Health
Gynecologist’s caution pregnant women against Vaginal delivery after two CS
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By Francesca Hangeior
Attempting labour and vaginal delivery after two previous caesarean sections could lead to a rupture of the uterine scar, resulting in severe bleeding and possible death of the expectant mother and her baby, maternal experts have warned.
The gynaecologists further noted that such deliveries posed risks of head compression and low oxygen supply and intake, leading to malformations.
The experts’ warning comes amid the stigma surrounding CS and the insistence of many Nigerian women who have previously undergone the procedure to attempt vaginal delivery in subsequent births.
Bleeding during and after delivery is a major cause of maternal mortality worldwide and in Nigeria.
In fact, it is the leading cause of maternal mortality in Nigeria, a country with one of the highest MMR in Africa.
The Nigeria Demographic and Health Survey, 2018, pegs the MMR at 512 deaths per 100,000 live births.
According to the World Health Organisation, every year, about 14 million women experience postpartum haemorrhage, resulting in about 70,000 maternal deaths globally.
A new study released by the WHO two weeks ago further revealed that severe heavy bleeding and hypertensive disorders like preeclampsia are the leading causes of maternal deaths globally.
It noted that the conditions were responsible for about 80,000 and 50,000 fatalities, respectively, in 2020, indicating that many women still lack access to lifesaving treatments and effective care during and after pregnancy and birth.
The experts urged expectant mothers to register for antenatal care and ensure delivery in healthcare facilities with skilled birth attendants to reduce risks and ensure optimum care for both mother and child.
A recent study on “Trial of labour following two previous caesarean sections – A UK cohort study” concluded that women considering a trial of labour following two caesarean sections had an increased risk of endometritis (infection of the inner lining of the uterus), sepsis and adverse neonatal outcome.
Providing expert insight into the matter, a Professor of Obstetrics Gynaecology at the College of Health Science, University of Uyo, Akwa Ibom State, Aniekan Abasiattai, explained that after a woman undergoes CS, the cut, after healing, forms a scar.
The don added that a woman who has undergone CS twice and in subsequent pregnancy attempts to go into labour and vaginal delivery, had an increased risk of tearing the scar, leading to bleeding.
He further noted that although women who have had one caesarean delivery could be allowed to attempt a vaginal delivery, it was done in specialised units and with close monitoring.
“Now, after two caesarean sections, because of the increased risk of rupture of the scar, which is much more than that of a previous caesarean delivery, in this environment, we usually do not allow our patients to attempt a vaginal delivery after two previous caesarean sections. That’s the standard in this country.
“I’m aware that there are varying publications of successful vaginal deliveries after two previous caesarean sections, both in the developed world, foreign literature, and even among a few of our colleagues, but we usually do not, that is not the accepted practice, basically, because of the increased risk of infection following surgical procedures, deliveries, whether vaginal or caesarean delivery,” Abasiattai said.
Speaking on the impact on the babies, the gynaecologist said, “When the uterus ruptures, it cuts off and the baby becomes affected directly. Low oxygen transfer, hypoxia sets in, and the rate of death or foetal mortality is quite high. Even in some instances, more than 50 per cent following rupture of the scarred uterus.
“So apart from the fact that the woman can have complications from excessive haemorrhage from the torn uterus, the baby, in a significant proportion of cases, dies inside the uterus. Unless surgical intervention is done promptly to arrest the ongoing haemorrhage, repair or stop the bleeding and then deliver the baby.”
The researcher on Community Obstetrics, Fetomaternal Medicine and Reproductive Health urged women who have had previous CS to refrain from having their next delivery at unconventional health facilities, stating that they had an increased risk of a ruptured uterus, among other complications.
Also, a Professor of Obstetrics and Gynaecology at the Obafemi Awolowo University, Ile-Ife, Osun State, Ernest Orji, stated that it was not safe for a woman to attempt labour and vaginal delivery after having two caesarean sections.
He explained, “It’s risky because the womb has been cut two times, and they say you don’t use a wounded soldier to go to battle. The chances of tearing or rupturing during labour are high.
“That’s why we tell women that if you have had caesarean section two times it is not safe to allow you to go into labour because during labour, the womb will be contracting and pushing and so the risk of the womb rupturing and the mother and baby dying is very high.”
The don stated that although there were reports of some women who despite having a history of two CS, tried vaginal delivery and went unscathed, such procedure was not advisable.
Speaking on the implications for the mother and baby, Orji said, “The first danger is that the womb can tear and when that happens, the baby may die depending on the site of the tear. The tear would make the woman start bleeding and when the bleeding is too much, she can bleed and die.
“When the woman is bleeding and is rushed to the hospital, sometimes, by the time they come to the hospital, it may be too late and you will have to remove the womb.
“So, apart from the risk that the woman may die, another risk is the fact that you may have to remove the womb because the womb may be so damaged that it can no longer be repaired.”
The researcher on Reproductive and Feto-maternal health further stated that the babies born through such a process may have their heads compressed, which could affect the babies’ brain and intellectual performance later in life.
Health
Ebola: WHO releases additional $3.4m as death toll rises to 139
The World Health Organisation (WHO) has approved an additional $3.4 million to support emergency response efforts following the worsening Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda, where suspected deaths have risen to 139.
WHO Director-General, Tedros Adhanom Ghebreyesus, announced on Wednesday during a media briefing in Geneva that the agency had declared the outbreak a Public Health Emergency of International Concern (PHEIC) amid growing fears of wider regional transmission.
Tedros said the declaration was made on Sunday under Article 12 of the International Health Regulations after consultations with health authorities in the DRC and Uganda, citing the need for urgent international action.
According to WHO, 51 Ebola cases have so far been confirmed in the DRC, particularly in the provinces of Ituri and North Kivu, including the cities of Bunia and Goma, while Uganda has recorded two confirmed cases in Kampala, including one death linked to travellers from the DRC.
The agency also confirmed that an American national who contracted the virus in the DRC had been transferred to Germany for treatment.
Tedros, however, warned that the outbreak was far more severe than confirmed figures indicate, with nearly 600 suspected cases and 139 suspected deaths already reported.
He said the outbreak had spread to several urban centres, while infections among health workers pointed to transmission within healthcare facilities.
The WHO chief identified insecurity, mass displacement and intense population movement in mining communities within eastern DRC as major factors heightening the risk of regional spread.
He noted that over 100,000 people had been displaced in Ituri Province following escalating violence since late 2025.
Tedros also expressed concern that the outbreak involves the Bundibugyo strain of Ebola, for which no approved vaccines or therapeutics currently exist.
“In light of all these risks, I decided it was urgent to act immediately to prevent more deaths and mobilise an effective international response,” he said.
He commended the governments of the DRC and Uganda for their cooperation, particularly Uganda’s decision to postpone the annual Martyrs’ Day celebrations, which typically attract millions of participants.
WHO said the additional $3.4 million approved from its Contingency Fund for Emergencies brings the organisation’s total emergency support funding for the outbreak to $3.9 million.
The agency added that response teams, medical supplies and emergency support personnel had already been deployed to affected areas as efforts intensify to contain the virus.
Health
WHO declares Ebola outbreak in DR Congo, Uganda global health emergency
The World Health Organization has declared the Ebola outbreak caused by the Bundibugyo virus strain in the Democratic Republic of the Congo and Uganda a Public Health Emergency of International Concern (PHEIC).
The global health body in a statement said the decision was based on the growing risk of international spread of the disease and the absence of approved vaccines or treatments specifically targeting the Bundibugyo virus strain.
WHO Director-General said the outbreak met the criteria for a global health emergency under the International Health Regulations, although it does not yet qualify as a pandemic emergency.
As of May 16, health authorities had recorded eight laboratory-confirmed cases, 246 suspected cases and 80 suspected deaths in Ituri Province of DR Congo, affecting Bunia, Rwampara and Mongbwalu health zones. Uganda also confirmed two cases in Kampala, including one death, involving travellers from DR Congo.
WHO said unusual clusters of deaths linked to symptoms consistent with Bundibugyo virus disease had also been reported across parts of Ituri and North Kivu provinces, while at least four healthcare workers had died from suspected viral haemorrhagic fever, raising fears of hospital-based transmission.
The agency warned that the true scale of the outbreak remained unclear due to limited epidemiological data, insecurity, population displacement and weak health systems in affected communities.
According to WHO, the high positivity rate from initial laboratory samples, increasing reports of suspected cases and deaths, and the detection of cases in Kampala indicate the outbreak could be significantly larger than currently reported.
WHO noted that unlike the Ebola Zaire strain, there are currently no approved vaccines or therapeutics specifically targeting the Bundibugyo virus strain.
The organisation said neighbouring countries sharing borders with DR Congo face a high risk of further spread because of population movement, trade activities and ongoing humanitarian challenges in the region.
WHO announced plans to convene an Emergency Committee under the International Health Regulations to advise on temporary recommendations for responding countries.
The global health agency urged DR Congo and Uganda to activate emergency response mechanisms, strengthen surveillance and laboratory testing, improve infection prevention measures in hospitals and intensify contact tracing and community engagement.
WHO also advised affected countries to implement screening at airports, seaports and land borders, isolate confirmed and suspected cases, and consider postponing mass gatherings until transmission is interrupted.
The organisation, however, warned countries against closing borders or imposing travel and trade restrictions, saying such measures lack scientific basis and could worsen the spread of the disease through unmonitored routes.
WHO further urged neighbouring countries to strengthen preparedness, establish rapid response teams and improve monitoring for unexplained deaths and suspected cases.
Health
World Hypertension Day: Nigerians living with deadly BP – May&Baker warns
The Managing Director and Chief Executive Officer of May & Baker Nigeria Plc, Pharm. Patrick Ajah, on Friday raised alarm over the growing burden of hypertension in Nigeria, warning that millions of Nigerians are living with dangerously high blood pressure without knowing it.
Ajah, who spoke in Lagos during the Walk for Life 2026 organised by the company to commemorate World Hypertension Day, also lamented that rising energy costs are hurting drug prices, as the company spends N170m monthly on factory power.
The event, themed “Controlling Hypertension Together,” featured a health walk, free blood pressure and blood sugar screening, medical consultations, fitness activities, and health talks in collaboration with the Ikeja 1 NYSC Medical CDS Group and other stakeholders.
Speaking during the exercise, Ajah described hypertension as a “silent killer,” disclosing that many Nigerians discovered during previous screenings had dangerously high blood pressure levels, including readings as high as 200 over 120.
“Many Nigerians are walking the streets every day without knowing that they have hypertension,” he said.
“Some of the results we see are frightening. We have seen cases where people’s blood pressure ranges from 200 over 120, which is almost a killer.”
He said the situation was particularly alarming among low-income earners and market women who rarely go for medical checks because of rising healthcare costs.
“Most market women are very hypertensive, but they don’t check. It is getting worse because many people cannot afford hospital bills anymore,” he stated.
According to him, worsening economic hardship and stress are contributing significantly to the rising cases of hypertension across the country.
“With the condition of the country, stress levels are high, and stress increases the tendency for hypertension. The burden is a lot more than it used to be,” Ajah added.
The May & Baker boss warned that hypertension becomes more dangerous when combined with diabetes, describing both conditions as a dangerous alliance responsible for increasing cases of stroke, kidney failure, and sudden deaths.
“In medical school, we were taught that hypertension and diabetes form a dangerous alliance. When somebody is hypertensive and diabetic, it kills faster,” he said.
“That is why we don’t just check blood pressure here, we also check blood sugar.”
Ajah stressed that hypertension treatment is lifelong and warned patients against abandoning medications once their blood pressure appears stable.
“People need to understand that hypertension is not like malaria that you treat and it disappears. Once diagnosed, especially above 40, you are likely going to be on medication for life,” he explained.
“Many people stop taking their drugs once their blood pressure becomes controlled. That is dangerous.”
He urged Nigerians, especially those aged 35 and above, to regularly monitor their blood pressure and blood sugar levels, reduce salt intake, exercise regularly, and maintain a healthy lifestyle.
Ajah also lamented the rising cost of drug production in Nigeria, revealing that soaring energy costs and infrastructure challenges are affecting pharmaceutical manufacturers and ultimately increasing medicine prices.
“Before 2023, we spent about N65 million monthly on power in our factory. Right now, it is costing about N170 million every month,” he disclosed.
“So whether we like it or not, those costs will affect medicine prices.”
He, however, commended the Federal Government for approving duty-free importation of pharmaceutical raw materials, saying the policy helped manufacturers avoid additional drug price increases.
“When the executive order came, we suspended a planned price increase. It probably saved about 10 to 15 per cent on medicine costs,” he said.
Ajah further called on government to improve healthcare infrastructure, make medicines more affordable and address the worsening brain drain in the health sector.
“These days, people get to hospitals and wait for hours before seeing doctors because many doctors have left the country. Government needs to do more to encourage them to stay.”
Speaking, the Chairman of Ikeja Local Government, Comrade Akeem Olalekan Dauda, commended May & Baker for the initiative and urged stronger collaboration between private organisations and government in promoting public health.
“This is public good governance. What you are doing is part of corporate social responsibility and I encourage you to continue partnering with government so our people can enjoy more healthcare support,” Dauda said.
One of the beneficiaries, Mrs. Bose Ayo, praised the organisers after receiving free medical screening and treatment during the outreach.
“I checked my blood pressure and sugar levels and everything is fine. The doctors also attended to my cough and gave me medication,” she said.
“I pray they continue doing this for people like us who cannot afford hospital bills.”
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