Postpartum Sequelae of the Hypertensive Diseases of Pregnancy: A Pilot Study.

BACKGROUND: Hypertensive disorders are one of the most common medical conditions that may complicate pregnancy. Postpartum blood pressure (BP) pattern is, however, less clear in affected women and decision to discharge them is usually decided arbitrarily. MATERIALS AND METHODS: A cohort study conducted at Lagos University Teaching Hospital, Lagos, Nigeria, aimed at determining the proportion of pregnant women with pregnancy-induced hypertension (PIH) and preeclampsia (PE) whose BP remains elevated 6 weeks postdelivery and factors associated with the persistent rise. Fifteen women each with PIH and PE were studied in different phases of pregnancy and followed up until 6 weeks postdelivery. Fifteen normotensive pregnant women served as controls. BP patterns were monitored and fasting lipid levels, serum creatinine, fasting glucose profile (FGP), and FGP/insulin ratio were assayed. Data were analyzed with IBM SPSS version 20. RESULTS: Proportion of women with PIH or PE who had persistent hypertension at 6 weeks postpartum was 3/29 (10.3%), risk ratio of 1.1. No statistically significant association was found between mean arterial BP at 6 weeks postpartum and age, parity, gestational age at delivery, body mass index, and family history of hypertension. Serum creatinine level showed moderate correlation with persistent hypertension at 6 weeks postpartum (r = 0.441,P = 0.006), with sensitivity of 100% and specificity of 81.8% at cutoff value of 1.2 mg/dL in detecting pregnant women with hypertensive disorders who will likely remain hypertensive at 6 weeks postpartum. CONCLUSION: There is a need for long-term follow-up of women with PIH/PE beyond puerperium.

Baby Factories in Nigeria: Starting the Discussion Toward a National Prevention Policy.

Baby factories and baby harvesting are relatively new terms that involve breeding, trafficking, and abuse of infants and their biological mothers. Since it was first described in a United Nations Educational, Scientific and Cultural Organization report in Nigeria in 2006, several more baby factories have been discovered over the years. Infertile women are noted to be major patrons of these baby factories due to the stigmatization of childless couples in Southern Nigeria and issues around cultural acceptability of surrogacy and adoption. These practices have contributed to the growth in the industry which results in physical, psychological, and sexual violence to the victims. Tackling baby factories will involve a multifaceted approach that includes advocacy and enacting of legislation barring baby factories and infant trafficking and harsh consequences for their patrons. Also, programs to educate young girls on preventing unwanted pregnancies are needed. Methods of improving awareness and acceptability of adoption and surrogacy and reducing the administrative and legal bottlenecks associated with these options for infertile couples should be explored to diminish the importance of baby factories.

The value of chlamydial antibody level for predicting tubal blockage among women undergoing hysterosalpingography in Lagos, Nigeria.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis infection among Nigerian women undergoing hysterosalpingography (HSG) and to identify any correlation between chlamydial antibody levels and a diagnosis of tubal disease. METHODS: A prospective cross-sectional study was conducted from January 1 to June 30, 2013, among women scheduled to undergo HSG in the radiology department of Lagos University Teaching Hospital, Nigeria. Endocervical swabs and serum samples were collected to assess the levels of chlamydial antigen and antibody, respectively. RESULTS: Among 150 participants, 83 (55.3%) had bilateral tubal patency and 67 (44.7%) had tubal disease. Overall, 53 (35.3%) women had positive test results for chlamydial antibodies; however, none of the participants tested positive for chlamydial antigen. Women with tubal disease were more likely to test positive for chlamydial antibodies (n=44 [65.7%]) than were those whose test results were negative (n=9 [10.8%]; P<0.001). The sensitivity and specificity of chlamydial antibody testing to predict tubal disease diagnosed by HSG were 66% and 89%, respectively. CONCLUSION: The presence of chlamydial antibodies was quantitatively related to the likelihood of HSG-diagnosed tubal disease.

Asymptomatic bacteriuria among antenatal women in Lagos.

This cross-sectional study was undertaken to determine the prevalence of asymptomatic bacteriuria (ASB), the commonest bacterial isolates and the antibiotic sensitivity pattern among 556 pregnant women in Lagos University Teaching Hospital (LUTH), Nigeria. Women with a bacterial count over 100,000 colony-forming units per millilitre of the same organisms in paired urine samples were considered to have ASB. The prevalence of ASB was 14.6%. Klebsiella was the commonest micro-organism (39.2%) isolated. ASB was significantly associated with marital status, body mass index and parity. There was a significant relationship between urinary nitrites and ASB. The isolated organisms showed remarkable resistance to commonly prescribed antibiotics such as amoxicillin, cloxacillin and trimethoprim but good sensitivity to ofloxacin, gentamycin and ceftazidime. These facts have implications for the management of ASB in pregnancy.

Baby factories taint surrogacy in Nigeria.

The practice of reproductive medicine in Nigeria is facing new challenges with the proliferation of 'baby factories'. Baby factories are buildings, hospitals or orphanages that have been converted into places for young girls and women to give birth to children for sale on the black market, often to infertile couples, or into trafficking rings. This practice illegally provides outcomes (children) similar to surrogacy. While surrogacy has not been well accepted in this environment, the proliferation of baby factories further threatens its acceptance. The involvement of medical and allied health workers in the operation of baby factories raises ethical concerns. The lack of a properly defined legal framework and code of practice for surrogacy makes it difficult to prosecute baby factory owners, especially when they are health workers claiming to be providing services to clients. In this environment, surrogacy and other assisted reproductive techniques urgently require regulation in order to define when ethico-legal lines have been crossed in providing surrogacy or surrogacy-like services.

The impact of medical tourism and the code of medical ethics on advertisement in Nigeria.

Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done.

Trends in maternal mortality at the Lagos University Teaching Hospital, Lagos, Nigeria.

BACKGROUND: Recent reports suggest that the burden of maternal mortality remains heavy in Sub-Saharan Africa; and that the fifth millennium development goal might not be achieved. As the target date 2015 draws near, we carried out a review of maternal mortality in a Teaching Hospital unitto assess the current situation. OBJECTIVES: To determine the Maternal Mortality Ratio (MMR), the clinical causes of maternal deaths and the numerical and etiological trends in maternal mortality at the Lagos University Teaching Hospital (LUTH). METHOD: The records of births and maternal deaths at LUTH over a five year period were reviewed. The data collected was analyzed to determine the maternal mortality ratio, the socio-biological factors associated with maternal death and the clinical causes. Comparisons are made with findings from previous studies done in LUTH and elsewhere. RESULTS: The maternal mortality ratio was 2096 per 100000 live births. The mortality ratio has more than doubled over a period of 3 decades. Unbooked patients accounted for 7.1% of deliveries but contributed 88.1% of the maternal deaths.Majority (59.0%) of the deaths occurred within 24 hours of admission. The main clinical causes of death included sepsis (17.9%), hypertensive diseases (17.9%), abortion (11.2%), HIV/AIDS infection (11.2%)), haemorrhage (9.0%) and medical disorders (18.7%). CONCLUSION: The maternal mortality ratio remains high in our unit in line with some other reports from Nigeria but in contrast to the trends in other developed and developing countries. Unless urgent action is taken, the 5th millennium development goal may not be achieved.

Proteomic biomarkers for ovarian cancer risk in women with polycystic ovary syndrome: a systematic review and biomarker database integration.

OBJECTIVE: To review and identify possible biomarkers for ovarian cancer (OC) in women with polycystic ovary syndrome (PCOS). DESIGN: Systematic literature searches of MEDLINE, EMBASE, and Cochrane using the search terms "proteomics," "proteomic," and "ovarian cancer" or "ovarian carcinoma." Proteomic biomarkers for OC were then integrated with an updated previously published database of all proteomic biomarkers identified to date in patients with PCOS. SETTING: Academic department of obstetrics and gynecology in the United Kingdom. PATIENT(S): A total of 180 women identified in the six studies. INTERVENTION(S): Tissue samples from women with OC vs. tissue samples from women without OC. MAIN OUTCOME MEASURE(S): Proteomic biomarkers, proteomic technique used, and methodologic quality score. RESULT(S): A panel of six biomarkers was overexpressed both in women with OC and in women with PCOS. These biomarkers include calreticulin, fibrinogen-γ, superoxide dismutase, vimentin, malate dehydrogenase, and lamin B2. CONCLUSION(S): These biomarkers could help improve our understanding of the links between PCOS and OC and could potentially be used to identify subgroups of women with PCOS at increased risk of OC. More studies are required to further evaluate the role these biomarkers play in women with PCOS and OC.

Perinatal mortality in Lagos University Teaching Hospital: a five year review.

BACKGROUND: An overwhelming proportion of the annual global perinatal deaths occur in developing countries. However few data on perinatal mortality are available from these countries. Reducing perinatal deaths requires adequate data that can be used to develop appropriate strategies. OBJECTIVES: To determine the perinatal mortality rate at the Lagos University Teaching Hospital (LUTH), the associated risk factors and the causes of perinatal deaths; and make recommendations to help reduce perinatal mortality. METHODS: A retrospective study of all deliveries in LUTH in the period between January 2002 and December 2006 was done. Data were collected on all stillbirths and early neonatal deaths. Analysis included such variables as booking status, maternal age, parity, gestational age, fetal weight and cause of perinatal death. RESULTS: The perinatal mortality rate was 70.6/1000 total births. The rate was higher among unbooked patients and those with multiple pregnancies. It increased with parity after the 2nd delivery and was highest at the extremes of reproductive age groups. The commonest causes of death were antepartum haemorrhage, pre-eclampsia/eclampsia, mechanical causes, intrapartum asphyxia and prematurity. CONCLUSIONS: The perinatal mortality rate in our institution is high. The causes of perinatal death are largely preventable. Urgent clinical and political actions are required to make any progress towards attaining the fourth millennium development goal (MDG4).