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 The challenges of single-short spinal anaesthesia for caesarean section in a morbidly obese patient: a case report(2005-10) Danladi, K. Y.; Sotunmbi, P. T.; Awolude, O. A.; Obisesan, K. A.An unusual case of morbid obesity, severe hypertension and twin gestation at 36weeks in an unbooked multigravid patient was presented for cesarean section. She was referred from a private clinic to the obstetric emergency unit of the University College Hospital, Ibadan with history of hypertension in pregnancy. She was a known hypertensive for ten years and her blood pressure was poorly controlled due to non-compliance with medications and medical check-up. She had been having progressive visual loss over the ten year period and had lost three, previous pregnancies. Following comprehensive clinical and radiological evaluation, she had a carefully planned single-shot spinal anaesthesia for cesarean delivery of a set of twin which was performed on a double operation table. She remained stable throughout the procedure and post operative period.Item Complete hydatidiform mole co-existing with a twin live fetus(2001) Obisesan, K. A.; Adesina, O. A.; Awolude, O. A.Item Rectovaginal and vesicovaginal communications following coital injury(2001) Odukogbe, A. A.; Onifade, R. A.; Adewole, I. F.; Adesina, O. A.; Awolude, O. A.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 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 Surgical patients’ knowledge and acceptance of autologous blood transfusion(2008-06) Olaitan, P. B.; Adekanle, D.A.; Olatoke, S.A.; Olakulehin, O.A.; Morhason- Bello, I. O.Background: Homologous blood transfusion carries a well-documented array of risks especially in an HIV endemic environment like Nigeria. It is therefore imperative to consider other forms of restoring blood volume in surgical patients. Autologous blood transfusion (ABT) is one of the ways the problem of HIV transmission can be reduced among surgical patients. The knowledge and acceptability of ABT among surgical patients about ABT, especially pre-donated ABT were assessed. It also assessed whether or not surgeons inform elective surgical patients about this alternative Materials And Methods: Questionnaires were distributed among elective surgical patients that presented during the study period. The knowledge, willingness and the factors influencing the willingness of the patients to participate in ABT were investigated. The data were analyzed with SPSS Version10. Results: Of the 116 patients [71 males; 45 females] interviewed, 29 (25.0 %) had heard about ABT, 80 (69.0 %) patients had never heard about ABT while 7 (6.1 %) were not sure. Of the 29 respondents who had heard about ABT, only 2 had had ABT. Of the 48 patients who needed blood for current surgical problems, only 4 (9.3 %) would have ABT. There was a significant difference in the number of respondents who believed that ABT is better than homologous transfusion (x2 = 69.11, p < 0.001). Conclusion: The knowledge of ABT is low among our surgical patients and surgeons should present this alternative to their patients. The acceptance of ABT may also help in reducing or eliminating HIV transmission via blood transfusionItem 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 Profile of women seeking fetal gender at ultrasound in a Nigerian obstetric population(British Medical Ultrasound Society, 2008) Ekele, B. A.; Maaji, S. M.; Bello, S. O.; Morhason-Bello, I.O.Objective: To determine the proportion of women that wanted to know fetal gender at ultrasound, characterize them and document reasons for wanting to know fetal gender. Methodology: A cross-sectional study on consecutive pregnant women at 20 weeks or more gestation that presented for prenatal ultrasound at a private hospital in Nigeria from May to December 2005. Results: Of the 1135 women, 167 (14.7%) sought to know the fetal gender. Significant independent factors included ethnic group, as women from the predominant Hausa–Fulani were less likely when compared to those of other ethnic groups (OR: 0.4, 95% CI: 0.2–0.7). Women with tertiary education were 6.6 times (OR: 6.6, 95% CI: 3.3– 13.2) more likely. Women with a previous male baby were 30.6 times more likely (OR: 30.6, 95% CI: 13.6–68.5), while those with previous female baby were 54.3 times more likely (OR: 54.3; 95% CI: 23.4–125.8) to seek fetal gender. Main reasons for seeking fetal gender were preference for a particular fetal gender (57%); what wears to buy for the baby (24%) and curiosity (18%). Conclusion: About 15% of the study group requested to know fetal gender and it was associated with ethnic group, maternal educational level and gender of the previous baby. The most common reason for wanting to know fetal gender was the desire for a particular gender