Experience with diagnostic laparoscopy for gynecological indications

Context: Diagnostic laparoscopy is an endoscopy procedure, which has become indispensable in the evaluation of the female reproductive organs especially in infertility.Aim: Experience with conversion to open laparotomy is presented and ways of averting this complication are discussed.Settings and Design: A retrospective study was performed.Materials and Methods: All the 1654 diagnostic laparoscopies performed at a private fertility center over a 10.year period (January 2000 to December 2009) were analyzed for indications, cases of conversion to open laparotomy, and measures taken to prevent this complication.Statistical Analysis Used: Simple percentage method was used.Results: Infertility was the commonest indication for 1627 (98.4%) procedures, while primary amenorrhoea and chronic pelvic pain were responsible for 20 (1.2%) and 7 (0.4%) procedures, respectively. There was no mortality in this series. There was conversion to open laparotomy due to hemorrhage in only 2 (0.12%) procedures and this happened at thefirst year of practice.Conclusions: The low rate of conversion was attributed to the surgeons experience, proper patient selection, and the use of Palmers point for insufflation in some patients with previous pelvic surgeries and use of supraumbilical access in patients with pelvic masses. Diagnostic  laparoscopy for gynecological indications is safe and wider application ofthis modern technology is recommended for our practice.Key words: Amenorrhoea, conversion, hemorrhage, infertility, laparoscop

Perceptions of Infertility and In Vitro Fertilization Treatment among Married Couples in Anambra State, Nigeria

There is a high rate of infertility among couples in Nigeria. This challenge is perceived differently in each socio-cultural context in which it is experienced but solution to the problem is adversely affected by the people‘s perception of the phenomenon. This study thus explored the perceptions of infertility and in vitro fertilization (IVF) and how to enhance the use of IVF treatment among married couples. This was a cross-sectional survey in Anambra State, Nigeria involving household respondents (married couples) and hospital respondents (couples undergoing infertility evaluation). Structured questionnaire and key informant interview (KII) guide were used for data collection. Altogether 600 questionnaires were administered and 589 were validly completed and analysed. The main outcome measures included perceptions of infertility and IVF treatment, utilization of IVF treatment and association between some demographic variables and IVF utilization. The results showed that infertility was perceived majorly as - destiny/supernatural powers (17.1%), threat to men‘s procreativity/continuity of lineage (14.3%), women‘s problem only (15.6%). Solutions to the challenges were adversely affected by perception. The use of IVF treatment was low with misconceptions like it‘s too costly (15.4%) and unnatural (7.6%), giving rise to unmet need for assisted reproductive technology. Women (especially above 35 years) were more likely to accept IVF treatment than men. Reproductive health education and awareness creation should target the misconceptions about infertility/IVF and fertility treatment should be covered by national health insurance to reduce the cost of IVF treatment and improve its use in Anambra State.Keywords: Married couples, Infertility, In vitro fertilization, Perception, Anambra State, Nigeri

Case Report - Heterotopic pregnancy following intrauterine insemination: Successful management with salpingectomy and continuation of intrauterine pregnancy

We report the first case of a heterotopic pregnancy (HP) following ovulation induction and intrauterine insemination (IUI) with resultant normal intrauterine pregnancy after salpingectomy. A 41‑year‑old para 0+0 that presented with primary infertility due to azoospermia and polycystic ovaries after laparoscopic evaluation. She had induction of ovulation with Clomiphene citrate, gonadotropin stimulation (hCG), and intrauterine insemination using donor sperm. The resulting pregnancy was later diagnosed as heterotopic pregnancy following rupture of the tubal component at 8 weeks’ gestation after an initial misdiagnosis as corpus luteum cyst of pregnancy. She had an emergency laparotomy and left salpingectomy, and the intrauterine pregnancy has continued subsequently to 25 weeks of gestation as at 01/04/2011. This report demonstrates that HP may occur after ovulation induction and IUI. The ectopic component could be misdiagnosed as corpus luteum cyst. It is recommended that pregnancies following this procedure be followed up with serial trans‑vaginal ultrasound in the first trimester. Presence of corpus luteum cyst of pregnancy in early ultrasound should be an index of suspicious of a possible heterotopic pregnancy. Early diagnosis and prompt intervention is essential to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality

Laparoscopic Retrieval Of Perforated Intrauterine Device

We present a case of successful laparoscopic retrieval of a perforated intrauterine device (Lippes loop). The Lippes loop was inserted after manual intrauterine adhesiolysis as a treatment of uterine synaechia presenting as secondary amenorrhoea of 20 months duration. The uterine perforation in this patient did not occur at the time of insertion but possibly during the attempt at transcervical removal of the missing IUD by manipulation with the retrieval hook. Double puncture laparoscopic technique under ketamine general anaesthesia was performed to remove the IUDwithout complication and patientwenthome the same day. Keywords: Laparoscopy, Missing Intrauterine Device (IUD), Lippes Loop, Uterine Perforation Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 394-39

Pregnancy following laparoscopic ovarian drilling for clomiphene resistant polycystic ovarian syndrome

No Abstract

The Developing World’s Contribution to Global Warming and the Resulting Consequences of Climate Change in These Regions: A Nigerian Case Study

Hundreds of millions of urban dwellers in low- and middle-income nations are at risk as 4-5 of the global weather-driven disasters experienced are consequent of a changing climate. Studies have shown that residents in least developed countries have ten times more chances of being affected by these climate disasters than those in wealthy countries. Further, critical views have it, that it would take over 100years for lower income countries to attain the resiliency of developed countries. Unfortunately, global South is surrounded by a myriad of socio-economic and environmental factors limiting their fight against climate crisis. It is this germane reality that provoked the cause of this review. Hence, this paper reviewed the developing world’s contribution to global warming and the resulting consequences of climate change with focus on Nigeria. This purposive approach adopted an analysis of secondary data related to climate information. The findings from the paper affirmed that impacts of climate change in developing countries include loss in agriculture/forestry resources, water shortage, food insecurity, biodiversity loss, health risks among others. Finally, it identified the major factors that exacerbate climate crisis, the human actions that trigger global warming and adaptive and mitigation approaches to minimize climate change related disasters

The use of torniquet to reduce blood loss at Myomectomy

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Knowledge, Attitude And Practice Of Screening For Cervical Cancer Among Female Students Of A Tertiary Institution In South Eastern Nigeria.

Background: Cervical cancer is the second commonest cancer of females worldwide and the commonest cancer of the female genital tract in our environment. It can be prevented through early detection by cervical screening (Pap smear). Objective: The objective of this study is to determine the knowledge, attitude and practice of cervical cancer screening among female undergraduates. Method: A pre tested questionnaire was administered to third and fourth year female students of the Faculty of Natural Sciences, Nnamdi Azikiwe University Awka, Nigeria. Result: Out of the 220 students involved in the study, 134 (60.9) had knowledge of cervical cancer and 118 (53.6%) were sexually active with the average age at sexual debut being 21.2 years. The mean age of the students was 23.8 years and the age range was 17 to 39 years with 175 (80%) in the age range of 20- 29 years. About 2/3 of the students did not know about Pap smear and worse still, none of them had undergone a Pap screening test before. This low participation in screening for cervical cancer was attributed to several reasons including ignorance of the existence of such a test, lack of awareness of centers where such services are obtainable, ignorance of the importance of screening and the risk factors to the development of cervical cancer. Conclusion: There is good level of awareness of cervical cancer among the female undergraduates but poor knowledge and participation in cervical cancer screening. The development of a comprehensive cervical cancer screening strategy is being recommended to improve participation with a view to prevent cervical cancer by early detection and treatment of the pre-malignant stages. Keywords: Cervical cancer, screening, female undergraduates. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 216-21

In-Vitro Fertilization Practice: Awareness and Perceptions AmongWomen Attending Fertility Clinics in Okija, Anambra State, Nigeria

BACKGROUND: In-vitro fertilization(IVF) is a procedure that is one of the options in managing infertility. It involves fertilizing the egg from the female with the spermatozoa from the male outside the human body. It is a common practice in the developed world. However it is still a new phenomenon in the developing countries. This is due to the level of awareness and acceptability, worsened by cost which is still beyond the reach of the poor masses in the developing countries. AIM: To assess the level of awareness andperceptions of invitro fertilization among women attending fertility clinics in Okija, Ihiala local Government area of Anambra State, Nigeria. METHODS: The study is a cross-sectional descriptive study. A total of 500 women attending fertility clinics in Okija were recruited using systematic sampling technique. Data were collected using pre-tested, structured, interviewer administered questionnaire and analyzed manually. RESULTS: The mean age of the respondents was 30 years. The mean duration of infertility was 11 years. Secondary infertility was more common (66%) than primary infertility (34%).Only 37.6%of the respondentswere aware of in-vitro fertilization. Only 37.2% of those that that aware accepted to undergo IVF procedure. 79.7% of those who rejected IVF claimed that the babies are abnormal, while 12.7% of believedthat the cost is high. CONCLUSION: There is need to put in efforts in spreading the knowledge of in-vitro fertilization in developing countries like Nigeria. Efforts should be made to make the procedure more affordable and accessible to the masses. Keywords: Awareness, Perceptions, In-vitro fertilization (IVF), Okija

Sexual practices of people living with HIV in south eastern Nigeria

Couples could be in serodiscordant or seroconcordant sexual relationship. The seroconcordant could be seroconcrdant positive or negative in a heterosexual or homosexual or bisexual relationship. The various sexual practices include vaginal sex; anal sex fisting; oral sex fellatio, cunnilingus; masturbation mutual or exclusive and a host of others. These sexual practices outside safer sex guidelines will lead to HIV transmission among couples. The study is set to determine the sexual practices of people livingwithHIV(PLWHA) in SoutheastNigeria. This is an analytical epidemiological study. A total of 300 subjects were studied using interviewer administered questionnaires. Data is presented in tables and figures. Analysis was done using SPSS 11.0 statistical package. Most respondents were in heterosexual relationship (97%). The married couples in serodiscordant relationship were 25.3% while the singles in serodiscordant relationship were 20%. About 56% do not use condom for the adopted sexual practice although 65% believe that condom use would protect against HIV transmission. Couples in seroconcordant seronegative relationship have it as a challenge to remain so. This study suggests that the PLWHA are very important in the spread of HIV infection as they are still sexually active, in non-cohabiting conjugal unstable relationship, and they do not use the condomconsistently. There is an urgent need to target this population with effective behavioural change communications thatwill translate to safer sexual behaviour. The practice of safer sex should be taught in every health care center, in schools and in village gatherings by qualified health care workers. This will help curb the transmission of HIV.