Browsing by Author "Aboyeji, Peter"
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Item Attitude and practice of birth attendants regarding the presence of male partner at delivery in Nigeria(Jimma University, Ethiopia, 2017-03-10) Adeniran, Abiodun; Adesina, Kikelomo; Aboyeji, Peter; Balogun, Olayinka; Adeniran, Peace; Fawole, AdegboyegaBACKGROUND: Despite increasing request for the male partners’ presence at delivery in developing countries, the view and practice of birth attendants remained poorly understood.This study aimed to evaluate the perception, attitude and practice of birth attendants concerning the requests in Nigeria. METHODS: A prospective, cross-sectional survey involving consenting birth attendants was conducted in six public and six private health facilities in North Central Nigeria. Statistical analysis was done with SPSS-version 20.0; p-value <0.05 was considered statistically significant. RESULTS: Among 564 participants (24.8% male, 75.2% female), 465(82.4%) support the presence of male partners at delivery, 409(72.5%) desire to be with their partner at delivery, 434(77.0%) had previous request for male partner’s presence at delivery while 225(51.8%) declined it due to perception that men will disturb. Among the male partners allowed at delivery, 92(44.0%) did not disturb the birth attendant while 5(2.4%) ended in litigation. Among birth attendants who allowed men at delivery in the past, 160(76.6%) will allow men in the future. There was no statistical significance regarding the age, gender, cadre or year of service of birth attendants and attitude to a protocol change to allow men at delivery. Birth attendants who support the presence of men at delivery showed positive attitude (OR33.178, 95%CI6.996-157.358; p<0.001) while those who opined that men would disturb at delivery had a negative attitude (OR0.306, 95%CI0.124-0.755); p0.010) to possible protocol change. CONCLUSION: Despite perceived negative effects of allowing male partners at delivery, many birth attendants are willing to allow them if necessary structural modifications are instituted.Item Domestic violence and obstetric outcome among pregnant women in Ilorin, North Central Nigeria(International Federation of Obstetrics and Gynaecology, 2014) Eno, Enang; Fawole, Adegboyega; Aboyeji, Peter; Adesina, Kikelomo; Adeniran, AbiodunItem Duration of labour with spontaneous onset at University of Ilorin Teaching Hospital (UITH), Ilorin Nigeria(Medknow, 2011-06) Ijaiya, Munirdeen; Adesina, Kikelomo; Raji, Hadijat; Aboyeji, Peter; Olatinwo, Abdulwaheed; Adeniran, Abiodun; Adebara, Idowu; Isiaka-Lawal, SalamatBackground/Objective: Duration of labor varies from one pregnancy to another and a period of less than 12 hours is regarded as normal. Modern obstetric practice involves active management of labor with the aim of preventing prolonged labor and its sequelae. The main objective of this study was to determine and compare the average duration of labor of spontaneous onset between nulliparas (Po) and multiparas (P 1) and to determine factors affecting duration of labor. Materials and Methods: This study was a prospective study carried out between 15 May and 14 June 2004 at the Labor Ward of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Two hundred and thirty-eight women who satisfi ed the inclusion criteria were studied. The inclusion criteria were term pregnancy with vertex presentation, labor with spontaneous onset, live fetus at presentation and spontaneous vertex delivery. Results: The mean ± SD admission–delivery interval in labor ward was shorter (3.77 ± 2.88 hours) among multiparas than that of nulliparas (5.00 ± 3.17 hours) (P = 0.235). The mean ± SD duration of labor (from the onset of labor to delivery) was shorter among multiparas (8.73 ± 4.17 hours) than that of nulliparas (11.23 ± 4.29 hours) (P = 0.426). The differences were not signifi cant (t-test, P > 0.05). Maternal age and individual parity had signifi cant correlation with the duration of labor in this study (Pearson correlation = −0.019, −0.027, respectively, P < 0.05). Conclusion: Interestingly, duration of labor was not signifi cantly different among multiparas and nulliparas although it was shorter. Correlation existed between duration of labor and maternal age and individual parity.Item Effect of male partner's support on spousal modern contraceptive in a low resourse setting(Jimma University, Ethiopia, 2016-09) Balogun, Olayinka; Adeniran, Abiodun; Fawole, Adegboyega; Adesina, Kikelomo; Aboyeji, Peter; Adeniran, PeaceBackground: As efforts continue to increase contraceptive uptake, male partner support remains important in spousal modern contraceptive use. METHODS: A prospective cross-sectional survey involving women on modern contraception was conducted at the family planning clinic of the University of Ilorin Teaching Hospital, Nigeria, between December 2013 and April 2014. All consenting participants completed a self-administered questionnaire designed for the study, and statistical analysis was done with SPSS version 20.0 using with chi square test and logistic regression; p value <0.05 was significant. RESULTS: There were 305 participants: 208(68.2%) were multipara, the commonest current and previous contraceptives used were IUD and injectables while male partner was responsible for discontinuation in 30(23.3%) of previous users. Covert contraceptive use was 22(7.2%), male partner support was 209(68.5%) as payment for the contraceptives (203; 66.6%) or transportation to the clinic (198; 64.9%). Also, 55(18.0%) women failed to comply with contraception recently due to male partner hindrance (25;45.5%) or inability to pay for contraceptive (11;20%) or transportation to the clinic (8;14.5%). Male partners hindered contraception by reporting the woman to relatives/friends (8;32%) or denying her money for feeding allowance (6;24%); 277(90.8%) women want contraception to be couple decision while 261(85.6%) want contraception administered only if both partners consented. The significant predictors of male partner support were awareness about the contraceptive use (p<0.001,OR0.114; CI0.041-0.319), level of education (p0.007,OR1.488; CI1.114-1.9870) and social class (p0.029,OR0.690;CI0.495-0.963). CONCLUSION: Male partner hindrances and costs of contraceptive or transportation to clinic are important in noncompliance. Male partner education, subsidized/free contraceptives and mobile/community services will improve compliance.Item Evaluation of parturient perception and aversion pre and post primary caesarean delivery in a low resourse setting(International Federation ofObstetrics & Gynaecology (FIGO), 2016) Adeniran, Abiodun; Aboyeji, Peter; Fawole, Adegboyega; Balogun, Olayinka; Adesina, Kikelomo; Isiaka-Lawal, SalamatObjective: To determine the perception of and aversion to cesarean delivery (CD) and their determinants before and after primary CD. Methods: A prospective cross-sectional survey of pregnantwomen undergoing primary CD (elective or emergency) was conducted in six health facilities in Ilorin, Nigeria. All participants completed an interviewer-administered questionnaire before the operation and 3–4 days thereafter. The statistical analysis included the calculation of odds ratios (ORs) with 95% confidence intervals (CIs) and a logistic regression. Results: Of the 254 participants, 182 (71.7%) and 53 (20.9%) had an aversion to CD before and after the procedure, respectively. A woman’s personal decision was the overriding factor influencing acceptance of the operation. Preoperative predictors of aversion were prenatal admission (OR 2.86 [95% CI,1.07–7.66]; P=0.030) and a history of previous surgery (OR 0.42 [95% CI, 0.24–0.75]; P = 0.003), whereas postoperatively a low number of prenatal clinic visits (less than four; OR 3.05 [95% CI,1.63–5.69]; P = 0.001) and a history of previous surgery (OR 0.51[95% CI, 0.27–0.96]; P = 0.034) were significant. Postprocedure, 164 (64.6%) women said they would accept a repeat CD. Conclusion: Patient education, prenatal care, and previous surgical experiences were important in determining women’s perception of and aversion to CD.Item Intermittent preventive therapy in pregnancy with sulfadoxine/pyrimethamine for malaria prophylaxis among parturients in Ilorin, Nigeria(Faculty of Medical Sciences, University of Jos, 2018-01) Adeniran, Abiodun; Mobolaji-Ojibara, Moji; Adesina, Kikelomo; Aboyeji, Peter; Ijaiya, Munirdeen; Balogun, OlayinkaBackground:The use of intermittent preventive treatment in pregnancy with sulfadoxine/pyrimethamine (IPTp-SP) for malaria remains an important tool for improving pregnancy outcome in malaria endemic areas. Objective: To assess the knowledge, attitude, and factors associated with the use of IPTp-SP among antenatal clinic attendees in Ilorin. Materials and Methods: A prospective, multicentre, cross-sectional study among consenting parturients receiving antenatal care at three public health facilities in Ilorin Ilorin, Nigeria. Statistical analysis was conducted with the Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, IL, United States) with the calculation of percentages, chi square, odds ratios (ORs), and confidence intervals (CIs); P < 0.05 was considered significant. Results: There were 422 participants with mean age of 28.8±4.7 years and 368 (87.2%) were aware of the use of IPTp-SP for malaria prevention, while 388 (91.9%) were willing to use IPTp-SP.Only 154 (36.5%)had prescription for IPTp-SPamong whom 139 (90.3%) were compliant; IPTp-SP uptake in preceding pregnancy was 148 (59.7%). The most common reason for the non use of IPTp-SP prescribed was the fear of harm to the fetus (53.3%). Significant determinants of willingness to use IPTp-SP were maternal age (P=0.007) and monthly income (P=0.013), IPTp-SP use in preceding pregnancy (P=0.001), and the treatment for malaria in index pregnancy (P=0.014). On logistic regression, maternal age <20 years (OR=36.457, 95% CI=2.260–588.011; P=0.011) and the use of IPTp-SP in preceding pregnancy (OR=0.051, 95% CI=0.010–0.252; P=0.001) were significant predictors of willingness to use IPTp-SP. Conclusion: Parturients desire IPTp-SP, but the prescription rate by healthcare providers was low. Health care providers should increase the prescription and address the concerns about its teratogenicity. Governments and other agencies should prioritize free provision and the availability of SP at health facilities.Item Male partner's role during pregnancy, labour and delivery: Expectations of pregnant women in Nigeria(College of Medicine, Qassim University, Kingdom of Saudi Arabia, 2015-07) Adeniran, Abiodun; Aboyeji, Peter; Fawole, Adegboyega; Balogun, Olayinka; Adesina, Kikelomo; Adeniran, PeaceObjectives: To evaluate the expectations of pregnant women on the role of the male partner during conception and delivery. Methodology: A prospective multi-centre observational study comprising 506 pregnant women at eight health facilities in Ilorin, Nigeria from January to June 2014. Consenting women were recruited at antenatal clinics using multistage purposive sampling and a self-administered questionnaire was administered with provision for interpreters in local dialects for those without western education. The data was analyzed using SPSS using percentages and chi-square test; p <0.05 was termed significant. Results: Participants were aged 17 to 49 years (mean 30.23±4.81), 82.4% desire male partners company during antenatal clinic visits and 59.1% experienced this in index pregnancy. During labour and delivery, 427(84.4%) want company; 345(80.8%) chose the male partner with 211(57.7%) hoping men will appreciate the value of females afterwards although 27.9% feared the men may disturb the health workers, 72(14.2%) male partners attended previous delivery and 84.8% of the women were satisfied with the experience. Significant predictors of support for male partner’s presence at delivery were maternal age (p=0.001), secondary or higher education (p=0.001) and parity less than four (p=0.001); religion (x21.010; p>0.001) and social status (p>0.001) were statistically insignificant. Pregnant women wanted education for male partners on care of pregnant women (77.0%) and sex during conception (25.2%). Conclusion: Parturient desire male partners’ presence at deliveries but their past participation was low; health facility modifications and education for men are required to meet the desires.Item Maternal near-miss in a great grandmultipara following unsafe abortion: A focus on the uncommon contributing factors(International Medical and Technological University, Tanzania, 2014-04) Adeniran, Abiodun; Fawole, Adegboyega; Adesina, Kikelomo; Aboyeji, Peter; Ezeoke, GraceUnsafe abortion and its complications have been limited to adolescents lacking family and partner support without attention to older, married women and their peculiarities regarding unsafe abortions. Main objective of the study was to focus on uncommon contributing factors to unsafe abortion in older women. A 40year old, great grandmultipara [Para 10+1,8 alive] with awareness on modern contraception underwent unsafe abortion following in severe morbidity [severe anaemia, perforated gangrenous uterus and septicaemia] which necessitated exploratory laparotomy and subtotal hysterectomy. Adequate puerperal care, cultural re- orientation, review of information in family planning jingles and liberalization of abortion law will assist in preventing unsafe abortions among older women.Item Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey(Royal College of Obstetricians and gynaecologists, 2019-03-21) Adeniran, Abiodun; Ocheke, Amaka; Nwachukwu, Dumm; Adewole, Nathaniel; Ageda, Ben; Onile, Temitope; Umezulike, A.C; Aboyeji, Peter; Oladapo, OlufemiObjective To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals. Design Secondary analysis of a nationwide cross-sectional study. Setting Forty-two tertiary health facilities. Population Women admitted with complications during pregnancy, childbirth or puerperium. Methods All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria. Main outcome measures Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). Results Of 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe non- obstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO. Conclusion Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications.Item An observation of umbilical coiling index in a low risk population in Nigeria(World Association of Perinatal Medicine, 2017) Adesina, Kikelomo; Ogunlaja, Olumuyiwa; Olarinoye, Adebunmi; Aboyeji, Peter; Akande, Halimat; Fawole, Adegboyega; Adeniran, AbiodunObjectives: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. Methods: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. Results: The mean umbilical cord length was 52.7 ± 11.5 cm, mean number of coils was 10.8 ± 5.1 and mean UCI was 0.21 ± 0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29 ± 0.12 (P = 0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. Conclusion: The UCI was not associated with adverse perinatal outcome in this study.Item Pregnancy outcome in Cervical Incompetence : Comparison of outcome before and after intervention(Society of Gynaecology and Obstetrics of Nigeria, 2014-04) Adeniran, Abiodun; Aboyeji, Peter; Okpara, Enoch; Fawole, Adegboyega; Adesina, KikelomoContext: Cervical incompetence is a major cause of recurrent mid-trimester pregnancy loss and preterm deliveries; it contributes significantly to fetal loss and neonatal morbidity and mortality. Despite its wide use, the effectiveness of cervical cerclage in its management remains unsettled. Objective: To evaluate the effectiveness of cervical cerclage by comparing the pregnancy outcome before and after its insertion in women with cervical incompetence. Study design: An observational study [retrospective] of 95 women diagnosed with cervical incompetence that had cervical cerclage inserted from 1st January 2007 to31st December 2010. The pregnancy outcome before and after cervical cerclage were compared, the data was analyzed using SPSS version 18; p value <0.05 was considered significant. Main outcome measure: The gestational age at the end of pregnancy, the duration of prolongation of the pregnancy after cervical cerclage and the pregnancy outcome. Results: Of 103 cases of cervical incompetence managed, 95 satisfied the inclusion criteria. The prevalence of cervical incompetence was 8.4/1000 deliveries or 0.85%. There were 85 elective and 10 emergency cerclage with mean gestational age at end of pregnancy of 36.06±3.96 vs. 25.10±3.99 and mean duration of prolongation of pregnancy 20.98±4.71 vs. 4.00±3.37 weeks. After cervical cerclage insertion, there was reduction in miscarriages [P<0.0001] and preterm deliveries [P<0.0001] and increase in term deliveries [P=0.4100] and viable pregnancies [P=0.001]. The child take home rate was 89.4% following elective and 20% after emergency cervical cerclage. Conclusion: Cervical cerclage resulted in improved pregnancy outcome in women with previous midtrimester losses or preterm delivery.Item Primary Postpartum Haemorrhage (PPH) in Ilorin: Current Trends(College of Health Sciences, University of Ilorin, 2014-07) Adeniran, Abiodun; Ijaiya, Munirdeen; Aboyeji, Peter; Balogun, Olayinka; Fawole, Adegboyega; Adesina, KikelomoPostpartum Haemorrhage [PPH] remains a major cause of maternal mortality all over the world. In line with the attainment of the Millennium Development Goal improve availability of blood and blood products for [MDG-5] which aims to reduce maternal death by three quarters, there is the need for a regular review. This study was carried out to determine the incidence of Primary Postpartum Haemorrhage following vaginal delivery and evaluate the trend at the University of Ilorin Teaching Hospital [UITH], Ilorin, Nigeria. This study was a hospital based retrospective study of all cases of Primary Postpartum Haemorrhage [PPH] following vaginal delivery at the centre between 1st January 2004 and 31 December 2008. The case notes of all women who had primary PPH over the study period were retrieved from the records department of the hospital and necessary information was extracted. The results were compared with previous studies on primary PPH at the centre from 1987-2003. There were 14,700 vaginal deliveries, primary PPH occurred in 614 giving the incidence of PPH as 4.2%. Unbooked patients had a three times higher risk of developing primary PPH than their booked counterparts; the commonest risk factor was grandmultiparity [27.0%], uterine atony was the commonest aetiology [54.1%] and 64.8% had blood transfusion. Uterine massage and uterotonics were effective in 44.3% and two maternal mortalities were recorded during the period. The trend in primary PPH over a 22 year period showed an improvement in survival and a reduction in mortality.Item Relationship between gross placental characteristics and perinatal outcome of low-risk singleton deliveries(National Postgraduate Medical College of Nigeria, 2016-10) Adesina, Kikelomo; Ogunlaja, Olumuyiwa; Aboyeji, Peter; Akande, Halimat; Adeniran, Abiodun; Olarinoye, Adebunmi; Fawole, AdegboyegaBackground: Gross examination of the placenta may provide useful insight into the aetiology of newborn and maternal complications. A review of literature revealed only a few epidemiological studies that determined the relationships between placental abnormalities, gestational age and occurrence of adverse outcome in babies of healthy pregnant women in our region. Patients and Methods: A prospective cross-sectional study was conducted at the Department of Obstetrics and Gynecology of University of Ilorin Teaching Hospital, between 1st February and August 2013. Pregnant women in labour at ≥28 weeks’ gestational age with singleton pregnancies were recruited. Gross examination of the placenta and umbilical cord after delivery were performed. Results: Four hundred and twenty-eight singleton deliveries were studied. The average placental weight was 580.8 ± 130.6 g (range = 125–1500 g). The mean values of the umbilical cord length and width were 52.7 ± 10.5 cm and 1.96 ± 1.11 cm, respectively. Placental abnormalities occurred in 1.2%. The umbilical cord was centrally inserted in 290 (67.8%), marginally in 31% of cases. There was significant but weak positive correlation between the placental weight, birth weight and gestational age at 40 weeks (P ≤ 0.001, r = 0.356). Placental weight was directly related to birth weight (P < 0.0001, r = 0.244) and greater in babies with congenital abnormalities (P = 0.002). Conclusions: There was an association between placental parameters and foetal outcome at birth. Placental weight was positively correlated with birth weight, gestational age and occurrence of congenital abnormalities.Item Role of risk-based approach in the prevention of vertical transmission of neonatal sepsis(National Postgraduate Medical College of Nigeria, 2015-06) Adeniran, Abiodun; Aboyeji, Peter; Fawole, Adegboyega; Adesiyun, Omotayo; Saidu, RakiyatAims and Objectives: Vertical transmission of infections remains a common cause of neonatal morbidity and mortality worldwide. We studied the risk-based approach in preventing the vertical transmission of neonatal sepsis. Patients and methods: A prospective case control study of 154 pregnant women with risk factors for vertical transmission of infections (subjects) and 154 pregnant women without the risk factors (control) at University of Ilorin Teaching Hospital, Ilorin from 1st July to 31st December, 2010. After counseling and consent taking, all participants had active management of labour and all subjects had parenteral intrapartum antibiotic prophylaxis with Ampicillin. There was postnatal evaluation of all babies for signs of neonatal sepsis followed by blood culture and treatment of culture positive babies. The outcome measures were signs and symptoms of neonatal sepsis, neonatal positive blood culture and maternal postpartum morbidity. Results: Neonatal sepsis occurred in 16 babies (subjects=11, control=5); three babies had Early Onset Group B Streptococcal Disease (EOGBSD) (subjects=2, control=1; P=0.501) while 13 had non Group B Streptococcal (GBS) infections (subjects=9, control=4; P=0.113); onset of signs and symptoms was <24hrs in all cases, incidence of EOGBSD were 12.9/1000 (subjects) and 6.5/1000 (controls). Subjects whose babies had sepsis had multiple risk factors; one dose of antibiotics and antibiotics to delivery interval <2hours. There was no sepsis in babies of mothers who had adequate antibiotic prophylaxis. There was no maternal or neonatal death but 17.5% of subjects had maternal postpartum morbidities. Conclusion: The risk-based approach is a practicable alternative in preventing vertical transmission of neonatal sepsis if antibiotic prophylaxis is adequate before delivery.Item Umbilical cord parameters in Ilorin: Correlates and foetal outcome(Kenya Medical Association, 2014-08) Adesina, Kikelomo; Ogunlaja, Olumuyiwa; Aboyeji, Peter; Olarinoye, Adebunmi; Adeniran, Abiodun; Fawole, Adegboyega; Akande, HalimatBackground: The anthropometric parameters of the umbilical cord have clinical significance. Current parameters of the cord, its correlates and related foetal outcome are lacking in our parturients. Objectives: To describe the anthropometric parameters and abnormalities of the umbilical cord; and determine their maternal correlates and foetal outcome. Design: A cross sectional analytical study. Setting: The Obstetric and Gynaecology Department of the University of Ilorin Teaching Hospital, between September 2012 and June 2013. Subjects: Healthy pregnant women with singleton pregnancies. Results: Four hundred and twenty- eight (428) singleton deliveries were studied. The respective mean values of the cord length and width were526.87±115.5mm and 19.56±11.12mm.Short cord (< 40cm) occurred in 7.2% while long cord (> 69cm) was found in9.3% of the parturient. The incidences of single umbilical artery, cord round the body and knots were 7%, 8.4% and 14.5% respectively. Nuchal cord was the most common (91.4%). Only gestational age had significant statistical relationship with cord length abnormalities (P = 0.0093). The cord length was an important correlate of cord helices, knots and vessels (P< 0.05).Parity had correlations with the number of vessels(R= 0.099, P=0.042). The cord coiling index was statistically related to the presence of congenital abnormalities (P=0.011). Other perinatal events were not related to umbilical cord parameters. Perinatal asphyxia was the most common indication for NICU admission (3.5%) but there was no significant statistical difference between NICU admission and cord parameters. Conclusion: The umbilical cord parameters in apparently healthy parturients in Ilorin were comparable with others elsewhere. The cord length and helix are important correlates of gestational age and congenital abnormalities. Parity may be related to abnormal umbilical vessels. Cord length,coils, coil index and umbilical vessels should be examined post-natally.Item Uncommon presentation of foetal bone retention after surgical induced abortion- A case report(College of Medical Sciences, University of Benin, Benin City, Nigeria, 2014-06) Adeniran, Abiodun; Fawole, Adegboyega; Aboyeji, Peter; Adesina, KikelomoRetention of foetal bone after termination of pregnancy is an uncommon gynaecological condition which may be symptomatic with its common features, asymptomatic or present with rather uncommon features. We present a 27 year old Para 0+1 single lady who was referred for suspected cervical carcinoma. She presented with foul smelling watery vaginal discharge and post coital bleeding following a surgical induced abortion performed 8 years prior to presentation. Her mother was receiving treatment for cervical cancer at the time of her presentation. Further evaluation confirmed retained foetal bones; they were removed and the symptoms stopped. The case highlights an uncommon presentation of retained foetal bone in the cervix mimicking cervical malignancy. It is a diagnosis that should be considered as a possible complication of pregnancy termination..Item Vesicovaginal fistula: A review of Nigerian experience(West African College of Physicians and Surgeons, 2010-09) Ijaiya, Munirdeen; Rahman, A; Aboyeji, Peter; Olatinwo, Abdulwaheed; Esuga, S; Ogah, O; Raji, Hadijat; Adebara, Idowu; Akintobi, Abdulhakeem; Adeniran, Abiodun; Adewole, AdebayoBACKGROUND: Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing countries. OBJECTIVE: To review the causes, complications, and outcome of vesicovaginal fistula in Nigeria. METHODS: Studies on vesicovaginal fistula were searched on the internet. Information was obtained on Pubmed (medline), WHO website, Bioline Innternational, African Journal on Line, Google scholar, Yahoo, Medscape and e Medicine. RESULTS: Many Nigerian women are living with vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria than southern Nigeria. Obstetric fistula accounts for 84.1%–100% of the vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9%–96.5%) in all the series. Other common causes include caesarean section, advanced cervical cancer, uterine rupture, and Gishiri cut. The identified predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria, while unskilled birth attendance and late presentation to the health facilities was common nationwide. Among the significant contributory factors to high rate of unskilled birth attendance were poverty, illiteracy, ignorance, restriction of women’s movement, non-permission from husband, and transportation. All but one Nigerian studies revealed that primiparous women were the most vulnerable group. Pregnancy outcome was dismal in most cases related to delivery with still birth rate of 87%–91.7%. Stigmatization, divorce and social exclusion were common complications. Overall fistula repair success rate was between 75% and 92% in a few centres that offer such services. CONCLUSION: Vesicovaginal fistula is prevalent in Nigeria and obstetric factors are mostly implicated. It is a public health issue of concern.Item When getting there is not enough: a nationwide cross-sectional study of 99 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country(Royal College of Obstetricians and Gynaecologists, 2015-05-14) Oladapo, Olufemi; Adetoro, O.O; Ekele, Bisalla; Chama, Calvin; Etuk, Saturday; Aboyeji, Peter; Onah, H.E; Abasiattai, A.M; Adamu, A.N; Adegbola, O; Adeniran, Abiodun; Aimakhu, C.O; Akinsanya, O; Aliyu, L.D; Ande, A.B; Ashimi, A; Bwala, M; Fabanwo, A; Giedam, A.D; Ikechebelu, J.I.; Imaralu, J.O; Kuti, O; Nwachukwu, D; Omo-Aghoja, L; Tunau, K; Tukur, J; Umeora, O.U.J; Umezulike, A.C; Dada, O.A; Tuncalp, O; Vogel, Joshua; Gulmezoglu, A.MObjective To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. Design Nationwide cross-sectional study. Setting Forty-two tertiary hospitals. Population Women admitted for pregnancy, childbirth and puerperal complications. Methods All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. Main outcome measures Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). Results Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were preeclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21–215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and nonavailability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. Conclusions Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.