African journal of medicine and medical sciences
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Vaginal birth (or trial of labour) after previous Caesarean delivery represents one of the most significant changes in obstetric practice. A five-year retrospective study was carried out at the Lagos University Teaching Hospital to determine the obstetric outcome after a previous Caesarean section and also to identify significant clinical factors that are predictive of successful subsequent vaginal delivery. Hospital records of 101 patients with previous Caesarean births and 105 patients without a previous Caesarean delivery were examined, the later group serving as control. ⋯ Uterine rupture/dehiscence occurred in 3 (2.97%) patients. No maternal or perinatal death occurred. We conclude from this study that trial of labour in carefully selected patients with previous Caesarean delivery poses low level of risk for both the mother and the baby and that its use is an important component of efforts to lower the rate of repeat Caesarean birth.
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Clinically, the commonly used routine test for assessing impaired renal function is the determination of creatinine clearance. The traditional 24 hour urine collection method is unreliable and inconvenient, particularly in ambulatory patients and outpatients because of errors in collection, timing of collection, and measurement of urine volume. The purpose of this study was to evaluate the possibility of determining creatinine clearance from urine collected for less than the traditional 24 hours. ⋯ Each of the subjects had his creatinine clearance determined from 4 hour, 20 hour and 24 hour urine collections as well as from the formula of Cockcroft and Gault. The mean creatinine clearance obtained from 4 hour urine collection (male = 92.8 ml/ min/1.73 m2 & female = 84.5 ml/min/1.73 m2) and 20 hour urine collection (male = 98.9 ml/min/1.73 m2 & female = 88.6 ml/min/1.73 m2) shows no significant difference from that obtained from the traditional 24 hour urine collection (male = 97.9 ml/min/1.73 m2 & female = 88.1 ml/min/1.73 m2) (P > 0.05). We therefore suggest that determination of creatinine clearance from fewer hours of urine collection especially in patients with renal impairment be explored towards their adaptation to routine practice.