Obstetrics. & Gynecology
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Item Emergency obstetric patients in a developing country and prevalence of HIV infection(2009) Awolude, O. A.; Oladokun, A.; Adesina, O. A.; Mutiu, W. B.; Adewole, I. F.The availability of VCT for HIV for booked antenatal patients offers a unique opportunity for best obstetrics practice but not for patients presenting with emergencies and unknown HIV status. Health workers who attend to such patients are at higher risk of acquiring HIV infections. Between 1st March 2005 and 30th September 2007, unbooked emergency obstetric patients in the labour ward of a teaching hospital who consented were tested using double rapid immunodiagnostic technique and confirmed by Western Blot. HTV positive patients were post-test counselled and offered single dose nevirapine tablet (200mg) in labour with syrup given to the baby at birth at 2mg/kg followed by syrup zidovudine for 6 weeks: The results showed that 275 (89.0%) of the 309 women pre-test counselled agreed to testing. The mean age of clients was 27.7 years (± 4.4 SD). The mean gestational age at presentation was 36.4 weeks (± 4.2 weeks). Primigravidae constituted 37.5% of the patients. Twenty-one (7.6%) of these consenting patients were H3V positive. In conclusion, the HIV prevalence of 7.6% among these unbooked obstetric patients is higher than the 4,7% among our booked antenatal patients and National prevalence of 4.4%. This poses substantial risk of transmission of HIV to attending health workers considering the readiness with which needle prick accident can occur in emergency situations.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 Screening for premalignant lesion of the cervix: determinants of patients’ practices(2005) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Adewole, I. F.Item Uncomplicated midvaginal vesico-vaginal fistula repair in Ibadan: a comparison of the abdominal and vaginal routes(2008-12) Morhason-Bello, I. O.; Ojengbede, O. A.; Adedokun, B. O.; Okunlola, M. A.; Oladokun, A.Background: Obstetric fistula is a resultant effect of prolonged obstructed labour. The best surgical management of simple uncomplicated fistula determines the outcome of care. Objective: To compare outcome of uncomplicated mid-vaginal fistula between vaginal and abdominal route of repair. Materials and Method: This was a hospital based retrospective study conducted at the University College Hospital, Ibadan from January, 2000 till December, 2006. Result: Of the 71 midvaginal fistulae managed, 40.8% had abdominal repair while the remainder were through vaginal approach. The overall repair success rate was 79.2% with comparable outcome in both groups-78.3% for the abdominal and 80% for the vaginal group (p=0.999). The duration of hospital stay did not differ significantly between the groups (p=0.972). Post operative complications were found in 41.4% of the abdominal group compared to none in the vaginal group (p<0.001). The complications were failed repair (20.7%) and urinary tract infection (20.7%). The mean estimated blood loss was 465.5ml in the abdominal group compared to 332.9ml for the vaginal group (p=0.303). Conclusion: Despite the comparable surgical repair outcome of the two methods, the vaginal approach is associated with lesser blood loss and lower risk of post-operative complications. It is recommended that the vaginal route should be employed in the repair of uncomplicated midvaginal fistula unless there are other compelling reasons to the contraryItem Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria(2008) Morhason-Bello, I. O.; Oladokun, A.; Enakpene, C. A.; Fabamwo, A .O.; Obisesan, K.A.; Ojengbede, O. A.This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15±2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p=0.00043). Majorities’ first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risksItem Awareness and desirability of the Nigerian antenatal women about analgesia use during childbirth(2007-12) Oladokun, A.; Morhason-Bello, I.O.; Eyelade, O. R.; Adedokun, B. O.; Akinycmi, J O.; Adewole, I. F.Item Sexual behaviour and contraceptie usage of secondary school adolescents in Ibadan, Nigeria(2007-12) Oladokun, A.; Morhason-Bello, I.O.; Enakpene, C. A.; Owonikoko, K.M.; Akinyemi, J.O.; Obisesan, K.A.Objective To determine the prevalence and pattern of sexual activity as well as the contraceptive practices among the selected secondary school adolescents in Ibadan, Nigeria. Methods A descriptive cross-sectional study was conducted among the selected senior secondary school students in Ibadan, Nigeria, following a stratified multistage random sampling technique. Results There were 695 respondents out of which the females constituted 51% and the males were 49%. Less than one third (28.3%) of the respondents have had previous sexual exposure at the time of the study. The median age of sexual debut among the sexually exposed was 15 years in both the males and the females. Bivariate analysis of sociodemographic characteristics of respondents with previous sexual exposure showed that, sex, religion, father’s and mother’s educational background and level of class were statistically significant(P<0.001). Further analysis using logistic regression model revealed that male respondents were 3 times more likely than females (95% CI 1.92-4.56) to have had sexual experience while those whose mother had tertiary educational background were less likely to have had previous sexual experience compared to those with secondary and lower educational background (OR= 1.76, 95% CI 1.11- 2.77). Of all the sociodemographic characteristics of respondents considered with the age of sexual partners using bivariate analysis showed that only level of class was significant (P=0.018). Less than half of the sexually active males (44.2%) were using modern method (male condom) of contraception, while 54.4% of the sexually active females were using different types of modern methods. Conclusion It is quite obvious that risky sexual behaviors are in practice among the secondary school students studied and by extension in the country. It therefore means that reproductive health issues especially concerning the adolescents will have to be openly discussed by all with our youths while abstinence/chastity should be cherishedItem Anaesthesia considerations for the HIV positive parturient(Association of Resident Doctors, University College Hospital, Ibadan, Nigeria, 2009-06) Adesina, O.; Oladokun, A.The HIV epidemic in children parallels that among women on account of perinatal transmission. A combination of antiretroviral therapy and elective caesarean section reduces the rate of vertical transmission to <2%. Elective caesarean section independent of antiretroviral therapy decreases the risk of HIV vertical transmission from mother to baby. However, a caesarean section is a major surgical intervention that has well-reported complications. Women infected with HIV have been reported to be more susceptible to such complications. The multi-organ nature of HIV poses challenges at the time of surgery and anesthesia. Preoperative evaluation will allow a good prediction for the perioperative risk of the HIV-patient. The anesthesiologist should be aware of the possible toxic side effects or the possible interaction of antiretroviral drugs with the anesthetics. Some of these adverse effects may mimic signs and symptoms of the HIV disease itself. Regional anesthesia has been shown to be associated with reduced morbidity and mortality in a wide range of patients, including HIV positive parturients. Finally, the possibility of transmission in the health care setting highlights the need for anesthetists to enforce rigorous infection control policies to protect themselves, other health workers and their patients.Item Emergency obstetric patients in developing countries and prevalence of HIV infection(College of Medicine, University of Ibadan, Ibadan, 2009) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Adewole, I. F.The availability of VCT for HIV for booked antenatal patients offers a unique opportunity for best obstetrics practice but not for patients presenting with emergencies and unknown HIV status. Health workers who attend to such patients are at higher risk of acquiring HIV infections. Between 1st March 2005 and 30th September 2007, unbooked emergency obstetric patients in the labour ward of a teaching hospital who consented were tested using double rapid immunodiagnostic technique and confirmed by Western Blot. HIV positive patients were post-test counselled and offered single dose nevirapine tablet (200 mg) in labour with syrup given to the baby at birth at 2 mg/kg followed by syrup zidovudine for 6 weeks. The results showed that 275 (89.0%) of the 309 women pre-test counselled agreed to testing. The mean age of clients was 27.7 years (± 4.4 SD). The mean gestational age at presentation was 36.4 weeks (± 4.2 weeks). Primigravidae constituted 37.5% of the patients. Twenty-one (7.6%) of these consenting patients were HIV positive. In conclusion, the HIV prevalence of 7.6% among these unbooked obstetric patients is higher than the 4.7% among our booked antenatal patients and National prevalence of 4.4%. This poses substantial risk of transmission of HIV to attending health workers considering the readiness with which needle prick accident can occur in emergency situations.Item A survey of preference of parturients in labor(Nigerian Medical Association, Akwa Ibom State Branch, 2007-02) Oladokun, A.; Adesina, O. A.; Odukogbe, A. A.; Morhason-Bello, I. O.; Kolawole, K.; Adewole, I. F.Background: There is a growing concern among parturient women to have labour management modified to accommodate some of their preferences based on their previous experience of information obtained from others. Objectives: As service care providers, we sought to identify women's attitude to some important aspects of childbirth, namely: the preferred place or environment of delivery; reasons for dislike of modem labour management; as well as attitudes (cognitive, affect and behaviour) to operative delivery, particularly caesarean delivery. Methods: A survey of women's attitude to some important aspects of childbirth was carried out with the use of questionnaires among women attending antenatal clinic at the University College Hospital, Ibadan, Nigeria. Results: The study showed a great desire by women to have someone they already know in labour (spouses 58.80%; mother/mother figure 88.68%). Forty percent of those who prefer to deliver outside hospital settings would do so due to unfriendly attitudes of doctors and midwives. Conclusion-There is the need to appropriately train doctors and midwives who attend to women in labour as regards the anxieties and needs of the women in labour.