Randomized controlled trial comparing 200µg and 400µg sublingual misoprostol for prevention of primary postpartum hemorrhage.

OBJECTIVE: To compare efficacy and adverse effects of 200µg and 400µg misoprostol for prevention of postpartum hemorrhage (PPH). METHODS: In a randomized control trial, women with term singleton pregnancies in active labor attending University College Hospital, Ibadan, Nigeria, were enrolled between July 2011 and February 2012. Participants were randomly assigned using random numbers (block size four) to receive 200µg or 400µg sublingual misoprostol after delivery of the anterior shoulder, alongside intravenous oxytocin. Investigators were masked to group assignment, but participants were not. The primary outcomes were blood loss up to 1h after delivery, PPH (blood loss ≥500mL), and adverse effects. RESULTS: Overall, 62 patients were assigned to each group. No significant differences between the 200-µg and 400-µg groups were recorded in mean peripartum blood loss (307±145mL vs 296±151mL; P=0.679) and PPH occurrence (5 [8.1%] vs 6 [9.7%] women; P=0.752). Noticeable adverse effects were reported by 16 (25.8%) women in the 200-µg group and 42 (67.7%) in the 400-µg group (P<0.001). Risk of shivering was significantly lower with 200µg than 400µg (relative risk 0.33, 95% confidence interval 0.19-0.58). CONCLUSION: Blood loss and PPH occurrence did not differ by misoprostol dose, but a 200-µg dose was associated with a reduction in adverse effects. Pan Africa Clinical Trials Registry: PACTR201505001107182.

Prevalence of antenatal hepatitis B infection in tertiary and non-tertiary health facilities in Ibadan, Nigeria.

BACKGROUND: Hepatitis B infection remains a significant source of morbidity among women and infants at different levels of care particularly in developing countries. AIM: To determine the prevalence of hepatitis B infection among pregnant women in tertiary and non-tertiary health facilities. MATERIALS & METHODS: Women receiving antenatal care in a tertiary centre and 2 non-tertiary centres in Ibadan. Nigeria were consecutively screened for Hepatitis B surface antigen by the ELISA method following written informed consent. The results were entered with socio-demographic and obstetric data into a proforma and significant associations determined by chi-square test and logistic regression (p < 0.05). RESULTS: A total of 658 women were recruited; 389 were from the tertiary hospital while 259 were from nontertiary health facilities. The mean age of the whole population was 30.17 +/- 5.24 years while the median gestational age was 27 weeks. Majority of the participants (64.5%) were between 26 and 35 years. The total prevalence of Hepatitis B infection was 16.3%. Prevalence of hepatitis B infection was 30.9% in the non-tertiary health facilities and 6.4% in the tertiary health facility (p = 0.000).The only significant positive predictor variable for hepatitis B infection was being in a non-tertiary health facility (OR: 0.086 CI: 0.037-0.199, p = 0.004). CONCLUSION: The burden ofAntenatal hepatitis B infection in Ibadan may be significantly greater in nontertiary health facilities. Health policy, particularly in these centres, should be directed towards education, screening and vaccination programmes.