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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

WHO endorses twice-a-year jab to combat HIV/AIDS scourge

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World Health Organization, injectable lenacapavir, HIV prevention efforts, Dr Tedros Ghebreyesus, mental health care for depression
The World Health Organization (WHO) has released new guidelines recommending the use of injectable lenacapavir (LEN) twice a year as an additional pre-exposure prophylaxis (PrEP) option for HIV prevention.

It is a landmark policy action that could help reshape the global HIV response.

The guidelines were issued at the 13th International AIDS Society Conference (IAS 2025) on HIV Science, in Kigali, Rwanda.

LEN, the first twice-yearly injectable PrEP product, offers a highly effective, long-acting alternative to daily oral pills and other shorter-acting options.

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With just two doses per year, LEN is a transformative step forward in protecting people at risk of HIV, particularly those who face challenges with daily adherence, stigma, or access to health care.

“While an HIV vaccine remains elusive, lenacapavir is the next best thing: a long-acting antiretroviral shown in trials to prevent almost all HIV infections among those at risk,” said WHO Director-General, Dr Tedros Ghebreyesus.

“The launch of WHO’s new guidelines, alongside the FDA’s recent approval, marks a critical step forward in expanding access to this powerful tool.

“WHO is committed to working with countries and partners to ensure this innovation reaches communities as quickly and safely as possible,” he added.

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The new guidelines come at a critical moment as HIV prevention efforts stagnate with 1.3 million new HIV infections occurring in 2024.

The WHO’s recommendation on LEN signals a decisive move to expand and diversify HIV prevention,

As part of these guidelines, WHO has recommended a public health approach to HIV testing, using HIV rapid tests to support delivery of long-acting injectable PrEP, including LEN and cabotegravir (CAB-LA).

The simplified testing recommendation removes a major access barrier by eliminating complex, costly procedures and enabling community-based delivery of long-acting PrEP through pharmacies, clinics, and tele-health.

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LEN joins other WHO-recommended PrEP options, including daily oral PrEP, injectable cabotegravir and the dapivirine vaginal ring, as part of a growing arsenal of tools to end the HIV epidemic.

While access to LEN outside clinical trials remains limited at the moment, WHO urges governments, donors and global health partners to begin rolling out LEN immediately within national combination HIV prevention programmes, while collecting essential data on uptake, adherence and real-world impact.

For the first time, WHO’s treatment guidelines include a clear recommendation for the use of long-acting injectable cabotegravir and rilpivirine (CAB/RPV) as an alternative switching option for antiretroviral therapy (ART) for adults and adolescents who have achieved full viral suppression on oral ART and do not have active hepatitis B infection.

This approach is designed to support people living with HIV facing adherence challenges to oral regimens.

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Updated guidelines on service delivery integration include recommendations to integrate HIV services with non-communicable diseases (NCDs) such as hypertension and diabetes, as well as mental health care for depression, anxiety and alcohol use disorders into HIV services, alongside interventions to support ART adherence.

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Edo confirms dengue fever outbreak, records 86 cases

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The Edo State Ministry of Health on Friday confirmed the outbreak of dengue fever, saying 86 cases have been reported across the state.

The Commissioner for Health, Dr Cyril Oshiomhole, stated this during a press briefing where he assured that the administration of Governor Monday Okpebholo remains fully committed to protecting residents and will continue to work until all outbreaks are brought under control.

Oshiomhole said the Director of Public Health, Dr Stephenson Ojiefoh, has been appointed as the incident manager to lead the response.

He said, “The Edo State Ministry of Health confirms the outbreak of dengue fever, and 86 cases have already been reported across the state.

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“The Director of Public Health, Dr Stephenson Ojiefoh, has been appointed as the incident manager to lead the response. The Emergency Operation Centre has also been activated, and the Ministry is rolling out a statewide response plan. This includes surveillance, case management, vector control, and environmental sanitation across all affected areas.”

He urged all healthcare workers across the state to be on high alert and to report any suspected case promptly.

The Commissioner said dengue fever is caused by a virus transmitted through the bite of Aedes mosquitoes, particularly Aedes aegypti. The disease spreads quickly, especially in areas with poor sanitation and stagnant water, which provide breeding grounds for mosquitoes.

To prevent the spread, Oshiomhole advised residents to keep their surroundings clean, cover water containers, use mosquito nets, apply insect repellents, and destroy mosquito breeding sites.

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Present at the briefing were representatives of the Nigeria Centre for Disease Control, the State Disease Surveillance Team, the Ministry of Health Directors, the Centre for Disease Control, and other key stakeholders.

Apart from Dengue Fever, the commissioner also said that the state has recorded 137 confirmed Lassa Fever cases and 24 deaths.

He also said that Yellow Fever has two confirmed cases with one death, Monkeypox (Npox) has eight confirmed cases with no deaths, while Diphtheria has eight confirmed cases with three deaths.

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Quick tips to get rid, prevent bedbugs in homes, beds, others

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A bedbug infection or infestation can be difficult to treat on one’s own and can take weeks to months.

Bed bugs are one of the great travellers of the world and are readily transported via luggage, clothing, bedding and furniture. In many cases, people carry bed bugs from place to place, often without realizing.

A person may notice itchy welts on their skin if they sleep in a bed with bedbugs. Bedbugs are small, but a person may notice them if they inspect the folds of mattresses and bedding.

Bedbugs do not usually hide on the human body. Instead, they tend to hide in the piping or folds of mattresses, in the creases of bedding, and in the cracks of the bed. They will usually only be on the body when feeding.

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To get rid of bed bugs, act at the first signs of infestation and use an integrated pest management approach involving prevention and sanitation.

Bedbugs are often tough to get rid of, so one may need a few different approaches. Once you identify and contain all infested areas, you can combine chemical and non-chemical treatments to kill the bugs.

Here are ways to eliminate bedbugs:

*Seal any small hiding areas. This eliminates hiding places and gets the bugs out into the open.

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*Remove infested items. Place them in a sealed plastic bag and treat them.

*Items that cannot be treated should be placed in a sealed plastic bag or storage container and left there for a long time to ensure any active bugs are dead.

*Purchase protective covers that seal mattresses and box springs. With covers that seal, the bed bugs will get trapped inside and die.

*Vacuum after each use. Seal the bag as tightly as possible and immediately throw it out in an outdoor trash container.

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*Discard furniture responsibly if you can’t safely eliminate the bed bugs. Destroy it so someone else won’t be tempted to bring it into their home.

*Consider non-chemical methods of killing bed bugs. Some will be more useful than others depending on your situation. These and other methods can be helpful, but they might not get rid of the infestation entirely:

*Heat treatment: You can use a clothes dryer on high heat. You can also use black plastic bags in a hot, closed car in the sun, but success depends on your climate and other factors. Do-it-yourself heat treatments might not work. Professionals have access to more intensive and proven methods that can even treat whole houses with heat. Do not try to kill bed bugs by increasing your indoor temperature with a thermostat, propane space heater, or fireplace – this does not work and is dangerous.

*Cold treatment may work, but can only be successful in the home environment if the freezer is set to 0o F.  Many home refrigerator freezers are not cold enough  to kill bed bugs. You must leave the items in a sealed bag in the freezer at 0o for three days. Always use a thermometer to check the temperature, since home freezers are not always set to 0o.

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Meanwhile, some chemicals or strong insecticides are good options to eliminate bedbugs. However, these can be hazardous if a person uses them indoors.

Mint leaves

Mint leaves are natural repellents to insects and most insects hate the smell of this plant and bed bugs are no exception. You can use mint leaves to prevent bed bugs from entering your homes.

All you need to do is crush some mint leaves into smaller pieces and sprinkle around the sleeping area or inside the cradleboard of small children. You can also put dried mint leaves packet between your linen closets and mattress. The mint leaf will dry up the bed bugs in no time. Repeat this exercise every 3-5 days for best results.

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Baking soda

Baking soda also is a wonderful response to the issue of how to get rid of bed bugs. Baking soda works very effectively in killing the bedbugs even before you know it.

It sucks the moisture present on these tiny parasites and this eventually causes their death. You will need half bowl of baking soda and a vacuum.

Put the soda at all the places affected with the bugs and vacuum all the soda after three days. Repeat the process and your home will be free of bed bugs in no time.

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You should see your doctor if you have:

Many bites

Blisters

Skin infection (bites feel tender or ooze discharge, such as pus)

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An allergic skin reaction (skin red and swollen or hives)

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