ABSTRACT
Background: Delivery following a previous caesarean section is associated with the fear of increased maternal and perinatal morbidity and mortality. The optimal mode of such delivery remains critical with increasing rate of caesarean births in the contemporary obstetric care. The intended choice of mode of delivery for the woman and her clinician remains between trial of vaginal birth after caesarean and elective repeat caesarean section. This study was therefore designed to appraise the obstetric outcomes of the two main modes of delivery after a primary caesarean delivery. Objective: This study assessed the feto-maternal implications of trial of vaginal birth and elective caesarean section after a prior caesarean in order to contribute data to the increasing volume of evidence for expeditious management of increasing caesarean section rates. Specifically the maternal and perinatal outcomes of trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean delivery (ELRCD) were estimated and compared. Methodology: This was a comparative analytical observational study of 245 and 57 women who respectively had Trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean section (ELRCS) in their subsequent delivery following a primary caesarean section. EPI-INFO statistical package was used for data collation and analysis. Results: Trial of vaginal birth was associated with 1.22% risk of hysterectomy, 0.82% of uterine rupture and 1.6% long hospital stay unlike elective repeat caesarean section that had no recorded incidence of any of these morbidities. The women who had TVBAC were twice at increased risk of blood transfusion and more than 50% increased risk of postpartum hemorrhage compared to those who had ELRCS. The differences were however not statistically significant. Composite perinatal morbidity was thrice higher among TVBAC (5.3% vs. 1.8%, OR 3.14 P=0.48) mainly 3.3%, 1.2% and 1.6% of Apgar scores less than7 at 5 minute, fresh stillbirths and perinatal deaths respectively. Again none of the differences was statistically significant. The morbidities associated with TVBAC seemed to increase when it failed and the need for emergency caesarean arose. Conclusion: There appeared to be subtle but insignificant increased likelihood of both maternal and perinatal adverse outcomes in trial of vaginal birth after caesarean. We recommend TVBAC in well selected cases since the feto-maternal outcome appeared similar in the two modes of delivery.
ABSTRACT
In the tropics where the prevalence of sickle cell anaemia (SCA) is high, reports of concurrence of sickle cell anaemia and diabetes mellitus are rare with diabetic ketoacidosis (DKA), being rarer. In this case report, we present the cases of two Nigerian adolescents (one male and one female) with homozygous SCA who presented in DKA. Sickle cell anaemia was diagnosed eight and nine months respectively prior to their presentation with DKA. There was no history of previous multiple blood transfusions. Neither of the two cases had positive family history of diabetes mellitus. The diagnosis of DKA in each case was based on the presence of hyperglycaemia, ketonuria and acidosis. The families of these two patients were of low socio-economic status. Conclusion: Although concurrent homozygous sickle cell anaemia and diabetic ketoacidosis is rare, it does occur in Nigerian children and adolescents.
ABSTRACT
Background: Eating habits are associated with the occurrence of obesity. In adolescence, eating habits differ greatly from that of any other phase of life. Objective: To describe the eating habits of adolescent urban secondary schoolgirls in Benin City, Nigeria. Methods: In this school-based cross-sectional study, data were obtained on the eating pattern and habits of adolescent urban public school girls, aged 12-19 years, using a structured anonymous-self-administered questionnaire. Information was obtained on frequencies of skipping meals, reasons for skipping meals, food choices as well as socio-demographic characteristics of participants. All the students in 2 randomly selected girls’ schools formed the study population. Data were entered directly from the pre-coded questionnaire. Statistical analysis was performed using the SPSS for Windows version 15.0. Results: Total study population in the 2 schools was 2,166 of which 2,097 (97%) students participated in the study. Mean age of the participants was 14.8±1.9 years (95% CI=14.7-14.9). Fifty three percent were from families of middle socio-economic status, 85% of them living with their parents. Among the participants, 1,009 (48%) admitted skipping at least one meal fortnightly. Of the 3 main meals, breakfast was most frequently skipped (46%) and dinner least frequently skipped (22%). Frequency of skipping meals was 30%, 50% and 59% among participants less than14 years old, 14-16 years old and above 16 years old respectively (p<0.001). The 2 main reasons cited by participants for skipping breakfast were lack of appetite and time. Only 15% of the participants consumed fruits and vegetables daily. Sixty percent of the participants consumed fast foods with 76% of them consuming fast foods along with soft drinks. Conclusion: Meal skipping, consumption of fast foods along with soft drinks and low consumption of fruits and vegetables were the main eating habits displayed by adolescent urban schoolgirls in Benin City, Nigeria.