The Role of Ultrasonography in In-vitro Fertilization And Embryo Transfer (IVF-ET)

BACKGROUND: Although ultrasonography was introduced into Obstetrics and Gynaecology by a British Gynaecologist over five decades ago, the requirement for formal training in its use by gynecologists in Nigeriais just beginning to catch on, despite its indispensible role in various aspects of our clinical practice.OBJECTIVE: To describe the role of ultrasonography in in-vitro fertilization and the indispensability of the instrument to reproductive medicine.METHOD: A review of literature written in English language on the use and application of ultrasonography in in-vitro fertilization was done. The review covered articles published between 1980-2012.RESULTS: Ultrasound is the most versatile method for pre-treatment assessment in IVF being the dominant instrument for assessing ovarian reserve, pelvic pathologies and for assessing the uterine cavity. Theability of ultrasonography to measure endometrial thickness in addition to detecting uterine masses gives it an edge over laparoscopy/hysteroscopy as a diagnostic procedure in uterine cavity assessment, although hysteroscopy has the advantage of therapeutic potential. Similarly, ultrasonography is superior to biochemical methods for follicular monitoring because of its ability to demonstrate the number and sizes of follicles, and guide preparations for oocyte retrieval. The relative easeof ultrasound guided oocyte retrieval; its less technical demands and the possibility of conducting the procedure under local anaesthesia have made ultrasound guided oocyte retrieval more popular across the world.Randomized controlled trials show that ultrasoundguided transfer techniques have better outcomes than the clinical touch technique in terms of on-going pregnancies and clinical pregnancies. Ultrasonographyis now the key instrument for diagnosing and monitoring pregnancy following embryo transfer, biochemical methods being complimentary.CONCLUSION: Ultrasonography is now the single most important  instrument in in-vitro fertilization programmes and gynaecologists with interest in reproductive medicine need necessarily to obtain a formal training in its use.KEY WORDS: ultrasonography, in-vitro fertilization, infertility, assisted reproduction technolog

A Review on Natural Gas Utilization and Cutting Carbon Emissions: How viable is Compressed Natural Gas for Road Vehicle Fuel?

As the world grows and economies develop, global demand for energy will continue to grow dramatically. Demand for natural gas is likely to overtake other fossil fuels due to its availability, accessibility, versatility and cleanliness. For instance, the International Energy Agency (IEA) proposed in May 2012 that global demand for natural gas could rise more than 50% by 2035, from 2010 levels. According to the Intergovernmental Panel on Climate Change (IPCC), global greenhouse gas (GHG) emissions must be reduced by 50 to 80 percent by 2050 to avoid dramatic consequences of global warming. In order to meet this growing energy demand and GHG reduction, we must develop all commercially-viable energy sources. As we know that no single energy source can meet the world's growing energy needs. We also need a more diverse energy mix which will enable energy security and help tackle the issue of climate change. Meeting this growing long-term societal demand requires that we develop all economic and environmentally-sound energy sources. Natural gas which is the cleanest compared to other fossil fuels is available to provide the world with a viable alternative. Its abundance, reliability, versatility and accessibility, will be a huge factor.  This paper considers the value of compressed natural gas (CNG) to be used for natural gas vehicles (NGV), and how it could  serve as a long-term emission-reducing energy source. Such uptake would also improve utilisation of natural gas instead of flaring it, thereby minimizing environmental harm and improving public safety. Keywords: Compressed Natural Gas (CNG), Natural Gas Vehicles (NGV), Green House Gas (GHG), Cash Flow Analysis of CN

Trends In Educational Evaluations In Nigeria: Issues And Challenges

The paper highlights the trends in educational evaluations in Nigeria starting from the pre-colonial Nigeria to the contemporary. Nigeria first practiced traditional educational evaluation but the system was criticized for lack of documented data. Then the colonial one – shot end of programme evaluation which was later found to be judgmental, breeds examination malpractice among other ills. The present continuous assessment system was introduced to take care of the anomalies and reposition our educational system. The new system is however not free from issues and challenges. These have been highlighted and recommendations made

Risks associated with subsequent pregnancy after one caesarean section: A prospective cohort study in a Nigerian obstetric population

Context: Aversion for cesarean delivery is common in our practice and risks associated with caesarean section may contribute to this phenomenon.Objective: The objective of this study was to estimate the risks associated with subsequent pregnancies in women with one previous cesarean section in a low resource setting.Setting and Design: A prospective cohort study carried out at two major tertiary maternity centers in Enugu.Materials and Methods: Maternal and perinatal outcomes were compared between women with one previous caesarean and women who had only previous vaginal deliveries.Statistical Analysis Used: Analysis was performed with SPSS statistical software version 17.0 for windows (IBM Incorporated, Armonk, NY, USA) using descriptive and inferential statistics at 95% of the confidence level confidence.Results: A total of 870 women were studied. These were divided into 435 cases and 435 controls. The absolute risk of cesarean section in a  subsequent pregnancy in women with one previous cesarean was 75.8% (95% confidence interval [CI]: 72.0, 80.0). Cesarean section was  significantly commoner in women with one previous cesarean comparedwith those who had previous vaginal delivery (Relative risk [RR] =3.78; 95% CI: 1.8, 6.2). Placenta praevia (RR = 5.0; 95% CI: 2.6, 7.2.), labor dystocia (RR = 6.4, 95% CI: 3.2, 11.2) intrapartum hemorrhage (RR = 5.0, 95% CI: 2.1, 9.3) primary postpartum hemorrhage (RR = 5.0, 95% CI: 1.5, 4.3.), blood transfusion (RR = 6.0, 95% CI: 3.4, 10.6) and Newborn special care admission (RR = 2.5; 95% CI: 1.1, 4.9) were significantly more common in women with one previous cesarean compared with those with previous vaginal deliveries. The absolute risk of failed trial of vaginal birth after a cesarean was 45% (95% CI: 38.5, 51.5).Conclusion: Women who have one previous C.section face a markedly  increased risk of repeat caesarean sections and feto.maternal  complications in subsequent pregnancies. There is a need for doctors in Nigeria to be mindful of these risks while offering primary cesarean section in this low resource setting.Key words: Absolute risks, pregnancy after caesarean, primary cesarean sectio

Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: A case for dedicated early pregnancy services

Context: It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient.Aims: To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by  Nigerian Gynecologists, and determine if dedicated early pregnancy  services such as Early Pregnancy Assessment Units could be introduced to improve care.Settings and Design: A cross.sectional survey of Nigerian Gynecologists  attending the 46th Annual Scientific Conference of the Society of  Gynaecology and Obstetrics of Nigeria.Materials and Methods: This was a questionnaire.based study.Statistical Analysis: Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA).Results: A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 } 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic  pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 } 1.4 hours (range .-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy.Conclusions: Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender  unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these  shortcomings in the way women with such conditions are currently  managed.Key words: Early pregnancy assessment units, ectopic pregnancy,  gynaecological ultrasonography, miscarriage,ultrasonograph

Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria

BACKGROUND: Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. METHODS: This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. RESULTS: Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). CONCLUSION: The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients

A comparison of postural and diurnal variations in intraocular pressure using the iCare rebound tonometer and Perkins applanation tonometer in admitted adults in Kenya

Background: Elevated intraocular pressure (IOP) remained the most important known risk factor for glaucoma. Aim: To compare the postural and diurnal IOP variations using the iCare rebound tonometer (RT) and Perkins applanation tonometer (PAT). Setting: Kakamega County Hospital, Kenya. Methods: Elevated intraocular pressure measurements were taken by two (masked) examiners with two devices in the morning (06:00–09:00), midday (12:00–15:00) and evening (18:00–21:00), in the sitting followed by supine positions in one randomly selected eye of 24 oculo-visual healthy hospital-admitted patients. Effects of the time of the day and position of the body within and between devices were analysed with the Statistical Package for Social Sciences. Results: The mean IOP measured by the RT ranged from 6 mmHg to 24 millimetres of mercury (mmHg) in the sitting position and from 10 mmHg to 26 mmHg in the supine position. The mean IOP measured using PAT ranged from 6 mmHg to 21 mmHg in the sitting position and from 8 mmHg to 24 mmHg in the supine position. The IOP measured by both devices significantly varied with position (p < 0.05). Perkins applanation tonometer on average gave a significantly higher IOP (1.7 mmHg [p = 0.003] and 1.3 mmHg [p = 0.034]) at 06:00 compared to that at 12:00 and 18:00, respectively. The IOP readings with the RT were on average 2.2 mmHg and 3.0 mmHg higher at 06:00 compared to that at 12:00 and 18:00, respectively (p < 0.0005). Conclusion: Significant reductions were observed in postural and diurnal IOPs in the sitting positions and in the afternoon, respectively. Diurnal IOP variations were slightly higher when measured by RT compared to when measured by PAT

Obstetric Outcome and Significance of Labour Induction in a Health Resource Poor Setting

Objectives. The aim of this study was to evaluate the methods, indications, outcome of induced labor and its significance in obstetric practice in the study area. Methods. This was a retrospective study of cases of induced labor at the Catholic Maternity Hospital in Ogoja, Cross-River State, Nigeria, between January 1, 2002, and December 31, 2011. Data on the sociodemographic characteristics of the parturient, induction methods, indications for induction, outcomes and reasons for failed induction were abstracted from personal case files and the hospital’s maternity/delivery register. The data were analyzed with SPSS15.0 window version. Result. The induction rate in this study was 11.5%. Induction was successful in 75.9% of cases but failed in 24.1%. Misoprostol was the commonest induction method (78.2%). The commonest indication for induction was postdate pregnancy (45.8%). Failed induction was due to fetal distress, prolonged labor, cephalopelvic disproportion and cord prolapse. The induction-delivery interval was 12±3.6 hours. Conclusion. Induction of labor is a common obstetric procedure which is safe and beneficial in well-selected and properly monitored high risk pregnancies where the benefits of early delivery outweigh the risk of continuing the pregnancy

Gender perspectives of sexual and reproductive practices of people living with hiv/aids in Enugu, south east Nigeria

Background: a major focus of attention in the efforts at controlling the spread of HIV infection has become the role of gender inequality.1, 2 The objective of the study was to compare the sexual practices of HIV-positive male and female patients who received counselling and treatment at an Anti-retroviral Clinic in Enugu, South-East Nigeria.Method: A comparative cross-sectional descriptive study of patients attending the free anti-retroviral clinic at the University of Nigeria Teaching Hospital Enugu was done.Results: A total of 146 males (30.8%) and 328 females (61.9%) were studied. Although there was no significant difference in the prevalence of sexual activity between the sexes, the reasons for sexual practices differed. Females indulged in risky sexual activity principally in obedience to the demands of their male partners and were more likely to have sexual partners who were unaware of their seropositivity than males.Conclusion: Risky sexual behaviour among women living with HIV/AIDS in Enugu despite exposure to intensive counselling was still mainly driven by the subordinate traditional gender roles of women in this culture.Key words: Perspectives, gender, sexual/reproductive practices, PLWHA, Nigeri