Maternal and fetal effect of misgav ladach cesarean section in Nigerian Women: A randomized control study

BACKGROUND: The poor utilisation of the Misgav-Ladach (ML) caesarean section method in our environment despite its proven advantage has been attributed to several factors including its non-evaluation. A well designed and conducted trial is needed to provide evidence to convince clinician of its advantage over Pfannenstiel based methods. AIM: To evaluate the outcome of ML based caesarean section among Nigerian women. SUBJECTS AND METHODS: Randomised controlled open label study of 323 women undergoing primary caesarean section in Lagos Nigeria. The women were randomised to either ML method or Pfannenstiel based (PB) caesarean section technique using computer generated random numbers. RESULTS: The mean duration of surgery (P < 0.001), time to first bowel motion (P = 0.01) and ambulation (P < 0.001) were significantly shorter in the ML group compared to PB group. Postoperative anaemia (P < 0.01), analgesic needs (P = 0.02), extra suture use, estimated blood loss (P < 0.01) and post-operative complications (P = 0.001) were significantly lower in the ML group compared to PB group. Though the mean hospital stay was shorter (5.8 days) in the ML group as against 6.0 days, the difference was not significant statistically (P = 0.17). Of the fetal outcome measures compared, it was only in the fetal extraction time that there was significant difference between the two groups (P = 0.001). The mean fetal extraction time was 162 sec in ML group compared to 273 sec in the PB group. CONCLUSIONS: This study confirmed the already established benefit of ML techniques in Nigerian women, as it relates to the postoperative outcomes, duration of surgery, and fetal extraction time. The technique is recommended to clinicians as its superior maternal and fetal outcome and cost saving advantage makes it appropriate for use in poor resource setting

Pregnancy, Obstetric and Neonatal Outcomes in HIV Positive Nigerian Women

While the effect of HIV infection on some maternal outcomes is well established, for some others there is conflicting information on possible association with HIV. In this study we investigated pregnancy and neonatal outcome of HIV positive women in large HIV treatment centre over a period of 84 months. They were managed according to the Nigerian PMTCT protocol. Adverse obstetric and neonatal outcome were observed in 48.3% HIV positives compared 30.3% to the negatives (OR: 2.08; CI: 1.84-2.34). Low birth weight ( OR:2.95; CI:1.95-3.1), preterm delivery (OR:2.05;CI:1.3-3.1), perinatal death (OR:1.9;CI:1.3-3.2), and spontaneous abortion (OR:1.37; CI:1.1-2.3) were factors found to be independently associated with HIV. Low CD4 count (OR: 2.45; CI: 1.34- 4.56) and opportunistic infections (OR: 2.11; CI: 1.56-3.45) were to be associated with adverse obstetric and neonatal outcome. This study confirms the association of HIV, severe immunosuppression and opportunistic infection and adverse obstetric and neonatal outcome.Alors que l&apos;effet de l&apos;infection par le VIH sur certains résultats maternels sont bien établis, pour certains d&apos;autres, il ya des informations contradictoires sur l&apos;association possible avec le VIH. Dans cette étude, nous avons étudié la grossesse et l&apos;état néonatal des femmes séropositives dans un grand centre de traitement du VIH au cours d’une période de 84 mois. Elles étaient prises en charge selon le protocole nigérian de PTME. On a remarqué des résultats obstétricaux et néonatals Indésirables chez 48,3% des séropositives par rapport à 30,3% pour les négatifs (OR: 2,08, IC: 1,84 à 2,34). Le faible poids de naissance (OR: 2,95, IC : 1,95-3 ,1), l&apos;accouchement prématuré (OR: 2,05, IC : 1,3-3 ,1), la mortalité périnatale (OR: 1,9, IC : 1,3-3 ,2), et l&apos;avortement spontané (OR: 1,37 IC :1,1-2 3) étaient des facteurs qui seraient associés de façon indépendante avec le VIH. Les femmes qui ont un faible taux de CD4 (OR: 2,45, IC: 1,34 à 4,56) et les infections opportunistes (OR: 2,11, IC : 1,56-3 .45) devaient être associées aux résultats obstétricaux et néonatals défavorables. Cette étude confirme l&apos;association entre le VIH, l’immunosuppression sévère et l’infection opportuniste, les résultats obstétricaux et néonatals défavorables

Pregnancy, Obstetric and Neonatal Outcomes in HIV Positive Nigerian Women

While the effect of HIV infection on some maternal outcomes is well established, for some others there is conflicting information on possible association with HIV. In this study we investigated pregnancy and neonatal outcome of HIV positive women in large HIV treatment centre over a period of 84 months. They were managed according to the Nigerian PMTCT protocol. Adverse obstetric and neonatal outcome were observed in 48.3% HIV positives compared 30.3% to the negatives (OR: 2.08; CI: 1.84-2.34). Low birth weight ( OR:2.95; CI:1.95-3.1), preterm delivery (OR:2.05;CI:1.3-3.1), perinatal death (OR:1.9;CI:1.3-3.2), and spontaneous abortion (OR:1.37; CI:1.1-2.3) were factors found to be independently associated with HIV. Low CD4 count (OR: 2.45; CI: 1.34- 4.56) and opportunistic infections (OR: 2.11; CI: 1.56-3.45) were to be associated with adverse obstetric and neonatal outcome. This study confirms the association of HIV, severe immunosuppression and opportunistic infection and adverse obstetric and neonatal outcome.Alors que l&apos;effet de l&apos;infection par le VIH sur certains résultats maternels sont bien établis, pour certains d&apos;autres, il ya des informations contradictoires sur l&apos;association possible avec le VIH. Dans cette étude, nous avons étudié la grossesse et l&apos;état néonatal des femmes séropositives dans un grand centre de traitement du VIH au cours d’une période de 84 mois. Elles étaient prises en charge selon le protocole nigérian de PTME. On a remarqué des résultats obstétricaux et néonatals Indésirables chez 48,3% des séropositives par rapport à 30,3% pour les négatifs (OR: 2,08, IC: 1,84 à 2,34). Le faible poids de naissance (OR: 2,95, IC : 1,95-3 ,1), l&apos;accouchement prématuré (OR: 2,05, IC : 1,3-3 ,1), la mortalité périnatale (OR: 1,9, IC : 1,3-3 ,2), et l&apos;avortement spontané (OR: 1,37 IC :1,1-2 3) étaient des facteurs qui seraient associés de façon indépendante avec le VIH. Les femmes qui ont un faible taux de CD4 (OR: 2,45, IC: 1,34 à 4,56) et les infections opportunistes (OR: 2,11, IC : 1,56-3 .45) devaient être associées aux résultats obstétricaux et néonatals défavorables. Cette étude confirme l&apos;association entre le VIH, l’immunosuppression sévère et l’infection opportuniste, les résultats obstétricaux et néonatals défavorables