Obstetrics and Gynaecology- Scholarly Publications

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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.
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    Open Access
    Actions and Adaptations Implemented for Maternal, Newborn and Child Health Service Provision During the Early Phase of the COVID-19 Pandemic in Lagos, Nigeria: Qualitative Study of Health Facility Leaders.
    (Ann Glob Health, 2022) Balogun M.; Banke-Thomas A.; Gwacham-Anisiobi U.; Yesufu V.; Ubani O,; Afolabi, B.B.
    Background: The early phase of the COVID-19 pandemic led to significant disruptions in provision of maternal, newborn, and child health (MNCH) services, especially in low- and middle-income countries (LMICs) with fragile health systems, such as Nigeria. Measures taken to 'flatten the curve' such as lockdowns, curfews, travel restrictions, and suspension of public services inadvertently led to significant disruptions in provision of essential health services. In these countries, health facility leaders are directly responsible for driving changes needed for service delivery. Objective: To explore perspectives of health facility leaders in Lagos, Nigeria, on solutions and adaptations implemented to support MNCH service provision during the early phase of the COVID-19 pandemic. Methods: Key informant interviews were remotely conducted with purposively sampled 33 health facility leaders across primary, secondary, and tertiary public health facilities in Lagos between July and November 2020. Following verbatim transcription of recordings, data familiarization, and coding, thematic analysis was used to synthesize data. Results: Health facility leaders scaled down or discontinued outpatient MNCH services and elective surgeries. However, deliveries, newborn, immunization, and emergency services continued. Service provision was reorganized with long and staggered patient appointments, collapsing of wards and modification of health worker duty rosters. Some secondary and tertiary facilities leveraged technology like WhatsApp, webinars, and telemedicine to support service provision. Continuous capacity-building for health workers through training, motivation, psychological support, and atypical sourcing of PPE was instituted to be able to safely maintain service delivery. Conclusion: Health facility leaders led the frontline of the COVID-19 response. While they took to implementing global and national guidelines within their facilities, they also pushed innovative facility-driven adaptations to address the indirect effects of COVID-19. Insights gathered provide lessons to foster resilient LMIC health systems for MNCH service provision in a post-COVID-19 world.
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    Open Access
    Intramuscular versus intravenous anti-D for preventing Rhesus alloimmunization during pregnancy.
    (Cochrane Database Syst Rev, 2013) Okwundu C. I.; Afolabi, B.B.
    Background: Antibodies to the red cell Rhesus D (RhD) antigen can be produced during pregnancy in a RhD-negative mother carrying a RhD-positive fetus, in particular following feto-maternal haemorrhage at birth or following any procedure that may cause feto-maternal haemorrhage. While the first baby is usually not harmed, these antibodies may cause haemolytic disease of the fetus/newborn (HDFN) in subsequent RhD-positive babies. RhD incompatibility is a major cause of HDFN.To reduce the risk of HDFN, anti-D is given to RhD-negative mothers at 28 or 30 weeks of pregnancy and within 72 hours of potential maternal exposure to fetal red cells. Anit-D is currently available in both intramuscular (IM) and intravenous (IV) preparations. Objectives: To compare the efficacy and effectiveness of IM versus IV anti-D IgG in preventing RhD alloimmunization in RhD-negative pregnant women. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012). Selection criteria: Randomized controlled trials, quasi-randomized trials and cluster-randomized trials comparing IM and IV anti-D for preventing RhD alloimmunization in RhD-negative pregnant women. Data collection and analysis: Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors extracted data. Data were checked for consistency by both authors. Main results: Two studies involving 447 (with sample sizes 14 and 432) RhD negative women were included. The studies compared IM and IV administration of anti-D prophylaxis. In both studies the women received a 1500 IU (300 microgram) dose of Rhophylac during week 28 of gestation. There was no incidence of RhD alloimmunization in either of the studies, as the sample size was insufficient for meaningful comparison of this uncommon outcome. One of the studies found that the mean anti-D IgG concentrations after IV and IM administration differed up to seven days (36.1 (2.6) ng/mL IV; 19.8 (8.7) ng/mL IM on day seven). However, from two to three weeks post-administration, the concentrations were similar for both routes of administration. None of the women involved in the studies developed antibodies against the RhD antigen. Authors' conclusions: It appears that IM and IV administration of anti-D are equally effective. The number of included studies and the number of participants are not enough to assess whether there are any differences. Anti-D can be administered by IM or IV injection. The choice of IM or IV route of administration will depend on the available preparations, the dose to be administered and also on the patients' preferences. This review found insufficient information upon which to guide practice due to the limited number of included studies, small sample sizes and methodological limitations.
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    Open Access
    A Review Of Eclampsia At The Lagos University Teaching Hospital (LUTH), Lagos, Nigeria: Have We Improved?.
    (IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 2014) Babah O.A.; Oluwole A.A.; Afolabi, B.B.; Odum C.U.
    A total of 12,234 patients were treated in the Lagos University Teaching Hospital (LUTH) for various obstetric conditions between January 1, 1996 and December 31, 2005. Of these, 165 (1.35%) were eclamptics. 148 (89.7%) of these were pre-delivery eclamptics and 17 (10.3%) were post-delivery eclamptics. Unbooked eclamptics remained a dominant group comprising 149 (90.3%) of all eclamptics. Mean maternal age was 26.59±0.44 years. Most of these patients were of low parity; primiparae constituting 76.8% and multiparae 23.2%. Mean gestational amenorrhoea at onset of eclampsia being 34.64±0.44 weeks. There were 22 maternal deaths due to eclampsia and its complications with a maternal mortality rate of 133.3 per 1000 eclamptics. The commonest causes of maternal deaths were septicaemia (13.64%), acute renal failure (9.09%) and respiratory failure (9.09%). There were 54 perinatal deaths, with a perinatal mortality rate of 346.2 per 1000. A comparison of the data obtained from this recent decade (1996 - 2005) to those of the previous three decades (1967 – 1976, 1977 – 1986 and 1986 – 1995) showed that there had been a progressive decline in the number of eclamptics managed in LUTH in the last three decades (572 eclamptics in 1977 – 1986, 299 eclamptics in 1986 – 1995, and 165 in 1996 – 2005). This study also showed a rise in the mean caesarean section rate for pre-delivery eclamptics and all eclamptics (55.41% and 49.70% respectively) compared to findings in the previous decades. There was a significant increase in the maternal mortality and perinatal mortality rates in recent decade. There was a decline in post mortem rate (40.9% in recent decade compared with 60% in previous decades).
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    Open Access
    A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos
    (Ann Afr Med, 2022-06) Ogunsola F. T.; Odukoya O.O.; Banigbe B.; Caleb-Adepoju S.O.; Folarin O.; Afolabi, B.B.; Okubadejo N.U.; Adeyemo W.L.; Akanmu A.S.; Osuntoki A.; Okonkwo P.; Murphy R.; Kanki P.
    Background: A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia. Aims and objectives: This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health. Methods: Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked. Results: The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3-18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05). Conclusion: Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP.