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 use of torniquet to reduce blood loss at Myomectomy

No Abstract

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

Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania

\ud Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.\u

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Review Of Presentation Of Mother –To – Child Transmission Of HIV.

The total number of AIDS death since the epidemic started is estimated at 21.8 million worldwide, of which 4.3 million were in children. Most of these children will have acquired their infection as a result of mother to child transmission (MTCT). This is a growing problem. Over 90% of women who are HIV positive are of the child bearing age- yet to start or complete their families. This risk of MTCT can occur during pregnancy – via the placenta and through the breast milk. Factors that will increase the risk of MTCT include: maternal viral load, maternal immune deficiency, placental abruption, invasive ante and intra- partum procedures, mode of delivery and breast feeding. Prevention of MTCT of HIV will involve; (1) Prevention of transmission from an HIV infected mother to her infant. (2) Prevention of unintended pregnancies in HIV infected women. (3) Prevention of new infections in pregnant women and their partners. And (4) Provision of treatment, care and support to women infected with HIV, their infants and families. These could be achieved through the use of the anti-retroviral (ARV) drugs- HAART (Highly Active Anti-Retroviral Therapy) or combination of two drugs. Use of safer obstetric practices- Elective caesarean section is preferred but vaginal delivery could be conducted with precaution to reduce risk of transmission especially in women with low viral load. Use of safer infant feeding practices- HIV positive women who opt to breast feed must do so for a short duration and stop if breast inflammation or abscesses occur. Use of condoms especially female condom is recommended to prevent new infections and HIV positive mothers are advised to abstain from sex during antenatal periods to avoid new infections. In conculsion, prevention of MTCT will depend on the vigorous implementation of these guidelines Keywords: vTropical Journal of Medical Research Vol. 10 (2) 2006: pp. 16-2