FACULTY OF CLINICAL SCIENCES
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Item Pregnancy outcome in diabetic patients at University College Hospital, Ibadan(2003-04) Oladokun, A.; Aimakhu, C. O.; Aimakhu, C. O.; Awolude, O. A.; Olayemi, O.; Adeleye, J.Context: Diabetes mellitus is one of the common medical complications in pregnancy, which if not properly controlled, can lead to significant perinatal and maternal morbidity and mortality. Objective: To determine the incidence of diabetes mellitus in pregnancy in this centre, and to assess the effect of maternal glucose control on the obstetric performance as well as perinatal outcome of pregnant diabetics managed at the University Collage Hospital, Ibadan. Study Design: A review of the obstetric outcome for 49 diabetic women who delivered at the University College Hospital, U.C.H, Ibadan, Nigeria during a 1 0-year period (January, 1991 t o D ecember 2 000) i s presented. Results: The incidence rate of diabetes in pregnancy was 0.74 per 1000 deliveries per year. Most patients (89.8%) booked for antenatal care and delivery in this centre. Good control was achieved in 77.6% of patients and the mean birth weight was 3.37 ± 1.52kg. There was no significant difference in the birth weight and fetal outcome if a patient had pre-existing or gestational diabetes. However, the outcome was significantly related to the level of control. With good control there was a better Apgar score at 5 minutes, which was prognostic for fetal outcome. The perinatal mortality rate was 98/1000 births and this was significantly associated with poor control when compared with good control (p < 0.05). There was no maternal death. Conclusion: Further improvement in the management is needed. Preconception control, early antenatal booking and good control in pregnancy are strongly advocated as means of achieving good pregnancy outcome.Item The role of ethnicity on pain perception in labour among parturients at the University College Hospital(2009-04) Olayemi, O.; Morhason-Bello, I. O.; Adedokun, B. O.; Ojengbede, O. A.Aims: In developing countries, the major mechanism by which parturients cope with labor pain is psychological. This study aims to assess the effect of ethnicity on the perception of pain by parturients in labor at the University College Hospital, Ibadan. Materials and Methods: The study was conducted between the 1 November 2006 and the 30 March 2007 at the University College Hospital Ibadan. The main outcome measure was pain perception assessed by the Box Numerical Scale (BNS). Univariate analysis was by t-test for continuous variables and c2 test for categorical variables. The multiple linear regression method was utilized for multivariate analysis. The level of statistical significance was set at P < 0.05. Results: The lowest adjusted mean BNS score was found in theYoruba ethnic group: they had scores lower than the mean scores for the other ethnic groups (-0.636 [95% confidence interval (CI) -0.959, -0.313]). The presence of a doula also reduced the mean BNS scores significantly (-0.533 [95% CI -0.844, -0.222]. Increasing parity also reduced pain scores (-0.182 [95% CI -0.342, -0.022]). Increasing educational attainment increased pain scores in labor (0.189 [95% CI 0.017, 0.361]). The influence of increasing age was not statistically significant in this model. In conclusion, ethnicity of the parturient relative to that of the predominant ethnicity in the place of birth has a significant effect on the perception of labor pain by the parturient. In our resource-challenged environment, trained doulas may help make labor less painful for the parturientItem Uterus bicornis unicollis; occurrence of consecutive viable pregnancies in separate horns(2007) Morhason-Bello, I. O.; Ojoko, I. E.; Owonikoko, K. M.; Olayemi, O.; Omigbodun, A.O.A case of two-consecutive viable pregnancies in separate horns of bicornuate unicollis uterus of a Nigerian is presented. The problem of misdiagnosis associated with the anomaly is noted. This case further demonstrates that women with such anomaly may not have unhindered reproductive carrier and antenatal care will improve their chanceItem Attitude and preferences of Nigerian antenatal women to social support during labour(Cambridge University Press, 2007) Morhason-Bello, I. O.; Olayemi, O.; Ojengbede, O.A.; Adedokun, B. O.; Okuyemi, O. O.; Orji, B.This was a hospital-based cross-sectional study of 224 randomly selected antenatal women receiving care at the University College Hospital, Ibadan, Nigeria. The study aimed to seek the attitude and preferences of respondents about social support during childbirth and also identify variables that may influence their decisions. Seventy-five per cent of respondents desired companionship in labour. Approximately 86% preferred their husband as companion while 7% and 5% wanted their mother and siblings as support person respectively. Reasons for their desire for social support were emotional (80•2%), spiritual (17•9%), errands (8•6%) and physical activity (6•8%). Socio-demographic variables found to be statistically significant on logistic regression analysis for the desire of a companion in labour were nulliparity (OR 3•57, 95% CI 1•49–8•52), professionals (OR 3•11, 95% CI 1•22–7•94) and women of other ethnic groups besides Yoruba (OR 2•90, 95% CI 1•02–8•26), which is the predominant ethnic group in the study area. Only those with post-secondary education were found to want their husbands as doula (OR 2•96, 95% CI 1•08–8•11). More than half of the respondents wanted information about labour prior to their experience. It is important that Nigerian women are allowed the benefit of social support during childbirth, particularly as there is a lack of one-to-one nursing care and other critical services, including epidural analgesia in labour, at many of the health care facilities in Nigeria. Men could play a pivotal role in the process of introducing support in labour so as to improve the outcome for both the mother and her newbornItem Promoting universal access to maternal and newborn health: myth or fact(2013) Morhason-Bello, I. O.; Aimakhu, C.O.; Adesina, O.A.; Olayemi, O.; Fasubaa, O.B.; Ladipo, O.A.Item Acceptability of counseling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria(Makerere University, 2011-03) Bello, F.; Ogunbode, O. O.; Adesina, O. A.; Olayemi, O.; Awonuga, O. M.; Adewole, I. F.Background: Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients. Objective: To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status presenting in labour. Methods: A cross-sectional study comprising counselling and obtaining consent for HIV testing among 104 unregistered patients who presented in labour over a 3-month period. Rapid and enzyme-linked immunosorbent assay screening was performed for 90 consenting respondents. Reactive results were confirmed by Western blot. Appropriate therapy was instituted. Results: Acceptance rate for HIV testing was 86.5%, prevalence of HIV was 6.7%. Women of lower educational status were more likely to accept testing in labour (OR: 0.3; 95% CI: 0.1-0.7; p=0.01); age, parity, occupation and knowledge of HIV had no influence. Most women (66.3%) had satisfactory knowledge of HIV. No one admitted to feeling coerced to test in fear of being denied care. Most refusals for screening were to avoid needle pricks (28.6%). Compared to ELISA screening test, specificity of the rapid test was 100%, sensitivity 85.7%, positive predictive value 100% and negative predictive value 98.8%. Attitude to testing was maintained on post-partum re-evaluation. Conclusion: The prevalence of HIV amongst unregistered parturients showed the importance of offering point-of-care HIV testing and intervention, especially in an environment where antenatal clinic attendance is poor. Rapid testing appeared to be acceptable and feasible in labour to prevent the mother-to-child transmission of HIV.Item Fetal macrosomia at the University College Hospital, Ibadan: a 3-year review(Taylor and Francis, 2003) Adesina, O. A.; Olayemi, O.The study aimed to determine the maternal characteristics and contribution to obstetric morbidity of infants presenting with fetal macrosomia at the University College Hospital, Ibadan. This was a retrospective study. Obstetric data of the mothers were extracted from the casenotes and analysed. Fetal characteristics such as sex and weight, and perinatal complication were also analysed. The maternal characteristics that were significantly different in the study and control groups were parity, term weight ≥90 kg, previous history of fetal macrosomia and mean duration of pregnancy. There was no significant difference in maternal age or height. The incidence of caesarean section was three times more common in the study group. There were three cases of shoulder dystocia in the study group but none in the control group. The mean birth weight of macrosomic babies delivered by section or macrosomic babies that died was higher than the mean birth weight of macrosomic babies delivered per vagina or that survived. Severe asphyxia at 1 minute was significantly higher in the study group. Perinatal mortality among macrosomic babies was 11.4/1000. There was no mortality in the control group. It is suggested that clinical suspicion of macrosomic based on risk factors such as those identified in this study may be found useful in antenatal prediction.Item Promoting universal access to maternal and newborn health: myth or fact(Corporate Office, One Media Studies, Ibadan, 2013) Morhason-Bello, I. O.; Aimakhu, C. O.; Adesina, O. A.; Olayemi, O.; Fasubaa, O. B.; Ladipo, O. A.