Uterine rupture is a life threatening obstetric emergency and is associated with high maternal and perinatal mortality. There are some risk factors associated with uterine rupture which may include: prolonged obstructed labour, previous scarred uterus, grand-multiparity, macrosomic baby, abnormal lie, instrumental delivery, induction of labour, oxytocin stimulation and excessive uterine manipulation. Its modes of presentation have been widely reported. Here, we present a case with an unusual mode of presentation where about two-third of the small intestines protruded through the vagina following some manipulations by an unskilled birth attendant. This highlights the fact that when uterine rupture is suspected, the cord-like structure protruding per vaginum may not always be umbilical cord.
BACKGROUND: Primary postpartum hemorrhage (PPH) contributes significantly to the high maternal mortality ratio, especially in the low resource nations. Placenta previa and retained placenta are major causes of postpartum hemorrhage. Uterotonics like misoprostol are medication used to improve uterine contractility with the purpose of reducing uterine bleeding after delivery of baby. Most studies on misoprostol for the prevention of obstetric hemorrhage have been focusing on its postpartum use. AIM: The aim of this study was to assess the effectiveness of pre-operative misoprostol in reducing blood loss during cesarean section for placental previa and manual removal of retained placenta. METHODS: This was a placebo-controlled study involving 154 women who were randomly assigned to the treatment and control groups. The study group received 400 ug of misoprostol rectally just before the commencement of the procedure. Estimation of blood loss was done in a standardized way. Data were analyzed using SPSS version 23. The level of significance was set at p < 0.05. RESULTS: The average age of the participants was 31.64 years. The overall incidence of PPH was comparable in both groups (0.070), however, misoprostol group experienced lower incidence of severe PPH compared to the placebo (p = 0.013). Other maternal and perinatal outcomes were comparable. CONCLUSION: Excessive intraoperative and immediate post-operative bleeding can be prevented with pre-operative misoprostol. It should be made available for high-risk obstetrics procedures.
Background and objectiveInfant survival depends on proper nutrition. Breastfeeding enhances infant health and offers some benefits to the mother as well. However, in the setting of the HIV pandemic, it is important to assess the benefits and the risk for each individual in choosing a feeding option. The purpose of this research was to determine the infant-feeding practices among women living with HIV/AIDS (WLWHA) and compare them with the general population of women. MethodsA mixed comparative survey was conducted among 246 HIV-positive mothers nursing infants of at least one year of age. An equal number of matched HIV-negative women from the same locality were selected as controls. Quantitative data were analyzed using IBM SPSS Statistics version 23 (IBM Corp., Armonk, NY) while qualitative findings were presented in a thematic approach. ResultsThe prevalence of exclusive breastfeeding (EBF) among WLWHA was 73.6% compared to 55.2% in the controls [p=0.002; chi-square (X 2 )=5.264]. Only 6.5% of WLWHA practiced exclusive replacement feeding (ERF). Vaginal birth was associated with increased odds for early initiation of breastfeeding [p=0.001; odds ratio (OR): 3.135; 95% confidence interval (CI): 2.130 to 4.616]. Also, urban dwellers commenced breastfeeding earlier than women residing in rural communities (p=0.002; OR: 5.58; 95% CI: 3.85 to 8.07). Based on in-depth interviews, cultural influences and non-disclosure of HIV status to family members promoted mixed feeding. Concomitant intake of anti-tuberculosis drugs was a major reason for adopting ERF in some women. ConclusionThere was a high prevalence of EBF among WLWHA. Counseling on infant feeding is an effective component of the Prevention of Mother-to-Child Transmission (PMTCT) programs. Cultural beliefs and fear of stigmatization are major challenges to infant nutrition in sero-exposed babies.
The COVID-19 pandemic has reawakened the necessity of wearing a face mask in public places in several countries including Nigeria. The effect of prolonged use of face mask on pregnant women is not yet evaluated. The objective of this study was to assess the impact of wearing a surgical face mask on the cardiopulmonary functions of pregnant women. A prospective and case-control study was conducted among 85 healthy pregnant women at gestational ages between 20 weeks and 37 weeks. Equal number of age and parity-matched healthy non-pregnant women were recruited as controls. Their baseline SpO2 and arterial pulse were measured. The participants were then instructed to wear surgical face masks and remain at a resting position for 1 h; thereafter, the SpO2 and pulse rates were measured using a mobile electronic pulse oximeter. Data analysis was done using SPSS version 23. The level of significance was set at 0.05. There was no significant difference in their mean SpO2 (97.44% ± 3.365) and (98.86% ± 1.014) for the pregnant women and the controls, respectively (P= 0.146). However, the mean pulse rate of the pregnant women was significantly higher than that of the controls (97. 58b/m ± 10.731 and 93.17b/m ± 8.850; P = 0.012). The incidence of hypoxemia (SpO2 < 90%) was very low (2.35%) in the pregnant women but non among the non-pregnant control. The incidence of hypoxia-related symptoms was also very low (1.8%). There was a weak negative correlation between the SpO2 and pulse rate (r = −0.0881; P = 0.464 in the pregnant group compared to the controls (r = −0.309; P = 0.004). A vast majority of healthy pregnant women can safely wear a surgical face mask for a long time.
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