Hysterosalpingographic findings in infertility – what has changed over the years?

Background: Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 – 50% of female infertility, with as high as 80% reported in some studies. With improved access tocontraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered.Objective: To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally.Method: A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables.Results: Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; .while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency.Conclusion: Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency.Keywords: HSG, infertility, female, Africa, tubal factors, uterine masses

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Fetal Macrosomia at a Tertiary Care Centre in Lagos, Nigeria.

Background: Large babies have attracted immense attention as they present obstetric problems with associated increase in perinatal morbidity and mortality. The major risk of fetal macrosomia is trauma to the fetus and mother during vaginal delivery.Objective: To compare the outcome of macrosomic babies with babies of normal birth weights. Methods: This was a retrospective comparative study of deliveries over a period of two years from 1st August 2005 to 31st July 2007.Results: There were 198 macrosomic babies (6.9%) out of a total of 2,879 deliveries that occurred within the study period. Majority of the mothers were multiparous; para 2 to 4 (47.5% in the study group and 33.7% in the control group). Emergency Caesarean Section (EMCS) rate in the study group was 44.4% while it was 25.3% in the control group and this was statistically significant ( p value <0.001). In this study the maternal injuries in the study group were not significantly higher than the control group. The fetal morbidity and mortality in the study group was significantly higher than the control group both with p values <0.001.Conclusion: Fetal macrosomia is associated with high morbidity and mortality in this centre, there is a need to identify pregnant women at risk as well as adequate counseling of possible interventions and outcomes.Keywords: Incidence, fetal and maternal outcome, fetal macrosomia

The factors affecting gestational age at booking in Lagos University Teaching Hospital, Lagos, Nigeria

Background: Antenatal care is an important part of safe motherhood and plays a major role in maternal and perinatal mortality and morbidity reduction. Thus early antenatal bookings contribute immensely to good pregnancy outcome. Objective: To ascertain the factors that determine gestational age at booking in Lagos University Teaching Hospital (LUTH) and how these factors affect timing of seeking antenatal care in the hospital. Materials and Methods: A cross-sectional study of 302 consenting consecutive pregnant women attending the antenatal clinic in LUTH from October 2009 to April 2010. Results: The mean age of the women was 31.5 ± 5 years (range 17-46 years) and the mean gestational age at booking was 18.9 ± 7.8 weeks (range 6-40 weeks). The majority of women, booked at 20 completed weeks or less were 185 (61.3%), while 117 (38.7%) booked after 20 completed weeks. The main reason for early booking for most patients was physician referral in 36.8%, while 27.6% perceived benefit by husband, partner or patient was the reason for early booking. The main reason for late booking was late referral from the previous hospitals where they initially booked. Conclusion: Most of the women booked early did so as a result of their doctor′s referral due to complications in pregnancy. Late booking was mainly due to late referrals from other hospitals

The influence of male partners on contraceptive usage in sub-Saharan Africa-Lagos experience

Background: Family planning programs, researches, and studies have focused mainly on women with little attention to men′s role in the contraceptive choices by the couple. Men′s exclusion from these programs has serious implications on the acceptance and use of contraceptives by the couple. Objective: To determine the influence of male partners on contraceptive use of their spouses. Subjects and Methods: This was a cross-sectional descriptive study at a Tertiary Care Centre in Lagos, Nigeria. It was conducted from January 1 to April 30, 2010, where all consecutive consenting pregnant women were given structured questionnaires to give to their partners so as to evaluate the contribution of the male partners to contraceptives use in their spouses as well as assess their awareness and knowledge of contraception. Categorical variables were analyzed using Chi-square test or Fisher′s exact test as appropriate while continuous variables by t-test. P < 0.05 was considered significant. Results: Of the 370 respondents, only 51.9% (192) knew about female contraceptive methods, while 50% (185) were willing to allow their wives to use contraception. Barrier method (17.3%) and periodic abstinence (15.7%) were the leading preferred choice for their wives. However, bilateral tubal ligation was the least preferred method (1.6%). Previous counseling of male partner significantly influenced their decision to allow their wives to use contraceptives (P = 0.001). Conclusion: Involving the male partner in family planning counseling plays an important role in increasing the acceptance and use of contraceptives by the couple

Evaluation of maternal serum levels of dehydroepiandrosterone sulphate and its association with successful labour outcome among parturients undergoing spontaneous labour at term

This study evaluated maternal serum levels of dehydroepiandrosterone sulphate (DHEAS) in spontaneous labour and its association with successful labour at term. A cross-sectional observational study was carried out on 140 parturients. Their blood samples were collected in active labour; allowed to clot, centrifuged, separated and stored at −20 °C before analysis for DHEAS was done using the ELISA method. Labour was termed successful when vaginal delivery was achieved. Serum DHEAS levels were higher among parturients with successful labour compared to women with unsuccessful outcome (p = 0.001). DHEAS level was also higher among parturients who did not require oxytocin augmentation compared with those who required it (p = .001). The odds ratio and incidence of successful labour increased significantly as DHEAS level increased above a critical value of 1.5 μg/ml (p = .001). The association between serum DHEAS level and successful labour remained significant after adjusting for other variables (p = .002)

Hysterosalpingographic findings in infertility \u2013 what has changed over the years?

Background: Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 \u2013 50% of female infertility, with as high as 80% reported in some studies. With improved access to contraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered. Objective: To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally. Method: A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables. Results: Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; .while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency. Conclusion: Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency. DOI: https://dx.doi.org/10.4314/ahs.v19i2.9 Cite as: Omidiji OAT, Toyobo OO, Adegbola O, Fatade A, Olowoyeye OA. Hysterosalpingographic findings in infertility \u2013 what has changed over the years? Afri Health Sci.2019;19(2): 1866-1874. https://dx.doi.org/10.4314/ahs.v19i2.