Obstetrics. & Gynecology
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Item Soil transmitted helminthes infection among pregnant women in peri-urban areas of Ibadan, Nigeria: A cross-sectional study(2018) Umezurike, C. E.; Adeoye, I. A.; Oluwatoba, O. A.; Oluwasola, T. A. O."Background: Soil Transmitted Helminthes (STH) infection is an important public health problem in developing countries which adversely affects pregnant women and their newborn infants. The epidemiology of STH among pregnant women has not been fully explored in Nigeria. We examined the prevalence, intensity and risk factors of STH among antenatal care attendees in Ibadan. Methods: A cross sectional facility-based study was conducted among the 326 pregnant women attending antenatal care clinics in six selected Primary Health Care centers, in the peri-urban areas of Ibadan Oyo State. An interviewer administered questionnaire was used to obtain information on the socio-demographic, maternal, environmental characteristics and hygiene practices. Kato-Katz method was used to identify the presence of STH from stool samples. Data were analysed using chi-square and bivariate logistic analysis. Results: The overall prevalence of STH was 13.8%, 95% CI (10.0–17.7). Ascaris lumbricoides 12.8%, 95% CI (9.5–16.9) was the most prevalent followed by hookworm infection 0.6%, 95% CI (−0.2–0.15) and Trichuris trichiura 0.3%, 95% CI (−0.2–0.9). Majority of the infection were of light intensity (44 out of 45). Walking bare footed in the home environment increased the likelihood of being infected with STH [OR 1.93 95% CI (1.01–3.72) p=0.048] compared with women who wore shoes. Conclusion: STH infection is prevalent among pregnant women in the peri-urban region of Ibadan. Therefore public health interventions like active surveillance of STH and the prescription of deworming drugs will be beneficial for pregnant women. "Item Prevalence of rectovaginal group B streptococcus (GBS) among pregnant women at University College Hospital, Ibadan, Nigeria.(2016) Bello, O. O.; Kehinde, A. A.; Oluwasola, T. A. O.; Odukogbe, A. A.Context: Group B Streptococcus (GBS) or Streptococcus agalactiae, a Gram-positive bacterium causes disease primarily in infants, pregnant or postpartum women. It is associated with up to 50% neonatal mortality and significant morbidity. GBS is responsible for adverse pregnancy outcomes such as premature rupture of membranes(PROM), preterm labour, low birth 'eight and chorioamnionitis. Objectives: To determine the prevalence of CBS carriage among pregnant women and identify the risk factors for colonization. Study Design: This is a prospective cohortstudy in which two hundred and forty consenting pregnant women were screened for GBS from 35 - 40 weeks. ""Vaginal and rectal swab specimens were collected from the mothers and examined using standard bacteriological methods -CHROMagar StreptB agar plate (CHROMagarLtd, Paris, France). All GBS positive isolates were tested for antibiotic sensitivity. Results: The prevalence of vaginal and rectal GBS colonization among pregnant women in University College Hospital (UCH), Ibadan was 9.6%. 0f the 23 pregnant women with GBS colonization, 60.9% (14) were vaginal cartiers,30.4% (7) were rectal carriers while 8.7% (2) had both. GBS colonization is significantly associated with previous Preterm birth, abnormal vaginal discharge in current preenancy and preterm PROM but not with maternals sociodemographic characteristics: age, parity and gestational age. Conclusion: GBS colonization of vagina and rectum has potential risks for pregnant women and their neomates. These call for screening of women during pregnaney so as to offer intrapartum antimicrobial prophylaxis to those who are carriers.Item Awareness and practice of dual contraception among female tertiary institution students in Ibadan, Nigeria.(2016) Bello, O. O.; Oluwasola, T. A. O.; Bello, F. A.Introduction: Preeclampsia is a common complication of pregnancy and a major cause of maternal morbidity. Pathogenetic explanations for preeclampsia include: Maladaptation of the immune system to paternal antigens and exaggerated maternal inflammatory response to trophoblastic tissue. Immune deficiency, induced by human immunodeficiency virus (HIV) or any other cause, could, therefore, inhibit a tendency to immune hyper‑reactivity and thus theoretically prevent the development of preeclampsia. The study aims to explore the role of the immune theory of preeclampsia by comparing the prevalence of preeclampsia among HIV‑positive and HIV‑negative pregnant women. Materials and Methods: The study was a cross‑sectional survey of pregnant women, beyond 28 weeks gestation, who delivered at the University College Hospital, Ibadan between 1st October 2011 and 31st December 2011. Data was collected using a prespecified proforma. The analysis was performed using SPSS version 17.0 and P value was set at <0.05. Results: A total of 766 women who gave birth during the study met the inclusion criteria. Among the cohort, HIV prevalence rate was 7.2% whereas preeclampsia was 10.7%. None of the HIV‑positive women had preeclampsia. Conclusion: This study suggested that the prevalence and perhaps, risk of developing preeclampsia is reduced among HIV positive women. This is similar to other studies done in various countries in the world. There is a need for further study as it may prove valuable in the management and prevention of preeclampsia.Item Primary Ovarian Pregnancy Mimicking Abdominal Pregnancy(Wolters Kluwer Medknow Publications, 2015) Ogunbode, O. O.; Aremu, O. O.; Okolo, C. A.The objectives of this study were to emphasise that ectopic pregnancy (EP) can occasionally occur in rare sites such as the ovary, and to show that it may be difficult making the diagnosis clinically and radiologically. It also highlighted the benefit of early surgical intervention in reducing mortality and morbidity from this condition. The case was a 31‑year‑old nulliparous woman who presented with amenorrhoea of 20 weeks and a 2‑month history of lower abdominal pain. Radiological studies suggested abdominal pregnancy coexisting with uterine fibroids for which she had an exploratory laparotomy, which revealed a primary right ovarian pregnancy necessitating the performance of right ovariectomy. Locating the sites of EP may still pose a diagnostic challenge. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be confirmed at surgery.Item Bell's palsy in pregnancy and the puerperium: a report of five cases(College of Medicine, University of Ibadan, 2010) Fawale, M. B.; Owolabi, M. O.; Ogunbode, O.The incidence of idiopathic facial nerve palsy is higher during pregnancy and the puerperium than in non-pregnant women of childbearing age. An important association also exists between Bell’s palsy and hypertensive disorders of pregnancy. We describe three patients with idiopathic facial nerve palsy in pregnancy and two in the puerperium. Two of these were associated with hypertensive disorder of pregnancy. This case report illustrates the fact that Bell’s palsy is common in pregnancy and in the puerperium and often associated with hypertensive disorders of pregnancy. Association also exists between Bell’s palsy and hypertensive disorders of pregnancy [1].The clinical manifestation is the same in pregnancy as in the general population, although, it tends to run a more severe course in the former [5]. Rarely, patients have recurrent Bell’s palsy in successive pregnancies [5]. Short course of steroids early in the course of the disease has been used with some evidence of benefit [7]. We present a crop of five cases of Bell’s palsy who we saw in quick succession within a few months at the Neurology Unit of the Department of Medicine, University College Hospital, Ibadan.Item Seroprevalence and factors associated with hepatitis C coinfection among HIV-positive pregnant women at the University College Hospital, Ibadan, Nigeria(Wolters Kluwer - Medknow, 2016) Adesina, O. A.; Akinyemi, J. O.; Ogunbosi, B. O.; Michael, O. S.; Awolude, O. A.; Adewole, I. F.Aim: This study estimated the hepatitis C virus (HCV) prevalence in a population of human immunodeficiency virus (HIV) infected pregnant women, compared women who were positive or negative for HCV and described risk factors associated with HCV infection. Materials and Methods: A retrospective, case control study was conducted at the University College Hospital, Ibadan among 1821 women. Twenty‑six (1.65%) women were HCV positive, 139 (8.83%) were HBsAg positive and 1407 (89.33%) were negative for both viruses. Three patients (0.19%) were positive for both viruses. These patients, i.e., the HBsAg positive women and 246 women with no result, for either virus were excluded from analysis. Data from 1433 pregnant women is presented. Chi square test and student’s t‑test examined associations, with level of significance set at P < 0.05. Results: Overall, the mean age of the HCV positive women was lower (26.77 ± 6.53 vs. 28. 95 years ± 5.33; P = 0.04), most women had attained primary (28.49%) or secondary (42.44%) education, over 90% were married and heterosexual sex (88.67%) was the most likely risk for HIV. HCV prevalence was higher in the lower age groups (5% in the ≤ 19 years group, P = 0.021). The coinfected had more unmarried women (3.6% vs. 1.7%; P = 0.164) and more likely to indicate blood transfusion as a risk factor for HIV (6.2%; P = 0.34). Conclusion: Only age showed any significant association with HCV infection. Lack of identifiable risk factors sum up challenges for developing screening strategies in sub‑Saharan Africa. Further studies will identify factors facilitating HCV transmission in the region.Item Community attitudes toward childbearing and abortion among HIV-positive women in Nigeria and Zambia(2013) Kavanaugh, M. L.; Moore, A. M.; Akinyemi, J.; Adewole, I.; Dzekedzeke, K.; Awolude, O.; Arulogun, O.Although stigma towards HIV-positive women for both continuing and terminating a pregnancy has been documented, to date few studies have examined relative stigma towards one outcome versus the other. This study seeks to describe community attitudes towards each of two possible elective outcome of an HIV-positive woman’s pregnancy – induced abortion or birth – to determine which garners more stigma and document characteristics of community members associated with stigmatising attitudes towards each outcome. Data come from community-based interviews with reproductive-aged men and women, 2401 in Zambia and 2452 in Nigeria. Bivariate and multivariate analyses revealed that respondents from both countries overwhelmingly favoured continued childbearing for HIV-positive pregnant women, but support for induced abortion was slightly higher in scenarios in which anti-retroviral therapy (ART) was unavailable. Zambian respondents held more stigmatising attitudes towards abortion for HIV-positive women than did Nigerian respondents. Women held more stigmatising attitudes towards abortion for HIV positive women than men, particularly in Zambia. From a sexual and reproductive health and rights perspective, efforts to assist HIV-positive women in preventing unintended pregnancy and to support them in their pregnancy decisions when they do become pregnant should be encouraged in order to combat the social stigma documented in this paper.Item Risk of anaemia in HIV positive pregnant women in Ibadan, Southwest Nigeria(2011) Adesina, O.; Oladokun, A.; Akinyemi, O.; Akingbola, T.; Awolude, O.; Adewole, I.Anaemia in pregnancy is an important cause of maternal and neonatal mortality. It is a recognized co-morbidity of HIV infection. This study aimed to determine the risk of anaemia in HIV positive pregnant women. Methodology- This is a cross sectional study of healthy pregnant women attending Adeoyo Hospital, a secondary health centre in South-western Nigeria over a 1- month period (January 2007). During the study period, 2,737 eligible women presented for antenatal care. About 98% (2,682) of these women consented to HIV testing. Over all, their mean (± S.D) packed cell volume was 30.96% (±4.13). The prevalence of HIV infection was 2.9% (95% Cl 2.3% - 3.6%) and the overall prevalence of anaemia was 33.1%. Frequency of anaemia was significantly higher in HIV +ve women (57.3% vs. 42.7%, p= 0.00. OR=2.81., CI=1.72-4.58). HIV +ve women presented more frequently with moderate or severe anaemia. In the logistic regression analysis only HIV infection (OR=2.4, 95%CI=1.37- 4.21) and primigravidity (OR=1.25,95% 0=1.04-15.2) remained independently associated with anemia. Anaemia is common in HIV positive pregnant women in this environment. Care providers must endeavor to determine the HIV status of every pregnant woman especially if she presents with anaemia with a view to providing appropriate interventions.Item Human immuno-deficiency virus and hepatitis B virus coinfection in pregnancy at the University College Hospital, Ibadan(2010) Adesina, O.; Oladokun, A.; Akinyemi, O.; Adedokun, B.; Awolude, O.; Odaibo, G.; Olaleye, D.; Adewole, I. F.Human Immuno-deficiency virus (HIV) and Hepatitis B Virus (HBV) share common modes of transmission which include blood borne and the vertical routes. Although, the natural course of HTV does not appear altered by HBV, the rate of liver-related deaths is several times higher among HIV/HBV co-infected persons. Clinicians providing care for HIV positive individuals, including pregnant women, need to be aware of this problem. This is a 2-year cross-sectional study that commenced in January 2006, among HIV positive pregnant women seen at the University College Hospital, Ibadan. During the study period, 721 HIV positive pregnant women were screened for hepatitis B virus infection. Sixty-four women (8.9%) were positive for HBsAg, 14(1.9%) were HCV positive and 642 (89.2%) were negative for both HBV and HCV. One patient was positive for both HBV and HCV. There were no remarkable differences between HIV infected and IIIV-HBV coinfected patients in terms of the hematological, albumin and bilirubin measurements. Alanine transaminase was however higher in the HIV-HB V co-infected patients than HIV patients and this was statistically significant (17.5 iu/ ml vs. 15.0 iu/ml, p value- 0.009). In addition, the CD4 cell count was lower and the viral load marginally higher in the hepatitis B virus positive patients. The differences were however not statistically significant (p value- 0.114 and 0.644 respectively). HIV- HBV co-infection in HTV positive pregnant women is not of negligible proportions as demonstrated in this study. Thus, HIV positive pregnant women should be screened for HBV and assisted to access care targeted at preventing morbidity and vertical transmission.Item Anemia in pregnancy at two levels of health care in Ibadan, south west Nigeria(Annals of African Medicine Society, 2011-12) Adesina, O.; Akinyemi, O.; Oladokun, A.Background: In Africa, anemia in pregnancy contributes to non-attainment of the MDG goals 4 and 5. This study examined the prevalence and some risk factors for anemia at two levels of health care in the Ibadan metropolis. Methods: This was a retrospective study of the booking records of pregnant women at the University College Hospital (UCH, a profit-making tertiary institution) and Adeoyo Maternity Hospital (AMH, a secondary level institution offering free services) in Ibadan, September 1, 2008 to December 31, 2008. Eligible women had singleton pregnancies and no known chronic illnesses. Anemia was defined as packed cell volume (PCV) <30%, and degrees of anemia as mild (PCV 27–29%), moderate (PCV 19–26%), and severe (PCV below 19%). Statistical analysis was done by the Chi-square test, Fisher exact test, and t-test. A P value of <0.05 was considered significant. Results: Data from 2702 women (384 and 2318 from UCH and AMH, respectively) were available for analysis. About 30% of the women were anemic. The patients in UCH had higher mean PCV (33.03± 4.32 vs. 31. 04 ± 4.09, P = 0.00). A higher proportion of anemia was seen in patients presenting in Adeoyo (32.4% vs. 16.7%, P = 0.00). Factors associated with anemia included young age (P = 0.00), low parity (P = 0.00), and hospital type (P = 0.00). Parity and hospital type remained significant on logistic regression. Conclusion: Lower prevalence of anemia at the tertiary hospital maybe attributed to the higher socioeconomic status of the clientele. Short-term early antenatal management of anemia and long-term economic/educational empowerment is advocated.