Dr Akunaeziri Uche - Academia.edu (original) (raw)

Papers by Dr Akunaeziri Uche

Background: Cervical cancer is the commonest gynaecological cancer in developing countries due to... more Background: Cervical cancer is the commonest gynaecological cancer in developing countries due to poor uptake of screening services. Objective: To determine the prevalence and pattern of abnormal Pap smears and the relationship of the abnormal smears with risk factors for the development of cervical cancers. Materials and Methods: Retrospective analysis of data from the cervical cancer screening centre of the Jos University Teaching Hospital (JUTH). Results: Of the 3875 women screened, 1418 (36.6%) had abnormal smears with low grade squamous intra-epithelial lesion (38.2%) being the commonest lesion. Among those with abnormal smears, 590 (41.6%) had one risk factor each and 828 (58.4%) had two or more risk factors while those women who were 50 years and above constituted the highest number with abnormal smears. Conclusion: This study showed that only few women access cervical screening services and amongst those who accessed the services, a large proportion had abnormal smears. Also...

Introduction: Fetal papyraceous results when an early fetal death occurs in utero (usually in ear... more Introduction: Fetal papyraceous results when an early fetal death occurs in utero (usually in early 2 nd trimester between 15 to 20 weeks) and the fetus is not expelled out. A single fetal death in multiple pregnancy is not uncommon. However the death of one or more fetuses in multiple pregnancy leads to increased morbidity and mortality of the surviving fetus/ fetuses. Case Discussion: A case of a 43 year old primigravida with a triplet pregnancy who had fetal demise of two of the fetuses. She was monitored closely and eventually had an Emergency caesarean section at 30 weeks gestation, with delivery of a live fetus and two fetal papyraceous. Conclusion: Fetal papyraceous diagnosed in the second or third trimester is rare. Careful fetal and maternal monitoring is required to improve fetal and maternal outcomes.

Nigerian Journal of Medicine

IntroductIon Asymptomatic bacteriuria (ASB) is the presence of bacteria in the properly collected... more IntroductIon Asymptomatic bacteriuria (ASB) is the presence of bacteria in the properly collected urine of a patient that has no signs or symptoms of a UTI. [1] The presence of bacteria is significant when the urine contains ≥10 5 colony-forming units/ml of a single bacteria. [2] UTI refers to both microbial colonization of the urine and tissue invasion of any structure of the urinary tract and carries a significant risk of morbidity and mortality to obstetric patient/mother and fetus. [2] Bacteria found in the urine of patients with ASB usually originate from flora that colonizes the gastrointestinal tract, vagina, and periurethral area. [2] These bacteria then remain in the urinary tract without eliciting a host response sufficient to produce symptoms or cause eradication [3]. Escherichia coli is the bacteria found in over 90% of cases, other pathogens are Klebsiella pneumoniae and Proteus. [2] Prompt diagnosis of ASB is essential in reducing morbidity and mortality. [4] The progression to symptomatic bacteriuria could lead to pyelonephritis with its serious complications including miscarriages, preterm contractions, preterm labour, and prematurity and its complications. [4,5] The American College of Obstetrics and Gynecology advises that a urine culture is done on the first antenatal clinic visit. [6] This will help to identify pregnant women with ASB for the purposes of early intervention. [6] This is, however, not currently a routine booking investigation in many facilities in Nigeria. Risk factors for UTIs include sickle cell trait or sickle cell disease; diabetes; immunosuppressive disorders; urinary tract obstructions (from stones); loss of bladder control (due to neuromuscular disease); and need for chronic Context: Asymptomatic bacteriuria (ASB) is the presence of bacteria in the properly collected urine of a patient that has no signs or symptoms of a urinary tract infection (UTI). If diagnosed early, UTI and its grave consequences can be prevented in pregnant women. Aims: The goal was to ascertain the prevalence of ASB in pregnant women attending antenatal clinic. Subjects and Methods: The study was a cross-sectional descriptive study. Data were collected using the proforma. Clean catch urine samples were taken and sent for microscopy, culture, and sensitivity. The data were analyzed by statistical package for social sciences (SPSS) version 23. Results: A total of 42 women had ASB on urine culture, giving a prevalence of 30.4%. The most common organism cultured was Escherichia coli (21[50%]) and most of the organisms isolated were sensitive to nitrofurantoin (88.3%). Conclusions: This study found that the prevalence of ASB among antenatal clients was 30.4%. The dominant organism was found to be E. coli. Majority of the organisms were sensitive to nitrofurantoin (88.3%), cefuroxime (78.6%), ceftazidime (78.6%), and ceftriaxone (71.4%). We found a positive association between the density/number of urinary pus cells of the participants and the occurrence of ASB.

Archives of Gynecology and Obstetrics

The diagnosis of premature rupture of membranes (PROM) can be difficult in equivocal cases. This ... more The diagnosis of premature rupture of membranes (PROM) can be difficult in equivocal cases. This study was designed to test the validity of vaginal fluid urea and creatinine in the diagnosis of PROM against the gold standard, the Amnisure ROM test™ The study was a prospective observational study. All consenting eligible pregnant women between gestational ages of 28 weeks to 41 weeks + 6 days were recruited from the obstetrics emergency and antenatal clinic of the Federal medical centre, Keffi. Patients with history of drainage of liquor were recruited as the case group, and controls who match for age, parity and gestational age were recruited from the antenatal clinic to constitute the control group. Vaginal fluid aspirated was assessed in the laboratory for urea and creatinine levels and an Amnisure ROM test™ done. The sensitivity, specificity, negative and positive predictive values of vaginal fluid urea and creatinine were assessed in the diagnosis of PROM. Vaginal fluid urea and creatinine had sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), respectively, of 94%, 82%, 93.18% and 83.93%, and 98%, 90%, 97.82% and 90.74%. The cutoff values for vaginal fluid urea and creatinine were 1.25 mg/dl and 0.23 mg/dl, respectively. This study has found that vaginal fluid urea and creatinine are very effective tests in diagnosis of PROM. It is a cheaper and more readily available alternative to the Amnisure test. It is especially useful in our environment, especially in cases of equivocal PROM, as a cost-effective means to confirm the diagnosis. 72961653, retrospectively registered on the 2020-07-09.

Women's Health

Background: Caesarean section, a common obstetric surgical procedure, is a major predisposing fac... more Background: Caesarean section, a common obstetric surgical procedure, is a major predisposing factor for puerperal infections, requiring the need for antibiotic prophylaxis. Evidence suggests that single-dose antibiotic prophylaxis has comparable efficacy to multiple-dose antibiotic prophylaxis, but with a lower cost and risk of antibiotic resistance. However, single-dose antibiotic prophylaxis after caesarean section is not generally used in many centres in sub-Saharan Africa. Objective: This study aimed to compare the effectiveness of single- versus multiple-dose antibiotic prophylaxis to prevent post-caesarean section infections. Methodology: This open-label, randomized controlled trial involved 162 consenting patients admitted for caesarean section (elective or emergency) at the Federal Medical Centre Keffi. They were distributed randomly into treatment arm A or B. Subjects in both arms received intravenous ceftriaxone (1 g) and metronidazole (500 mg) 30–60 min before incision; ...

Highland Medical Research Journal, 2020

Background: Early initiation of antenatal care is believed to improve maternal and foetal outcome... more Background: Early initiation of antenatal care is believed to improve maternal and foetal outcome. We sought to ascertain gestational age at booking and the outcome of these pregnancies at a faith based hospital in northern Nigeria. Methods: A retrospective descriptive study of patients who booked for antenatal care at the Faith Alive Hospital, Jos, st st Nigeria between 1 January, 2010 to 31 December, 2017 was done. Information regarding demographics, gestational age at booking and outcome of these pregnancies were analyzed. Result: During the study period, 3739 women registered for antenatal care. Majority of women were 20-24years (n= 1252 , 33.5 %) while The mean age was 28 ± 4years Of these women, 96.2% were married , 75.2% were Christians, 43.8% had secondary level of education and 41.2% were traders. st Furthermore, 23.2% of the clients booked in the 1 trimester in 2010, decreased to 17.3% in 2012 but progressively increased to 35.2% , 40.2% and 53.4% in 2014, 2015 and 2017 respectively. There was a significant statistical association between parity, marital status and educational status with late booking for antenatal care. Clients who booked late for antenatal care had poorer neonatal outcomes (low birth weight, still births and birth asphyxia) compared to those who booked early. Conclusion: Late initiation of antenatal care is common in our environment and associated with poorer neonatal outcomes.  Nonetheless, a progressive improvement in early bookings was noticed with improved pregnancy outcome. Key Words: Gestational age, booking, pregnancy outcome, Faith Alive, Jo

BACKGROUND: The foetal consequences of CMV infection have made it one of the most serious infecti... more BACKGROUND: The foetal consequences of CMV infection have made it one of the most serious infections contracted during pregnancy. Recurrent pregnancy loss is a challenging problem for the obstetrician. Human cytomegalovirus is a major cause of congenital infection and has been implicated as a cause of pregnancy loss. Knowledge about the magnitude of this problem in our locality will help in developing methods of prevention of this infection which will eventually improve obstetric outcome.OBJECTIVE: The objective was to compare the prevalence of CMV infection among women with recurrent pregnancy loss and normal postnatal women.DESIGN: It was a case control study.METHODOLOGY: The study involved 42 women presenting with recurrent miscarriage and 42 postpartum women with no adverse obstetric outcome. Subjects were recruited from JUTH, Plateau State Specialist Hospital and Faith Alive Hospital. A semi-structured researcher administered questionnaire was used to obtain socio-demographic i...

Purpose: The diagnosis of premature rupture of membranes (PROM) can be difficult in equivocal cas... more Purpose: The diagnosis of premature rupture of membranes (PROM) can be difficult in equivocal cases. This study was designed to test the validity of vaginal fluid urea and creatinine in the diagnosis of PROM against the gold standard which is the Amnisure test.Methods: The study was a prospective observational study. All consenting eligible pregnant women between gestational ages of 28 weeks to 41weeks + 6 days were recruited from the obstetrics emergency and antenatal clinic of the Federal medical centre, Keffi. Patients with a history of drainage of liquor were recruited as the case group, and controls that match for age, parity and gestational age were recruited from the antenatal clinic to constitute the control group. Vaginal fluid aspirated was assessed in the laboratory for urea and creatinine levels and an Amnisure test done. The sensitivity, specificity, negative and positive predictive values of vaginal fluid urea and creatinine were assessed in the diagnosis of PROM.Resul...

The Nigerian Journal of General Practice, 2021

Introduction: Asymptomatic bacteriuria (ASB) in pregnancy is defined as the presence of at least ... more Introduction: Asymptomatic bacteriuria (ASB) in pregnancy is defined as the presence of at least 105 colony-forming units per milliliter of a bacteria species in clean-catch urine in the absence of obvious symptoms of urinary tract infection during pregnancy. It is associated with obstetric complications such as preeclampsia, pyelonephritis, preterm labor, low birth weight, and prematurity. Determining the microbial isolates and sensitivity patterns of ASB among pregnant women locally will aid the management of ASB in pregnancy and prevention of complications associated with it. Objective: The aim of the study was to determine the microbial isolates and sensitivity pattern among antenatal patients with ASB at the Federal Medical Center (FMC), Keffi, Nasarawa state. Materials and Methods: This is a cross-sectional study among pregnant women attending the antenatal clinic at the FMC, Keffi, with ASB. Clients who met the selection criteria were recruited for the study. A structured pro forma was administered, and midstream urine samples were collected and processed. Result was analyzed using the Statistical Package for the Social Sciences version 20. Chi-square at a significant level of 0.05 and confidence level of 95% was used to determine significance. Results: A total of 184 consented women presenting for their first antenatal visit were screened for ASB, of which 82 were positive for significant bacteriuria, giving a prevalence of 44.6%. The ages of the participants ranged from 18 to 43 with a mean age of 29.58 ± 5.42 years. The common uropathogens isolated were Staphylococcus aureus 43 (52.4%), Klebsiella spp. 14 (17.1%), and Escherichia coli 13 (15.9%). The isolates were most sensitive to amoxicillin-clavulanate (85.4%), nitrofurantoin (82.9%), and gentamicin (79.3). Conclusion: The prevalence of ASB among the study participants was high. S. aureus, Klebsiella spp., and E. coli were the predominant organisms cultured while most of the isolates were sensitive to amoxicillin-clavulanate, nitrofurantoin, and gentamicin.

Highland Medical Research Journal, Sep 17, 2021

Background: Labor is among the most painful experiences a woman will endure. Labor analgesia in l... more Background: Labor is among the most painful experiences a woman will endure. Labor analgesia in low income countries as against  developed countries is not in widespread use. This is as a result of issues related to awareness, culture, acceptability and availability of analgesia. This study aims to assess the knowledge, attitude and practices for labor analgesia amongst healthcare workers.Methods: This was a descriptive cross-sectional questionnairebased study on the knowledge and practice of labor analgesia among practitioners at the Departments of Obstetrics and Gynecology and Family Medicine of the Federal Medical Centre, Keffi.Results: This study found that despite 92.3% having had education about labor analgesia and 95.2% of respondents believing labor pain should be relieved, 19.2% still believed labor analgesia should not be routinely prescribed. In addition, about 35% of the surveyed health workers had never counseled pregnant women on any form of intra-partum analgesia before, while about 24% had never prescribed labor analgesia.Conclusion: We found that despite adequate awareness of labor analgesia, a lot of health care workers in the obstetrics unit unfortunately fail to counsel patients on and prescribe labor analgesia

Nigerian Journal of Medicine, 2020

This is an open access journal, and articles are distributed under the terms of the Creative Comm... more This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Jos Journal of Medicine, 2018

International Journal of Advanced Research in Gynaecology and Obstetrics, 2019

Background: Caesarean section (CS) rates have been increasing steadily globally. Although caesare... more Background: Caesarean section (CS) rates have been increasing steadily globally. Although caesarean section is becoming increasingly safe, women still have aversion for caesarean section in our environment. Objective: To determine the perception, knowledge and attitude of antenatal clinic (ANC) attendants in Jos University Teaching Hospital towards caesarean section as a mode of delivery. Method: This was a descriptive cross-sectional study. A pre-tested structured questionnaire was administered to pregnant women who receive care at the antenatal clinic of the Jos University Teaching Hospital between 1 st December 2013 to 31st January 2014. Results: The average age of the respondents was 29.06±6.00 years, while the average income per month was 6786 ± 1053.92 naira. Fifty-five (24.2%) of the respondents did not know any indication for caesarean section while one hundred and seventy-two knew at least one correct indication out of which four (1.8%) knew three correct indications for caesarean section. Caesarean section was considered to be dangerous by 55.1%. The commonest reason given was that the mother could die (47.37%). Vaginal delivery was preferred by 88.5%, 6.20% had no preference while 5.30% preferred caesarean section. The commonest reason given for preference for vaginal delivery was that it is safer (32.34%). Eleven out of 12 respondents that preferred caesarean section preferred it because the stress of labour is eliminated. The commonest reasons for aversion to caesarean section was fear of operation (48.98%), lack of finance (30.61%) and fear of being stigmatized (26.53%). There was statistical significant relationship between income, religion and willingness to undergo caesarean section. Conclusion: There is a high level of awareness of caesarean delivery among ANC attendants at the Jos University Teaching Hospital. Client education is necessary to address some concerns on safety of the operation, indications for the operation, and stigmatisation.

Nigerian Journal of Medicine, 2020

Background: Instrumental vaginal delivery, either with forceps or vacuum-assisted, is used to fac... more Background: Instrumental vaginal delivery, either with forceps or vacuum-assisted, is used to facilitate childbirth and to avoid caesarean section delivery (CS) and its associated morbidities. Nevertheless, instrumental techniques are associated with a greater tendency for birth injury than spontaneous delivery. There is a need to maintain and improve the skills for this procedure through training and research in order to improve the benefits for both mothers and their babies. Objectives: 1. To determine and compare the incidence of vacuum versus forceps. 2. Indications of instrumental vaginal delivery. 3. Compare the foetal and maternal outcome of vacuum and forceps deliveries. Materials and Methods: This was a retrospective review on instrumental vaginal deliveries (vacuum extraction and forceps delivery) carried out between 1st January 2011 and 31st December 2014. The hospital records of all the patients who had vacuum or forceps delivery were obtained and data on age, parity, bo...

Archives of Gynecology and Obstetrics

Background Subclinical beta-cell (β-cell) dysfunction is an endocrine abnormality and its associa... more Background Subclinical beta-cell (β-cell) dysfunction is an endocrine abnormality and its association with recurrent miscarriages (RM) has not been extensively studied. Objective This study aimed to determine the prevalence of β-cell dysfunction and abnormal glucose metabolism [fasting blood glucose (FBG) ≥ 5.1 mmol/L] among non-diabetic women with recurrent miscarriages and to establish if there was an association between RM and β-cell dysfunction and FBG ≥ 5.1 mmol/L. Methodology This was a cross-sectional study involving 80 women with miscarriages at ≤ 13 weeks gestation and 80 women with normal pregnancies at ≤ 13 weeks of gestation with at least one successful live-birth and no history of miscarriage (comparison group). Interviewer-administered questionnaire was used to obtain relevant information. From each participant, FBG and fasting insulin were assayed. β-Cell function was computed. The data obtained was analysed using IBM-SPSS version 22.0. Results A significantly higher prevalence of β-cell dysfunction and abnormal glucose metabolism were observed among non-diabetic women with RM compared to age-matched controls (38.8% vs 10.0%, P < 0.001) and (27.5% vs 6.3%, P = 0.005) respectively. The mean β-cell function of the cases was 59.0% of the controls (264.41 ± 105.13 vs 447.82 ± 181.24, P < 0.001). Mean FBG was significantly higher in the case-group compared to the controls (4.77 ± 1.14 mmol/L vs 3.58 ± 0.78 mmol/L, P < 0.001). There was a significant association between RM and FBG ≥ 5.1 mmol/L and low β-cell function (P < 0.001). Conclusion This study suggests that women with recurrent miscarriages are more likely to have impaired β-cell function and abnormal glucose metabolism (FBG ≥ 5.1 mmol/L).

International Journal of Advanced Research in Gynaecology and Obstetrics, 2018

Archives of Gynecology and Obstetrics, 2020

International Journal of Biomedical Research, 2018

Background: Urinary tract infections (UTIs) are the most frequently encountered bacterial infecti... more Background: Urinary tract infections (UTIs) are the most frequently encountered bacterial infections among pregnant women. Untreated UTIs increase both maternal and perinatal morbidity and mortality. Objective: To determine the uropathogens profile of pregnant women with urinary tract infections and their susceptibility pattern to commonly used antimicrobials. Methods: A total of 358 urine samples from pregnant women with urinary tract infections at different trimesters were collected and processed for the isolation of uropathogens and tested against six groups of commonly used antibiotics. Results: A total of 358 pregnant women were recruited for the study over the study period. Of these, 120 (33.5%) had positive urine culture and varying antibiotic sensitivity pattern. Escherichia coli was the most common bacteria isolated with a percentage of 56.7%. Other isolated microorganisms included Staphylococcus aureus (21.7%), Klebsiella spp. (4.2%), Pseudomonas spp. (3.3%), Enterococcus spp. (1.7%), Enterobacter spp. (1.7%), Proteus spp. (1.7%) and Citrobacter spp. (1.7%). Levofloxacin had the highest overall antibiotic sensitivity of 83.0%. Others with overall antibiotic sensitivity pattern greater than 50% included ciprofloxacin (82.5%), streptomycin (70.0%), perfloxacin (61.6%), ceftriaxone (69.2%), cefixime (65.0%), amoxicillin (61.6%) and gentamicin (60.0%). There was strong resistance to nalidixic acid, cotrimoxazole and chloramphenicol. Conclusion: Uropathogens causing UTIs in pregnancy were the usual known organisms but the antibiotic resistance patterns varied. Fluoroquinolone, Cephalosporin and aminoglycosides were shown to be very effective against the organisms causing UTIs in these pregnant women.

Nigerian Journal of Medicine

Archives of Gynecology and Obstetrics

Women's Health

Highland Medical Research Journal, 2020

The Nigerian Journal of General Practice, 2021

Highland Medical Research Journal, Sep 17, 2021

Nigerian Journal of Medicine, 2020

Jos Journal of Medicine, 2018

International Journal of Advanced Research in Gynaecology and Obstetrics, 2019

Nigerian Journal of Medicine, 2020

Archives of Gynecology and Obstetrics

International Journal of Advanced Research in Gynaecology and Obstetrics, 2018

Archives of Gynecology and Obstetrics, 2020

International Journal of Biomedical Research, 2018