 vs. 22.83 ± 4.02ng/mL, p = 0.003). However, the mean umbilical cord serum leptin level in the pre-eclampsia group was significantly lower than in the control group (6.43 ± 2.08 vs. 7.27 ± 2.24; p = 0.034). There was a weak positive correlation between maternal serum leptin level and neonatal umbilical serum leptin level in the pre-eclamptic group (r = 0.21, p = 0.04). CONCLUSION: Maternal serum leptin concentration is significantly increased in women with pre-eclampsia, compared with their normotensive counterparts. This increase becomes even more pronounced as the severity of the disease progresses. Maternal serum leptin assessment has the potential to become a veritable tool in the diagnosis and monitoring of pregnancies complicated by pre-eclampsia.

Obstetric Outcome of Induction of Labour in a Tertiary Hospital in Nigeria: A Five-Year Retrospective Cross-Sectional Study.

Background: Induction of labour has remained one of the most valuable interventions in obstetric practice. Over the years, the proportion of women undergoing induction of labour (IOL) has been on a steady increase. The significance to obstetrics practice as well as its maternal and perinatal outcomes are sacrosanct, hence the need for its periodic review. Objective: To determine the obstetric outcomes of induction of labour. Methods: A five-year retrospective study of all cases of induction of labour at the maternity unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria between January 1st 2017 and 31st December 2021. The labour ward's records were assessed to determine the total number of women who had induction of labour during the study period. Women whose case files could be not retrieved were excluded. The folder numbers of the patients were extracted and their case files retrieved from the medical records department of the hospital. The primary outcomes measures were the indications and the methods of induction of labour, while the secondary outcome measures were the mode of delivery, cause of failed induction, and the perinatal outcome. Data were obtained using proformas and analysed using statistical packages for social sciences (SPSS) version 26.0 IBM corporation. Result: A total of 3,638 deliveries were taken during the period under review and 168 patients had induction of labour giving an overall prevalence of 4.6% (46/1000 deliveries). Induction of labour was successful in 71.2% of cases. Misoprostol was used in 90.4% of cases as an induction agent. The commonest indication for induction of labour was postdate pregnancy (53.8%). Failed induction was due to fetal distress, poor progress of labour from cephalopelvic disproportion/malposition and failed cervical ripening. In about 72% of deliveries, there was good perinatal outcome, 10.3% of babies had moderate to severe asphyxia while 1.3% had neonatal death. Conclusion: Induction of labour is a safe and beneficial procedure in obstetrics. However, it can be associated with adverse obstetric outcomes.