Is hysterosalpingography still relevant in workup of infertility? A review article

Objective: To examine the current role of Hysterosalpingography in the investigation of the infertile couple in view of the increasing use of Laparoscopy in the evaluation and management of infertility.Materials: Electronic search of published literature was done using the Pubmed, Cochrane libraries and Google search engine. The search was restricted to English language articles.Conclusion: Hysterosalpingography is a simple method of evaluating fallopian tube patency and cervicouterine abnormalities. It is virtually non-invasive; and it can be therapeutic. HSG has a high specificity and a high positive predictive value; it also has a low complication rate. It requires less skill acquisition and necessary equipment are readily available. Laparoscopy should be performed in cases of abnormal hysterosalpingogram or persisting infertility in despite of normal HSG and other parameters

Knowledge and Practices of PMTCT among Health Care Providers in Private Hospital in Ilorin, Nigeria

Introduction: In the developed countries where mother to child transmission of the virus is still high preventing MTCT is essential and starts during the antepartum period where diagnosis can be made andantiretrovirals and other prevention strategies can be instituted. A  significant proportion of Maternity care and delivery services are rendered by private hospitals. Adequate knowledge by health care providers ofantiretroviral use and other PMTCT strategies will be required to ensure control of vertical transmission of the virus.Objective: To assess the knowledge and practice of PMTCT among health care providers in private health facilities in Ilorin, Nigeria.Method: This is a review of health care providers in private health facilities Ilorin, Nigeria, between December2011 and November2012. Information on biodata, general knowledge on HIV and PMTCT and practices done to prevent vertical transmission were collected with use of questionnaires and were analyzed using SPSS statistical software version 17.Result: 265 questionnaires were applied but 223 were complete and analyzed. Their age range was 20-62years; mean age was 32.45+7.0SDyrs and Mean working experience was 5.89+5.17SD yrs. Nurses constituted the greater percentage 64.1% of the health care providers. Knowledge that vertical transmission could be prevented was good (95.5%), however 15.2% felt HIV could be transmitted through sharing of spoon or eating together. Only 20% had training in PMTCT and 17% worked in health facilities where ARV was administered to HIV positive pregnant women. A larger number 72% referred the HIV positive women to other centres for antenatal care and delivery. Antiretroviral drugs administered to the mothers were, 42.1% administered single drug ARV therapy, 21.1% gave 2 ARV drugs which is not in any standard protocol while only 5.3%  administered 3 ARV drugs. Prophylactic ARV administration to the babies also revealed deficiencies.Conclusion: Knowledge and practice of PMTCT among health care providers in private sectors was poor. There were no clear cut guidelines for  antiretroviral drug administration for mothers and babies. Training and retraining on PMTCT should be encouraged.Keywords: Knowledge, Practice, health care provider, PMTC

Pregnancy Outcome in Cervical Incompetence: Comparison of Outcome Before and After Intervention

Context: Cervical incompetence is a major cause of recurrent mid-trimester pregnancy loss and preterm deliveries; it contributes significantly to fetal loss and neonatal morbidity and mortality. Despite its wide use, the effectiveness of cervical cerclage in its management remains unsettled.Objective: To evaluate the effectiveness of cervical cerclage by comparing the pregnancy outcome before and after its insertion in women with cervical incompetence.Study design: An observational study [retrospective] of 95 women  diagnosed with cervical incompetence that had cervical cerclage inserted from 1st January 2007 to31st December 2010. The pregnancy outcomebefore and after cervical cerclage were compared, the data was analyzed using SPSS version 18; p value <0.05 was considered significant.Main outcome measure: The gestational age at the end of pregnancy, the duration of prolongation of the pregnancy after cervical cerclage and the pregnancy outcome.Results: Of 103 cases of cervical incompetence managed, 95 satisfied the inclusion criteria. The prevalence of cervical incompetence was 8.4/1000 deliveries or 0.85%. There were 85 elective and 10 emergency cerclage with mean gestational age at end of pregnancy of 36.06±3.96 vs. 25.10±3.99 and mean duration of prolongation of pregnancy 20.98±4.71 vs. 4.00±3.37 weeks. After cervical cerclage insertion, there was reduction in miscarriages [P<0.0001] and preterm deliveries [P<0.0001] and increase in term deliveries [P=0.4100] and viable pregnancies [P=0.001]. The child take home rate was 89.4% following elective and 20% after emergency cervical cerclage.Conclusion: Cervical cerclage resulted in improved pregnancy outcome in women with previous midtrimester losses or preterm delivery.Keywords: Cervical cerclage; cervical incompetence; pregnancy outcome; intervention

Umbilical cord parameters in Ilorin: correlates and foetal outcome

Background: The anthropometric parameters of the umbilical cord have clinical significance. Current parameters of the cord, its correlates and related foetal outcome are lacking in our parturients.Objectives: To describe the anthropometric parameters and abnormalities of the umbilical cord; and determine their maternal correlates and foetal outcome.Design: A cross sectional analytical study.Setting: The Obstetric and Gynaecology Department of the University of Ilorin Teaching Hospital, between September 2012 and June 2013.Subjects: Healthy pregnant women with singleton pregnancies.Results: Four hundred and twenty- eight (428) singleton deliveries were studied. The respective mean values of the cord length and width were 526.87±115.5mm and 19.56±11.12mm. Short cord (< 40cm) occurred in 7.2% while long cord (> 69cm) was found in 9.3% of the parturient. The incidences of single umbilical artery, cord round the body and knots were 7%, 8.4% and 14.5% respectively. Nuchal cord was the most common (91.4%). Only gestational age had significant statistical relationship with cord length abnormalities (P = 0.0093). The cord length was an important correlate of cord helices, knots and vessels (P< 0.05).Parity had correlations with the number of vessels(R= 0.099, P=0.042). The cord coiling index was statistically related to the presence of congenital abnormalities (P=0.011). Other perinatal events were not related to umbilical cord parameters. Perinatal asphyxia was the most common indication for NICU admission (3.5%) but there was no significant statistical difference between NICU admission and cord parameters.Conclusion: The umbilical cord parameters in apparently healthy parturients in Ilorin were comparable with others elsewhere. The cord length and helix are important correlates of gestational age and congenital abnormalities. Parity may be related to abnormal umbilical vessels. Cord length, coils, coil index and umbilical vessels should be examined post-natally

Pharmacological Exposure of Pregnant Mothers in Ilorin, Nigeria

Context: Use of drug during pregnancy is a universal event. However, in developing countries, drug use is poorly controlled as most of the drugs could be obtained without prescription. This constitutes potential hazard both for the mother and the fetus.Objective: To determine the pattern of drug use (including alcohol and smoking) prescription and non prescription of drug by pregnant mothers in Ilorin, Kwara State, Nigeria.Study Design: A cross sectional study of pregnant mothers attending antenatal clinic of the University of Ilorin Teaching Hospital, Ilorin.Result: Four hundred 400 pregnant women participated in the study, 335 adequately completed questionnaire for data analysis. Majority of the respondents 273 (81.5%) had taken one or more drugs, 62 (18.5%) had not used any. Average number of drugs used was 2.7. Routine haematinics (folic acid and Ferrous Sulphate) are the common drug taken by 241 (81.5%) of the respondents. Anti malarial drugs were taken by 47 (14%) while herbal drug was taken by 41 (12.2%). Five (1.5%) of the respondents admitted to taking alcohol and only one woman (0.3%) admitted to smoking cigarette. One (0.3%) each of the respondents was on anti depressant and anticonvulsant drugs. Occupation was significantly related to herbal use. Parity was also significantly related to alcohol consumption and the use of unprescribed drugs.Conclusion: Drug use is common during pregnancy. Haematinics were the commonest drug used. Herbs are used to some extent and antimalarials are underutilized. Alcohol is minimally used and smoking during pregnancy is virtually non- existent. There is need to caution our pregnant mothers on the use of herbs as there is no full understanding of their pharmacokinetics

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Background. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C).Objectives. To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it.Methods. A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant.Results. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future  daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as  wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this.Conclusion. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Abdominal Hysterectomy at University of Ilorin Teaching Hospital: A 5-year Review

Background: Hysterectomy is the commonest major gynaecological operation performed on women for treatment of a diverse disorder. The indications are mostly gynaecologic but may occasionally be obstetric. Objectives: To determine the prevalence of the procedure, the indications, the operative and histological findings and the pattern of morbidity and mortality associated with the procedure. Methods: A retrospective analysis of patients who had abdominal hysterectomy at University of Ilorin Teaching Hospital, Ilorin. The case notes of patients who had the procedure over a 5-year period were retrieved from the hospital records department. Variables considered in the study were socio-demographic characteristics, pre-operative investigations done, operative findings, histological findings, associated complications and follow-up findings. Results:A total of 2054 major gynaecological operations were performed from 1st January 2004 to 31st December 2008 of which 255 were abdominal hysterectomies, giving an incidence of 12.4% of major gynaecological surgeries. The mean age at which the procedure was performed was 43.8 + 7.3 years. Menorrhagia was the commonest presenting symptom, occurring in 62.9% of patients while uterine fibroid was the commonest indication for surgery. The commonest complication was superficial wound infection and less than half (47.2%) of the patients reported for follow-up. Conclusion: Abdominal hysterectomy is a safe operative procedure and i/t is a viable treatment option to a variety of gynaecological disorders. Adequate preoperative assessment, intraoperative and post operative measures to reduce infection can improve outcome of the procedure. Key words:Abdominal hysterectomy, findings, follow-up