Single embryo transfer and multifetal pregnancy reduction: perception and attitude of women seeking assisted reproduction in Nigeria

Background: In-vitro fertilization (IVF) is associated with increased multiple pregnancy and its attendant complications. This study evaluates the attitude and acceptance of single embryo transfer (SET) and multifetal pregnancy reduction (MFPR) by clients assessing assisted reproduction in this region.Methods: A cross sectional survey of patients selected for IVF was conducted. Information on demography, knowledge of IVF procedure and their perception, attitude and acceptability of multiple pregnancy as well as their knowledge, attitude and perception to single embryo transfer and multifetal pregnancy reduction were extracted for statistical analysis.Results: Seventy-three women participated in the study. The mean age was 39 years and mean duration of infertility was 8.6 years. Only 3 (4.1%) respondents agreed to have SET as the overwhelming majority (70) 95.9% preferred 2 or more and they felt the more number of embryo transferred the better the chances of achieving pregnancy. Similarly most respondents, 38.4% (28) did not accept MFPR. Most respondents considered age (63%) and duration of infertility (78.1%) as major influencing factor for rejecting SET. Over 75% of respondents said they will still accept multiple embryos transferred despite knowledge of the possible complications.Conclusions: While most infertile women in our sub region appear to recognize the risks with multiple pregnancy, they are less interested in SET or MFPR because they perceive more embryos transferred as a means to maximize treatment outcome. Government funding, client education and a blastocyst transfer protocol may improve acceptability as well as overall preference for less number of embryos transferred in our environment

Maternal and neonatal factors associated with mode of delivery under a universal newborn hearing screening programme in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme.</p> <p>Methods</p> <p>A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses.</p> <p>Results</p> <p>Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery.</p> <p>Conclusions</p> <p>The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.</p

Maternal Malaria Induces a Procoagulant and Antifibrinolytic State That Is Embryotoxic but Responsive to Anticoagulant Therapy

Low birth weight and fetal loss are commonly attributed to malaria in endemic areas, but the cellular and molecular mechanisms that underlie these poor birth outcomes are incompletely understood. Increasing evidence suggests that dysregulated hemostasis is important in malaria pathogenesis, but its role in placental malaria (PM), characterized by intervillous sequestration of Plasmodium falciparum, proinflammatory responses, and excessive fibrin deposition is not known. To address this question, markers of coagulation and fibrinolysis were assessed in placentae from malaria-exposed primigravid women. PM was associated with significantly elevated placental monocyte and proinflammatory marker levels, enhanced perivillous fibrin deposition, and increased markers of activated coagulation and suppressed fibrinolysis in placental plasma. Submicroscopic PM was not proinflammatory but tended to be procoagulant and antifibrinolytic. Birth weight trended downward in association with placental parasitemia and high fibrin score. To directly assess the importance of coagulation in malaria-induced compromise of pregnancy, Plasmodium chabaudi AS-infected pregnant C57BL/6 mice were treated with the anticoagulant, low molecular weight heparin. Treatment rescued pregnancy at midgestation, with substantially decreased rates of active abortion and reduced placental and embryonic hemorrhage and necrosis relative to untreated animals. Together, the results suggest that dysregulated hemostasis may represent a novel therapeutic target in malaria-compromised pregnancies

Placenta Percreta; Presenting As Acute Abdomen In Pregnancy – A Case Report

Morbidly adherent placenta often presents as a case of retained placenta or occasionally encountered at caesarian section especially repeat caesarian section. O.T. had placenta percreta and presented as a case of acute abdomen with haemoperitoneum in pregnancy. The haemoperitoneum resulted from complete placenta penetration of the uterine wall. She was treated with urgent laparotomy and caesarian hysterectomy. Placenta percreta with intraperitoneal bleeding should be considered a differential diagnosis in cases of acute abdomen in pregnancy; particularly in patients with risk for morbidly adherent placenta. Keywords: Placenta percreta, Uterine perforation, Acute abdomen Annals of Biomedical Science Vol. 2 (1) 2003: pp. 65-6

The Effect of Female Age on the Outcome of Intrauterine Insemination Treatment in a Public Hospital‑Assisted Reproduction Technology Unit

Objective: The objective of the study is to evaluate the effect of female age on the outcome of ovarian stimulation (OS) and intrauterine insemination (IUI) treatment. Methodology: This was a 36 months’ retrospective analysis of all IUI treatment cycles with prior OS. Based on the age of the women, 4 groups were identified for comparative analysis, namely women below 30 years, between 30 and 34; 35–39 years, and women aged 40 years and beyond. Results: Two hundred and seventeen IUI procedures were conducted during the study and 39 had a positive pregnancy test outcome (a pregnancy rate of 18%). Majority of the women were 35–39 years (41.5%), while 12% were 40 years and above. The pattern showed that the pregnancy rate was highest in the younger age group who were below 30 years, 6/18 (33.3%) and 30–34 years, 19/83 (22.9%) compared with women 35–39 years, 12/90 (13.3%) and ≥40 years, 2/26 (7.7%). The difference in the linear association of each age class compared to the next was significant (P = 0.06 and P = 0.007, respectively). The trend revealed that baseline follicle stimulating hormone increased with age and the youngest age group required significantly fewer units of human menopausal gonadotropin to achieve adequate response to OS compared to the oldest age group (P &lt; 0.001). Conclusion: Advanced age negatively affects OS and IUI outcome. Treatment is associated with better pregnancy outcome in women under 35 years compared to women who were 40 years and beyond. This fact should be clearly emphasized at counseling of the 40‑year‑old that may opt for IUI treatment.Keywords: Age, assisted reproduction, infertility, intrauterine insemination, ovarian stimulatio

Comparison of induced labour pattern in women with premature rupture of membranes at term and those with intact membranes

Background: Membrane rupture may be integral to labour initiation in paturients with premature rupture of membranes [PROM] and therefore, it may be logical to expect that their labour characteristic and pattern should differ from those with intact membrane undergoing induction of labour. This study compared the ′a′bour characteristics in patients with PROM who had stimulation of uterine contractions with oxytocin with ′tose parturients with intact membranes who underwent induction of labour. Wtethod: This was a retrospective study conducted at the Obstetrics and Gynaecology department of the University of Benin Teaching Hospital (UBTH). The case files of 463 consecutive patients for induction/stimulation of labour from October 2008 to September 2009 were reviewed. Paturients were located into two groups; those with term premature rupture of membranes (PROM) and those with intact membranes who underwent induction of labour. Comparison was made between the labour characteristics of groups, mode of delivery, intrapartum complications and neonatal outcome. Results: During the study period a total of eligible 284 paturients with intact membranes had induction of labour [IOL], while 179 paturients with PROM had stimulation of labour [SOL]. Both groups were comparable in their sociodemographic and clinical characteristics. Majority of the PROM cases were contracting at admission [40.8% to 22.5%], also they had significantly shorter latent period [3.3hrs to 5hrs], required less use of higher oxytocin dose [3.9% to 7.4%] and had shorter labour duration (induction f c delivery interval: 6.7hrs to 9.1hrs). There was no difference in their mode of delivery or caesarean section rate. There were no significant differences in intrapartum complications and neonatal outcome measures. Conclusion: The finding of a significant shorter latent period, requirement for less oxytocin dose and overall shorter duration of stimulated labour cases with PROM compared to induction of labour for those with intact membranes suggest that PROM may be a means of labour initiation by some parturients and thus implies that these two groups of paturients are different obstetric entities and should therefore be treated as such in their labour management and research consideration

Causes and Consequences of Late Arrival in Labour

Background: The outcome of labour depends to a large extent on the quality of intrapartum care given. Prompt arrival in hospital is essential for optimal care of parturient women. The causes and consequences of late arrival in labour have not been analysed in our setting. Objective: To determine the causes and consequences of late arrival in hospital during labour. Study Design and Setting: A case-control study in a university teaching hospital. Methods: Data was collected from patients who delivered vaginally immediately after arrival in the labour ward (Subjects: N=150) and the next two consecutive patients who presented early in labour (cervical dilatation of 3-5cm) and had vaginal delivery (Controls: N=300) Outcome Measures: Maternal complications such as perineal tears, frequency of episiotomy, blood loss and duration of stay in hospital. Apgar scores at 1 and 5 minutes, and neonatal hospital admission. Results: Late arrival to the labour ward was significantly associated with high parity, low educational status, poor antenatal attendance and increased peripartum blood loss. However, early arrival was associated with a higher risk of having an episiotomy (Relative Risk: 2.5). The neonatal outcome was similar in both groups of patients. Conclusion: High parity, low educational status and poor utilization of antenatal facility are risk factors for late arrival in hospital during labour. Late presentation was associated with increased blood loss at delivery. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 52-55

Successful triplet pregnancy in an African with pure gonadal dysgenesis: A plus for assisted reproduction

Gonadal dysgenesis represents a congenital developmental disorder of the reproductive system, with its main gynaecologic manifestations being amenorrhea and infertility. We present a unique case of pure gonadal dysgenesis in an ‘about to be’ married lady resident in a society where high premium and success in marriage is dependent on childbirth. With astute evaluation and counseling, assisted reproductive technology (ART) was safely and successfully used in this case with eventual triplet pregnancy and delivery. Our index experience shows that situations with compromised fertility the availability and access to ART aids effective treatment planning and births a re-invigorated hope for family life

Observation On The Rates, Benefits And Complications Of Episiotomy In A Tertiary Health Institution In Nigeria

This was an observational study undertaken at the University of Benin Teaching Hospital, Benin City from September 1, 2001 to October 31, 2002. The women who delivered per vagina with episiotomy were analyzed and compared with those who delivered without it. Outcome measures were 2nd stage duration, birth weight, Apgar score, perineal tear, perineal pain, dyspareunia and incontinence in the pueperium. There were 1,404 vaginal deliveries and 34.5% of them had episiotomy. Episiotomy was more frequent in nulliparous (65.7%) than multiparous (17.4%) women. The commonest indication for episiotomy was tight perineum (75.2%) followed by vacuum extraction (8.6%), forceps delivery (6.6%), fetal prematurity (4.1%), assisted breech delivery (2.9%) and the delivery of big babies (2.9%). The duration of second stage was not influenced by episiotomy but the Apgar score at one minute was better with episiotomy. Blood loss was more with episiotomy. Perineal tear occurred more in women who delivered without episiotomy. (25.6%vs.4.1%; P=0.0001; OR=12). Dyspareunia was more common after vaginal delivery with episiotomy. Conclusively, episiotomy was associated with a better Apgar score at one minute and it protected against perineal tear. However blood loss at delivery was more with episiotomy. Perineal pain and dyspareunia were commoner with it. Keywords: Episiotomy, Indications, Complications Annals of Biomedical Science Vol. 1 (2) 2002: pp. 141-14

Seroevidence of Chlamydia Trachomatis Antibody in Infertile Women in University of Benin Teaching Hospital (Ubth) Benin City, Nigeria

The role of Chlamydia trachomatis in the pathogenesis of Pelvic inflammatory disease and majority of cases of salpinigitis are well acknowledged in women. A total of 213 sera from infertile women were tested for antibodies to Chlamydia trachomatis by using an indirect solid phases enzyme Immuno absorbent commercial ELISA test. Women with confirmed Hysterosalpinographic report suggesting tubal occlusion (tubal factor infertility) had 92 (43.2%) followed by 63 (29.6%) infertile women with infertile male partner and 58 (27.2%) were having unexplained infertility. Out of the tubal factor (TF) infertile women 40 (18.8%) were seropositive for Chlamydia trachomatis antibodies, as against 19 (8.9%) in the group of women with normal patent tubes and 10 (4.6%) women with infertile male partner. In this study there was a statistical significant correlation between the infertile women with tubal factor infertility in relation to seroevidence of Chlamydia trachomatis infection with p<0.05. There was no age bias in the serodetection of Chlamydia trachomatis antibodies. The seropositivity of Chlamydia trachomatis is an indication that the organism may be an independent risk factor in the development of an inflammatory process leading to scaring of the uterine tubes in women and thereby causing infertility