Obstetric Cholestasis, Find out more

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Obstetric cholestasis (OC) is an uncommon pregnancy condition that affects your liver and makes you feel itchy, sometimes intensely so. Doctors still don’t know what triggers OC but they do know that OC happens as a result of the way your body uses bile, a liquid produced in your liver. Bile helps to break down food, in particular fats, in your gut. Continue reading

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Maternal Obesity: Know more about it

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Obesity is defined as having an excessive amount of body fat. A formula based on height and weight — called the body mass index (BMI) — is often used to determine if a person is obese.  Maternal Obesity however refers to obesity (often including being overweight) of a woman during pregnancy.

Obesity during pregnancy increases the risk of a number of obstetric complications for both mother and child and is associated with significant maternal mortality and morbidity including increased risk of maternal death, pre-eclampsia and gestational diabetes mellitus. For the offspring of obese mothers, there is a higher incidence of foetal distress, stillbirth and neonatal death.

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Hypertensive Disorders in Pregnancy: Do you know enough about it?

gestational-hypertensionBlood pressure is the force exerted by the blood pushing against the artery walls. When the pressure in the arteries becomes too high, it’s called high blood pressure, or hypertension.

A blood pressure reading is given as two numbers. The first number represents the pressure created when your heart beats (systolic pressure); the second number is the pressure when the heart is at rest between beats (diastolic pressure).  Your blood pressure (measured in millimetres of mercury, or mm Hg for short) is recorded regularly during your pregnancy. It is recorded as a higher (systolic) pressure and a lower (diastolic) pressure – for example, 120/70 mm Hg, or 120 over 70.

High blood pressure is defined as a reading of 140/90 or higher, even if just one of the numbers is higher. If you have high blood pressure, or hypertension, your heart has to work harder to pump the blood around your body.

Most pregnant women with high blood pressure have healthy babies, but a few have problems. High blood pressure problems occur in 5 percent to 10 percent of all pregnancies in the Nigeria. Globally, by conservative estimates, hypertensive disorders are responsible for 76,000 maternal and 500,000 infant deaths every year thus remaining one of the leading causes of maternal and infant illness and death. Continue reading

What you need to know about Group B Streptococcus in Pregnancy

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Group B streptococcus (GBS), also known as group B strep, is one of many different bacteria which live inside your body. About a third of us has GBS in our gut without even knowing it. This bacteria is normally found in the vagina and/or rectum of about a quarter of women. If you do, you won’t know it’s there, as GBS doesn’t have any obvious symptoms.

GBS bacteria can be passed from you to your baby during labour but this doesn’t usually cause problems, and most women who carry GBS bacteria have healthy babies. It is thankfully only in rare cases that GBS can cause serious illness and, even more rarely, the loss of a newborn baby.

Though it’s unusual, GBS is the most common cause of severe infection in newborns, particularly in the first week after birth (early onset infection).  If you are carrying GBS, you won’t necessarily know, because there aren’t usually any ill-effects. There is a test available for GBS, but it’s not routinely carried out in pregnancy due to concerns about its reliability.

You may discover that you have GBS by chance, when you have a vaginal swab taken to check for something else. GBS test kits can be bought privately, but many experts don’t recommend these because GBS comes and goes, so a positive test early in your pregnancy doesn’t mean you’ll still have GBS at your baby’s birth and a negative test doesn’t necessarily mean you won’t have GBS at a later stage.
Among babies, there are 2 main types of group B strep disease.

  • Early-onset disease — occurs during the first week of life. The group B strep bacteria are passed from the mother to the baby, most often during labor and birth. Antibiotics given during labor can be very effective at preventing this transmission.
  • Late-onset disease — occurs from the first week through three months of life. This is sometimes due to passing of the bacteria from mother to newborn, but sometimes the bacteria come from another source. For a baby whose mother does not test positive for group B strep, the source of infection for late-onset disease can be hard to figure out and is often unknown.

Early-onset disease used to be the most common type of disease in babies. Today, because of effective early-onset disease prevention, early and late-onset disease occurs at similar low rates.

For early-onset disease, group B strep most commonly causes Sepsis (infection of the blood), Pneumonia (infection in the lungs), and sometimes Meningitis (infection of the fluid and lining around the brain). Similar illnesses are associated with late-onset group B strep disease. Meningitis is more common with late-onset group B strep disease than with early-onset group B strep disease.

For both early and late-onset group B strep disease, and particularly for babies who had meningitis, there may be long-term consequences of the group B strep infection such as deafness and developmental disabilities.

Risk Factors:

Some pregnant women are at higher risk of having a baby with early-onset disease. The factors that increase risk include:

  • Testing positive for group B strep late in the current pregnancy (35-37 weeks gestation)
  • Detecting group B strep in urine during the current pregnancy
  • Delivering early (before 37 weeks gestation)
  • Developing fever during labor
  • Having a long period between water breaking and delivering
  • Having a previous infant with early-onset disease
  • If you carry GBS in your vagina and/or rectum during your pregnancy.

Late-onset disease is more common among babies who are born prematurely (< 37 weeks). This is the strongest risk. Babies whose mothers tested group B strep positive also have a higher risk of late onset disease. The risk factors for late onset disease are not as well understood as for early-onset disease.

Most babies exposed to GBS before or during birth are healthy and suffer no ill-effects.  It isn’t clear why some babies develop an infection, while others don’t. What is clear is that most GBS infections in newborn babies can be prevented.
If you are in a high-risk group, you can have antibiotics via a drip that a doctor or nurse will put in a vein in your arm. This will be either from the start of your labour or from when your waters break, whichever comes first, and until your baby is born.

Caesareans are not recommended as a method of preventing GBS infection in babies. That’s because having a caesarean doesn’t eliminate the risk of GBS being passed on to your baby.  GBS may also cause you to have a uterus infection or urinary tract infection (UTI).

If you have been affected by GBS in a previous pregnancy, or are carrying it in your current pregnancy, talk to your midwife or obstetrician. You can then discuss a birth plan that includes steps to protect your baby from the infection.

If you have GBS in your current pregnancy, a hospital birth will be recommended, so you can have antibiotics if you need them.  Your pregnancy will then be managed so your baby is as protected as possible.

Women who are group B strep positive can breastfeed safely. There are many benefits for both the mother and child. Your baby is not at risk of catching GBS from breastfeeding, so there is no need to change your plans if you intend to breastfeed your baby.

Introducing Cervical Cancer Screening in Nigeria through a Social Franchise Project

Cervical Cancer is the most common female cancer in developing countries, with approximately 500,000 new cases and 250,000 deaths each year. In Nigeria, it is thesecond most frequent cancer in women, after breast cancer. Around the world, a woman dies of cervical cancer every two minutes. Women in developing countries suffer disproportionately from the burden of cervical cancer and account for over 80% of cases. Ada Ezeokoli and Chioma Thomas of the Nigeria Health Watch team recently visited a cervical cancer screening project run by the Society for Family Health in Nyanya, Abuja, to learn about the work they are doing to improve the awareness and treatment of this silent killer amongst women.

Cynthia sits quietly with a group of other women at Saffron Hospital in Nyanya, an outlying annex to the city of Abuja. The women are waiting for a nurse to check their vitals and do some paperwork before being ushered into an adjoining room where a doctor and two other hospital personnel are waiting to conduct a simple screening test that will tell if a woman has changes in her cervix that may dispose her to cervical cancer (Cervical pre-cancer). Some of the women, clutching small children, look around nervously. Cynthia however is calm. She is not here to be tested. She has already been diagnosed with cervical pre-cancer and is undergoing cryotherapy treatment, which involves using a cold probe to freeze away the abnormal cells. Until recently, a service like this would not have been available to Cynthia in Nigeria.

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Gestational Diabetes: What you need to know

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Gestational diabetes develops during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby’s health. Between 2 and 10 percent of expectant mothers develop this condition, making it one of the most common health problems of pregnancy.

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Sickle Cell & Pregnancy

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Sickle cell disease often becomes more severe – and pain episodes more frequent – during pregnancy, particularly in the third trimester. A pregnant woman with sickle cell disease is more likely to have a miscarriage, still birth, preterm labor, or a low-birth-weight baby and Sickle cell pregnancies are almost always considered high risk.

Ideally, women with sickle cell disease should receive preconception counseling. This is because with early prenatal care and careful monitoring, women with sickle cell disease can have a healthy pregnancy and successful delivery.Women with sickle cell are more prone to pain episodes during pregnancy, especially during the third trimester. Continue reading

Dr. Yinka Olaniyan: Preventing Cervical Cancer in Nigeria

Cancers that affect women are referred to medically as gynaecological cancers. These are cancers that occur within a woman’s reproductive organs. Breast cancer is often included in this group although its occurrence is not limited to women, as it may on rare occasions occur in men too. Gynaecological cancers in the order of frequency in which they occur are:

Cervical cancer – Cancer of the neck of the womb
Ovarian cancer – Cancer of the ovary
Endometrial or uterine cancer – Cancer of the womb
Vulvar cancer – Cancer of the external genitals
Vaginal cancer – Cancer of the birth canal

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Of these, cervical cancer is the only one that lends itself readily to cost-effective preventive measures and whose incidence has been greatly curtailed through effective prevention strategies. It presents the greatest opportunity where the knowledge of the life history of a disease is employed in its control. Paradoxically, cancer of the cervix, which is the commonest, is also the most preventable of the lot. Not only does it occur most commonly, most cases that report to hospital come at very advanced stages of the disease.

About 10,000 new cases of cervical cancer occur annually in Nigeria and 8,000 women die of the disease each year. The same picture exists in other developing countries, compared to the western world where it is rather rare; and where, when it occurs, it is diagnosed at very early stages, leading to less pain and suffering and greater chances of survival.

While this is a result of the interplay of several factors, the absence of an effective screening program is the chief factor for this difference between the developed and developing countries.

Other factors are ignorance of the disease, lack of accessibility to quality and qualified medical care, dearth of relevant healthcare personnel and, of course, pervading poor socio-economic conditions. We shall look at these factors and the state of the Nigerian situation and current activities aimed at curtailing the problem.

Screening programme
By ‘screening’, we mean a situation where the health-seeking behaviour is initiated by the healthcare provider rather than the ‘patient’. In a cervical cancer screening programme, the healthcare provider actively canvases and invites healthy individuals to present themselves for the screening test.
A screening test is a simple test applied to individuals in order to determine who is at risk of disease. The distinction should be noted that this screening test is not a diagnostic test – the purpose of the screening is to prevent cervical cancer and not to diagnose it. This is because the changes that may eventually lead to cervical cancer can be identified and treated by relatively simple methods ever before they become cancer.

The purpose of screening is to identify these changes before the cancer develops.
The traditional screening test that has resulted in the low incidence of cervical cancer in the developed world is the ‘Pap Smear’. The nature of how a pap smear based screening program works is such that it is not applicable to most developing countries. Its success is dependent on sophisticated technology and manpower; it also requires repeated visits to healthcare facilities by women. These conditions are far from obtainable in developing countries. In effect, where the political will exists to establish programmes, the challenge has been to find an applicable screening and prevention method suited to the peculiar situation of the recipient community.

Sophistication in man and material is not available, the mechanism of call and recall for screening do not exist. And women, who often contribute immensely in bringing bread to the family table, do not have the luxury of time to make repeated visits to be screened and treated for a disease which they know nothing about. Mass awareness and acceptance of screening and prevention may also pose special challenges either due to myths or misconceptions. These are the obstacles that must be overcome if screening is to be effective in developing countries.

Human Papilloma Virus
Cervical cancer can be regarded as a sexually transmitted disease. This is because the cancer is caused by a virus – the Human Papilloma Virus (HPV) which is transmitted during sexual activity. This is why the risk of development of cervical cancer in a woman increases with her number of sexual partners, because the risk of acquiring the virus also increases.
Women who are committed to one sexual partner will also be at risk if the partner in turn has several other sexual partners.

Most women who get HPV will naturally eliminate the virus in a short while through their natural body defences. In a small group of women however, the virus persists. Persistence of the virus may then begin to induce some changes in the woman’s cervix; these changes, if not detected and treated, may then progress to develop into cervical cancer. The interval from HPV infection to development of cervical cancer usually takes about 20 years or more. Smoking or exposure to cigarette smoke has also been identified as a major factor that supports progression of HPV infection to cervical cancer.

Low-technology screening
New low-technology approaches to screening have lately been developed which address the obstacles outlined earlier, and these approaches have been proved to compare favourably and sometimes better than the traditional pap smear.

In Nigeria the Federal Ministry of Health is promoting one such method, called Visual Inspection with Acetic acid (VIA). This method has been proved to be effective and cheap; the result is immediate and where the test is positive, treatment can be provided in a short period of time and at the same visit. This service can be delivered at the local primary health centre and by non-physician practitioners following an appropriate period of training. Nigeria has gained ground over the last few years in propagating this method and is currently in the process of a scale-up of the service to achieve a wide reach of previously un served populations.

Vaccination
Another interesting new approach to cervical cancer prevention is the development of vaccines against the virus – HPV – that is responsible for the development of cervical cancer. These vaccines are best administered to young girls aged nine to fourteen years, before onset of sexual activity, although older women may also benefit from the vaccine. This represents a very attractive approach, especially in areas where widespread screening may not be achievable.
Potential challenges exist though: first, in achieving vast vaccine coverage to adolescent girls for whom it was primarily developed; and second, in achieving effective coverage of the target population i.e. adolescent girls. Potential pitfalls exist as to its acceptance, as in the Nigerian experience with the polio vaccine which was mired in controversy and misconceived as a surreptitious attempt to interfere with the fertility potential of recipients. A successful vaccination programme holds immense promise for the eradication of the disease in Nigeria.

Greater public awareness
Regarding public awareness, a welcome development over the past two decades or so has been the noticeable plethora of activities surrounding cancer. Where hitherto, cancer had been a subject of taboo, it is good to see that Non-governmental organizations, corporate organizations and philanthropists have emerged, willing to contribute their quota. This synergy of activities is crucial to the prosecution of an effective cancer prevention and control. Much misconception exists towards screening activities which causes people to hold a fatalistic view. Individuals are able to make rational choices about their health when they have information. They are able to make lifestyle changes to reduce their risk of cancer as well as utilise available screening procedures.

It has been a long road to curtailing the scourge of cervical cancer even in advanced countries. There is hope however that developing countries have learnt from these experiences for a variety of reasons, especially the globalisation of the world through modern communication modalities – internet social media etc.

Evidence is accumulating that Nigeria is on the positive trail through knowledge, awareness and willingness to engage in health seeking behaviour. Gender discriminatory beliefs are being jettisoned by a modern generation as cultural divides are gradually demolished through this globalisation. All these factors portend a beacon of hope that with proper synergy of activities backed by strong political will, the battle against cervical cancer will be won.

Dr. Yinka Olaniyan is a Chief Consultant Obstetrician & Gynaecologist, Gynaecare Clinic, Abuja.
Contact: dryinka@gynaecarenigeria.com

Dr. Luther-King Fasheun: Improving Maternal Health in Nigeria through Partnership

Embedded image permalinkIt is no longer news that Nigeria is a peculiar country, a nation with huge human and natural resources, and whose diversity of peoples and internal geographies is a blessing. Sadly, it is also not news that the country represents at least 10% of the global maternal mortality burden, with a currently estimated maternal mortality ratio (MMR) of 487 per 100,000 livebirths (as at 2011). However, the well thought-out targets of the Ending Preventable Maternal Mortality (EPMM) Working Group present the country with an unprecedented opportunity to change the tide, improve livelihoods for its women and families, and aim to eliminate preventable maternal mortality within a generation, harnessing the right tools and interventions, at the right scale and quality, as well as building on the success factors in the chase for the Millennium Development Goals (MDGs), including the harnessing of a burgeoning private sector and surging political will for improved health outcomes for women, families, and communities.

Based on the EPMM Working Group targets, the proposed MMR target for Nigeria is ‘less than 100 per 100,000 livebirths by 2035, with country-specific milestones, with the expectation that Nigeria will cross one milestone within every 5 year interval.’ For Nigeria, I humbly recommend that the country-specific 5 year interval milestones be context-driven on a State by State basis, given that Nigeria has 36 States, with one Federal Capital Territory (FCT, Abuja). While the federal government provides strategic guidance and robust supportive frameworks for implementation of reproductive, maternal, newborn and child health (RMNCH) interventions for the entire country, the infrastructural and health systems challenges of Nigeria, as well as the resources available to mitigate these challenges, are mainly State-driven. More so, because of the vast population and heterogeneity of Nigeria, as well as the strategic importance of the country to the attainment of global goals, I wish to strongly recommend that the EPMM Working Group sets State-by-State targets, working in partnership with the Nigerian Federal Ministry of Health, and governments of all the 36+1 States.

A State-by-State framework must not shy away from the interconnectedness of States, and the virtual nature of geographic borders, especially because of the very mobile nature of Nigerian women and families, as well as unavoidably shared natural resources, for example. To this end, there should be significant cooperation and sharing of insightful knowledge, under the leadership of the Federal Ministry of Health, and with the assistance of NGOs, CSOs, bilaterals and multilaterals. In this manner, Nigeria presents a window of opportunity to show the world a model that works to eliminate inequities to the last mile, helping to reach global set goals and targets for maternal mortality ratio (MMR) reduction.

The adoption, last year, of the Maternal Death Review (MDR) surveillance mechanism, at the National Council on Health (NCH) meeting, marked a watershed in the history of Nigeria, as it demonstrated a readiness for evidence-based policy frameworks that will mitigate Nigeria’s huge maternal mortality burden. This policy adoption is being followed through with full vigour. Even more recently, the Presidential Summit on Universal Health Coverage promises a new guiding light for the elimination of inequities and barriers to access to healthcare, especially at the primary healthcare level, where the key to unleashing tremendously scaled-up interventions, to save the lives of mothers and children, exists.

Source: Maternal Health Task Force Blog