Ovarian capsular drilling in the treatment of clomiphene citrate resistant polycystic ovarian syndrome: Laparoscopy or hydrolaparoscopy

Background: Laparoscopic Ovarian Drilling (LOD) is an effective and a well evaluated surgical Treatment of Clomiphene Citrate resistant Polycystic ovarian syndrome. Transvaginal hydrolaparoscopy (TVHL) is a relatively new simple method of exploring the pelvis and has recently been introduced as a transvaginal approach to ovarian capsular drilling and it seems promising.Objective: To explore whether the newly introduced Transvaginal Hydrolaparoscopy (TVHL) will have a significant advantage over the standard laparoscopy (SL) for Laparoscopic Ovarian Drilling (LOD) in Women with polycystic ovarian syndrome.Methods: Published literature in English language was retrieved through searches of Pubmed, Highwire and Google using appropriate controlled vocabulary and key words. The articles that met the review criteria were selected and the relevant references screened.Results: All the studies agreed that Transvaginal Hydrolaparoscopy (TVHL) is as effective as Standard Laparoscopy (SL) for ovarian drilling in polycystic ovarian syndrome. Unlike Standard laparoscopy, TVHL can be performed under local anesthesia as an office procedure. Postoperative adhesions are less in TVHL than SL and pregnancy rate is slightly higher. However, incomplete view of the pelvic structures and the requirement of ultrasound guidance were some setback when compared to the standard laparoscopy.Conclusions: In experienced hands, TVHL is a good alternative to SL. TVHL has the possibility of replacing SL as more Minimal Access Surgeons become more comfortable with the technique.Key words: Transvaginal Hydrolaparoscopy, Standard Laparoscopy, Ovarian Drillin

Outcome Of Eclampsia At The Obafemi Awolowo University Teaching Hospital Complex, Ile-ife.

Objective: Eclampsia is a serious obstetric complication with attending high maternal and perinatal morbidity and mortality. There is need for periodic audit of our management of these cases so as to identify potential areas for possible intervention aimed at improving the management outcome of this pregnancy complication. Methods: The records of cases of Eclampsia managed at the OAUTHC Ile-Ife between January 1, 1994 and December 31, 2003 were retrospectively analysed. Results: The incidence of Eclampsia was 0.91% of total deliveries. It was highest in teenagers and young adults who are less than 25years (1.56%),who were carrying their first pregnancy (2.64%) and were unbooked (6.3%). Headache was the commonest symptom (100%), while hypertension and fever were the commonest signs being present in 75% and 20.2% of the patients respectively. Antepartum Eclampsia accounted for 56.5% of the cases and majority was delivered by emergency caesarean section. Maternal and perinatal mortality were 8.0% and 19.1% respectively. Conclusion: Provision of good quality and widespread antenatal care, improving the capacities of the hospitals to handle emergencies and intensive care unit management of all cases of Eclampsia are measures that could reduce the burden of Eclampsia in this environment Keywords: Eclampsia, Morbidity and Mortality. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 279-28

Myasthenia gravis following chicken pox infection in a Nigerian primary school girl

We report a case of myasthenia gravis occurring post Chicken pox infection in a 9 year old Nigerian girl. The girl was growing and seeing normally until 2weeks after a chicken pox infection when she observed progressive drooping of both upper eye lids which worsens as the day progresses and has persisted for more than one year. There was good response to Neostigmine

The impact of religion on the contraceptive choice among women in the south west Nigeria

Objective: To determine the frequency of use and the impact of religion on the choice of the available modern methods of contraception among women in a semi-urban area in the Southwest Nigeria.Methods: A total of 848 case reports of the new acceptors of the modern methods of contraception at the family planning unit of the University Teaching Hospital between January 2009 and December 2010 were retrieved. Relevant data regarding biodata and religion characteristics of the clients were collated and analyzed.Results: Overall, 407 of the 848 (48%) clients studied accepted injectable hormonal contraceptives. Very closely, 382 (45%) accepted IUCD. The third and fourth most frequently accepted modern methods of contraception were Oral contraceptive pills 5.5% and implant, 1.2% respectively. Least accepted was the male condom by only 0.2% of the clients. More than half, 509 of the 848 clients (60%) were between 30 – 39 year age brackets, while only 1 client out of the 848 clients was an adolescent below 20 years. Pentecostals (605 out of 848) accounted for the majority (71.3%) ofthe new acceptors of Modern methods of contraception in this study. Only 61(7.2%) were Roman Catholics. Other non-catholic orthodox represented 14 %, while 7.4% were Muslims. There was no significance relationship between the religious denominations and the choice of contraceptive methods among the clients in this study {X2 (35) = 32.04; p>.05}.Conclusion: This study shows clearly that religion to a large extent affects the acceptance of the modern method of contraception. However, there is no significant relationship between religious denomination and the choice of modern methods of contraception in our environment.Keywords: Modern Contraceptive Methods, Acceptance, Choice, Religion, Nigeri

Effect of intermittent preventive treatment of malaria on the outcome of pregnancy among women attending antenatal clinic of a Nigerian Teaching Hospital

Background: Malaria is a public health problem globally especially in the Sub-Saharan Africa and among the under five children and pregnant women. Malaria in pregnancy is well known to be associated with a lot of maternal and fetal complications. Intermittent Preventive Treatment with Sulphadoxine-Pyrimethamine is the currently recommended regimen for prevention of malaria in pregnancy in the endemic areas.Objective: The study was on the effect of intermittent preventive treatment of malaria in pregnancy on the prevalence of malaria in pregnancy and the outcome of pregnancy.Method: It was a prospective descriptive cross-sectional study and a semi-structured questionnaire was administered to women in the lying in ward University Teaching Hospital, Ado-Ekiti, who booked in the hospital, attended at least two antenatal clinic visits and delivered in the hospital.Results: The study revealed that about 75% of the pregnant women studied had access to intermittent preventive treatment of malaria and also that among the women attending the antenatal clinic that received the IPT, about 78% of them took the recommended dose of the IPT. The prevalence of malaria was statistically higher in women who did not receive intermittent preventive treatment with sulphadoxinepyrimethamine during pregnancy (44.7% vs 31.3%, p=0.0001) and among women who had one dose of the drug instead of two doses (40.0% vs 28.7%, p= 0.0001). There was no statistical significant difference in the mean age in years (31.53±5.238 vs 31.07±4.751, p= 0.09 and the gestational age at delivery (38.76±1.784 vs 38.85±1.459, p= 0.122) between the women who did not receive IPT and those who had it. There was a statistical significant difference in the outcome of pregnancy among women who had IPT and those who did not viz a viz in the duration of labor (8.6±1.491 vs 8.7 ± 1.634, p= 0.011) and the birth weight of the babies (3.138 ±0.402 vs 3.263± 0.398, p=0.0001)Conclusion: Intermittent preventive of malaria with Sulphadoxine-pyrimethamine in pregnancy is effective as a prophylaxis against malaria and improves the outcome of pregnancy in malaria's endemic areas.Keywords: Pregnancy, Malaria, Intermittent preventive treatment, sulphadoxine-PyrimethamineTrop J Obstet Gynaecol, 30 (1), April 201

B-Lynch Suture-Uterine Artery Ligation in Severe Postpartum Haemorrhage: First Experience at a New Tertiary Institution in Nigeria

Postpartum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical methods have been used to arrest bleeding but none has been uniformly successful. Experience withcombined B-Lynch suture(Brace suture) and bilateral uterine artery  devascularisation procedure is limited in southwestern Nigeria as there is dearth of data on it and most times (especially in our center) hysterectomy is done to secure haemostasis in severe postpartum haemorrhage which could as well, in well selected cases, respond to the procedures being described. A combined B-Lynch suture and bilateral ligation of the uterine vessels(the first experience in the centre of study) was done in the case reported below which was successful and effective with no complications. This is thus highly recommended as alternative to obstetric hysterectomy especially in well selected primipara. (B-Lynch, uterine artery ligation, postpartum haemorrhage, Nigeria

Diagnostic Laparoscopy to the rescue: The first experience in EKSUTH

Summary: Diagnostic Laparoscopy is an established investigative procedure. Its advantage in establishing accurate diagnosis has been proven over time. The duration is short, it provides direct visualization of the lesion and it avoids exposure to irradiation. It is also far cheaper to set up compared to CT scan and MRI. It may therefore be more beneficial for Health Institutions in Nigeria to set up facilities for this procedure and encourage its use. Key words: Diagnostic Laparoscopy, Laparoscopic Surger