By Francesca Hangeior.

Citing various complications associated with poorly managed miscarriages, maternal health experts have warned women to avoid visiting untrained and unskilled health practitioners for treatment whenever they experience the condition.

The gynaecologists stressed the need for pregnant women who had a miscarriage to visit health facilities with maternal health specialists for appropriate treatment.

Miscarriage, the loss of a pregnancy before 20 weeks, is a common event that occurs in an estimated 15 per cent of all pregnancies, according to the American College of Obstetricians and Gynaecologists.

They noted that visiting a gynaecologist for the management of a miscarriage was crucial to ensuring proper treatment and evacuation of the foetus as well as to prevent the risk of complications and infections, which could lead to secondary infertility or even death.

The experts warned that poorly managed miscarriage has been identified as one of the causes of infertility in women.

According to the Nigeria Demographic and Health Survey 2018, the country still records a maternal mortality ratio of 512 per 100,000 live births, which is a far cry from achieving the Sustainable Development Goal target of less than 70 per 100,000 live births.

However, a Consultant Obstetrician and Gynaecologist at the Family Health Department, Federal Ministry of Health, Abuja, Dr. Kamil Shoretire, said stated that miscarriage can profoundly affect the health and well-being of the mother, either from the complications of the process itself or from the complications arising from the treatment and management of the condition.

For those who survive a dangerous miscarriage, the gynaecologist says, there can be untold complications afterwards, including infertility.

Shoretire said, “It is always good for women who have miscarriages to go to the hospital where the experts are and they will be well taken care of.

“Apart from treating them, the experts will also counsel them. “They will tell them the possible causes of the miscarriage and what to do in preparation for the next pregnancy.”

The gynaecologist noted that by going to the hospital, the women would be well-educated and enlightened to know about the condition itself

“A woman that has a miscarriage cannot assess herself. So, the right thing for her to do is to go to the hospital.

“Some women will not know that they have things like diabetes. It is only at such a time that they have a miscarriage that it will be detected.

“So, it is always good for women who have miscarriages to go to the hospital where the experts are and they will be well taken care of.”

He also warned that poorly managed miscarriage could lead to an infection that might cause severe damage to the womb.

In a 2019 article published in PMC journal, titled, ‘Causes and Prevalence of Factors Causing Infertility in a Public Health Facility’, the authors said infertility affects roughly 10 per cent of the world’s population. The authors noted that the problem of infertility has become universal now, and thus, understanding the causes is the first step in solving this issue.

“In the population coming to a public sector tertiary care centre, the incidence of primary infertility is more than secondary infertility.

“Increasing age of marriage influences the causes with unexplained infertility and male factors more commonly seen as the age of marriage increases. Female factor remains the main cause of infertility followed by unexplained causes. Male factor is a significant cause of infertility with semen parameters being affected by age and by consumption of tobacco and alcohol”, the authors said.

Speaking in the same vein, an Associate Professor and Consultant Obstetrician and Gynaecologist at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State, Dr. Uche Agu, urged women who have fibroid to stop patronizing quacks and traditional homes for treatment to avoid exposing themselves to the risk of infertility.

Warning against the dangers of seeking help in unorthodox places and taking local concoctions, the gynaecologist said, “The problem with fibroid comes from people who are not experienced.

“They could injure the lining of the womb and the woman may not see her menses again. They may have complications. Those who have their tubes inadvertently removed may not be pregnant again.

“Some will even take those local concoctions and will never see their menses again. Some may take the concoction and it will knock off their ovaries and they will never see their menses.

“Some of the local concoctions get the fibroid matted together and by the time they come for surgery, it becomes difficult to operate. I have seen cases like that.”

By Francesca Hangeior.

Now, pregnant women living with the Human Immunodeficiency Virus who are on Antiretroviral Therapy and have a low or undetectable viral load can have a vaginal delivery, says the National Agency for the Control of AIDS.

In as much as HIV can pass to the infant during birth, NACA said the risk of transmission is low in women with virally suppressed loads.

The agency noted that the advances in HIV treatment have greatly lowered the chances that a birthing parent would pass HIV on to their baby (also known as perinatal HIV transmission, vertical transmission, and sometimes called ‘mother-to-child’ transmission).

According to NACA, Nigeria has the highest burden of children born with HIV in the world.

It, however, warned that HIV can be transmitted from an infected mother to her child during pregnancy, childbirth, and breastfeeding if she is not on treatment.

The Deputy Director, Community Prevention and Care Department, NACA, Dr Yewande Olaifa, said for many years now, pregnant women living with HIV have been giving birth vaginally and not only through caesarean sections.

Olaifa said, “Yes, for over a decade now, vaginally, women can deliver unless it is contraindicated because of obstetrics matters.

“But as long as there is no contraindication, she can deliver per vaginal irrespective of the fact that she is HIV positive.

“What is important is that if she is HIV positive, she is on treatment not only for herself but also for the baby. So if we can bring the viral load down with ART, the probability that she will transmit to the baby is limited.”

The American College of Obstetricians and Gynaecologists also affirms that vaginal delivery is appropriate for HIV-infected pregnant women, who have been maintained on combined antiretroviral therapy and who have viral loads of 1,000 copies/mL or less at or near delivery.

Speaking further, the deputy director said it is also compulsory to test all pregnant women for HIV when they come to for antenatal clinic, stressing that it helps in the prevention of motor-to-child transmission of the disease.

According to the World Health Organisation, without any intervention, the risk of HIV transmission from a mother to her child during pregnancy, labour, delivery, or breastfeeding can be as high as 45 per cent.

As such, the WHO states that the identification of HIV infection should be immediately followed by an offer of linkage to lifelong treatment and care, including support to remain in care and virally suppressed, as well as an offer of partner services.

Nigeria faces a critical challenge in PMTCT of HIV and ensuring access to care for children living with HIV.

According to NACA, its epidemiological estimates indicate that 140, 000 children under 14 are living with HIV as of 2023, with 22,000 new infections and 15,000 AIDS-related deaths in children.

The agency disclosed that current PMTCT and paediatric HIV coverage remain alarmingly low at less than 33 per cent, far short of the 95 per cent target.

Meanwhile, the Joint United Nations Programme on HIV/AIDS established the 95-95-95 targets calling for 95 per cent of all people living with HIV to know their HIV status, 95 per cent of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95 per cent of all people receiving antiretroviral therapy to have viral suppression by 2030.

The National Agency for Food and Drug Administration and Control, NAFDAC, has dismissed reports that nearly all paracetamol sold in Nigeria are underdosed.

Arise TV anchor, Rufai Oseni, had shared a tweet insinuating that a research carried out showed that nearly all the paracetamols being sold are underdosed.

Reacting, the agency stated that the claims were false because it conducted comprehensive tests on tablets sampled from various pharmacies.

See NAFDAC’s response below…