Does the use of antenatal corticosteroids reduce respiratory morbidity in babies born in late preterm period?

BACKGROUND: The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period. METHODS: Two hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity. RESULTS: The primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties. CONCLUSIONS: Administration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth. TRIAL REGISTRATION: PACTR ( www.pactr.org ) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.

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.

World Health Organization Recommendation for Using Uterine Balloon Tamponade to Treat Postpartum Hemorrhage.

The World Health Organization (WHO) recently published a new recommendation on the use of the uterine balloon tamponade for the treatment of postpartum hemorrhage. The recommendation that uterine balloon tamponade should be used only where there is already access to other postpartum hemorrhage treatments (including immediate recourse to surgery) has proved controversial. It is especially problematic for those working in low-level health care facilities in under-resourced settings, where there are already programs that have introduced low-cost uterine balloon tamponade devices for use, even in settings where recourse to surgical interventions is not possible. However, there are now two separate randomized trials that both unexpectedly show unfavorable outcomes in these settings when a condom catheter uterine balloon tamponade device was introduced. Considering the balance of potential benefits and these safety concerns, the WHO postpartum hemorrhage guideline panel therefore recommends that uterine balloon tamponade should be used only in contexts where other supportive postpartum hemorrhage interventions are available if needed.

Parental acceptance of human papillomavirus vaccination for adolescent girls in Lagos, Nigeria.

BACKGROUND AND AIMS: Human papillomavirus (HPV) vaccination is recommended for adolescent girls and would offer a long-term solution to cervical cancer especially in developing countries. However, parental perception and acceptance is a critical success factor. This study examined the degree of parental acceptance of HPV vaccination for adolescent secondary-school girls in Lagos, Nigeria. MATERIALS AND METHODS: A descriptive cross-sectional survey of adolescent girls' parents was undertaken in two urban and two rural secondary schools in Lagos. Univariate and multivariate analysis were carried out using logistic regression to determine correlates of parental acceptance of HPV vaccine. RESULTS: Of the 318 respondents, 45.9% had poor knowledge of cervical cancer and HPV infection, whereas 29.6% had good knowledge. Majority (54.7%) also had poor knowledge of HPV vaccine, whereas 26.7% had good knowledge. Most (72%) would vaccinate their daughters if vaccines were free, whereas only 35.5% would, if not free. Poor knowledge of cervical cancer and HPV infection significantly reduced the likelihood of vaccination even if free (adjusted odds ratio [OR] =0.48; 95% confidence interval [CI] =0.24-0.94; P = 0.0325), whereas good knowledge of HPV vaccines (adjusted OR = 6.11; 95% CI = 1.37-27.34; P = 0.018) and tertiary education in the mother (adjusted OR = 29.17; 95% CI = 3.98-214.08; P = 0.0009) increased the likelihood, if not free. CONCLUSION: HPV vaccination was acceptable to most parents only if offered free. Poor knowledge of cervical cancer, HPV infection, and vaccine may hinder acceptability. It is recommended that HPV vaccination is offered free through the National Programme on Immunization in Nigeria.

Multi-stakeholder perspectives on access, availability and utilization of emergency obstetric care services in Lagos, Nigeria: A mixed-methods study.

Globally, Nigeria is the second most unsafe country to be pregnant, with Lagos, its economic nerve center having disproportionately higher maternal deaths than the national average. Emergency obstetric care (EmOC) is effective in reducing pregnancyrelated morbidities and mortalities. This mixed-methods study quantitatively assessed women's satisfaction with EmOC received and qualitatively engaged multiple key stakeholders to better understand issues around EmOC access, availability and utilization in Lagos. Qualitative interviews revealed that regarding access, while government opined that EmOC facilities have been strategically built across Lagos, women flagged issues with difficulty in access, compounded by perceived high EmOC cost. For availability, though health workers were judged competent, they appeared insufficient, overworked and felt poorly remunerated. Infrastructure was considered inadequate and paucity of blood and blood products remained commonplace. Although pregnant women positively rated the clinical aspects of care, as confirmed by the survey, satisfaction gaps remained in the areas of service delivery, care organization and responsiveness. These areas of discordance offer insight to opportunities for improvements, which would ensure that every woman can access and use quality EmOC that is sufficiently available.

Opinion of women on emergency obstetric care provided in public facilities in Lagos, Nigeria: A qualitative study.

Limited attention has been given to opinions of women receiving emergency obstetric care (EmOC) in developing countries. We organized focus groups with 39 women who received this care from Lagos public facilities. Availability of competent personnel and equipment were two positive opinions highlighted. Contrarily, women expressed concerns regarding the seeming unresponsiveness of the service to nonmedical aspects of care, associated stress of service utilization, and high treatment costs. There is a need to leverage the positive perception of women regarding the available technical resources while improving institutional care components like administrative processes, basic amenities, and costs toward increasing utilization and preventing complications.

Multi-stakeholder perspectives on access, availability and utilization of emergency obstetric care services in Lagos, Nigeria: A mixed-methods study

Globally, Nigeria is the second most unsafe country to be pregnant, with Lagos, its economic nerve center having disproportionately higher maternal deaths than the national average. Emergency obstetric care (EmOC) is effective in reducing pregnancy related morbidities and mortalities. This mixed-methods study quantitatively assessed women's satisfaction with EmOC received and qualitatively engaged multiple key stakeholders to better understand issues around EmOC access, availability and utilization in Lagos. Qualitative interviews revealed that regarding access, while government opined that EmOC facilities have been strategically built across Lagos, women flagged issues with difficulty in access, compounded by perceived high EmOC cost. For availability, though health workers were judged competent, they appeared insufficient, overworked and felt poorly remunerated. Infrastructure was considered inadequate and paucity of blood and blood products remained commonplace. Although pregnant women positively rated the clinical aspects of care, as confirmed by the survey, satisfaction gaps remained in the areas of service delivery, care organization and responsiveness. These areas of discordance offer insight to opportunities for improvements, which would ensure that every woman can access and use quality EmOC that is sufficiently available

Assessing emergency obstetric care provision in low- and middle-income countries: a systematic review of the application of global guidelines.

BACKGROUND: Lack of timely and quality emergency obstetric care (EmOC) has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Since 2009, the global guideline, referred to as the 'handbook', has been used to monitor availability, utilization, and quality of EmOC. OBJECTIVE: To assess application and explore experiences of researchers in LMICs in assessing EmOC. DESIGN: Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis. RESULTS: Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each) and Bangladesh and Ghana (three each). Most studies (17) were done at subnational levels with 23 studies using the 'handbook' alone, whereas the others combined the 'handbook' with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes. CONCLUSIONS: There is clear justification to review how EmOC assessments are being conducted. Synergy between researchers, EmOC program managers, and other key stakeholders would be critical for improved assessments, which would contribute to increased accountability and ultimately service provision.

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.

Caesarean section--an appraisal of some predictive factors in Lagos Nigeria.

BACKGROUND: Several maternity units in the developing world lack facilities for caesarean section and often have to transfer patients in extremis. This case controlled study aimed to appraise predictive factors for caesarean section. METHODS: One hundred and fifty two consecutive women with singleton pregnancies who had caesarean section were studied. The next parturient with normal delivery served as control. Variables such as age, parity, marital status, booking status, past obstetric history, weight, height, infant birth weight were assessed. Data obtained were analysed using SPSS 16.0 Windows package. RESULTS: During the study period, there were 641 deliveries with 257 of them by caesarean section (40.1%).Logistic regression analysis showed that parity, booking status, maternal height; maternal weight, birth weight, previous caesarean section and ante-partum bleeding were significant predictive factors for caesarean section while maternal age was not. CONCLUSIONS: These predictive factors should be considered in antenatal counseling to facilitate acceptance by at risk women and early referral.

Ruptured uterus and bowel injury from manual removal of placenta: a case report.

BACKGROUND: Retained placenta is a significant cause of maternal mortality and morbidity throughout the developing world. 'Though, intestinal injury may arise as a complication of induced abortion following instrumentation through the genital tract, the involvement of the large bowel in complicated manual removal of placenta is a very rare occurrence CASE REPORT: We present the case of a 28 year-old Para 3+0, 3 alive woman who had attempted manual removal of placenta in a basic emergency obstetric care facility that resulted in lower uterine segment rupture with evisceration of bowels through the laceration outside the introitus. She subsequently had right hemi- colectomy with ileo-transverse anastomosis and repair of uterine rupture with bilateral tubal ligation. CONCLUSION: This case highlights the risk of exposing parturients to inexperienced attendants at delivery and emphasises the need for intensification of manpower training to attain the 5th MDG enunciated by the United Nations.

Mammography and mammographic screening: are female patients at a teaching hospital in Lagos, Nigeria, aware of these procedures?

PURPOSE To determine the level of awareness of mammography and mammographic screening amongst women in Lagos, Nigeria. MATERIALS AND METHODS A structured questionnaire was administered to 555 consecutively recruited women who visited various clinics at the Lagos State University Teaching Hospital, Ikeja, between January 2009 and June 2009. RESULTS The mean age of respondents was 38.16 ± 9 years, and the majority (59.6%) had a tertiary education. A family history of breast cancer was present in 33 (6.0%) women, less than 20% of whom had undergone mammography. Only 20% of all subjects were aware of the recommendation that they should receive routine mammography and mammographic screenings on an annual or biannual basis, depending on their age, and of the side effects associated with the procedure. The mass media was women's main source of information regarding these procedures. The majority (67.6%) of participants confirmed that they performed breast self-examinations, though less than 5% of them had had their breasts examined by mammography. CONCLUSION This study revealed a rather low level of awareness about mammography and mammographic screening, indicating the need to educate women about the risk of breast cancer and the importance of screening as a tool for the early detection and treatment of this condition.

Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria.

BACKGROUND: Haemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies. METHODS: Case records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed. RESULTS: There were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units). CONCLUSION: Even though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.

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.

Prenatal ultrasonic diagnosis of conjoint twins.

BACKGROUND: A primipara with multiple pregnancy who booked for antenatal care at 21 weeks presented with vaginal bleeding and pedal oedema at the 27th week. She had had five previous ultrasound scans that gave conflicting results. MATERIALS AND METHODS: The patient was therefore sent for a confirmatory scan, which was performed using a linear 3.5 MHz transducer of a dynamic imaging dedicated, concept MC ultrasound scan machine. RESULTS: A diagnosis of conjoint twins was made. The twin was joined from the mandible to the abdomen. Although they cried at birth, they died a few minutes after. The pregnancy was terminated by caesarian section at the patient's request. The patient did well postpartum and was discharged on the 5th postoperative day. Records confirm that this is the first case seen in this hospital, which has been in existence for 18 years. CONCLUSION: To diagnose conjoint twins by ultrasound, one needs the expertise and careful scanning techniques, as the diagnosis may be easily missed, especially if the union is extensive.

Female reproductive tract infections: understandings and care seeking behaviour among women of reproductive age in Lagos, Nigeria.

BACKGROUND: Reproductive tract infections (RTI's) are endemic in developing countries and entail a heavy toll on women. If untreated, RTI's can lead to adverse health outcomes such as infertility, ectopic pregnancy and increased vulnerability to transmission of the human immunodeficiency virus. It is also associated with adverse pregnancy outcomes. While RTI's and its sequelae abound in Nigeria, there is paucity of publications on the subject in the country. This study assessed the understandings and care seeking behavior with regards to RTI's among women of reproductive age in Lagos, Nigeria with the aim of improving awareness on the subject. METHODS: A descriptive cross sectional survey of women attending the gynaecological outpatient and family planning clinics of the Lagos State University Teaching Hospital was carried out between 1st June 2008 and 31st August 2008 using a pre-tested questionnaire. Data was analysed using the Epi-Info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U.S.A. RESULTS: Most of the respondents (77.2%) had heard of RTI's. Toilet was the most perceived mode of contracting RTI's (44.6%), followed by sexual intercourse and poor hygiene. Vaginal discharge was the commonest symptom of RTI's named while inability to get pregnant was the commonest named complication. Majority of the respondent's demonstrated poor overall knowledge of symptoms and complications of RTI"s. 37.4% of the respondents had experienced symptoms of RTI's in the preceding six months. Vaginal discharge was the commonest symptom reported (21.8%) and the majority of those who reported symptoms sought medical treatment. Government health centres were the most visited health facilities for treatment. CONCLUSION: Even though most of the respondents have heard of RTI's and sought treatment when symptomatic, they demonstrated poor overall understanding of the subject. There is need to educate women on preventive strategies, as RTI's are often assymptomatic.

Active management of third stage of labor: evidence versus practice.

OBJECTIVE: To determine the correct use of active management of third stage of labor (AMTSL) (using the full complement of existing standard definitions) and compare the outcomes of third stage of labor in women who received AMTSL (according to these definitions) with those who did not. DESIGN: Observational, cross-sectional survey. SETTING: Seven tertiary centers in southwest Nigeria. POPULATION: Women undergoing non-instrumental vaginal deliveries. METHODS: Prospective direct observations of childbirth procedures. AMTSL was defined according to Cochrane review, ICM/FIGO (International Confederation of Midwives/International Federation of Gynecology and Obstetrics), and WHO (World Health Organization) recommendations. Main outcome measures. Use of AMTSL and its components and outcome of third stage of labor. RESULTS: There was a high rate of compliance with most of the individual components of AMTSL. The use of AMTSL varied widely with the definition applied and tended to decrease with increasing strictness of the criteria (Cochrane review: 88.9%; ICM/FIGO: 42%; WHO: 1.8%). The frequencies of adverse labor outcomes were generally low (postpartum hemorrhage (PPH): 4.9%; severe PPH: 0.8%; retained placenta: 1.9%; uterine inversion: 0.0%). Frequencies of PPH, postpartum anemia, and mean blood loss among women who received AMTSL according to the Cochrane review definition were significantly lower than for those who did not (p < 0.05). There was no significant difference between any of the outcomes for women who received AMTSL according to the ICM/FIGO definition and those who did not. CONCLUSIONS: The survey reveals substantial definition-dependent variation in the providers' adherence to recommended AMTSL practices. The clinical implications of the current practice in this population suggest the need for randomized comparison of various AMTSL packages to determine their comparative effectiveness in the prevention of PPH.

Active management of third stage of labour: a survey of providers' knowledge in southwest Nigeria.

BACKGROUND: The disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers' knowledge on the subject. OBJECTIVE: To assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL. METHODS: Questionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria. RESULTS: Female nurses at different cadres accounted for most of the respondents. Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13 potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identified the components of AMTSL as defined by FIGO/ICM. Many procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being in administrative position (adjusted OR: 2.68; CI 1.19-6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21-5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI 0.05-0.39), matron (adjusted OR: 0.25; CI 0.08-0.79) or intern (adjusted OR: 0.07; CI 0.01-0.29) compared to postgraduate resident doctors reduced the odds of having accurate knowledge of AMTSL. CONCLUSION: AMTSL was a familiar but poorly understood intervention among obstetric care providers in this region. Improvement in healthcare quality and practitioners' adherence to recommended guidelines on AMTSL urgently requires educational interventions that target those who provide routine delivery care and organisation of the health care delivery system in such a way that enables providers to act on acquired knowledge.