Open Access Minireview Article

Paralysed with Fear a Literature Review on Aspects of Pregnancy in Polio Survivors

Tanmayee Pore, Pallavi Wakode

Asian Journal of Pregnancy and Childbirth, Page 31-37

After several decades of stability, female polio survivors often experience new signs and symptoms of their condition, characterized by global and muscular fatigue, decreased muscular strength and pain along with secondary changes in body anatomy and physiology with respect to pregnancy. Problems of ante-partum care and delivery of women who have been victims of poliomyelitis are fortunately rarely encountered. These women have a higher occurrence of pre-eclampsia, gestational proteinuria, renal disease prior to pregnancy, vaginal bleeding and urinary tract infection during pregnancy. Deliveries complicated by obstruction of the birth process are more common in the polio group, and cesarean section is performed at a higher rate throughout the time period. The prognosis of the disease when it occurs during pregnancy may be less predictable, but it is generally good for both mother and infant. Although the incidence of abortion is relatively high, if the pregnancy goes to term parturition is expected to be normal. An amalgamation of good antenatal assessment & care, psychological counselling and support groups have been found to be successful in providing them with the best possible outcome. This paper reviews what is currently known about disabled survivors of polio and highlights areas of need in public health research, policy and programming along with the effects of post-polio syndrome on pregnancy and possible interventions to achieve symptomatic relief & aid in better quality of life.

Open Access Original Research Article

Association of Literacy-Related Factors to Antiretroviral Therapy Adherence among Sero-Positive Pregnant Women in Murang’a County Referral Hospital, Kenya

Kiama John Mwaniki, Hannah Inyama, Joyce Jebet

Asian Journal of Pregnancy and Childbirth, Page 1-10

Background: Adherence of more than 95% to Antiretroviral Therapy (ART) is highly regarded as a success in HIV treatment. Globally, there are various challenges associated with ART adherence among sero-positive pregnant women especially in sub-Saharan Africa. In Kenya, there is inadequate information on challenges of ART adherence among sero-positive pregnant women.

Aim: This study aimed to establish literacy-related factors affecting ART adherence among sero-positive pregnant women.

Methodology: The research design was analytical cross-sectional design with a current case review of ANC records. The research study utilized both quantitative and qualitative methods of data collection using interviewer administered questionnaire for the sero-positive pregnant women and in-depth interview for the key informants. The interviewer-administered questionnaire was used on sero-positive pregnant women while one-on-one in-depth interview using interview-guide was utilized to obtain detailed information from Maternal and Child Health (MCH) unit nurse in-charge and doctor in-charge. The data was recorded using an audio recorder and in written notes. A data sheet was incorporated in current case review of clients’ viral load results and information concerning drug refill report.

The sample size was 57 sero-positive pregnant women who were sampled using census method. Quantitative data cleaning, entry and analysis employed the Statistical Package for Social Sciences (SPSS) Program version 20 while Chi square test and multivariate logistic regression was used to determine the challenges. Significance level of 95% was used to determine the strength of the association between variables. Qualitative data was analyzed using NVIVO 8 software.

Results: The literacy levels’ influence on ART adherence among the sero-positive pregnant women was significant in aspects such as low education level (p=0.01), poor knowledge on condom use (p=0.004), selective disclosure (p=0.003), poor compliance to ART (p=0.002) and sense of full recovery (p=0.009).

Conclusion: There are literacy related challenges that greatly affect ART adherence. These include; poor knowledge of condom use, selective disclosure, inadequate knowledge on importance of ART adherence, alcoholism, fear of being seen by others, sense of full recovery and lack of support from relatives. Other non-literacy related factors that also found to affect ART adherence include; forgetfulness, depression and unclear instructions.

Open Access Original Research Article

Assessment of Chrysophyllum albidum Extracts for Abortifacient Activities in Adult Female Rats: In vitro and in vivo Investigations

O. N. Nwankudu, S. N. Ijioma, K. C. Ugwuanyi, E. N. Nwaogazi, B. B. Iloh, V. N. Agu, C. F. Aaron

Asian Journal of Pregnancy and Childbirth, Page 22-30

Background/Aim: Chrysophyllum albidum (African star apple) fruit is widely consumed by pregnant women in Nigeria. In this study, the effects of extracts prepared from its epicarp, mesocarp and seed endosperm on rat’s uterine smooth muscles were investigated (In vitro and In vivo).

Methods: In the In vitro study, about 3 cm length of the uterine horn was isolated from a stunned adult female rat pretreated with stilboesterol (0.1 mg/kg i.p) 24 hours earlier and was suspended vertically in a 30 ml organ bath containing De Jalon’s solution and continuously bubbled with air. After equilibration and recording basal contractions, responses to the extracts, oxytocin and acetylcholine were established. The effects of salbutamol on responses due to the extracts and oxytocin were also investigated and recorded. For each drug application, a minimum time of 1 minute was allowed for response before washing. The in vivo study was carried out on 12 pregnant rats assigned to 4 groups of 3 rats each. Pregnant rats in group 1 were given no treatment and served as control but those in groups 2, 3 and 4 were administered 800 mg/kg body weight of the epicarp, mesocarp and seed endosperm extracts respectively (orally and daily for 3 days). These rats were all sacrificed in a further 10 days to check for arborted fetuses and resorped embryos.

Results: Results obtained showed that uterine contraction elicited by extracts from the epicarp and mesocarp was insignificant but those elicited by the seed endosperm was highly significant and compared favourably with that of oxytocin. Pre-incubation of the tissue in salbutamol also significantly inhibited the contractile effects of the extract (p<0.01). In vivo study, extracts from the epicarp and mesocarp caused no abortion in the pregnant rats. However, the seed endosperm at 800 mg/kg did, as a number of resorped embryos were observed.

Conclusion: Chrysophyllum albidum fruit may be safe for consumption during pregnancy but the seed endosperm has demonstrated significant abortifacient activity and as such may be avoided during gestation but may be used for uterotonic purpose.

Open Access Original Research Article

Post Partum Depression in a Tertiary Health Centre in South West Nigeria

Dada Mobolaji Usman, Aduloju Olusola Peter, Akintayo Akinyemi, Oluwole Lateef Olutoyin, Obadeji Adetunji, Oderinde Kehinde Oyeyemi

Asian Journal of Pregnancy and Childbirth, Page 38-43

Aims: Various studies have shown that Psychological morbidities of various types occur frequently during pregnancy and after delivery. The main aim of this study was to determine the prevalence as well as correlates of depression among postpartum women attending the postnatal clinic of a tertiary health centre.

Study Design: Descriptive  cross sectional study.

Place and Duration of Study: The study was done at the Post natal clinic of Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, southwest Nigeria over a period of 3 months.

Methodology: Women attending the postnatal clinic of the centre were interviewed with a sociodemographic questionnaire and the Edinburgh postnatal depression scale using a cut off value of  9 as suggested by various studies among post partum women in this environment.

Results:A total of 287 respondents were recruited in the study. The mean age of the participants was 30.81 ±4.28. The proportion of respondents with post partum depression was 20.4%.It was observed that unbooked patients, respondents with lower education, patients with difficulty in breastfeeding and patients who had suicidal thought had statistically significant higher mean scores on the EPDS ( p< .05).

Conclusion: PPD is a common psychiatric morbidity. Encouraging pregnant women to seek proper care during pregnancy/child birth will help in reducing postpartum depression; thereby ensuring good maternal and child health.

Open Access Review Article

Myomas in Pregnancy: A Review

Oduremi A. Emmanuel, Ijioma N. Solomon, Nwaogazi N. Edith

Asian Journal of Pregnancy and Childbirth, Page 11-21

Uterine myoma or uterine fibroid is a mass of compacted smooth muscle and fibrous tissue that grows on the wall or sometimes on the outside of the uterus, usually appearing as benign, monoclonaltumors of the myometrium that contain collagen, fibronectin and proteoglycan. In this article, we review the etiology, incidence in pregnancy, risk factors, types and locations, degenerative changes, growth and complications of myomas in pregnancy as well as the role of ultrasound scan technology in its management. We searched databases for information and identified articles with sufficient information onmyomas in pregnancy and excluded those that did not specifically focus on our area of discourse. Our findings show that, although causes of myomas remain unknown, several factors including age, late reproductive years, race, nulliparity, obesity, early menarche menopause and smoking are predisposing factors. Other unestablished factors are diet, exercise, oral contraceptives, hormone replacement therapy and genetic make-up. Women, 35 years and above are more susceptible and incidence rate in pregnant women ranges from 1.5-10%. Types include intramural (70%), submucosal (10%), subserosal (20%), pedunculatedsubserous (minimal), cervical (minimal) and retroplacentalmyomas. Sonography reveal that degenerative changes in myomas may be hyalinic, necrotic, cystic, fatty, haemorrhagic, calcified or sarcomatous. Only a few cases of myomas increase with pregnancy, while majority remain stable and may even decrease, but with higher risk of complications, fetal injury and caesarean delivery. Early and routine ultrasound scan may be encouraged in all pregnancies for early detection of myomas for the purpose of better obstetric management.