Prof E.O Orji

Prof Orji Ernest Okechukwu
Department of Obstetrics, Gynaecology and Perinatology

prof_orjiProf Orji Ernest Okechukwu

10 Abstracts
1. Int J Gynaecol Obstet. 2012 Nov;119(2):159-62
The effect of post-cesarean rectal misoprostol on intestinal motility.
Adanikin AI, Orji EO, Fasubaa OB, Onwudiegwu U, Ijarotimi OA, Olaniyan O.
Source
Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
Abstract
OBJECTIVE:
To determine whether rectally administered misoprostol can induce intestinal motility compared with oxytocin infusion when used to prevent primary postpartum hemorrhage after cesarean delivery.
METHODS:
In a prospective randomized double-blind study in Nigeria, 218 parturients undergoing cesarean delivery who had risk factors for primary postpartum hemorrhage were enrolled between July 1, 2010, and March 31, 2011. Participants received 600 μg of rectal misoprostol or 20 intravenous units of oxytocin for 4 hours after surgery. The primary outcome was time until passage of flatus. Adverse effects, need for additional analgesic, and length of hospital stay were also assessed.
RESULTS:
The misoprostol group had a significantly shorter mean postoperative interval to passage of flatus (20.27 ± 7.77 hours versus 38.34 ± 10.98 hours; P<0.001) and commencement of regular diet (21.08 ± 7.69 hours versus 39.13 ± 10.94 hours; P<0.001). Gastrointestinal adverse effects were more frequent, albeit not significantly, in the misoprostol group: nausea, 6.4% versus 1.8%; vomiting, 7.3% versus 2.8%; and abdominal distension, 3.7% versus 2.8%. The need for additional analgesic was the same in the 2 groups.
CONCLUSION:
After cesarean delivery, rectal misoprostol had the added benefit of inducing intestinal motility. Misoprostol might be considered in a clinical setting where postoperative ileus is anticipated.

2. J Obstet Gynaecol Res. 2012 Nov;38(11):1294-301.
. 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.
Source
Department of Obstetrics, Obafemi Awolowo University, and Obafemi Awolowo University Teaching Hospitals Complex, Nigeria. oobmed@yahoo.com
Abstract
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.
2.2. 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.
Source
Department of Obstetrics, Obafemi Awolowo University, and Obafemi Awolowo University Teaching Hospitals Complex, Nigeria. oobmed@yahoo.com
Abstract
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.

3. Singapore Med J. 2010 Mar;51(3):207-11.
Oral misoprostol versus intramuscular oxytocin in the active management of the third stage of labour.
Afolabi EO, Kuti O, Orji EO, Ogunniyi SO.
Source
Department of Obstetrics and Gynaecology, General Hospital, Randle Street Avenue, Lagos, Lagos State, Nigeria. eoorji11@yahoo.com
Abstract
INTRODUCTION:
Although the third stage of labour is usually uneventful, several significant complications may be encountered that may lead to maternal morbidity and mortality, especially primary postpartum haemorrhage. The objective of this study was to compare 400 ug oral misoprostol with 10 IU intramuscular oxytocin in the active management of the third stage of labour.
METHODS:
This was a prospective randomised controlled clinical trial in which 200 parturients at term who had vaginal delivery were randomly assigned into two groups: oral misoprostol and intramuscular oxytocin, after the delivery of the baby and the clamping of the umbilical cord. The primary outcome was the incidence of primary postpartum haemorrhage. Secondary outcomes included a drop in haemoglobin concentration 48 hours after delivery, the need for extra oxytocics, duration of the third stage of labour and side effects of the oxytocics. These results were subjected to statistical analysis using chi-square test or student’s t-test.
RESULTS:
No occurrence of primary postpartum haemorrhage or significant difference in the drop in haemoglobin concentration levels was reported after delivery (p-value is 0.49), and no significant differences were observed in other secondary outcome measures with the exception of nausea, which occurred solely in the misoprostol group (4 percent, p-value is 0.04).
CONCLUSION:
Oral misoprostol appeared to be as effective and as safe as intramuscular oxytocin in the active management of the third stage of labour.

4. J Matern Fetal Neonatal Med. 2009 Jan;22(1):65-71.
A randomised controlled trial of early initiation of oral feeding after cesarean section.
Orji EO, Olabode TO, Kuti O, Ogunniyi SO.
Source
Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospital, Osun State, Nigeria. eoorji11@yahoo.com
Abstract
OBJECTIVE:
To evaluate the safety and efficacy of early oral feeding after cesarean delivery.
METHODS:
Two hundred women who had cesarean section were randomly assigned to early feeding or routine feeding. Women in the early feeding group were encouraged to take sips of water 8 h post-operatively, followed by oral tea of 100 mL at the time of supervision. Women in the routine feeding group were managed by restricting oral intake for the first 24 h and administration of sips of water 24-48 h post-operatively. The outcome measures include the rate of ileus symptoms, post-operative time interval to presence of bowel sounds, passage of flatus and bowel movement, time interval to return to regular diet, length of hospital stay, post-operative complications, acceptability and benefit of early oral feeding.
RESULTS:
The early feeding group had a shorter mean post-operative time interval to bowel sounds 18.90 +/- 4.17 h versus 36.21 +/- 3.52 h (p < 0.001), passage of flatus 44.81 +/- 3.73 h versus 60.58 +/- 4.40 h (p < 0.001) and bowel movement 58.30 +/- 5.91 h versus 72.76 +/- 4.25 h (p < 0.001). There was no significant difference in paralytic ileus symptoms. Early feeding group had a shorter mean hospital stay 4.80 +/- 0.59 days versus 6.69 +/- 0.71 days (p = 0.001). Early feeding group required less intravenous fluid 7.14 +/- 1.34 bottles versus 11.8 +/- 1.32 bottles (p < 0.001).
CONCLUSIONS:
Early feeding after cesarean section was well tolerated and safe and can be implemented without an increase in adverse outcome

5. Aust N Z J Obstet Gynaecol. 2008 Dec;48(6):570-4.
A randomised controlled trial of uterine exteriorisation and non-exteriorisation at caesarean section.
Orji EO, Olaleye AO, Loto OM, Ogunniyi SO.
Source
Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria. eoorji11@yahoo.com
Abstract
BACKGROUND:
There is not enough information to evaluate the routine use of exteriorisation of the uterus for repair of the uterine incision and further studies are needed to examine the value of exteriorisation of the uterus at caesarean section as against non-exteriorisation.
AIMS:
To assess intraoperative and postoperative morbidity following exteriorisation of the uterus at caesarean section as compared to those with non-exteriorisation.
METHODS:
A randomised controlled trial at Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria. Two hundred and ten women were randomised to either exteriorisation (N = 105) or non-exteriorisation group (N = 105). Statistical analysis using SPSS compared intraoperative and postoperative outcome. The outcome measures include intraoperative blood loss, number of analgesic dose, difference in operating time, febrile morbidity, intraoperative complications, and duration of hospital stay.
RESULTS:
There were significant reductions in intraoperative blood loss (P < 0.05), number of analgesic dose (P < 0.05) and duration of hospital stay (P < 0.05) in the uterine exteriorisation group as compared to those in the non-exteriorisation group. There was no significant difference in operating time, febrile morbidity, intraoperative complications and operating time. The period for return of bowel function was significantly longer in the exteriorisation group.
CONCLUSION:
Exteriorisation of uterus at caesarean section is associated with less intraoperative blood loss, less number of analgesic dose and shorter hospital stay

6. J Matern Fetal Neonatal Med. 2008 Sep;21(9):638-42.
Comparison of ceftriaxone versus triple drug regimen in the prevention of cesarean section infectious morbidities.
Alekwe LO, Kuti O, Orji EO, Ogunniyi SO.
Source
Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.
Abstract
OBJECTIVE:
To compare the effectiveness of single dose ceftriaxone versus multiple doses of ampiclox, gentamicin, and metronidazole to prevent infectious morbidity at elective cesarean section.
METHODS:
This was a randomized clinical trial involving 200 pregnant women who had an elective cesarean section for various reasons during the study period. Outcome measures included endometritis, urinary tract infections, febrile morbidities, wound infections, duration of hospital stay, and cost of antibiotic therapy. Data were managed using SPSS.
RESULTS:
There was no statistically significant difference in the mean duration of hospital stay between the two groups, but a significant statistical difference was found in the mean cost of antibiotic treatment ($15 for the combination and $9 for ceftriaxone; p = 0.000), with the group of patients taking a single dose of ceftriaxone (ROPHEX) having a lower mean cost of treatment than those taking a combination of ampiclox, gentamicin, and metronidazole. The study groups did not differ significantly in the incidence of endometritis (14% versus 15%), urinary tract infection (11% versus 15%), wound infections (7% versus 8%), febrile morbidity (7% versus 6%), and peritonitis (0% versus 0%).
CONCLUSION:
Single dose ceftriaxone was as effective as a combination of ampiclox, gentamicin, and metronidazole in preventing post-elective cesarean section complications.

7. Int J Gynaecol Obstet. 2008 Sep;102(3):267-70.
A prospective randomized clinical trial of urethral catheter removal following elective cesarean delivery.
Onile TG, Kuti O, Orji EO, Ogunniyi SO.
Source
Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.
Abstract
OBJECTIVE:
To compare immediate and 24-hour postoperative removal of urethral catheters for elective cesarean delivery.
METHOD:
A prospective randomized trial of 200 women admitted for elective cesarean delivery where the urethral catheter was removed 24 hours postoperatively or immediately after the procedure. Urine samples were collected preoperatively and 72 hours postoperatively for microscopy, culture, and sensitivity (MCS). Outcome measures included preoperative and 72-hour postoperative urine MCS, postoperative morbidities, and length of hospital stay.
RESULTS:
There were no significant differences in postoperative urinary retention (P=0.986), dysuria (P=0.188), urgency (P=0.134), fever (P=1.000), 72-hour postoperative urine MCS (P=0.489), and length of hospital stay (P=0.879) between the 2 groups. There was a non-significant lower incidence of positive urine culture 72 hours postoperatively for women in the immediate removal group compared with those who were catheterized for 24 hours (8.1% vs 11.2%; P=0.489).
CONCLUSION:
Immediate postoperative removal of a urethral catheter after elective cesarean delivery may be associated with a lower risk of urinary infection

8. Int J Gynaecol Obstet. 2008 Jan;100(1):41-4
Evaluation of health workers’ training in use of the partogram.
Fatusi AO, Makinde ON, Adeyemi AB, Orji EO, Onwudiegwu U.
Source
Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
Abstract
OBJECTIVE:
To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers.
METHODS:
Fifty-six health workers offering delivery services in primary health care facilities were trained to use the partogram and were evaluated after 7 months.
RESULTS:
A total of 242 partograms of women in labor were plotted over a 1-year period; 76.9% of them were correctly plotted. Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram occurred in 6.6%. No statistically significant difference was recorded in the rate of correct plotting and consequent decision-making between nurse/midwives and the CHEWs.
CONCLUSION:
Lower cadres of primary health care workers can be effectively trained to use the partogram with satisfactory results, and thus contribute towards improved maternal outcomes in developing countries with scarcity of skilled attendants

9. Int J Gynaecol Obstet. 2008 Jan;100(1):41-4. .
Evaluation of health workers’ training in use of the partogram.
Fatusi AO, Makinde ON, Adeyemi AB, Orji EO, Onwudiegwu U.
Source
Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
Abstract
OBJECTIVE:
To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers.
METHODS:
Fifty-six health workers offering delivery services in primary health care facilities were trained to use the partogram and were evaluated after 7 months.
RESULTS:
A total of 242 partograms of women in labor were plotted over a 1-year period; 76.9% of them were correctly plotted. Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram occurred in 6.6%. No statistically significant difference was recorded in the rate of correct plotting and consequent decision-making between nurse/midwives and the CHEWs.
CONCLUSION:
Lower cadres of primary health care workers can be effectively trained to use the partogram with satisfactory results, and thus contribute towards improved maternal outcomes in developing countries with scarcity of skilled attendants10. Int J Gynaecol Obstet. 2008 May;101(2):129-32.

10. A randomized comparative study of prophylactic oxytocin versus ergometrine in the third stage of labor.
Orji E, Agwu F, Loto O, Olaleye O.
Source
Department of Obstetrics, Gynecology and Perinatology, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. eoorji11@yahoo.com
Abstract
OBJECTIVE:
To compare the effect of prophylactic use of oxytocin and ergometrine in management of the third stage of labor.
METHODS:
A prospective randomized study of 600 women assigned to receive either oxytocin or ergometrine in the third stage of labor. Outcome measures were the predelivery and 48-hour postdelivery hematocrit, duration of the third stage, specific side effects, and incidence of postpartum hemorrhage. Statistical analyses were done using the t test for continuous variables and chi2 test for categorical variables. The level of significance was set at P<0.05.
RESULTS:
There were no significant differences between the 2 groups in maternal age, gestational age, duration of third stage, birth weights, risk for retained placenta, manual removal of placenta, or need for additional oxytocics. Patients in the ergometrine group were at significant risk for nausea, vomiting, headaches, and elevated blood pressure (P=0.0001).
CONCLUSION:
Oxytocin is as effective as ergometrine at reducing the incidence of postpartum hemorrhage, but without the undesirable side effects of nausea, vomiting, and elevated blood pressure associated with ergometrine