Misoprostol versus oxytocin in preventing postpartum hemorrhage: A randomized controlled trial

Objective: To compare low dose sublingual misoprostol with the standard 10 IU of intramuscular oxytocin in active management of third stage of labor.Materials and Methods: A total of 104 women with term pregnancy were randomized to receive either 200 μg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included duration of third stage of labor, side effects of drugs and need for additional oxytocics to treat life‑threatening hemorrhage.Results: A total of 104 women with term pregnancy in two groups of 52 were studied. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58 ± 244.12 vs. 253.27 ± 171.74 ml; P = 0.11. There was no significant differences between the misoprostol and oxytocin groups with regard to the incidence of PPH (19.2% vs. 13.5% respectively; P = 0.43). More women in the misoprostol group experienced side effects compared with those in oxytocin group; however, the difference was not statistically significant (P = 0.26). The mean duration of third stage of labor was similar and the difference was statistically not significant (6.65 ± 3.47 vs. 6.08 ± 3.07 minutes) (P = 0.38), as well as need for additional oxytocics (13.5% vs. 5.8% P = 0.18) misoprostol and oxytocin, respectively.Conclusion: Sublingual misoprostol has similar efficacy to standard intramuscular oxytocin in preventing PPH following vaginal birth. Misoprostol at 200 μg with its thermostability may be an effective alternative to intramuscular oxytocin in active management of third stage of labor.Keywords: Primary postpartum hemorrhage; misoprostol; uterotonic

Abundance of earthworms in Nigerian ecological zones: implications for sustaining fertilizer-free soil fertility

The abundance of earthworms in the ecological zones in Nigeria has been determined and the possibility of earthworm functions replacing both mechanized land preparation and organic fertilizers discussed. The most abundant earthworms, comprising 62 % of the population, were the advantageous solid-wormcast makers. Mixed Leguminous Wooded Savanna had the highest earthworm density (1.50 million worms/ha), while Wooded Savanna had the lowest (0.23 million worms/ha). Coastal Forest and Mangrove (0.51 t/ha) had the highest earthworm biomass and Afziela Savanna/Semi-Deciduous Forest (0.03 t/ha) had the least. A new soil impact index (SIINDEX) is introduced, which simultaneously incorporates both earthworm biomass and density. The highest SIINDEX was from Mixed Leguminous Wooded Savanna (0.72) and the lowest from Afziella Savanna/Semi-Deciduous Forest (0.11). Forests with SIINDEX less than 0.2 should be regarded as endangered, because their earthworm functions are too low to accomplish significant leaf-litter breakdown and recycling. We suggest that if the illegal annual bush burning is prevented, the soil surface will be naturally mulched, earthworms protected, and by their function in the soil, the need for soil mechanization and fertilization could be replaced by earthworms to produce natural foods.Keywords: Annelida, Oligochaeta, leaf litter breakdown, soil fauna, SIINDE

SEPTICAEMIA IN HIGH RISK NEONATES AT A TEACHING HOSPITAL IN ILE-IFE, NIGERIA

Objectives: To determine the incidence, predisposing factors,clinical features, bacteriologicalpattern and antibiotic sensitivity in septicaemia in high-risk newborns.Design: A prospective study.Setting: Neonatal unit, Ife State Hospital, a unit of the Obafemi Awolowo UniversityTeaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria.Subjects: All newborns admitted with clinical features and/or risk factors suggestive ofneonatal septicaemia from February 1994 to March 1995.Main outcome measures: Culture results and mortality rates.Results: The incidence of neonatal septicaemia among new born was 22.9 per 1000 livebirths.The predisposing perinatal factors were low socio-economic status, lack of antenatal care,maternal peripartum pyrexia and congenital malformations. Gram-positive bacteria werefound to be the most prevalent causative organisms (59.4%). Staphylococcusaureus (36.2%),Pseudomonas aerugirzosa (18.8%) and Coagulase negative Staphylococcus (15.9%) were thecommonest causes of septicaemia. Meningitis and UTI were associated diagnoses in 16.7%and 18.2% of the septicaemic babies, respectively. The bacterial isolates showed a highdegree of in-vitro antimicrobial resistance. However, all the isolates were sensitive toofloxacin. Amongst the commonly used antibiotics, gentamicin had the lowest resistance.The overall mortality rate was 33.3%.Conclusion: Improvement in the socio-economic status of the populace and availability ofaffordable antenatal care would reduce the incidence of neonatal septicaemia in Nigeria.Continuous surveillance in every unit, as well as close attention to preventive strategieswould be necessary to reduce morbidity and mortality from neonatal septicaemia. Werecommend the inclusion of gentamicin in the initial treatment of septicaemia in the neonatalunit of OAUTHC, Ile-Ife, Nigeria

SEPTICAEMIA IN HIGH RISK NEONATES AT A TEACHING HOSPITAL IN ILE-IFE, NIGERIA

Objectives: To determine the incidence,predisposingfactors, clinical features, bacteriologicalpattern and antibiotic sensitivity in septicaemia in high-risk newborns.Design: A prospective study.Setting: Neonatal unit, Ife State Hospital, a unit of the Obafemi Awolowo UniversityTeaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria.Subjects: All newborns admitted with clinical features andfor risk factors suggestive ofneonatal septicaemia from February 1994 to March 1995.Main outcome measures: Culture results and mortality rates.Results: The incidence of neonatal septicaemia among new born was 22.9 per 1000 livebirths.The predisposing perinatal factors were low socio-economic status, lack of antenatal care,maternal peripartum pyrexia and congenital malformations. Gram-positive bacteria werefound to be the most prevalent causative organisms (59.4%). Staphylococcus aureus (36.2 %),Pseudomonas aeruginosa (18.8%) and Coagulase negative Staphylococcus (15.9%) were thecommonest causes of septicaemia. Meningitis and UTI were associated diagnoses in 16.7%and 18.2% of the septicaemic babies, respectively. The bacterial isolates showed a highdegree of in-vitro antimicrobial. resistance. However, all the isolates were sensitive toofloxacin. Amongst the commonly used antibiotics, gentamicin had the lowest resistance.The overall mortality rate was 33.3%.Conclusion: Improvement in the socio-economic status of the populace and availability ofaffordable antenatal care would reduce the incidence of neonatal septicaemia in Nigeria.Continuous surveillance in every unit, as well as close attention to preventive strategieswould be necessary to reduce morbidity and mortality from neonatal septicaemia. Werecommend the inclusion of gentamicin in the initial treatment of septicaemia in the neonatalunit of OAUTHC, lle-Ife, Nigeria