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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.

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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.

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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.

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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.

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“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.

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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.

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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.

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Health

NAFDAC Blacklists Onifam Laboratories, Directors Over Regulatory Infractions

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The National Agency for Food and Drug Administration and Control (NAFDAC) has blacklisted Onifam Laboratories Limited, its Managing Director/Chief Executive Officer, all members of its board of directors, and every affiliated or associated individual and entity found to have participated in regulatory violations, following what it described as extensive investigations into the company’s operations.

The sanction, which takes immediate effect, effectively excludes the company and all affected individuals from participating in any pharmaceutical business regulated by NAFDAC pending further directive from the agency.

In a statement signed on Monday by its Director-General/CEO, Prof. Mojisola Adeyeye, the agency said its investigations established that Onifam Laboratories engaged in regulatory misrepresentation, misuse of NAFDAC approvals and certificates, improper registration and transfer of pharmaceutical products, as well as activities that deliberately circumvented established regulatory procedures.

According to NAFDAC, the alleged infractions compromise product traceability, weaken accountability within the pharmaceutical supply chain and expose the public to significant health risks.

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The agency said the company’s actions violate the provisions of the NAFDAC Act, the Food, Drug and Related Products (Registration, etc.) Act, the Drug and Related Products Registration Regulations 2021 and other applicable regulatory guidelines governing pharmaceutical products in Nigeria.

As part of the blacklist, Onifam Laboratories and all affected persons are prohibited from participating, either directly or indirectly, in any pharmaceutical business regulated by NAFDAC.

The prohibition extends to applying for or benefiting from any NAFDAC registration, licence, permit, certificate or approval.

It also bars them from operating as manufacturers, importers, distributors, marketing authorisation holders, agents, representatives, consultants, promoters or sponsors of any product regulated by the agency.

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Prof. Mojisola Adeyeye, Director-General/Chief Executive Officer of the National Agency for Food and Drug Administration and Control (NAFDAC), whose agency announced the immediate blacklisting of Onifam Laboratories Ltd, its Managing Director, directors and affiliated entities over multiple regulatory violations/Credit: NAFDAC

The sweeping sanctions equally apply to affiliated companies and associated entities found to have been involved in the regulatory violations.

NAFDAC stated that the blacklist would remain in force until otherwise directed by its management.

The agency further warned that it reserves the right to initiate additional regulatory, administrative, enforcement and legal actions where necessary to protect public health and preserve the integrity of Nigeria’s medicines regulatory system.

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It stressed that the action reflects its determination to ensure strict compliance with pharmaceutical regulations and deter practices capable of undermining the safety and quality of medicines available to Nigerians.

Reaffirming its commitment to safeguarding public health, NAFDAC urged all stakeholders in the pharmaceutical sector to comply fully with applicable laws and regulatory requirements.

The agency maintained that only safe, quality-assured and properly regulated medicines should be manufactured, imported, distributed and sold in Nigeria, warning that any attempt to bypass regulatory procedures would attract decisive sanctions.

The blacklist of Onifam Laboratories marks one of the agency’s strongest recent enforcement actions and underscores its resolve to strengthen regulatory oversight, improve accountability within the pharmaceutical industry and sustain public confidence in Nigeria’s medicines regulatory framework.

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What is being released to NCDC is a drop in the ocean- Senate C’ttee laments

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Poor  funding could undermine the ability of the North Central Development Commission (NCDC) to deliver on its mandate, the Senate has said, insisting that the N2.9 billion monthly allocation being released to the commission is only “a drop in the ocean” compared to its N140 billion budget  allocation for 2026.

The Chairman of the Senate Committee on the North Central Development Commission, Titus Zam, sounded the warning while briefing journalists after an interactive session between the committee and the commission’s management at the National Assembly on Tuesday.

According to him, the current monthly release would amount to less than half of the commission’s approved budget if maintained throughout the year, expressing optimism that the federal government would increase funding as the commission becomes fully operational.

“If you give someone that has a budget of N140 billion, N2.9 billion per month, in 12 months, it won’t be up to half of the entire budgetary sum,” Zam said.

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“I suppose that is just a temporary package. When the commission finally comes to fruition, much more funds will be released. So we thank Mr President and the Executive for dropping something now, but we look forward to more.”

The lawmaker, however, assured that the Senate Committee would ensure the prudent utilisation of the funds already released by providing effective oversight and guiding the commission on areas of priority.

He urged the commission to focus its interventions on agriculture, security and rural development, stressing that the North Central region is largely agrarian and continues to face serious security challenges.

“North Central is mostly an agricultural land. We have arable land, we have good rainfall and vegetation. There is policy for agriculture. We need the department of NCDC to take agriculture very seriously.

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“We also have a challenge of insecurity. The commission is advised to support the security forces and state governments to complement their efforts towards mitigating the tide of insecurity within the region.

“We also ask them to take rural development very seriously because we are also rural in nature,” Zam said.

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Health

NCDC records rise in Lassa fever cases, death toll hits 221

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The Nigeria Centre for Disease Control and Prevention (NCDC) says Nigeria recorded an increase in confirmed Lassa fever cases during epidemiological week 26 of 2026, with 31 new infections reported, up from 22 the previous week.

The new confirmed cases were recorded in Bauchi, Ondo, Taraba and Benue states, according to the latest NCDC Lassa fever situation report released by the public health agency on Friday.

The report showed that 221 deaths have been recorded cumulatively in 2026, with a Case Fatality Rate (CFR) of 24.0 per cent, higher than the 18.7 per cent reported in 2025.

It stated that 23 states had reported at least one confirmed Lassa fever case across 111 Local Government Areas, indicating the continued geographic spread of the disease nationwide in 2026.

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According to the report, 85 per cent of all confirmed cases originated from Ondo, Bauchi, Taraba, Edo and Benue states, while the remaining 15 per cent were reported elsewhere.

The report said Ondo accounted for the highest proportion of confirmed cases at 30 per cent, followed by Bauchi with 26 per cent, Taraba with 14 per cent, Edo with nine per cent, and Benue.

It revealed that people aged between 21 and 30 years remained the most affected group, although confirmed cases ranged from one to 93 years, with a median age.

The report also showed that the male-to-female ratio among confirmed cases stood at 1:0.9, suggesting nearly equal infection rates between males and females across affected states.

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Health authorities noted that both suspected and confirmed Lassa fever cases increased compared with the corresponding period in 2025, while one healthcare worker was infected during week 26.

The report added that the National Lassa Fever multi-partner, multi-sectoral Incident Management System remains activated to coordinate surveillance, case management, risk communication and response activities nationwide.

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