Obstetrics and Gynaecology- Scholarly Publications

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    Open Access
    Regional versus general anaesthesia for caesarean section
    (Cochrane Database Syst Rev, 2012) Afolabi, B.B.; Lesi, F.E.
    Background Regional anaesthesia (RA) and general anaesthesia (GA) are commonly used for caesarean section (CS) and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is more efficacious. Objectives To compare the effects of RA with those of GA on the outcomes of CS. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 November 2011). We updated the search on 20 August 2012 and added the results to the awaiting classification section of the review. Selection criteria Randomised and quasi-randomised controlled trials evaluating the use of RA and GA in women who had CS for any indication. Cluster-randomised trials and trials using a cross-over design are not included. Data collection and analysis Two review authors independently assessed trials for inclusion, assessed risk of bias and extracted data. Data were checked for accuracy. Main results Twenty-two out of 29 included studies (1793 women) contributed data to this review. The included studies did not report some our primary outcomes: maternal death, incidence of maternal postoperative wound infection, maternal postoperative other infection such as endometritis and urinary tract infection, neonatal death. Compared to women who had GA, women who had either epidural anaesthesia or spinal anaesthesia were found to have a significantly lower difference between pre and postoperative haematocrit. For epidural, the mean difference (MD) was 1.70% and 95% confidence interval (CI) 0.47 to 2.93 (one trial, 231 women) and for spinal anaesthesia, the MD was 3.10% and 95% CI 1.73 to 4.47 (one trial, 209 women). Compared with GA, women having either an epidural anaesthesia or spinal anaesthesia had a lower estimated maternal blood loss (epidural versus GA: standardised mean difference (SMD) -0.32 mL; 95% CI -0.56 to -0.07; two trials, 256 women; spinal versus GA anaesthesia: SMD -0.59 mL; 95% CI -0.83 to 0.35; two trials, 279 women). There was evidence of a significant difference in terms of satisfaction with anaesthetic technique - compared with the epidural or spinal group, more women in the GA group stated they would use the same technique again if they needed CS for a subsequent pregnancy (epidural versus GA: risk ratio (RR) 0.80; 95% CI 0.65 to 0.98; one trial, 223 women; spinal versus GA anaesthesia: RR 0.80; 95% CI 0.65 to 0.99; one trial, 221 women). No significant difference was seen in terms of neonatal Apgar scores of six or less and of four or less at five minutes and the need for neonatal resuscitation with oxygen. Authors’ conclusions There is no evidence from this review to show that RA is superior to GA in terms of major maternal or neonatal outcomes. Further research to evaluate neonatal morbidity and maternal outcomes, such as satisfaction with technique, will be useful.
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    Open Access
    Effects of obesity on the development of uterine leiomyomata: a retrospective study of 169 women who had myomectomy in southern Nigeria
    (IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 2014) Babah, O.A.; Oluwole, A.A.; Afolabi, B.B.
    This is a retrospective study of 169 women who had myomectomy for symptomatic uterine leiomyomata in Lagos, Nigeria between January 1, 2008 and December 31, 2012. This study aimed at ascertaining the relationship between uterine leiomyomata and obesity. The patients in this series were in their reproductive age with peak incidence amongst the 35-44 years age group (57.23% of study population). Majority of these subjects (69.16%) were obese (BMI ≥ 25 in this series). They were predominantly nulliparous women (83.23%) and mostly of the middle socioeconomic class. There was no statistical significant difference between social class and obesity, duration of symptom and pre￾operative uterine size, parity and pre-operative uterine size, parity and number of fibroid nodules shelled out at surgery, and between obesity and the number of fibroids shelled out at surgery. The commonest post-operative complications were haemorrhage (42.86%), anaemia (32.65%), sepsis (12.24%) and wound dehiscence (10.20%). A statistical significant association exists between obesity and development of post-operative complications but NOT in the overall morbidity of patients with fibroids in terms of duration of hospitalization. In conclusion, obesity does not appear to influence growth of uterine leiomyomata but impacts significantly on occurrence of post-operative complications.
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    Open Access
    A study of urinary prostacyclin products and some haematological parameters in pregnant women with sickle cell anaemia
    (Journal of Clinical Sciences, 2013) Akanmu, A.S.; Afolabi, B.B.; Taiwo-Osunubi, P.A.; Abudu, O.O.
    Objective: Normal gestation is associated with an increased plasma volume (PV) and vasodilation which plasma prostacyclin (PGI2) may account for. This study measured PGI2 levels in pregnant haemoglobin (Hb) SS patients as they have been reported to lack PV expansion. Methods: Urinary prostacyclin (UP) concentration and full blood count parameters were determined in pregnant Hb AA and Hb SS women, with non-pregnant controls. Results: Thirty-three Hb AA (19 non-pregnant and 14 pregnant) and 25 Hb SS (18 non-pregnant and 7 pregnant) were studied. UP did not rise in pregnant Hb SS women compared to non-pregnant (Geometric mean (GM) 614 ± 2.4 vs 248 ± 3.8, p=0.063), despite a very significant rise in Hb AA pregnancy (GM 1406 ± 2.1 vs 260 ± 2.9 pg/ml, p<0.0001). Conclusion: There is a lack of significant rise in plasma prostacyclin levels during pregnancy in Hb SS women, which could account for their reported lack of plasma volume expansion.
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    Open Access
    Obstetric Performance in Pregnant Nigeria Women Aged 40 Years and Above at the Lagos University Teaching Hospital (LUTH) between 2007 and 2011
    (International Journal of Science and Research, 2014) Oluwole, A.A.; Babah, O.A.; Adejuwon, O.C.; Olamijulo, J.A.; Afolabi, B.B.; Oye-Adeniran, B.A.
    Advanced maternal age has been regarded as a risk factor for complications in pregnancy and with associated fetal morbidity. Methods: This was a case-control study comparing pregnancy outcome of 113 parturients aged 40years and older that delivered in our hospital and compared with women between ages18 to 30 years between January,2007 and December ,2011. Retrospective analysis of the antepartum and intrapartum records was done and compared to clinical outcome.113 parturients aged 40 years and above (study group SG) among 6285 parturients that delivered during the study period were compared with113 parturients aged below 40 years(control group CG). Results: The incidence of pregnant women aged 40 years and above was1.79% with a mean age of 41.03+/-1.47(SD).The mean age of the control was 29.5+/-4.00(SD).The mean parity in the SG was 4.12 and 2.38 in the CG. Majority of the women in the SG (72%) were unbooked while majority (79.6%) in the CG were booked. All complications reviewed during pregnancy, labour and puerperium occurred more frequently in the SG than in the CG. Hypertensive disorders of pregnancy, Caesarean section, assisted breech delivery and postpartum haemorrhage were found to be statistically higher in the SG than the CG. Conclusion: Women aged 40 years and above have a higher risk of complications than younger nulliparous women. These older women have a higher risk of operative delivery, medical problems and neonatal complications. Although maternal morbidity was increased in the older women in this study, the overall neonatal outcome did not appear to be affected.
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    Open Access
    A study of urinary prostacyclin products and some haematological parameters in pregnant women with sickle cell anaemia
    (Journal of Clinical Sciences, 2013) Akanmu A.S.; Afolabi, B.B.; Taiwo-Osunubi P. A.; Abudu O.O.
    ABSTRACT Objective: Normal gestation is associated with an increased plasma volume (PV) and vasodilation which plasma prostacyclin (PGI2) may account for. This study measured PGI2 levels in pregnant haemoglobin (Hb) SS patients as they have been reported to lack PV expansion. Methods: Urinary prostacyclin (UP) concentration and full blood count parameters were determined in pregnant Hb AA and Hb SS women, with non-pregnant controls. Results: Thirty-three Hb AA (19 non-pregnant and 14 pregnant) and 25 Hb SS (18 non-pregnant and 7 pregnant) were studied. UP did not rise in pregnant Hb SS women compared to non-pregnant (Geometric mean (GM) 614 ± 2.4 vs 248 ± 3.8, p=0.063), despite a very significant rise in Hb AA pregnancy (GM 1406 ± 2.1 vs 260 ± 2.9 pg/ml, p<0.0001). Conclusion: There is a lack of significant rise in plasma prostacyclin levels during pregnancy in Hb SS women, which could account for their reported lack of plasma volume expansion.