Obstetric performance following previous uterine rupture: A report of three cases

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An Assessment of Policies and Programs for Reducing Maternal Mortality in Lagos State, Nigeria

The objective of the study was to review the current state of policies and programs for attaining optimal maternal health in Lagos state, Nigeria. The methods consisted of in-depth interviews with key officials in the State as well as reviews of available health records. The results indicate high level commitment of the government towards achieving a reduction inmaternal mortality. Maternal mortality ratio in Lagos state is below the national average. Nevertheless, the government has accorded the provision of maternal health a top priority and has made substantial allocations in the budget for its attainment. A maternal health advisory committee exists in the state, while antenatal care services are free to women within the public health sector. The state has also embarked on training of its workforce, while major infrastructural repairs in state public hospitals are ongoing. However, residual problems include the lack of access to services for women residing in hard to reach areas, rather uncoordinated inter hospital referral system, and women’s lack of information relating to maternal health. Attention to maternal health education and women’s empowerment would boost maternal health and reduce maternal mortality in Lagos state (Afr. J. Reprod. Health 2010; 14[3]: 55-63).Key words: Maternal mortality, Lagos state, maternal health, health policies, programs

Correlates of Abortion Related Maternal Mortality at the Lagos State University Teaching Hospital, Ikeja

This study was carried out to highlight the probable correlates of mortality among patients managed for abortion related complications at the Lagos State University Teaching Hospital, Ikeja. All patients managed for abortion related complications between 1st January 2000 and 31st December 2003 were studied. Certain relevant socio demographic and clinical factors were compared among the survivors and fatalities. There were a total of 338 patients with abortion related complications. 299 survived while 39 died. Being single, nulliparous, of low educational status, presenting late and having major complications were significantly associated with mortality in this series. Encouragement of safe sex practices, increasing adolescents’ access to contraception, additional training of physicians and other appropriate heath workers in abortion care as well as the liberalisation of the restrictive abortion laws in Nigeria will go a long way in reducing abortion related mortality (Afr J Reprod Health 2009; 13[2]:139-146)

Recurrent breech presentation due to congenital uterine malformation

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Commencing open heart surgery in resource limited countries: lessons from the LASUTH experience

The challenge of commencing cardiac surgery in developing countries of Africa is onerous. We present a model from the experience of carrying out open cardiac surgical procedures at the Lagos State University Teaching Hospital (LASUTH) with three separate missions between 2004 and 2006. This paper details the challenges of starting open heart surgery in a resource limited environment. We propose that owing to the huge financial investment needed, government sponsorship as well as collaboration with overseas based and local  non-governmental agencies may be required to jump start the process of open cardiac surgery. Local staff training opportunities are also provided by such missions and this can further be complemented by overseas  exposure in areas of need for capacity building. In our centre, the initial investment has led to the recruitment of additional trained staff including 2 cardiothoracic surgeons. Further benefits of training of 2 perfusionists and a nurse has improved capacity in cardiac surgery service at our center.Key words: Open heart surgery, developing countries, lesson

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria

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 risks. Keywords: Adolescents, In- School, Sexual activity, Sexual exposure, NigeriaAfrican Journal of Reproductive Helath Vol. 12 (2) 2008: pp. 89-9

Feto‑maternal outcome of induced versus spontaneous labour in a Nigerian Tertiary Maternity Unit

Background: Induction of labour may be associated with postpartum haemorrhage, instrumental delivery, blood transfusion, longer hospital stay and admission into neonatal intensive care unit.Objective: To assess the feto‑maternal outcome of induced labour compared to spontaneous onset labour.Materials and Methods: Prospective comparative study involving 440 participants divided into induction (study) and spontaneous labour (control) groups. Data were collected on socio‑demographic data, maternal complications, blood transfusion and neonatal outcomes.Results: A total of 1540 deliveries occurred during the study period, out of which 257 had induction of labour. Successful induction rate was 16.47%. Vaginal delivery was 67.6% in the study group compared to 83.4% in the control group. Postdated pregnancy and hypertensive diseases accounted for 56.8% and 28% of the indications for induced labour, respectively. Induced labour was associated with a significantly higher caesarean section rates (P < 0.001). Cephalo‑pelvic disproportion was the most common indication for caesarean section (P = 0.038). Maternal complications include primary postpartum haemorrhage, perineal lacerations and endometritis. The study group had longer duration of hospital stay compared to the control (P < 0.001). Five perinatal mortality occurred among the study group compared to three in the control (P = 0.848).Conclusion: Induction of labour is associated with increased risk of caesarean delivery and postpartum haemorrhage compared with spontaneous labour, however, overall rates remain low.Key words: Induced labour; maternal complications; neonatal outcome; spontaneous labour

Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria

<p>Abstract</p> <p>Background</p> <p>Haemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies.</p> <p>Methods</p> <p>Case records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1^stOctober and 31^stDecember 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed.</p> <p>Results</p> <p>There were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units).</p> <p>Conclusion</p> <p>Even though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.</p

A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method.

BACKGROUND: Pregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria. METHODS: A community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15-49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee. RESULTS: Most of the respondents (28.7%) were aged 25-29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20-24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45-49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360-510]. CONCLUSION: Our findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care

Subsequent Reproductive Performance in Survivors of Complicated Abortion

Objective To study the subsequent reproductive performance of women who had undergone complicated abortions. Materials and Methods Attempts were made to trace 299 survivors of complicated abortions from an earlier study. Their contact telephone numbers and addresses had been recorded at the time of initial management. Only 237 (79.3%) were traced. Questionnaires were administered bordering on their gynecological and obstetric histories since the antecedent complicated abortions. The results were then analyzed. Results Only 237 (79.3%) subjects were available to complete the questionnaires. There was a total of 49 pregnancies (20.7%), 21 (8.9%) of which resulted in 6 preterm and 15 term deliveries, 11 (4.6%) induced abortions and 17 (7.2%) spontaneous abortions. There were 2 cases of ectopic pregnancies. There were no striking antenatal complications. 14 cases had spontaneous vertex deliveries while 5 had caesarian sections while 2 had forceps deliveries. There were 2 cases of postpartum hemorrhage. 103 (44%) of the subjects who still desired pregnancy were yet unable to conceive. Conclusions The subsequent reproductive performance in survivors of complicated abortion appears to be largely characterized by a high rate of sub-fertility, fetal wastage and preterm deliveries. Key words: abortion, reproduction, fertility, complication, survivor