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Biomedical subjects

O Ogunbode

Publications and source records attributed to O Ogunbode.

At least 19 recordsLinked to original sources

Pre-induction cervical ripening: transcervical foley catheter versus intravaginal misoprostol.

The object of this study was to compare the effectiveness of the intravaginal Misoprostol and transcervical Foley catheters as pre-induction cervical ripening agents, to estimate the proportion of patients achieving vaginal delivery and to compare the complications of labour and foetal outcome between the two groups. The study was a prospective, randomised study of pregnant women, with singleton pregnancies who presented for antenatal care and delivery at the University College Hospital (UCH), Ibadan, Nigeria. Ninety-nine patients were invited to participate and ninety-six (96) agreed. No patient withdrew from the study. The patients were assigned by means of computer-generated random numbers to receive transcervical Foley catheters (Size 16F, with 30 ml balloon capacity) or 50 microg intravaginal Misoprostol (Cytotec tablet, Searle & Co., Chicago). Fifty (50) patients received intravaginal Misoprostol and Forty-six (46) received Transcervical Foley catheters. The proportions of nulliparous, primiparous and multiparous patients were 52, 20 and 28% in the misoprostol group and 43.5, 26.1 and 30.4%, respectively, in the Foley catheter group. The time to achieve a favourable cervical status was significantly shorter in the Misoprostol group, with 98.0% of the subjects attaining Bishop score > or = 6 within 6-12 hours of insertion of the study agent, in contrast to 69.0% of the subjects in the Foley catheters group (P<0.001). Thirteen (26.6%) and three (6.5%) patients in the Misoprostol and Foley catheters groups, respectively, went into labour while undergoing cervical ripening and all had uneventful vaginal deliveries (P<0.05). The induction-delivery interval did not differ significantly between the groups. The incidence of caesarean delivery was 6.0% in the Misoprostol group compared with 2.2% in the Foley catheter group (P=0.62). Instrumental vaginal delivery rates were similar in both groups. Overall, the mode of delivery did not differ significantly between the groups. The number of neonates with 1-minute Apgar score <7 did not differ significantly in both groups and no neonate had 5-minute Apgar score <7. Meconium stained liquor was noticed in 5 (Misoprostol) vs 2 (Foley catheters) patients in labour. None of the neonates had any features suggestive of meconium aspiration. Labour complications were mainly precipitate labour {2 (Misoprostol) vs 1 (Foley catheters) } and 1 patient with transient tachysystole (> or =6 contractions in 10 minutes for two consecutive 10-minute periods) in the Misoprostol group. Hyperstimulation was not noticed in any of the patients in either arm of the study groups. Intravaginal Misoprostol is as effective a pre-induction cervical ripening agent as transcervical Foley catheters, with added advantages of shorter duration of cervical ripening, reduced oxytocin requirement for induction of labour and greater acceptability to patients. The incidence of caesarean sections, other labour complications and the foetal outcome were similar with both methods.

Administration, Intravaginal↗

The application of operational research (OR) procedures to maternal mortality from puerperal sepsis in a rural community.

An operation research (OR) procedure on maternal mortality from puerperal sepsis was carried out in Irepodun Local Government Area of Kwara State of Nigeria. The study involved ten focus groups discussion (FGD) in two districts of the Local Government Area. The findings were analysed from three broad perspectives, that is, consumers' views, providers' views and community decision takers' views. In general, the analysis revealed that the community knowledge of puerperal sepsis is poor. In addition, limited access and prohibitive cost of orthodox health care services prevented the community from full utilization of the few available health care centres in the community. The study also revealed that there is urgent need to introduce three key interventions for an improved maternity care in the community. These interventions are community health education, health institutions development and community participation in provision of ancillary services such as transportation.

Female↗

Lack of efficacy of pyrimethamine prophylaxis in pregnant Nigerian women.

To evaluate the efficacy of pyrimethamine on the blood stage (suppressive prophylaxis) and liver stage (causal prophylaxis) of Plasmodium falciparum in pregnant women, in vivo and in vitro field studies were conducted in Ilorin, Nigeria, from Jan 1 to June 30, 1988. For pregnant women with P falciparum infections who received 25 mg of pyrimethamine weekly for suppressive prophylaxis, 67% (59/88) of in vivo and 60% (6/10) of in vitro tests showed pyrimethamine resistance. A second group of parasitaemic and parasite-free pregnant women was enrolled to evaluate the efficacy of pyrimethamine as a primary tissue schizonticide; after receiving a curative dose of chloroquine (25 mg/kg), half the women were given 25 mg of pyrimethamine weekly and half received no prophylaxis. Parasitologic failure rates did not differ between the pyrimethamine-treated (8/34) and the control (11/37) groups during the 16-week follow-up. Thus, pyrimethamine is not effective for suppressive or causal prophylaxis in pregnant women in Ilorin.

Adolescent↗

Problems of obstetric care in Nigeria.

The problems of obstetric care in Nigeria are multifactorial, enormous but represent inevitable evolutionary stages through which every community in the world must pass. In a population of around 90 million, there is one doctor for every 11,000 people and only 35% of the population is at present covered by any form of modern health care services. There are fewer than 500 doctors with specialist obstetric qualifications and many of them are concentrated in the large cities. A disquietingly small number (17%) of our women are delivered by personnel with modern obstetric knowledge; 83% are delivered by traditional birth attendants. The maternal mortality rate is around 8/1000, and the perinatal mortality is about 60/1000. Currently less than 20% of the population is educated. Only 3% of the national budget is devoted to health. A proper communication system so vital to the establishment of liaison between doctors and the community of patients is virtually non-existent. These problems are compounded by hostile environmental factors. A mixture of tribal, superstitious and religious practices permit marriages as early as 10 years of age and prevent women in labor from seeking medical attention in a timely fashion. Fortunately programmes for improved obstetric care are being expanded. Thus the present difficulty of working in an unfavorable and challenging situation may well be worthwhile.

Communication↗

Benign hydatidiform mole in Ibadan, Nigeria.

A study was conducted to analyze 61 patients with benign hydatidiform mole (HM) who were admitted to the University College Hospital in Ibadan, Nigeria, during a 5-year period. The hospital incidence of HM was 1:205 pregnancies, and the condition was seen most commonly in young women, probably because early marriage is customary in our culture. Management of the condition generally was conservative because of the patients' youth. There was no correlation between HM and parity. Vaginal secondaries due to an embolic phenomenon were detected in 5% of the patients. Subsequent pregnancies followed within 6 months of treatment because the majority of the patients failed to heed medical advice to delay pregnancy for 2 years. No diagnostic problems were encountered in the patients who became pregnant during the follow-up period.

Abortion, Therapeutic↗

Iron deficiency in pregnant women in Ibarapa District of Western Nigeria.

Ninety-nine pregnant women with anaemia (haematocrit less than 0.30) were detected by antenatal screening in Ibarapa District. Studies on 23 anaemic women and 17 non-anaemic women from the same clinic on the same day showed that eight out of 23 anaemic women had a transferrin saturation of less than 15%. The mean level (19.5%) for the anaemic patients was significantly less than that found in the nonanaemic controls; mean 33.0% (P less than 0.01). Bone marrow studies on 32 anaemic women revealed megaloblastic change and absent iron in 27 of the 32 patients. In a trial of parenteral iron treatment in 66 patients the mean haematocrit of Imferon treated patients rose from 0.27 to 0.32 in 6 weeks but remained at 0.28 or less in the controls. There was a significant difference between the iron-treated group and the comparable group receiving no imferon (P less than 0.001 at 6 weeks). The method of using parenteral iron treatment to make a diagnosis of iron deficiency anaemia is discussed together with the possible advantages and disadvantages of giving iron.

Anemia, Hypochromic↗

The treatment of iron-deficiency anaemia with a new intramuscular iron preparation (Ferastral).

The treatment of iron-deficiency anaemia in pregnancy with a new intramuscular iron preparation, iron-poly (sorbitol-gluconic acid) complex (Ferastral), has been assessed and compared with oral iron therapy. Sixty-one of the eighty-four patients studied, many of whom had mild to moderate degree of anaemia were treated with Ferastral. The results were satisfactory, the mean increase of haematocrit at the sixth post treatment week was 28.7% for the whole series. Complete correction of anaemia was achieved in most patients between the 4th and 6th week of treatment. The mean haematocrit of the group treated with oral iron was initially significantly higher than for the group treated with Ferastral. At the first follow-up, two weeks after beginning treatment, the mean values for both groups were similar; at four weeks, those receiving Ferastral had a significantly higher mean PCV than those on oral iron, and remained so through the period of observation. No side-effects were detected using 10 ml of Ferastral intramuscularly on alternate days. The mean hospitalization time of patients with severe to moderate anaemia was reduced when given parenteral therapy, and the frequency of blood transfusion in these patients was also decreased.

Administration, Oral↗

Iron deficiency anaemia in a rural area in Nigeria. Evaluation of diagnosis and treatment with imferon.

In 32 pregnant women with packed cell volume (PCV) of 30% or less (Hb 10 g/100 ml or below), iron depletion was present in 87.5% and megaloblastic changes in 84.5% as judged by bone marrow findings. Parenteral iron gave statistically significant rise in the PCV (p less than 0.001) in those who received iron therapy compared with control group with no iron therapy. Routine iron administration during pregnancy is therefore indicated in this population.

Anemia, Hypochromic↗

Diagnosis of iron deficiency anaemia among Nigerian pregnant women by serum iron/T.I.B.C. determination.

Fifty-five patients have been investigated for anaemia in pregnancy. Using the serum iron/T.I.B.C. ratio as a diagnostic index it has been found that iron deficiency exists in 60% of our expectant mothers with mild anaemia. This type of anaemia was more common in multiparous women and more frequent in the first and second trimesters of pregnancy, There is, therefore, a strong indication for the routine administration of iron supplements to our women during pregnancy and the puerperium.

Anemia, Hypochromic↗

Iron deficiency anaemia in Nigerian pregnant women.

Ninety-four Nigerian pregnant women, many of who had mild to moderate anaemia, were investigated for the presence of iron deficiency. Using the bone marrow as the diagnostic index, 90% of these patients were found to be iron deficient. Iron deficiency is thus common among our expectant mothers. They should, therefore, be given iron supplement in addition to the present practice of folic acid and antimalarials, throughout pregnancy and the puerperium.

Adolescent↗

Urinary tract changes in obstetric vesico-vaginal fistulae: a report of 216 cases studied by intravenous urography.

Intravenous urographies carried out routinely on 216 cases of vesico-vaginal fistulae were reviewed. All the patients had suffered from urinary incontinence following obstructed labour for periods varying from immediate post-partum period to as long as 35 years with the majority (48%) presenting in the first year of the disease. One hundred and eleven patients (51-4%) showed no urinary tract abnormality. Calyceal abnormality was graded from 1-5 in ascending order of severity. The most frequent abnormality was Grade 1 (or minimal calyceal blunting) found in 75 (71%) of 105 cases showing lesions. Ten patients had non-functioning kidneys. There was no correlation of severity of calyceal grading with duration of the disease. Other notable changes were hydroureter in 75 (34%), medial deviation of the terminal ureters in 21 (9-7%) and bladder calculi in four. The study reveals a high risk of morbidity to the kidneys in patients with vesico-vaginal fistulae and the predominant role of fibrous itssue in tis genesis is postulated.

Adolescent↗