Exploring Serum Vitamin D, Sex Hormones, and Lipid Profile Disparities in Women With and Without Polycystic Ovarian Syndrome: A Case-Control Study.

Background Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is characterized by dyslipidemia, hormonal imbalances, and metabolic dysfunctions. Vitamin D deficiency may be implicated in the pathogenesis of PCOS, potentially exacerbating its metabolic syndrome. However, the exact interplay between these factors remains underexplored. Aim This study aimed to evaluate serum levels of vitamin D and its association with modalities of PCOS among women with PCOS and healthy controls.  Methods This was a hospital-based case-control study where 60 women newly diagnosed with PCOS and 56 non-PCOS controls were consecutively recruited within a 10-month period. The women aged 20-40 were recruited at the gynecology clinics of Lagos State University Teaching Hospital and Lagos Island Maternity Hospital. PCOS was diagnosed using the Rotterdam's criteria. The biodata, anthropometry, clinical features, serum vitamin D, cortisol, progesterone, testosterone, estradiol, prolactin, anti-Mullerian hormone (AMH), thyroid-stimulating hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin, fasting blood glucose (FBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and very-low-density lipoprotein cholesterol (VLDL-C) levels of PCOS-diagnosed women were assessed and compared with those of women without PCOS. The exclusion criteria comprised known diabetics, women with gynecological pathologies such as fibroids, and women on medications affecting the study analytes or hormones. Statistical analyses included chi-square or Fisher's exact tests for categorical variables, student t-test for continuous variables, and Pearson's correlation for assessing relationships between continuous variables. The significance level was set at p<0.05 and a confidence interval of 95%. Results Individuals with PCOS exhibited a younger mean age (26.90±3.73 versus 29.95±5.00 years, p=0.001) and a higher prevalence of irregular menstrual patterns (46.7% versus 14.3%, p=0.0001) and acne (58.3% versus 37.5%, p=0.025). Moreover, PCOS was associated with elevated levels of TC (p = 0.03), TG (p = 0.03), LDL-C (p = 0.014), FBG (p = 0.001), LH:FSH ratio (p = 0.002), AMH (p = 0.0001), and testosterone (p = 0.003), but low progesterone (p = 0.001) and vitamin D (p = 0.033), alongside a higher incidence of vitamin D deficiency (33.3% versus 26.1%) and insufficiency (66.7% versus 56.5%). Additionally, significant but weak correlations were observed between serum vitamin D levels and waist-hip ratio (r = 0.4, p = 0.016) and FBG (r = -0.4, p = 0.036) in the PCOS group, suggesting potential metabolic implications. Conclusion The PCOS subjects in this study had decreased vitamin D and progesterone levels, with elevated concentrations of testosterone, AMH, lipid profile (TC, LDL, and TG), FBG, and LH:FSH ratio. Studies on the therapeutic effect of vitamin D administration in managing PCOS will need to be further evaluated.

A decennial cross-sectional review of assisted reproductive technology in a Tertiary Hospital in Southwest Nigeria.

BACKGROUND: The World Health Organization recommends that Assisted Reproductive Technology be complementary to other ethically acceptable solutions to infertility. Whereas fertility centres are increasing in number in urban regions of Africa, published reports of their performance are sparse. We present a 10-year review of assisted reproductive technology performed in a public tertiary centre in Lagos, Nigeria. METHODS: This was a hospital-based, retrospective, cross-sectional review of 604 women, over a 10-year period that had in-vitro fertilization or in-vitro fertilization with intra-cytoplasmic sperm injection at the Institute of Fertility Medicine, Lagos State University Teaching Hospital. Data obtained were expressed in descriptive statistics and Pearson correlation was used to determine the strength of linear relationship between two continuous variables at a significance level of p < 0.05. RESULTS: The mean age of the women was of 37.7 ± 6.2 years and 89.7% had no previous parous experience. About 27.2% of the male partners had normal seminal fluid parameters while 4.6% had azoospermia. Median serum follicle stimulating hormone of the women was 8.1 IU/L and median serum anti-mullerian hormone was 6.3 pmol/L. There was weak positive correlation between age and serum follicle stimulating hormone (r = 0.306, p < 0.001); weak negative correlation between age and serum anti-mullerian hormone (r = -0.48, p < 0.001) and very weak correlation between body mass index and serum follicle stimulating hormone (r = 0.173, p = 0.011). In-vitro fertilization and intra-cytoplasmic sperm injection was the method of fertilization used in 97.4% of the cases and 81.8% of embryos formed were of good quality. Most women (94.5%) had 2 embryos transferred and 89.9% had day-5 embryo transfer done. About 1 in 4 of the women (143/604, 23.7%) had clinical pregnancy and 49.7% of women who got pregnant had delivery of a live baby at term while 11.9% had preterm delivery of a live baby. CONCLUSION: Despite increasing use and success of assisted reproductive technology in south-western Nigeria, there is room for improvement in clinical pregnancy rates and live birth rates post- assisted reproductive technology. Complication rates are desirably low.

Comparison of the diagnostic accuracy of HE4 with CA125 and validation of the ROMA index in differentiating malignant and benign epithelial ovarian tumours among patients in Lagos, Nigeria.

This prospective cross-sectional study compared the diagnostic accuracy of human epididymal protein 4 (HE4) with cancer antigen 125 (CA 125) and validates the risk of malignancy algorithm (ROMA) in differentiating benign from malignant ovarian tumours. The study population included 112 women with an ultrasound diagnosis of an adnexal mass, out of whom 49 women had a diagnosis of ovarian cancer following optimal debulking surgery, and 63 women had a diagnosis of benign ovarian tumour. All diagnosis was confirmed by histopathological analysis. Serum HE4 and CA 125 were assessed preoperatively according to the manufacturer's instructions. CA 125 and HE4 cut-offs were 35 U/mL and 70 pM/L respectively. Serum CA 125 and HE4 were significantly higher in ovarian cancer patients compared to those with benign ovarian tumours (p < 0.001 and p < 0.000, respectively). HE4 had higher sensitivity (77.5% versus 69.4%), specificity (96.8% versus 82.5%), positive predictive value (PPV) (95% versus 75.6%) and negative predictive value (84.7% versus 77.6%) than CA 125. When the two markers were combined with each other in the ROMA index, Specificity and PPV reached 100% each. In the receiver operative characteristics analysis, the area under the curve for CA 125 was 0.679 (95% CI 0.566-0.791, p = 0.001), HE4 was 0.845 (95% CI 0.760-0.930, p = 0.000) and ROMA was 0.902 (95% CI 0.851-0.998, p = 0.000) and this was statistically significant (p < 0.001). Conclusively, HE4 performed better than CA 125 in differentiating benign from malignant ovarian tumours and the combination of the two biomarkers improved the detection of ovarian cancer. In addition, the cut off values corresponding to the highest accuracy for CA 125 and HE4 were 126 U/mL and 42 pM/L respectively in this study. The value for CA 125 is much higher while that of HE4 is much lower than the reference values obtained predominantly from the white population.

Misoprostol and oxytocin versus oxytocin alone in the active management of the third stage of labour: a randomised, double-blind, placebo-controlled trial.

We investigated whether the use of misoprostol plus oxytocin in the active management of the third of stage of labour (AMTSL) would reduce the rate of primary postpartum haemorrhage (PPH) compared with intramuscular oxytocin alone. This was a multicentre, double-blind, placebo-controlled, randomised trial where 1036 pregnant women, in addition to intramuscular oxytocin (10 IU) in the third stage of labour, randomly received either 400 µg sublingual misoprostol (519 women) or a placebo (517 women). The primary outcome measure was the mean blood loss (MBL) within 1 h of delivery. The trial was registered with ClinicalTrials.gov (NCT02424201). The MBL in the oxytocin plus misoprostol group was 229.73 ± 108.12 compared to 274.58 ± 121.09 in the oxytocin plus placebo group (t = 6.289, p < .001). Twenty-eight (5.4%) women in the misoprostol group had a blood loss ≥500 ml versus 39 (7.5%) women in the placebo group (risk-ratio [RR] - 0·72, 95%CI 0.45-1.14; p = .1616). The combination of misoprostol with oxytocin in the AMTSL reduces MBL post-delivery but is not superior to oxytocin alone in the reduction of the rate of PPH.IMPACT STATEMENTWhat is already known on this subject? The routine use of 10IU of intramuscular oxytocin in the active management of the third stage of labour reduces the rates of postpartum haemorrhage.What do the results of this study add? The addition of 400ug of sublingual misoprostol to the routine use of 10IU of intramuscular oxytocin in the active management of the third stage of labour reduces mean blood loss when compared with intramuscular oxytocin alone, but is not better in reducing the rates of postpartum haemorrhage.What are the implications of these findings for clinical practice and/or further research? Routine use of misoprostol as adjuncts to the active management of the third stage of labour does not reduce the rate of PPH.

Maternal hyperlipidemia and spontaneous preterm delivery: a multi-centre cohort study.

BACKGROUND: Hyperlipidemia is a precursor of inflammation and oxidative stress and suggested to be associated with adverse pregnancy outcomes such as preterm delivery. This study evaluated the association between maternal hyperlipidemia and spontaneous preterm delivery. METHODS: This was a prospective, multicentre cohort study in which 239 pregnant women aged 20-35 years with singleton pregnancy, were consecutively recruited at estimated gestational ages of 14-18weeks. Maternal serum lipids were determined at recruitment over a 2-month period and they were followed up until 37 weeks for the subsequent 6 months. Pregnant women with medical conditions and medications that could alter serum lipid levels were excluded from the study. Demographic and baseline variables were summarized using descriptive statistics. Comparison of continuous variables was done using the student's t-test and categorical variables were compared using the Chi square or Fisher's exact test as appropriate. Correlation was determined using Pearson's correlation. Odd ratios were calculated at 95% confidence interval, width of CI as 10% (0.1) and all significances are reported at p < .05. FINDINGS: The prevalence of spontaneous preterm delivery and maternal hypercholesterolemia was 10.2% and 33.1% respectively. There was no significant association between spontaneous preterm delivery and hyperlipidemia in pregnancy (p = .102). Mean serum total cholesterol (mmol/L), LDL cholesterol (mmol/L), HDL cholesterol (mmol/L) and triglyceride (mmol/L) was 5.31 ± 0.84, 2.60 ± 0.72, 1.64 ± 0.36 and 1.23 ± 0.40 respectively in women with spontaneous preterm delivery was similar to mean values of 5.23 ± 0.98, 2.54 ± 0.82, 1.64 ± 0.49 and 1.30 ± 0.59 respectively in women with term delivery. There was no significant correlation between mean individual serum lipids, determined at 14-18weeks gestational age, and gestational age at delivery. CONCLUSION: Serum lipid values determined early in pregnancy were observed to be similar in women with preterm and term delivery. There was no association between hyperlipidemia and spontaneous preterm delivery. There was no correlation of individual mean lipid values, determined early in pregnancy, and gestational age at delivery.

Risk Factors for Postcesarean Wound Infection in a Tertiary Hospital in Lagos, Nigeria.

BACKGROUND: There has been a global increase in cesarean section rates. While this has improved perinatal outcome, it is associated with complications such as wound infection. We determined risk factors for cesarean section wound infection in a tertiary hospital in Lagos, Nigeria. MATERIALS AND METHODS: We prospectively studied a cohort of 906 women who had cesarean section at the Obstetrics Unit of the Lagos State University Teaching Hospital between January 1, 2011, and December 31, 2011. A comparison was made between 176 women who had wound infection and 730 women who did not using logistic regression. RESULTS: Of the 2134 deliveries during the study, 906 (42.5%) had cesarean section and of which 176 (19.4%) had wound infection. Independent risk factors for wound infection were: preoperative anemia (adjusted odds ratio [aOR] = 1.88; 95% confidence intervals [CI] = 1.03-3.41; P = 0.0396), presence of diabetes mellitus (aOR = 7.94; 95% CI = 1.60-39.27; P = 0.0111), HIV infection (aOR = 6.34; 95% CI = 1.74-23.06; P = 0.0051), prolonged operation time (aOR = 2.30; 95% CI = 1.19-4.42; P = 0.0127), excessive blood loss at surgery (aOR = 5.05; 95% CI = 2.18-11.66; P = 0.0002), and chorioamnionitis (aOR = 9.00; 95% CI = 1.37-59.32; P = 0.0224). CONCLUSIONS: Patients with HIV infection, diabetes mellitus, preoperative anemia and chorioamnionitis have an increased risk of postcesarean wound infection as is when surgical time exceeds 1 h or when associated with blood loss >11.

Risk factors for maternal mortality associated with eclampsia presenting at a Nigerian tertiary hospital.

BACKGROUND: Eclampsia remains a leading contributor to maternal mortality, particularly in developing countries, and remains a challenge even to the most experienced obstetrician. We aimed to determine the factors associated with maternal mortality in eclamptics at the Lagos State University Teaching Hospital (LASUTH), Nigeria, in order to suggest ways to prevent this avoidable tragedy. MATERIALS AND METHODS: Data were prospectively collected with the aid of a specially designed proforma from January 1, 2011 to December 31, 2012. Comparison was made between the patients who died (cases) and the survivors (control). Univariate and multivariate analyses were carried out using logistic regression. RESULTS: The case fatality rate was 19.4%. Factors independently associated with mortality were as follows: period between onset of seizures to arrival in LASUTH >12 hours (adjusted OR=22.04; 95% CI=4.62-104.95; P=0.001), vaginal delivery (adjusted OR=10.96; 95% CI=2.54-47.27; P=0.0013), presence of aspiration pneumonitis (adjusted OR=7.77; 95% CI=2.37-25.46; P=0.0007), and presence of renal failure (adjusted OR=7.09; 95% CI=2.14-23.48; P=0.0014). The use of magnesium sulfate reduced the risk of mortality (adjusted OR=0.25; 95% CI=0.09-0.72; P=0.0104). CONCLUSION: Maternal mortality in patients with eclampsia was associated largely with preventable factors. The use of standard obstetric services, prompt referral of patients for definitive care, and the use of simplified dosing regimen of magnesium sulfate may improve its utilization and also improve maternal outcome.

Complicated unsafe abortion in a Nigerian teaching hospital: pattern of morbidity and mortality.

Addressing unsafe abortion in developing countries may propel a rapid decline in overall maternal death. A retrospective review of patients with complicated unsafe abortion was conducted in a Nigerian Tertiary Hospital. In order to provide evidence that may inform policy changes, we describe patients' clinical profiles, abortion providers, and morbidity and mortality patterns. Of 3122 gynaecological admissions, 231 (7.4%) had unsafe abortion-related complications. The majority (53.2%) of admissions were between 16 and 25 years. Single women constituted 51% while 57% were nulliparous. Common presentations were abdominal pain (62%), fever (54%) and vaginal bleeding (53%). The most frequent complications were anaemia (55%) and retained products of conception (47%). Doctors reportedly performed 42% of abortions. There were 392 maternal mortalities; 39 (9.9%) from unsafe abortions and sepsis was responsible in 31 (80%) patients. Abortion remains a major public health issue. Youths are mostly involved. Doctors were reportedly the highest abortion providers. Mortality is high, occurring mostly from sepsis. Impact Statement What is already known on this subject? Doctors are reported as being involved in a high proportion of unsafe abortions in low and middle income countries where abortion remains a significant contributor to maternal mortality and morbidity. What the results of this study add? Our study agrees with existing literature that doctors reportedly performed most of the unsafe abortions. It also found that doctors were reported as abortion providers in the majority (35.9%) of those unsafe abortions that ended in mortality. What the implications are of these findings for clinical practice and/or further research? There is a need to conduct studies that will verify the status of abortion providers rather than rely on clients' report; and also inspect facilities to confirm adherence to minimum medical standards. Such research findings will be needed prior to local and possibly national healthcare interventions and policy changes.

Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria.

BACKGROUND: Caesarean delivery carries a risk of major intra-operative blood loss and its performance is often delayed by non-availability of blood and blood products. Unnecessary cross-matching and reservation of blood lead to apparent scarcity in centres with limited supply. This study set out to identify the risk factors for blood transfusion in women who underwent caesarean delivery at a tertiary obstetric unit with a view to ensuring efficient blood utilization. METHODS: A prospective cohort analysis of 906 women who had caesarean deliveries at the Lagos State University Teaching Hospital, Nigeria between January and December, 2011. A comparison was made between 188 women who underwent blood transfusion and 718 who did not. Data were obtained on a daily basis by investigators from patients, clinical notes and referral letters using structured pre-tested data collecting form. Socio-demographic characteristics; antenatal, perioperative and intraoperative details; blood loss; transfusion; and puerperal observations were recorded. EPI-Info statistical software version 3.5.3 was used for multivariable analysis to determine independent risk factors for blood transfusion. RESULTS: Of the 2134 deliveries during the study period, 906 (42.5%) had caesarean deliveries and of which 188 (20.8%) were transfused. The modal unit of blood transfused was 3 pints (41.3%). The most common indication for caesarean section was cephalo-pelvic disproportion (25.7%).The independent risk factors for blood transfusion at caesarean section were second stage Caesarean Section (aOR = 76.14, 95% CI = 1.25-4622.06, p = 0.04), placenta previa (aOR = 32.57, 95% CI = 2.22-476.26, p = 0.01), placental abruption (aOR = 25.35, 95% CI = 3.06-211.02, p < 0.001), pre-operative anaemia (aOR = 12.15, 95% = CI 4.02-36.71, p < 0.001), prolonged operation time (aOR = 10.72 95% CI = 1.37-36.02, p < 0.001), co-morbidities like previous uterine scar (aOR = 7.02, 95% CI = 1.37-36.02, p = 0.02) and hypertensive disorders in pregnancy (aOR = 5.19, 95% CI = 1.84-14.68, p < 0.001). Obesity reduced the risk for blood transfusion (aOR = 0.24, 95% CI = 0.09-0.61, p = 0.0024). CONCLUSION: The overall risk of blood transfusion in cesarean delivery is high. Paturients with the second stage Caesarean section, placenta previa, abruptio placentae and preoperative maternal anaemia have an increased risk of blood transfusion. Hence, adequate peri-operative preparations for blood transfusion are essential in these situations. Optimizing maternal hemoglobin concentration during antenatal period may reduce the incidence of caesarean-associated blood transfusion.

Socio-demographic and clinical characteristics of clients seeking assisted conception at Lagos State University Teaching Hospital, Ikeja, Nigeria.

The socio-demographic and clinical characteristics of 246 consecutive couples seeking assisted conception in a university teaching hospital in Nigeria from inception in 2011 till 2014 were reviewed restrospectively. Eighty-five (34.5%) were in the 35-40 years age group. The body mass index of the women showed that 111 (45.1%) were overweight. One hundred and ninety five (88%) were referred on account of secondary infertility. The mean duration of infertility was 9.6 ± 4.8 years. Major factors identified were male factor 128 (52%), ovarian/age-related decline in fertility 107 (43.5%), tubal 83 (33.7%) and combined male/female factor 71 (28.9%). One hundred and ninety (77.2%) clients seeking assisted conception were Christians at advanced age (greater than 35 years) with a longstanding duration of infertility of more than 10 years. Government, private and religious organisations need to raise public awareness about the availability of in-vitro fertilisation services as well as encourage early resort to assisted reproductive technologies. Impact statement What we already know: Secondary infertility due mainly to tubal factor is reported to be the commonest cause of infertility in developing countries like Nigeria and clients affected seek assisted reproductive techniques late. What the results of this study add: Male factor infertility is more common amongst infertile couples seeking in vitro fertilisation in LASUTH. The implications of the findings for practice and/or further research: A thorough examination of the male partner followed by investigation is vital at the initial visit so that they can be referred early for assisted conception.

An open-label, randomized, parallel-group comparative study of the efficacy of sorghum bicolor extract in preoperative anemia.

OBJECTIVE: Anemia in patients presenting for elective surgery is associated with increased morbidity, allogeneic blood transfusion, and delay of surgery. Extract of sorghum bicolor has been shown to have hemopoietic, immune-stimulating, and antioxidant effects in rats and in patients with HIV. The aim of this study was to determine the effect of the extract in patients with preoperative anemia booked for myomectomy. METHODS: Consenting patients (N = 66) were randomly assigned to two groups. The test group (n = 34) was given folic acid 5 mg/d, 200 mg iron tablet three times daily, and 500 mg/d of the extract. The control group (n = 32) was given the same doses of folic acid and iron for a period of 3 wk. Blood samples were taken at baseline and weekly for full blood cell count and liver and kidney function tests. Participants were screened for tuberculosis, HIV, hepatitis, and sickle cell anemia. RESULTS: Increases in red blood cell count, hematocrit, and hemoglobin concentration in participants in the test group were highly significant (P < 0.0002, P < 0.0001, and P < 0.0001, respectively). Participants in the control group had a significant increase in the hemoglobin concentration (P > 0.04). The changes in liver enzymes, urea, and creatinine for participants in the test group were within the normal ranges. CONCLUSION: The addition of the extract of sorghum bicolor to routine hematinics is superior to the use of routine hematinics alone. Although the difference is not statistically significant, the extract will correct preoperative anemia in an additional 15% of the patients.

Malaria prevention and treatment in pregnancy: survey of current practice among private medical practitioners in Lagos, Nigeria.

We studied the practice of malaria prevention and treatment in pregnancy of 394 private medical practitioners in Lagos State, Nigeria using a self-administered pre-tested structured questionnaire. Only 39 (9.9%) respondents had correct knowledge of the World Health Organization (WHO) strategies. Malaria prophylaxis in pregnancy was offered by 336 (85.3%), but only 98 (24.9%) had correct knowledge of recommended chemoprophylaxis. Of these, 68 (17.3%) had correct knowledge of first trimester treatment, while only 41 (10.4%) had knowledge of second and third trimester treatment. Only 64 (16.2%) of respondents routinely recommended use of insecticide-treated bed nets. The most common anti-malarial drug prescribed for chemoprophylaxis was pyrimethamine (43.7%); chloroquine was the most common anti-malarial prescribed for both first trimester treatment (81.5%) and second and third trimester treatment (55.3%). The study showed that private medical practitioners have poor knowledge of malaria prophylaxis and treatment in pregnancy, and the practice of most do not conform to recommended guidelines.

Sexual assault in Lagos, Nigeria: a five year retrospective review.

BACKGROUND: Cases of sexual assault are increasingly reported. However, Nigerian researchers have not given adequate attention to this subject despite its attendant social, physical and psychological consequences.This study assessed survivors' characteristics, circumstances of assault and treatment offered with a view to reducing the incidence as well as improving evaluation and management. METHODS: A retrospective review of survivors' case records at Lagos State University Teaching Hospital, Ikeja, between January 2008 and December 2012. Data was analysed using the Epi-info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U S A. RESULTS: Of the 39,770 new gynaecological cases during this period, 304 were alleged sexual assault giving an incidence of 0.76% among hospital gynaecological consultations. Only 287 case notes had sufficient information for statistical analysis. Of these, 83.6% were below 19 years, 73.1% knew their assailants (majority were neighbours), most assaults (54.6%) occurred in the neighbours' homes and over 60% of victims presented after 24 hours of assault. Although 77.3% were assaulted at daytime, teenagers were likely to be raped during the day and non-teenagers at night (P < 0.001). Threat and physical violence were mostly used to overcome victims. Seventy three point six percent had Human Immunodeficiency Virus (HIV) screening with one positive at onset. Post Exposure Prophylaxis for HIV was given in 29.4% of those eligible and emergency contraception in 22.4% of post-menarcheal victims (n = 125). There were neither referrals for psychotherapy nor forensic specimen collected. No record of post-assault conception or HIV infection was found during follow-up. CONCLUSIONS: Adolescents remain the most vulnerable requiring life skills training for protection. Survivors delay in presenting for care. Therefore, public enlightenment on the benefits of early interventions and comprehensive care of survivors with the use of standardized protocols are recommended.

Gestational thrombocytopaenia among pregnant women in Lagos, Nigeria.

BACKGROUND: Thrombocytopaenia is a common haematologic abnormality during pregnancy. Pregnant women with thrombocytopenia have a higher risk of bleeding excessively during or after childbirth, particularly if they need to have a caesarean section or other surgical intervention during pregnancy, labour or in the puperium. The aim of this study was to determine the prevalence of gestational thrombocytopaenia among pregnant women reporting for antenatal care at tertiary health care centres in Lagos. MATERIALS AND METHODS: Platelet count was analyzed in 274 consecutive pregnant women who gave informed consent and 70 non-pregnant female staff of the hospitals. Platelet count was performed on each sample using the Sysmex KN-21N automated haematology analyzer. The study design was cross-sectional, proportions were analyzed for statistical significance with the chi-square, and Odds ratio was also calculated. Thrombocytopaenia is classically defined as a platelet count of less than 150 × 10(9)/L.34 Counts from 100 to 150 × 10(9)/L are considered mildly depressed, 50 to 100 × 10(9)/L are moderately depressed and less than 50 × 10(9)/L are severely depressed. RESULTS: Thirty-four (13.5%) pregnant women were thrombocytopaenic compared with three (4.3%) non-pregnant women. This was statistically significant; P = 0.03; Odds ratio: 3.5 (95% CI 1.03-11.82). Out of the 37 pregnant women who were thrombocytopaenic, most of them (78%) had mild thrombocytopenia, only 6% had severe thrombocytopaenia. CONCLUSION: The prevalence of gestational thrombocytopaenia in this study was 13.5%. Although majority of the pregnant women had mild thrombocytopaenia, healthcare providers should screen all pregnant women routinely for thrombocytopaenia to avoid excessive bleeding during or after childbirth.

Hematological profile of normal pregnant women in Lagos, Nigeria.

BACKGROUND: Hematological profile is considered one of the factors affecting pregnancy and its outcome. Anemia is the most common hematological problem in pregnancy, followed by thrombocytopenia. Leukocytosis is almost always associated with pregnancy. The study reported here was designed to evaluate the overall mean values of seven major hematological parameters and their mean values at different trimesters of pregnancy. SUBJECTS AND METHODS: This examination was a cross-sectional study of 274 pregnant women who registered to attend the Lagos University Teaching Hospital or Lagos State University Teaching Hospital antenatal clinics between their first and third trimester. Blood (4.5 mL) was collected from each participant into a tube containing the anticoagulant ethylenediaminetetraacetic acid (EDTA). A full blood count was performed on each sample and the results were analyzed. RESULTS: Overall, the values obtained were (mean ± standard deviation [SD]): hematocrit level, 30.16% ± 5.55%; hemoglobin concentration, 10.94 ± 1.86 g/dL; white blood cells, 7.81 ± 2.34 × 10(9); platelets, 228.29 ± 65.6 × 10(9); cell volume 78.30 ± 5.70 fL, corpuscular hemoglobin, 28.57 ± 2.48 pg; and corpuscular hemoglobin concentration, 36.45 ± 1.10 g/dL. When grouped by trimester, the mean ± SD value of packed cell volume at first trimester was 32.07% ± 6.80%; of second trimester, 29.76% ± 5.21%; and of third, 33.04% ± 3.88%. The mean ± SD hemoglobin concentration values were 11.59 ± 2.35 g/dL, 10.81 ± 1.72 g/dL, and 10.38 ± 1.27 g/dL for women in their first, second, and third trimester, respectively. Mean ± SD white blood cell concentration for first, second, and third trimesters were 7.31 ± 2.38 × 10(9), 7.88 ± 2.33 × 10(9), and 8.37 ± 2.15 × 10(9), respectively, while the mean ± SD platelet values for first, second, and third trimesters were 231.50 ± 79.10 × 10(9), 227.57 ± 63 × 10(9), and 200.82 ± 94.42 × 10(9), respectively. A statistically significant relationship was found to exist between packed cell volume and white blood cell count with increase in gestational age (P = 0.010 and 0.001, respectively). However, there was no statistically significant association between platelet count and increase in gestational age (P = 0.296). CONCLUSION: These findings reinforce the need for supplementation and provide additional information on hematological reference values in pregnancy in Nigeria.

Factors associated with acceptability of child adoption as a management option for infertility among women in a developing country.

BACKGROUND: Adoption as a treatment option for infertility amongst those that cannot access and/or afford assisted reproduction is not well accepted in developing countries. This study sets out to determine the willingness of infertile women in developing countries to adopt a child and factors that influence women's attitude to adoption. METHODS: We conducted a questionnaire survey of consecutive infertile patients who attended the gynecological clinic of a regional teaching hospital over a 2-month period. Information on demographics, fertility history, and attitude to adoption was obtained, and the data were analyzed using SPSS version 16.0. Tests of statistical significance were used where appropriate at the 95% confidence level. RESULTS: The majority of respondents were aware of child adoption, and the most common source of information was friends (47.8%), followed by the media (39.7%); 42.6% of respondents were willing to adopt if their infertility became intractable. The main reasons given by those unwilling to adopt were culture (78.3%) and family constraints (13.45%). On univariate analysis of factors associated with a favorable or unfavorable attitude to adoption, awareness of adoption (P = 0.002), duration of infertility > 5 years (P = 0.015), no living child (P = 0.007), tertiary education (P < 0.001), pressure from parents (P = 0.041), household yearly income ≥ $650 (P < 0.001), and belief that treatment will bring about the desired results (P < 0.001) were significant, and all except awareness of adoption turned out to be significant on multiple logistic regression analysis. CONCLUSION: There was a high level of awareness about child adoption among all respondents. However, the acceptability of adoption was significantly lower among poor women and those with limited education. Community advocacy and mobilization, especially through the media as well as via health care providers, will go a long way towards enlightening and enhancing the uptake of adoption among women in Nigeria.

Determinants of perinatal mortality in Nigeria.

OBJECTIVE: To determine risk factors for perinatal mortality among hospital-based deliveries in Nigeria. METHODS: The WHO Global Maternal and Perinatal Health Survey was implemented in Nigeria as a first step in establishing a global system for monitoring maternal and perinatal health. Twenty-one health facilities with more than 1000 deliveries annually were selected by a stratified multistage cluster sampling strategy. Information was recorded on all women who delivered and their neonates within a 3-month period. RESULTS: Overall, there were 9208 deliveries, comprising 8526 live births, 369 fresh stillbirths, 282 macerated stillbirths, 70 early neonatal deaths, and 721 perinatal deaths. The stillbirth and perinatal mortality rates were, respectively, 71 and 78 per 1000 deliveries; the early neonatal death rate was 8 per 1000 live births. Approximately 10% of all newborns weighed less than 2500 g, and 12.3% were born at less than 37 weeks of gestation. Predictors of perinatal mortality were mother's age, lack of prenatal care, unbooked status, prematurity, and birth asphyxia. CONCLUSION: The perinatal mortality rate remains unacceptably high in Nigeria. Fresh stillbirth accounted for most perinatal deaths. Interventions to improve the utilization and quality of prenatal care, in addition to the quality of intrapartum care, would considerably reduce perinatal death.

Seroprevalence of cytomegalovirus antibodies amongst normal pregnant women in Nigeria.

OBJECTIVE: Cytomegalovirus (CMV), a ubiquitous virus belonging to the herpes family, is known to be transmitted frequently to developing fetuses in pregnancy. In an immunocompromised state like pregnancy, primary infection through blood transfusion or reactivation of a latent CMV infection can cause severe illness. The study was carried out to determine the seroprevalence of the immunoglobulin G (IgG) antibody to cytomegalovirus amongst pregnant women in correlation with previous exposure to blood transfusion. METHODS: A cross sectional study was carried out amongst 179 HIV negative pregnant women attending the antenatal clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria. Five mL of blood was collected and stored in a plain bottle, centrifuged on the same day and the serum stored at -20°C. All samples were screened for anti-CMV IgG antibodies using the enzyme linked immunosorbent assay (ELISA). Consenting participants were instructed to fill a semi-structured questionnaire to obtain demographic and other related information. Statistical analysis of the results was done using Pearson's chi squared test for analytical assessment. RESULTS: A total of 97.2% of the pregnant women recruited for this study were anti-CMV IgG positive. Out of the 179 recruited for the study 174 responded to the question on previous history of blood transfusion, 14.9% of the respondents (26 of 174) had a previous history of blood transfusion and all tested positive to the anti-CMVIgG antibody. However, past history of blood transfusion and educational level were found to be insignificant to the risk of acquiring CMV infection. CONCLUSION: The seroprevalence of the CMV antibody amongst pregnant women in this environment is high in relation to findings in other developing countries. There is the need to assess anti-CMV immunoglobulin M antibodies in pregnant women, which is a determinant of active infection.

Morbidity associated with failed vaginal birth after cesarean section.

We investigated morbidity and factors associated with failed vaginal birth after cesarean delivery (VBAC). In a retrospective cohort study maternal and neonatal outcomes of women who underwent VBAC in three Nigerian University Teaching Hospitals were reviewed. Univariate, followed by multivariate analyses, were conducted. VBAC was successful in 683 of 1,013 women (67.4%), whereas 330 (32.6%) had failed VBAC. Failed VBAC was associated with higher incidence of chorioamnionitis, postpartum hemorrhage, blood transfusion, uterine rupture, hysterectomy, and composite major neonatal morbidities. Younger age, lack of previous vaginal delivery, induction of labor and fetal weight >4,000 g were risk factors for failed VBAC. A majority of women who try VBAC achieve a vaginal delivery. Failed VBAC is associated with increased maternal and neonatal morbidity and is somewhat predictable.

Risk factors for hepatitis B virus infection among pregnant women in Lagos, Nigeria.

OBJECTIVES: To determine the risk factors for hepatitis B virus infection among pregnant women in Lagos, Nigeria, and the possible implications for hepatitis B prevention in the country. DESIGN: Prospective case control study. SETTING: Lagos Island Maternity Hospital. METHODS: Between 1 August 2006 and 31 January 2007, risk factors for hepatitis B infection were determined amongst pregnant women using a structured questionnaire. The women were tested for hepatitis B surface antigen (HBsAg) as part of routine antenatal care. Univariate and multivariate analyses were carried out using logistic regression. MAIN OUTCOME MEASURES: Risk factors for hepatitis B virus infection among pregnant women. RESULTS: Of the 1,052 women attending the antenatal clinic, 6.08% (n = 64) were positive for HBsAg. A total of 61 HBsAg positive and 183 negative controls were interviewed. The significant risk factors for HBV infection were an early age of sexual debut below 19 years (adjusted OR = 2.79; 95% CI = 1.44-5.40; p = 0.0023); history of multiple sexual partners (adjusted OR = 2.02; 95% CI = 1.02-3.98; p = 0.0427); and past history of sexually transmitted infection (adjusted OR = 2.61; 95% CI = 1.15-5.90; p = 0.0214). Of the HBsAg positive women, 45 (73.77%) had at least one of these risk factors while 91 (49.73%) of the controls had at least one risk factor. CONCLUSION: Screening pregnant for hepatitis B infection on the basis of risk factors may not be effective. Education on modification of lifestyle and sexual behavior as well as non-selective screening of pregnant women for HBV infection is recommended.