Department of Obstetrics and Gynaecology

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Browsing Department of Obstetrics and Gynaecology by Subject "Anaemia"

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    Open Access
    Low-dose aspirin for preventing intrauterine growth restriction and pre-eclampsia in sickle cell pregnancy (PIPSICKLE): a randomised controlled trial (study protocol)
    (BMJ Open, 2021-08) Afolabi, B.B.; Babah, O.A.; Adeyemo, T.A.; Odukoya, O.O.; Ezeaka, C.V.; Nwaiwu, O.; Oshodi, Y.A.; Ogunnaike, B.A.
    Introduction: Pregnancy in sickle cell disease is fraught with many complications including pre-eclampsia (PE) and intrauterine growth restriction (IUGR). Previously, we found an abnormality in prostacyclin-thromboxane ratio in sickle cell pregnant women, a situation that is also found in non-sickle pregnancies with PE and unexplained IUGR. Low-dose aspirin (LDA) has been shown to reduce the incidence of PE and IUGR in high-risk women by reducing the vasoconstrictor thromboxane while sparing prostacyclin, in effect 'correcting' the ratio. It has been found to be safe for use in pregnancy but has not been tested in sickle cell pregnancy. We hypothesise that LDA will reduce the incidence of IUGR and PE in pregnant haemoglobin SS (HbSS) and haemoglobin SC (HbSC) women. Methods and analysis: This is a multisite, double blind, randomised controlled trial, comparing a daily dose of 100 mg aspirin to placebo, from 12 to 16 weeks' gestation until 36 weeks, in Lagos state, Nigeria. Four hundred and seventy-six eligible pregnant HbSS and HbSC women will be recruited consecutively, randomly assigned to either group and followed from recruitment until delivery. The primary outcome will be the incidence of birth weight below 10th centile for gestational age on INTERGROWTH 21 birth weight charts, or incidence of miscarriage or perinatal death. Secondary outcomes will include PE, maternal death, preterm delivery, perinatal death, number of crises, need for blood transfusion and complications such as infections and placental abruption. Analysis will be by intention to treat and the main treatment effects will be quantified by relative risk with 95% CI, at a 5% significance level.
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    Open Access
    Primary Postpartum Haemorrhage in Lagos, Nigeria
    (Society of Gynaecology and Obstetrics of Nigeria, 2007-04) Adegbola, O; Ola, E.R.
    Context: Postpartum haemorrhage (PPH) remains a significant cause of maternal mortality worldwide, necessitating this study to determine the magnitude in a developing country. Objective: To determine the frequency, risk factors, mode of management and outcome of primary postpartum haemorrhage (PPH) in a Nigerian obstetric population. Study Design, Setting and Subjects: A case-control study done in a University Teaching Hospital in Nigeria. Data was extracted from the delivery register and individual case records over a five-year period in two groups of women. One group consisted of those with primary PPH following vaginal delivery (Study Group) and the other consisted of consecutive women who delivered the same day but without PPH (Control Group). Main Outcome Measures: Frequency of occurrence and sources of PPH, delivery outcome and complications. Results: There were 298 patients with primary PPH, a frequency of 6.6%. Atonic uterus 84 (33.8%), genital tract lacerations 70 (28.2%), episiotomies 61 (24.6%) and retained placenta 32 (13%) were the four leading identifiable causes. Other apparent risk factors for primary PPH were instrumental deliveries, augmented labours, absence of antenatal care and deliveries conducted by senior registrars and midwives. Complications noted included anaemia (i.e. Hb < 11gm/dl/) in 108 patients (36.2%), episiotomy dehiscence in 4 (1.3%) and one maternal death (0.3%). Conclusion: Timely, less liberal episiotomies are advocated. Active management of the third stage of labour should be promoted and there is need to re-appraise the storage and potency of oxytocics available for usage.
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    Open Access
    Spontaneous heterotropic pregnancy in sickle cell disease with survival of the abdominal pregnancy
    (Niger Postgrad Med J, 2006-06) Afolabi, B.B.; Ola, E.R.; Ibidapo, M.O.; Anorlu, R.I.
    A case is presented of a spontaneously conceived heterotopic pregnancy in a 38-year-old Haemoglobin SS woman, with intrauterine foetal demise and survival of the extra-uterine pregnancy, which was an abdominal pregnancy. The diagnosis was not made until delivery. This report should create the awareness of the possibility of abdominal or heterotopic pregnancy in spontaneous cycles, particularly in patients with recurrent severe anaemia in pregnancy, whether or not they have haemoglobinopathies.