Dr Loto O.M

Publications;

dr o m loto obstetrics and gynaecologyoau1. J Matern Fetal Neonatal Med. 2012 Nov;25(11):2359-62. doi:
10.3109/14767058.2012.696160. Epub 2012 Jun 19.
Comparative study of the outcome of induction of labor using 25 µg and 50 µg of vaginal misoprostol.
Loto OM, Ikuomola AA, Ayuba II, Onwudiegwu U.

Department of Obstetrics, Gynecology & Perinatology, Obafemi Awolowo University,
Ile-Ife, Nigeria. bisiloto@yahoo.co.uk

OBJECTIVE: To compare the safety and effectiveness of vaginal misoprostol 25 μg
with those of 50 μg in induction of labor.
METHOD: One hundred and sixty eligible women of low parity with indications for
induction of labor at term were enrolled for the study. The subjects were
randomized into two groups of vaginal misoprostol 25 µg and 50 µg dose regimens.
Maternal characteristics, labor and newborn outcome were compared.
RESULTS: The total duration of labor was significantly shorter in the 50 µg group
(8.24 ± 1.5 h) than 25 µg group (9.09 ± 2.7 h), p = 0.02. Oxytocin augmentation
was significantly higher in the 25 µg group (18.75%) than in the 50 µg group
(7.5%), p = 0.04. The indications for caesarean section were significantly
different, (p = 0.02) between the two groups although the incidence was similar.
The intrapartum adverse effects like fetal distress, meconium stained liquor, and
tachysystole were significantly higher in the 50 µg group, p = 0.003. Similarly,
the postpartum adverse effects such as cervical and vaginal tears were
significantly higher in 50 µg group, p = 0.01.
CONCLUSION: The two dose regimens were both effective in induction of labor, but
50 µg dose regimen resulted in significantly shorter duration of labor but with
higher rate of labor complications than the 25 µg dose regimen.
PMID: 22640229 [PubMed - in process]

2. J Obstet Gynaecol Res. 2012 Nov;38(11):1294-301. doi:
10.1111/j.1447-0756.2012.01869.x. Epub 2012 May 21.

Adjunctive rectal misoprostol versus oxytocin infusion for prevention of
postpartum hemorrhage in women at risk: a randomized controlled trial.

Badejoko OO, Ijarotimi AO, Awowole IO, Loto OM, Badejoko BO, Olaiya DS, Fatusi AO, Kuti O, Orji EO, Ogunniyi SO.

Department of Obstetrics, Obafemi Awolowo University, and Obafemi Awolowo
University Teaching Hospitals Complex, Nigeria. oobmed@yahoo.com

AIM: The aim of this study was to evaluate the efficacy of adjunctive rectal
misoprostol compared to oxytocin infusion in the prevention of primary postpartum
hemorrhage after routine active management of the third stage of labor in women
with identifiable risk factors for uterine atony.
MATERIAL AND METHODS: A double-blind randomized controlled trial was carried out
at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A
total of 264 parturients with known risk factors for postpartum hemorrhage were
randomized to receive either rectal misoprostol (600 µg; n = 132) or oxytocin
infusion (20 IU in 500 mL; n = 132) after routine active management of the third
stage of labor. Intrapartum blood loss was measured using a combination of the
BRASSS-V calibrated drapes and differential pad weighing. Hematocrit was measured
intrapartum and 24 h postpartum.
RESULTS: There was no significant difference (P = 0.07) in the mean intrapartum
blood loss between the misoprostol (387.28 ± 203.09 mL) and oxytocin
(386.73 ± 298.51 mL) groups. There was also no difference in the requirement for
additional intervention for uterine atony (P = 0.74). Postpartum hematocrit drop
and blood transfusion were, however, significantly less in the misoprostol group.
CONCLUSION:  Rectal misoprostol is as effective as oxytocin infusion as an adjunct for prevention of postpartum hemorrhage in women with risk factors for uterine atony and is associated with a lower hematocrit drop and blood transfusion postpartum. However, shivering, pyrexia and vomiting are more frequent with misoprostol, though usually self-limited.
© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.
PMID: 22612662 [PubMed - in process]

3. Niger Postgrad Med J. 2012 Mar;19(1):7-14.

Accuracy of intra-partum prediction of birth weight using maternal anthropometric
parameters.

Loto OM, Eniowo AR, Oboro VO, Eniowo PI, Akintayo AA, Fasubaa OB, Onwudiegwu U.

Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching
Hospitals Complex, Ile-Ife. Osun State. Nigeria.

AIMS AND OBJECTIVES: This study aimed at predicting foetal birth weight using
various clinical methods and to determine which of the methods is the most
accurate in this population.
SUBJECTS AND METHODS: Parturients of all parities admitted into the labour ward
of OAUTHC, Ile-Ife at term for delivery were recruited for this study. They had
their symphysiofundal height, abdominal circumference at the umbilical level,
height and weight measured. The body mass index was then calculated. The birth
weight was calculated from these measurements using four clinical formulae. The
weights of the babies were measured after delivery and compared with the
individual estimated birth weights.
RESULTS: There were 400 women who met the inclusion criteria during the time of
this study. Three of the methods [Johnson's Rule, Ojwang's Rule and 5% maternal
weight] overestimated the birth weight while 10% BMI underestimated the birth
weight significantly.
CONCLUSION: There is a strong correlation between the birth weights predicted by
the various clinical methods and the actual birth weight. The accuracy of the
methods can be improved by using the derived modified formulae.
PMID: 22430595 [PubMed - in process]

4. J Pregnancy. 2012;2012:379271. doi: 10.1155/2012/379271. Epub 2011 Nov 1.

Tuberculosis in pregnancy: a review.

Loto OM, Awowole I.

Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching
Hospital, P.M.B. 5538, Ile-Ife, Osun State, Nigeria.

Tuberculosis (TB) was declared a public health emergency by WHO in 2005. The
disease is a significant contributor to maternal mortality and is among the three
leading causes of death among women aged 15-45 years in high burden areas. The
exact incidence of tuberculosis in pregnancy, though not readily available, is
expected to be as high as in the general population. Diagnosis of tuberculosis in
pregnancy may be challenging, as the symptoms may initially be ascribed to the
pregnancy, and the normal weight gain in pregnancy may temporarily mask the
associated weight loss. Obstetric complications of TB include spontaneous
abortion, small for date uterus, preterm labour, low birth weight, and increased
neonatal mortality. Congenital TB though rare, is associated with high perinatal
mortality. Rifampicin, INH and Ethambutol are the first line drugs while
Pyrazinamide use in pregnancy is gaining popularity. Isoniazid preventive therapy
is a WHO innovation aimed at reducing the infection in HIV positive pregnant
women. Babies born to this mother should be commenced on INH prophylaxis for six
months, after which they are vaccinated with BCG if they test negative.
Successful control of TB demands improved living conditions, public
enlightenment, primary prevention of HIV/AIDS and BCG vaccination.

PMCID: PMC3206367
PMID: 22132339 [PubMed]

5. Afr Health Sci. 2011 Jun;11(2):271-8.

Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations
and management outcome.

Okogbo FO, Ezechi OC, Loto OM, Ezeobi PM.

Dept. of Obstetrics & Gynaecology, Irrua Specialist Teaching Hospital, Edo State,
Nigeria.

BACKGROUND: Uterine leiomyoma is remarkably common, however only a subset of
women have their fibroids clinically detected, symptomatic, or warrant surgical
treatment. Its removal is commonly associated with complications. To prevent or
control the occurrence of this complication requires the understanding of the
factors associated with the complications.
OBJECTIVE: To evaluate the sociodemographic, clinical characteristics, management
outcome and its determinants in southwestern Nigeria.
METHODS: Study was carried out at two large tertiary hospitals in the south west
region of Nigeria. Retrospective review of case records of all surgically managed
cases of uterine leiomyoma over a period of 25 years. One hundred and fifty nine
women with uterine leiomyoma seen and managed surgically in South-Western Nigeria
were the participants.
RESULTS: The common presenting complaints were menstrual irregularities (47.7%),
abdominal swelling (39.1%) and infertility (31.9%). The average uterine size at
presentation was 15±9.7 weeks. The majority (79.9%) of the women presented with
multiple leiomyomata. The commonest anatomical position of the nodules were
multiple positions and intramural in 707(60.9%) and 172(14.8%) respectively.
Myomectomy was performed in 54.7% of cases. Postoperative complications occurred
in 20.9 % of cases with postoperative pyrexia (13.5%), blood loss warranting
transfusion (12.8%) and postoperative anaemia (10.4%) been the most common
complications.
CONCLUSION: Uterine fibroid is common in our environment and its removal is
commonly associated with post-operative pyrexia, blood loss, and anaemia and
wound infection. Midline incision, closure of rectus sheet with chromic catgut
and myomectomy were associated with postoperative complications in this review.
PMCID: PMC3158515
PMID: 21857861 [PubMed - indexed for MEDLINE]

6. Acta Obstet Gynecol Scand. 2010;89(1):35-8. doi: 10.3109/00016340903280966.

Cesarean section in relation to self-esteem and parenting among new mothers in
southwestern Nigeria.

Loto OM, Adewuya AO, Ajenifuja OK, Orji EO, Ayandiran EO, Owolabi AT, Ade-Ojo IP.

Department of Obstetrics, Gynecology and Perinatology, Faculty of Clinical
Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. bisiloto@yahoo.co.uk

BACKGROUND: Maternal psychopathology and self-esteem during childbirth may have
an effect on maternal parenting self-efficacy.
OBJECTIVE: This study aimed to asses the self-esteem of newly delivered
primiparous mothers who had cesarean section (CS) in relation to their parenting
self-efficacy.
METHODS: A total of 115 primiparous women who delivered by CS were compared with
97 matched controls who had vaginal delivery during the same period. They
completed the Rosenberg self-esteem scale prior to discharge. They also completed
the parent-child relationship questionnaire at six weeks postpartum, together
with the Rosenberg self-esteem scale.
RESULTS: The mean score on the Rosenberg self-esteem scale was significantly
lower for the CS group, both prior to discharge (p = 0.006) and at six weeks (p <
0.001), than the vaginal delivery group. The mean score on the parent-child relationship questionnaire was also lower in those who had CS compared with those who had vaginal delivery (p < 0.001, OR 4.71, 95% CI 1.75-14.71).
CONCLUSION: CS in Nigerian women is associated with lowered self-esteem and predicts poor parenting self-efficacy in the postnatal period. Psychological support and techniques to improve self-esteem and parenting should be incorporated into the management of women having CS.
PMID: 19824868 [PubMed - indexed for MEDLINE]

7. Acta Obstet Gynecol Scand. 2009;88(11):1252-60. doi: 10.3109/00016340903280958.

Active management of third stage of labor: evidence versus practice.

Oladapo OT, Akinola OI, Fawole AO, Adeyemi AS, Adegbola O, Loto OM, Fabamwo AO,
Alao MO, Sotunsa JO; Nigerian AMTSL Group.

Maternal and Fetal Health Research Unit, Department of Obstetrics & Gynecology,Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
tixon_y2k@hotmail.com

OBJECTIVE: To determine the correct use of active management of third stage of
labor (AMTSL) (using the full complement of existing standard definitions) and
compare the outcomes of third stage of labor in women who received AMTSL
(according to these definitions) with those who did not.
DESIGN: Observational, cross-sectional survey.
SETTING: Seven tertiary centers in southwest Nigeria.
POPULATION: Women undergoing non-instrumental vaginal deliveries.
METHODS: Prospective direct observations of childbirth procedures. AMTSL was
defined according to Cochrane review, ICM/FIGO (International Confederation of
Midwives/International Federation of Gynecology and Obstetrics), and WHO (World
Health Organization) recommendations. Main outcome measures. Use of AMTSL and its
components and outcome of third stage of labor.
RESULTS: There was a high rate of compliance with most of the individual
components of AMTSL. The use of AMTSL varied widely with the definition applied
and tended to decrease with increasing strictness of the criteria (Cochrane
review: 88.9%; ICM/FIGO: 42%; WHO: 1.8%). The frequencies of adverse labor
outcomes were generally low (postpartum hemorrhage (PPH): 4.9%; severe PPH: 0.8%;
retained placenta: 1.9%; uterine inversion: 0.0%). Frequencies of PPH, postpartum
anemia, and mean blood loss among women who received AMTSL according to the
Cochrane review definition were significantly lower than for those who did not (p
< 0.05). There was no significant difference between any of the outcomes for
women who received AMTSL according to the ICM/FIGO definition and those who did
not.
CONCLUSIONS: The survey reveals substantial definition-dependent variation in the
providers’ adherence to recommended AMTSL practices. The clinical implications of
the current practice in this population suggest the need for randomized
comparison of various AMTSL packages to determine their comparative effectiveness
in the prevention of PPH.
PMID: 19824866 [PubMed - indexed for MEDLINE]

8. J Matern Fetal Neonatal Med. 2009 Sep;22(9):765-9. doi:
10.3109/14767050902801660.

The effect of caesarean section on self-esteem amongst primiparous women in
South-Western Nigeria: a case-control study.

Loto OM, Adewuya AO, Ajenifuja OK, Orji EO, Owolabi AT, Ogunniyi SO.

Department of Obstetrics, Gynaecology & Perinatology, Obafemi Awolowo University,
Ile-Ife, Nigeria. bisiloto@yahoo.co.uk

OBJECTIVE: This study aims to assess the level of self-esteem of newly delivered
mothers who had caesarean section (CS) and evaluate the sociodemographic and
obstetrics correlates of low self-esteem in them.
METHODS: Newly delivered mothers who had CS (n = 109) and who had spontaneous
vaginal delivery (SVD) (n = 97) completed questionnaires on sociodemographic and
obstetrics variables within 1 week of delivery. They also completed the Rosenberg
self-esteem scale. RESULTS. Women with CS had statistically significant lower
scores on the self-esteem scale than women with SVD (p = 0.006). Thirty (27.5%)
of the CS group were classified as having low self-esteem compared with 11
(11.3%) of the SVD group (p = 004). The correlates of low self-esteem in the CS
group included polygamy (odd ratio (OR) 4.99, 95% confidence interval (95% CI)
1.62-15.33) and emergency CS (OR 4.66, 95% CI 1.55-16.75).
CONCLUSIONS: CS in South-Western Nigerian women is associated with lowered
self-esteem in the mothers.
PMID: 19544153 [PubMed - indexed for MEDLINE]

9. J Psychosom Obstet Gynaecol. 2009 Jun;30(2):127-32. doi:
10.1080/01674820802545446.

Pattern and correlates of premenstrual symptomatology amongst Nigerian University
students.

Adewuya AO, Loto OM, Adewumi TA.

Department of Psychiatry, Lagos State University College of Medicine, Lagos,
Nigeria. biodunwuya@yahoo.com

This study aimed to evaluate the pattern and correlates of premenstrual symptomatology amongst Nigerian female undergraduates. Female University students(n = 409) completed questionnaires detailing sociodemographic, menstruation/gynecological history and personality traits. They were then rated with a checklist for premenstrual symptoms. The most frequent premenstrual symptoms were ‘breast tenderness’ (35.5%), ‘sleeplessness’ (15.6%), ‘decreased interest in usual activities’ (15.4%), ‘lethargy/easy fatigability/lack of
energy’ (13.2%) and ‘change in appetite’ (13.2%). The prevalence of premenstrual symptomatology was 50.1% and the correlates of increasing premenstrual symptomatology included increasing age, increasing severity of menstrual pain,personality traits of neuroticism and agreeableness and increasing body mass
index. Although the rate of premenstrual symptomatology in sub-Saharan African women was comparable with that in the western cultures, there may be cross-cultural differences in the pattern of presentation. Dysmenorrhoea and personality traits should be taken into consideration when planning and implementing effective strategy to manage perimenstrual problems in this region.

PMID: 19533493 [PubMed - indexed for MEDLINE]

10. Arch Gynecol Obstet. 2009 Dec;280(6):945-52. doi: 10.1007/s00404-009-1036-x. Epub
2009 Mar 21.
Active management of third stage of labour: a survey of providers’ knowledge in
southwest Nigeria.

Oladapo OT, Fawole AO, Loto OM, Adegbola O, Akinola OI, Alao MO, Adeyemi AS.

Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. tixon_y2k@hotmail.com

BACKGROUND: The disparity between current evidence and practice on active
management of third stage of labour (AMTSL) demands assessment of providers’ knowledge on the subject.
OBJECTIVE: To assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL.
METHODS: Questionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria.
RESULTS: Female nurses at different cadres accounted for most of the respondents.
Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13
potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identified the components of AMTSL as defined by FIGO/ICM. Many
procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine
compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being
in administrative position (adjusted OR: 2.68; CI 1.19-6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21-5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI
0.05-0.39), matron (adjusted OR: 0.25; CI 0.08-0.79) or intern (adjusted OR: 0.07; CI 0.01-0.29) compared to postgraduate resident doctors reduced the odds of
having accurate knowledge of AMTSL.

CONCLUSION: AMTSL was a familiar but poorly understood intervention among
obstetric care providers in this region. Improvement in healthcare quality and
practitioners’ adherence to recommended guidelines on AMTSL urgently requires
educational interventions that target those who provide routine delivery care and
organisation of the health care delivery system in such a way that enables
providers to act on acquired knowledge.

PMID: 19306012 [PubMed - indexed for MEDLINE]