Induction of labour is a common mode of management of intrauterine fetal deaths, and the process ... more Induction of labour is a common mode of management of intrauterine fetal deaths, and the process usually involves ripening of the cervix by traditional methods of intracervical Foley's catheter insertion or the use of prostaglandin preparations intravaginally. Such methods are usually very effective independently. The objective of this case report is to call the attention of practising obstetricians to the possibility of an abdominal pregnancy as a cause of failure to ripen the cervix and that careful re-evaluation and use of ultrasound scan can improve diagnostic acumen with favorable outcome of management in such cases The case file of the patient was thoroughly reviewed. A literature search on the subject of abdominal pregnancy using local and international journals and relevant textbooks was done to document the current status of the management of such cases. A 29-year-old Gravida 4 para 3+0 (2 alive) presented at an estimated gestational age of 32 weeks with loss of fetal movement, which was suggestive of fetal death and was referred as such from a private hospital. A process of induction of labour was commenced; to ripen the cervix with intracervical Foleys catheter and misoprostol tablet and stimulate uterine contraction, but this was not successful due to failure of the cervix to ripen. This prompted further review of the patient with the aim of excluding the possibility of an abdominal ectopic pregnancy. A repeat ultrasound scan was done and this confirmed a diagnosis of abdominal pregnancy. The patient had laparotomy done to deliver a dead fetus and the placenta was removed with the right tube and ovary as they were deeply embedded in the placental mass. The definitive diagnosis was that of a secondary abdominal pregnancy. She made a satisfactory postoperative recovery and was discharged home. A high index of suspicion is needed to make a first time diagnosis of abdominal pregnancy. With timely diagnosis and appropriate management, the prognosis in most cases is favourable.
ABSTRACT This is meant to draw attention to the presentation of leiomyosarcoma as a recurrent abd... more ABSTRACT This is meant to draw attention to the presentation of leiomyosarcoma as a recurrent abdominopelvic mass following total abdominal hysterectomy and salpingo-oophorectomy and the difference that a detailed histological assessment could make in the proper management of such cases. Case note was reviewed. She was a 51-year-old woman who had Total Abdominal Hysterectomy & Bilateral Salpingo-oophrectomy for a clinically suspected and histologically diagnosed Uterine Leiomyoma. A debulking surgery was done later for a recurrence of the abdominopelvic mass and the repeated histology confirmed it to be a Leiomysarcoma. She however, died few days after the 2nd operation without the opportunity of benefiting from adjuvant cytotoxic therapy. A low index of suspicion and inadequate histopathologic assessment of tumor mass were the major contributory factors in this case. A more detailed histological assessment of fibroid masses would have prevented this and similar tragedy. Nigerian Medical Practitioner Vol. 52 (2) 2007: pp. 47-49
Revista panamericana de salud pública = Pan American journal of public health, 2015
To test whether the proposed features of the Obstetric Transition Model-a theoretical framework t... more To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. Data from 314 623 women showed that female fertility, indirectly estimated by pa...
Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during c... more Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon. We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven ...
Health institutions need to contribute their quota towards the achievement of the Millennium Deve... more Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (2...
A total of 76 children diagnosed with TB were screened for HIV. Eight (10.5%) were found to be HI... more A total of 76 children diagnosed with TB were screened for HIV. Eight (10.5%) were found to be HIV seropositive.
AIM: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of ... more AIM: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre. METHODS: Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss
To explore sociodemographic determinants of perceived quality of antenatal care (ANC) at the prim... more To explore sociodemographic determinants of perceived quality of antenatal care (ANC) at the primary care level. A survey of 452 randomly selected pregnant women accessing antenatal care at the primary healthcare facilities in Sagamu Local Government Area (LGA) of Ogun State, southwest Nigeria. The relationships between 13 sociodemographic characteristics of women and their overall perception of the quality of care (expressed by their level of overall satisfaction) were examined through bivariate analyses, by computing odds ratio at 95% confidence interval. Multivariate logistic regression analyses were used to determine independent sociodemographic determinants of overall satisfaction with quality of care received. A P-value <0.05 or CI which did not embrace unity was considered as statistical significance. From bivariate analyses, increasing parity, increasing number of living children, gainful employment of client and Islamic religion increases the likelihood of positive perception of antenatal care quality. Characteristics such as age, being married, women's monthly earning, ethnicity, employment status of husband, educational level, duration of pregnancy, frequency of antenatal visits, and previous use of antenatal care at the same centre were not associated with overall satisfaction with antenatal care quality. Independent predictors from multivariate regression analyses include parity (adjusted OR 0.13; CI: 0.05-0.33, P = 0.005) and religion (other religions vs. Islam; adjusted OR: 0.14, CI: 0.04-0.40, P = 0.0003). The study suggests that sociodemographic characteristics of women have limited impact on their perception of ANC quality. The identified predictors may serve as the criteria for selecting women that require intensive health centre-specific antenatal interventions aimed at improving perceived quality and thus sustained utilization of antenatal care services in these primary health care facilities.
Congenital malaria, defined as the presence of malaria parasites in the erythrocytes of newborns ... more Congenital malaria, defined as the presence of malaria parasites in the erythrocytes of newborns aged <7 days, was considered rare in endemic areas until recent studies started reporting high prevalence rates. Various theories have been postulated to explain this phenomenon, but they are not proven conclusively from research. Against this background, a prospective study was designed with the following objectives. To determine the prevalence of congenital malaria parasitaemia and identify possible risk factors amongst newborns delivered in O.O.U.T.H Sagamu, Ogun State. Over a 6-month period, 192 live newborns and their mothers were consecutively recruited into the study. Within 3 days of life, neonatal peripheral blood samples were collected for malaria screening by blood film microscopy and detection of plasmodium lactate dehydrogenase (pLDH) with the OptiMAL Rapid Malaria Test kit. Maternal peripheral blood samples were taken simultaneously, to check for malaria infestation by blood film microscopy, and questionnaires were administered on the mothers to identify possible factors associated with the development of neonatal parasitaemia. Neonatal clinical and laboratory data were recorded in a pro forma designed for the study. Data analysis was done with Epi-info version 6 software and level of significance set at <5%. Twenty-one of 192 newborns delivered in O.O.U.T.H within the study period were diagnosed as having congenital malaria by blood film microscopy, giving a prevalence rate of 10.9%. The main identified innate neonatal risk factor for congenital malaria parasitaemia was prematurity. First-order pregnancy, history of fever within 3 months of delivery and peripheral parasitaemia at delivery (p < 0.001) were the variables that were significantly higher in the mothers of the parasitemic newborns. We conclude that congenital malaria parasitaemia in tropical endemic areas is not rare. Pre-term neonates, infants of primigravidae, women with history of fever within 3 months of delivery and women with post-partum peripheral parasitaemia may benefit from routine screening for malaria.
Induction of labour is a common mode of management of intrauterine fetal deaths, and the process ... more Induction of labour is a common mode of management of intrauterine fetal deaths, and the process usually involves ripening of the cervix by traditional methods of intracervical Foley's catheter insertion or the use of prostaglandin preparations intravaginally. Such methods are usually very effective independently. The objective of this case report is to call the attention of practising obstetricians to the possibility of an abdominal pregnancy as a cause of failure to ripen the cervix and that careful re-evaluation and use of ultrasound scan can improve diagnostic acumen with favorable outcome of management in such cases The case file of the patient was thoroughly reviewed. A literature search on the subject of abdominal pregnancy using local and international journals and relevant textbooks was done to document the current status of the management of such cases. A 29-year-old Gravida 4 para 3+0 (2 alive) presented at an estimated gestational age of 32 weeks with loss of fetal movement, which was suggestive of fetal death and was referred as such from a private hospital. A process of induction of labour was commenced; to ripen the cervix with intracervical Foleys catheter and misoprostol tablet and stimulate uterine contraction, but this was not successful due to failure of the cervix to ripen. This prompted further review of the patient with the aim of excluding the possibility of an abdominal ectopic pregnancy. A repeat ultrasound scan was done and this confirmed a diagnosis of abdominal pregnancy. The patient had laparotomy done to deliver a dead fetus and the placenta was removed with the right tube and ovary as they were deeply embedded in the placental mass. The definitive diagnosis was that of a secondary abdominal pregnancy. She made a satisfactory postoperative recovery and was discharged home. A high index of suspicion is needed to make a first time diagnosis of abdominal pregnancy. With timely diagnosis and appropriate management, the prognosis in most cases is favourable.
ABSTRACT This is meant to draw attention to the presentation of leiomyosarcoma as a recurrent abd... more ABSTRACT This is meant to draw attention to the presentation of leiomyosarcoma as a recurrent abdominopelvic mass following total abdominal hysterectomy and salpingo-oophorectomy and the difference that a detailed histological assessment could make in the proper management of such cases. Case note was reviewed. She was a 51-year-old woman who had Total Abdominal Hysterectomy & Bilateral Salpingo-oophrectomy for a clinically suspected and histologically diagnosed Uterine Leiomyoma. A debulking surgery was done later for a recurrence of the abdominopelvic mass and the repeated histology confirmed it to be a Leiomysarcoma. She however, died few days after the 2nd operation without the opportunity of benefiting from adjuvant cytotoxic therapy. A low index of suspicion and inadequate histopathologic assessment of tumor mass were the major contributory factors in this case. A more detailed histological assessment of fibroid masses would have prevented this and similar tragedy. Nigerian Medical Practitioner Vol. 52 (2) 2007: pp. 47-49
Revista panamericana de salud pública = Pan American journal of public health, 2015
To test whether the proposed features of the Obstetric Transition Model-a theoretical framework t... more To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. Data from 314 623 women showed that female fertility, indirectly estimated by pa...
Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during c... more Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon. We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven ...
Health institutions need to contribute their quota towards the achievement of the Millennium Deve... more Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (2...
A total of 76 children diagnosed with TB were screened for HIV. Eight (10.5%) were found to be HI... more A total of 76 children diagnosed with TB were screened for HIV. Eight (10.5%) were found to be HIV seropositive.
AIM: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of ... more AIM: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre. METHODS: Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss
To explore sociodemographic determinants of perceived quality of antenatal care (ANC) at the prim... more To explore sociodemographic determinants of perceived quality of antenatal care (ANC) at the primary care level. A survey of 452 randomly selected pregnant women accessing antenatal care at the primary healthcare facilities in Sagamu Local Government Area (LGA) of Ogun State, southwest Nigeria. The relationships between 13 sociodemographic characteristics of women and their overall perception of the quality of care (expressed by their level of overall satisfaction) were examined through bivariate analyses, by computing odds ratio at 95% confidence interval. Multivariate logistic regression analyses were used to determine independent sociodemographic determinants of overall satisfaction with quality of care received. A P-value <0.05 or CI which did not embrace unity was considered as statistical significance. From bivariate analyses, increasing parity, increasing number of living children, gainful employment of client and Islamic religion increases the likelihood of positive perception of antenatal care quality. Characteristics such as age, being married, women's monthly earning, ethnicity, employment status of husband, educational level, duration of pregnancy, frequency of antenatal visits, and previous use of antenatal care at the same centre were not associated with overall satisfaction with antenatal care quality. Independent predictors from multivariate regression analyses include parity (adjusted OR 0.13; CI: 0.05-0.33, P = 0.005) and religion (other religions vs. Islam; adjusted OR: 0.14, CI: 0.04-0.40, P = 0.0003). The study suggests that sociodemographic characteristics of women have limited impact on their perception of ANC quality. The identified predictors may serve as the criteria for selecting women that require intensive health centre-specific antenatal interventions aimed at improving perceived quality and thus sustained utilization of antenatal care services in these primary health care facilities.
Congenital malaria, defined as the presence of malaria parasites in the erythrocytes of newborns ... more Congenital malaria, defined as the presence of malaria parasites in the erythrocytes of newborns aged <7 days, was considered rare in endemic areas until recent studies started reporting high prevalence rates. Various theories have been postulated to explain this phenomenon, but they are not proven conclusively from research. Against this background, a prospective study was designed with the following objectives. To determine the prevalence of congenital malaria parasitaemia and identify possible risk factors amongst newborns delivered in O.O.U.T.H Sagamu, Ogun State. Over a 6-month period, 192 live newborns and their mothers were consecutively recruited into the study. Within 3 days of life, neonatal peripheral blood samples were collected for malaria screening by blood film microscopy and detection of plasmodium lactate dehydrogenase (pLDH) with the OptiMAL Rapid Malaria Test kit. Maternal peripheral blood samples were taken simultaneously, to check for malaria infestation by blood film microscopy, and questionnaires were administered on the mothers to identify possible factors associated with the development of neonatal parasitaemia. Neonatal clinical and laboratory data were recorded in a pro forma designed for the study. Data analysis was done with Epi-info version 6 software and level of significance set at <5%. Twenty-one of 192 newborns delivered in O.O.U.T.H within the study period were diagnosed as having congenital malaria by blood film microscopy, giving a prevalence rate of 10.9%. The main identified innate neonatal risk factor for congenital malaria parasitaemia was prematurity. First-order pregnancy, history of fever within 3 months of delivery and peripheral parasitaemia at delivery (p < 0.001) were the variables that were significantly higher in the mothers of the parasitemic newborns. We conclude that congenital malaria parasitaemia in tropical endemic areas is not rare. Pre-term neonates, infants of primigravidae, women with history of fever within 3 months of delivery and women with post-partum peripheral parasitaemia may benefit from routine screening for malaria.
Uploads
Papers by Olufemi Oladapo