Ante-Natal Care Utilization and Comparison of Obstetric Performance of Pregnant Women Attending Tertiary and Secondary/Primary Health Facilities in South West Nigeria.

BACKGROUND: The successful outcome of any pregnancy depends on a well formulated and implemented ANC, which to a larger extent also depends on its functional and operational continuum of care, that is affordable, accessible and of high quality during and after pregnancy and childbirth. Defective ANC, in terms of coverage and quality, has been shown to be associated with unfavourable pregnancy outcome. OBJECTIVE: To determine the maternal and perinatal outcome(Obstetric performance) of booked and referred pregnant women who though, booked for ANC in lower health care facilities but were delivered at our facility. METHODS: The is a retrospective and cross-sectional study conducted at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from the 1st of January 2017 to 31st of December 2018. RESULTS: The booked were significantly older than the unbooked (29.4±5.0 vs 28.5±5.5; P=0.001), while 47.6% and 35.3 % were nulliparous in the study and control groups respectively. Majority of the booked (69.3%) and the unbooked (59.3%) were aged 25-34 years. The mean Apgar scores at one minute were 7.0±2.0 and 4.7±3.1(P<0.001) for the booked and unbooked respectively while at five minutes they were 8.6±1.9 and 6.4±3.6 (P<0.001) for the booked and unbooked respectively and the differences were statistically significant at one and five minutes. The proportion of maternal deaths were higher among the unbooked than the booked (2.6% vs 0.4%; P<0.001), maternal morbidity ( 8.1% vs 2.5%; P<0.001) and fetal deaths (40.6% vs 6.3%; P<0.001) CONCLUSION: In all the indices and parameters compared between the two groups the unbooked patients (control) performed poorly and this is surprising despite the huge resources extended to secondary and primary health care delivery services in Nigeria.

Review of current concept in the management of pressure ulcers

Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus dis­ease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery

A retrospective analysis of eclampsia as a major cause of maternal and perinatal mortality in Sagamu

Background: While eclampsia remains a leading cause of maternal death in the developing world, the prevalence and case fatality of the condition in the developed world has reduced due to early detection and prompt treatment. The understanding of the factors associated with eclampsia may reduce the burden and enhance the quality of foeto-maternal outcome.Objective: To determine the prevalence of eclampsia and the associated foeto-maternal outcome. Methods: A retrospective study of patients who presented with eclampsia at the Olabisi Onabanjo University Teaching Hospital (OOUTH) between January 2008 and December 2012 was carried out. The hospital records were retrieved and the data extracted included the age, parity, gestational age at presentation, booking status, mode of delivery, outcome of baby and mother, and the total delivery in the hospital over the period.Results: The prevalence of eclampsia over the period was 1.1%. Eclampsia was common among women aged 25years and below (64.3%), nulliparous women (78.6%) and unbooked (100.0%). Caesarean section was carried out on 63.0% of the patients on account of unfavourable cervix, while 22.2% of patients had spontaneous vagina delivery. Most (96.4%) received magnesium sulphate (MgSO4) therapy but 22.2% convulsed while receiving it. Maternal mortality was 7.1% while perinatal mortality rate was 250/1000 live birth.Conclusion: Eclampsia remains a cause of maternal morbidity and preventable death in the understudied community. Early antenatal booking and the use of MgSO4 are effective in reducing the burden

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria.

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6%) and 3 (0.9%) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12 (3.4%) and 4 (1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups. (Afr Reprod Health 2008; 12[1]:96-100)

Presentation and outcome of eclampsia at a Nigerian university hospital.

OBJECTIVE: To review the presentation of eclampsia and its outcome on the mother and babies in our environment with a view to suggesting strategies for improvement. METHODS: A retrospective study at 93 cases of eclampsia treated at Olabisi Onabanjo University Teaching Hospital Sagamu was undertaken. Data was collected by scrutinizing the case files collected from the medical records library after collecting their numbers from the labour ward register. RESULTS: There were 93 cases of eclampsia out of a total delivery of 5423 giving an incidence of 1.7 percent. Almost all the patients (96.8%) were unbooked. Antepartum eclampsia constituted 93.5 percent of cases. Nulliparous teenagers were the most commonly affected with a relative risk of 25 when compared with multips. Caesarean delivery was more common than vaginal delivery in the ratio 6:4. There were 19 maternal deaths, a case fatality rate of 20.0 percent and this was not related to the mode of delivery. (RR 1- 1.1). The perinatal mortality was significantly less with caesarean delivery (RR 1:0.38). CONCLUSION: Eclampsia, occurring mainly in unbooked patients is still one of the major causes of maternal mortality and good antenatal care will significantly reduce the incidence and improve the outcome especially in teenage nullipara who are mostly susceptible.

Tertiary hospital staff and caesarean section risk.

A matched case-control study was conducted to determine whether pregnant employees of a Nigerian teaching hospital are more at risk of caesarean than vaginal delivery. Cases (n = 167) were booked patients who had singleton emergency caesarean delivery in their last confinement at term while controls (n = 167) were similar patients who had vaginal delivery (spontaneous or assisted) during the same period. Cases and controls were matched for known clinical risk factors for caesarean section. The proportion of hospital staff members among the cases was 36/167 (21.6%), compared with 21/167 (12.6%) among the controls, a difference that reached statistical significance (p = 0.03). Matched analysis examining the association of place of work with caesarean delivery indicated that hospital staff members are almost twice at risk of caesarean section than vaginal delivery (Mantel-Haenszel OR: 1.83; CI: 1.08 - 3.85). Multivariate conditional logistic regression analysis examining the association of hospital personnel with caesarean delivery while controlling for potential confounding variables revealed an adjusted odds ratio of 1.79 (CI: 1.02 - 3.74). Appraisal of caesarean section rate in teaching hospitals in southwest Nigeria could benefit from critical evaluation of the risk of caesarean section among parturients who are members of staff.

Cancer of the cervix.

Cases of cancer of the cervix histologically diagnosed at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between January 1991 and December 2000 were reviewed. There was 1,912 total gynaecological admissions during that period and 56 histologically diagnosed cancer of the cervix for an incidence of 2.9%. The mean age at occurrence of the cancer was 51.7 + 12.4 years. It was more common in grandmultiparous women and major presenting complaints were abnormal vaginal bleeding, (64.3%) watery discharge (25.0%) and postcoital bleeding (7.1%). Histologically, 96.4% has squamous cell carcinoma of varying degree of differentiation and most (78.6%) presented in the advanced stages. Majority (80.4) were referred for radiotherapy at either Lagos University Teaching Hospital or University College Hospital, Ibadan. Only 5.4% of cases were treated by radical hysterectomy. Measures to reduce the incidence and morbidity would include mass education of the sexually active women to have cervical smear regularly and also to report symptoms early so as to diagnose the invasive disease in the early stages.

Microbial isolates and HIV infection in couples attending fertility clinics in Sagamu, Nigeria.

This observational study was designed to determine the prevalence of HIV infection and the microbial isolates from the genital tracts of couples attending the fertility clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria between January 2001 and December 2002. A total of 110 women and 49 of their male partners were recruited into the study. The majority of the patients were between 25 and 34 years (women: 71.8%; partners: 65.3%), though the men were significantly older than the women (p < 0.001). The overall prevalence of HIV infection in those who consented to screening was 8.2%, which was over twice the reported prevalence among the general population in Ogun State, Nigeria during the study period. Candida albicans (32.5%) and Staphylococcus aureus (27.5%) were the most frequently isolated microorganisms from the endocervix while Trichomonas vaginalis (37.9%) and Staphylococcus aureus (24.1%) were the most common microbes isolated from the posterior vaginal fornix. Of all the seminal qualities, only the volume showed a significant difference between the infected and non-infected samples (p < 0.004). This study suggests a higher prevalence of HIV infection among the infertile couples in our environment and it may be advisable to have them screened for HIV in the face of the present HIV situation in sub-Saharan Africa.

Sexual behaviour and contraceptive practice of future doctors in Southwest Nigeria.

The sexual behaviour and contraceptive practice of 498 clinical students of a randomly selected medical college in Southwest Nigeria was studied in June 2003. More than two-thirds (67.5%) of the students had (ever had) sexual intercourse while 49.8% of them had ever used contraception. Only 26.1% of the 119 sexually active students used contraception during their last sexual intercourse. The most common contraceptive methods ever used by the students were the condom (54.6%) and rhythm method (39.5%) though a third of them incorrectly identified the limits of the fertile period. Contraception for single sexually active students was disapproved by 11.2% of the participants while 9.8% of them regarded avoidance of HIV patients in the hospital as a preventive measure against HIV infection. This survey reinforces the need for integration of a suitable sexuality course into our medical undergraduate curriculum in order to facilitate the delivery of reproductive health programmes in the future.

Factors militating against delivery among patients booked in Olabisi Onabanjo University Teaching Hospital, Sagamu.

BACKGROUND: A preliminary review of antenatal and delivery records of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu revealed that only 47.6% of booked pregnant women subsequently delivered there. This observation stimulated a thought to carry out a study to find out the proportion of pregnant patients who booked in OOUTH and subsequently delivered in OOUTH, patients' preferred place of delivery and factors militating against OOUTH delivery. METHOD: A cross-sectional study was carried out on pregnant patients booked at OOUTH, Sagamu between December, 2001 and May, 2002 to find out factors militating against delivery at OOUTH. Two hundred and sixty six questionnaires were returned properly filled. RESULTS: The age range of the pregnant women was 16 to 42 years with a mean age of 31.2 +/- 3.4 years. The parity ranged from 1-5 with a mean of 2.1 +/- 1.1. The preferred place of delivery was private hospital (58.3%), followed by OOUTH (28%). The higher the educational level, the more they tended to hospital delivery; 57% of the pregnant women who had hospital deliveries had tertiary education. While 52.7% of the pregnant women gave miscellaneous reasons such as relocation, being used for experiment, too many students being present, and frequent strikes by hospital workers for not delivering in OOUTH, as much as 16.5% said the time wasting and bad attitude of the hospital staff were responsible for preferring centres other than OOUTH for delivery. CONCLUSION: OOUTH like most other teaching/government hospitals need to be more user-friendly to encourage better patronage. There is a need to educate the patients that attend teaching hospital on the essence of establishing teaching hospitals and the importance of training medical students and retraining of doctors in order to maintain a continuity and high standard of medical practice.

The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetric practice.

A retrospective and comparative study of women delivered by caesarean section over two different 3-year periods was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The caesarean section rate (CSR) increased from 10.3% in 1989-1991 to 23.1% in 2000-2003. The most frequent indication in both periods was different: prolonged/obstructed labour (20.0%) in 1989-1991 and antepartum haemorrhage (14.9%) in 2000-2003. Malpresentation, antepartum haemorrhage and pre-eclampsia/eclampsia were responsible for 51.7% of the difference in the CSR recorded between both periods. The CSR rose from 13.3% to 25.0% while the instrumental vaginal delivery (IVD) rate decreased significantly by 11.4% among the nulliparous women between the periods. Increase in CSR can be attributed mainly to reduction in IVD rate and alteration in the management of labour complications and induction policy. Strategies to reduce the CSR should cut across all indications and focus on encouraging instrumental vaginal deliveries, especially among nulliparous women.

Female genital mutilation: an analysis of 522 cases in South-Western Nigeria.

This study was conducted at three teaching hospitals in South-Western Nigeria. Paturients were examined to find out if they had had female genital mutilation. Those who did were given a self-administered questionnaire. Results show that all the patients had either Type I (69%) or Type II (31%) mutilation (using WHO classification). The average age at which the procedure was performed was 6.9+/-2.9 years, with 4% of women having the procedure performed in pregnancy. The majority of the procedures were performed by medically untrained personnel (89%). Up to 67% of the women reported complications following the procedure. Severe pain and bleeding were the most common (69%) of the complications reported. The most common reason given for the procedure is cultural/traditional (63%). About a fifth of the women want their female child to undergo female genital mutilation. This study highlights the need for further interventions aimed at discouraging the practice of female genital mutilation.

The pattern of infertility cases at a university hospital.

Pattern of infertility cases attending the gynaecologic out patient clinic of Ogun State University Teaching Hospital, Sagamu Nigeria is presented. The incidence of infertility was found to be 14.8% with a mean duration of 3.38 +/- 1.65 years. Secondary infertility predominated with 78.3% incidence. About three quarters (71.1%) were between 25 and 34 years of age and only 6.0% were below 25 years of age Nullipara constituted majority of cases with 56.6%. Past history of induced abortion was significantly present in those with tubal blockage. Male factor only was the cause in 26.8%, female factor only in 51.8% and both male and female factors were contributory in 21.4% cases. The male partners refused semen analysis in about one third of cases (32.5%).

Ruptured uterus at Sagamu, Nigeria.

Ruptured uterus, the largest contributor to maternal deaths in our center was reviewed to find ways of reducing it and improve the outcome. Sixty cases treated at Ogun State University Teaching Hospital, Sagamu between January 1988 and December 1997 were scrutinised. During the 10 year period, total deliveries were 5,214 giving an incidence of 11.5 per 1,000. 76.7% of cases occurred in patients aged 30 years and more; and 58.6% in para 4 and more. 88.3% were unbooked. The ruptures were spontaneous in 76.7% and lower uterine segment was the most common (80%). Uterine repair with sterilisation was carried out in 46.7%, sub total hysterectomy in 26.7% and repair only in 11.7%. Most of the aetiological factors were preventable by good antenatal care and the outcome improved by early referral and efficient blood transfusion system.

Impact of asymptomatic maternal malaria parasitaemia at parturition on perinatal outcome.

A cross-sectional study involving 564 parturients who delivered singleton babies and 214 matched non-pregnant controls was carried out to determine the prevalence and impact of asymptomatic maternal malaria parasitaemia at parturition on the perinatal outcome. One hundred and forty (24.8%) parturients and 50 (23.4%) non-pregnant women were found to have asymptomatic malaria parasitaemia, respectively, while the congenital malaria rate in the neonates of the parasitaemic parturients was 0.7%. The incidence of malaria parasitaemia was higher in the para 2 and over (29.33%) as compare to the para 1 (21.43%) and primigravid (18.42%). There was no significant difference between the mean birth weight of infants delivered by parasitaemic parturients (2.93+/-0.61 kg) and aparasitaemic parturients (3.07+/-0.32 kg) (P=0.501). There was also no significant difference when comparing the mean placental weight of the parasitaemic mothers (0.60+/-0.15 kg) with that of the aparasitaemic mothers (0.62+/-0.20 kg) (P=0.329). Only in the para 2 and over was the mean placental weight of the parasitaemic mothers significantly lower than that of the aparasitaemia mothers (0.46+/-0.16 kg; 0.66+/-0.23 kg P=0.035). The mean packed cell volume of the parasitaemics parturients (30.89+/-1.87) was significantly lower than the aparasitaemic parturients (31.98+/-2.25) (P<0.001). Significant difference was not achieved between the parasitaemics and aparasitaemics inrespect of apgar score at 1 minute, or at 5 minutes, premature births (16.43%; 15.33%; P>0.05), stillbirth rate (3.57%; 2.59, P>0.05), mean placental index (0.204, 0.202, P>0.50) and mode of delivery. The findings in this study show that even though malaria parasitaemia is prevalent in our locality, the effects on maternal and fetal wellbeing are comparable with the aparasitaemics.

Complicated induced abortion in Sagamu, Nigeria.

A review of cases of induced abortion managed at Ogun State University Teaching Hospital, Sagamu from January 1988 to December 1997 is presented. One hundred and two cases were treated for various complaints and complications of induced abortion during the period of review. The mean age in years was 24.6+/-5.8. The groups 20-24 years, 15-19 years and 25-29 years constituted 39.2%, 23.5% and 18.6%, respectively, of the patients. Mean parity was 1.7+/-1.8. Thirty-eight point two per cent, 30.4% and 17.6% were para zero, 2-4 and 1, respectively. Fifty-one per cent of the patients were single. Thirty-four point three per cent, 15.7% and 2.0% of the patients have had one, two and three induced abortions before. Forty-five point one per cent of the patients refused to disclose where and who performed the abortion, while 31.4%, 10.8% and 7.8% of the abortions were carried out by physicians, quacks and nurses. Forty-five point one per cent of the patients procured the abortion at the gestational age of 13-24 weeks, while 26.5% waited for 10 days and over after the abortions before seeking for medical help. Thirty-six point eight per cent and 26.3% of operators in fatal cases were physicians and nurses, respectively. The mean admission interval after abortion for fatal cases was 11.1+/-3.2 days and 4.0+/-3.5 days for other cases that survived and the difference was significant (t=8.0930; P<0.001). Eighty-five point three per cent had never used any form of contraception. Seventy-nine point four per cent, 61.8% and 6.9% of the patients presented with bleeding per vaginam, abdominal pains and fever, respectively. The most common complications were anaemia (56.9%), haemorrhages (46.1%), sepsis (33.3%) and maternal death (18.6%). The maternal mortality ratio was 18 627.5 per 100 000. The difference between maternal mortality ratio due to abortion and the general population (1578.9) was statistically significant (chi(2)=126.4281, P<0.001). Sunction aspiration (76.5%) and exploratory laparatomy (9.8%) were the most common operations performed. The findings in this series further highlight the urgent need to eliminate or reduce substantially the factors responsible for septic induced abortion.

Maternal mortality at Sagamu, Nigeria--a ten year review (1988 - 1997).

A review of maternal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria over a 10 year period is presented. During the period, there were 92 maternal deaths, those from abortion and ectopic pregnancy inclusive. The total deliveries were 5423 giving a maternal mortality ratio of 1700 per 100,000. Ruptured uterus was the most common cause followed by eclampsia, postpartum haemorrhage and complications of abortion in that order. Unbooked patients constituted about one third of the total (29. 1 %). Primipara and grandmultipara were the most at risk of maternal death and the risk of dying following operative delivery was six times that of vaginal delivery. Easy access to affordable antenatal care, good blood transfusion services, more widespread use of contraceptives and training of traditional birth attendants would help reduce the risk of maternal death.