Ectopic Pregnancy: Reasons for the High Tubal Rupture Rates in a Nigerian Population

Context: Nigeria has a high incidence of ruptured ectopic pregnancy. Identification of predisposing factors will help reduce morbidity and mortalityAim: To determine the reasons for the high incidence of ruptured ectopic pregnancy.Methods: All cases of ectopic pregnancies managed at Wesley Guild Hospital, Ilesha, Nigeria , between January 2004 and December 2008 were the subjects of this study. The case notes were reviewed to obtain information on the socio demographic characteristics of the patients, clinical history and operative findings.Results: Of the 1,048 gynaecological admissions during the study period 98(9.4%) were for ectopic pregnancy out of which76(96.2%) were ruptured The mean age of the patients was 28.3 years (SD=5.1), majority (82.3%) were married and 68.4% have had one or more previous deliveries.Amenorrhea was present in 66(83.5%). Abdominal pain (98.%), dizziness (62.0%) and vaginal bleeding (44.3%) were the commonest symptoms. Only 30 (38.0%) presented to any medical facility within 24 hours of the onset of symptoms. The ectopic was tubal in 67(84.8%), abdominal in one and could not be specified in 11. Of the tubal pregnancies ampulla (49.3%), cornual (25.4%) and isthmus (15..0%) were the commonest sites. All patients had laparotomy and salpingectomy. There was no maternal death.Conclusion In our community ectopic pregnancy tends to occur more often in parous women and are more commonly located in the isthmio cornual part of the tube. Besides, majority of our women present late making them more vulnerable to ruptured ectopic pregnancy.Key Words: Ectopic, Pregnancy, Complications, Presentation

Improving maternal health in the face of tuberculosis: the burden and challenges in Ile-Ife, Nigeria.

Context: The super-imposition of tuberculosis on the demands of pregnancy confers a grim prognosis.Objectives: To determine the prevalence, pattern of presentation, management and outcome of tuberculosis among pregnant women in Ile-Ife during the first 10 years of the Millennium Development Goal-driven intervention.Study Design: A retrospective analysis of 29 women managed for tuberculosis during pregnancy and the puerperium at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife between 2001 and 2010 was done using SPSS version 16.0. Prevalence was determined using the total deliveries over the same period. Social class was determined using the Olusanya et al classification and assessment for congenital tuberculosis was done with Cantwell's diagnostic criteria.Results: There were 29 women with tuberculosis in pregnancy and puerperium, with 15,194 deliveries during the review period; giving a prevalence of 191 cases/100,000 deliveries. Cough and weight loss were the commonest complaints, and 53% of screened subjects were retroviral positive. Only 24% of these women were successfully treated using Directly Observed Treatment Short course; strike action and financial constraints being the hindering factors in 36% of them. The mean weight and EGA at birth were 1.87±0.69kg and 35.1±4.0 weeks respectively. Maternal and fetal case-fatality rates were 16.6% and 31.6% respectively.Conclusion: The high prevalence of tuberculosis in pregnancy in Ile-Ife is comparable to the national figures. The associated high feto-maternal morbidity and mortality rates also contribute to the unhealthy statistics of the country. Prevention of HIV infection and consistent health service delivery are advocated to reduce this scourge figures. The associated high feto-maternalmorbidity and mortality rates also contribute to the unhealthy statistics of the country. Prevention ofHIV infection and consistent health service delivery are advocated to reduce this scourge

Re-usable low density polyethylene arm glove for puerperal intrauterine exploration

Objective: To design a long arm glove that can be used within a puerperal uterus to prevent the health-care worker contracting HIV from an infected patient. The designed long arm glove should be cheap (affordable) and readily available in low resource centres and must have proven sterility assurance and tensile strength to confer protection for the health worker. Design: Prospective study. Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st December 2006 to 31st May, 2007. Subjects: Fifty medical students of both sexes were selected randomly and the average length from the styloid process to the mid upper-arm of each was measured and the average length was later determined. This was to determine the length of the low density polyethylene long arm gloves to be made from virgin polyethylene material. Consecutive cases of patients with retained placentae in the puerperium who were scheduled for manual removal of the placenta within the period. Results: Packs of low density polyethylene (LDPE ) long arm gloves were made from virgin polyethylene material. When subjected to bacteriological analysis, three out of four glove packs were contaminated with Staphylococcus, Bacillus and Klebsiella species of bacteria. Gamma irradiation ranging from 28.133 to 83.35 kiloGray of gamma-irradiation (kGy) sterilised all the gloves as postirradiation glove specimens showed no bacterial contamination. However, at doses up to 50 kGy gamma irradiation caused “strengthening” of the polyethylene gloves. While at doses greater than 50 kGy, gamma irradiation caused “embrittlement” of the material. Thus, 50 kGy of gamma irradiation was found to be an ideal dose to strengthen and to sterilise the glove for usage. The sterilized gloves were found to be effective when used in consecutive cases of retained placenta in protecting the health care workers (HCW) from contamination by possibly HIV contaminated blood. Conclusion: There is a risk of contracting HIV for the health-care worker while carrying out a procedure within the puerperal uterus. The low density polyethylene arm glove was designed to prevent this in low resource centres as it would be affordable, available, with proven sterility assurance and mechanical properties to confer protection for the healthcare worker. East African Medical Journal Vol. 85 (7) 2008: pp. 355-36

Retrograde ejaculation related infertility in Ile-Ife, Nigeria

Background: Globally, the incidence of male infertility is on the increase1,2. However, the contribution of retrograde ejaculation to this increasing incidence of male infertility is not known locally.Objectives:1. To determine the incidence of retrograde ejaculation by using the WHO criterion among male partners of patients who were being managed for infertility at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between 1st of February and 31st of August 2006 . 2. To determine the Retrograde-ejaculation ratio (RER) of each subject by a proposed formula as an extension of the WHO criterion.3. To highlight the risk factors and the management options available for the treatment of retrograde ejaculation.Subjects and methods: During the study period, 71 male partners of consecutive female patients who reported at the Infertility clinic were recruited. However, the specimens of 70 male partners were analyzedbecause one of them inadvertently spilled his post-ejaculatory urine specimen and consequently was excluded from the study. Prior to the collection of ejaculatory fluid and post-ejaculatory urine specimens foranalysis, they were instructed to abstain from sexual intercourse for at least 3 days and to collect the first post-ejaculatory urine specimen for analysis. The WHO criterion 1 states that a cloudy urine specimen with the presence of a total number of spermatozoa in urine equal to or exceeding the number of spermatozoa in semen, strongly supports the diagnosis of retrograde ejaculation. The sperm counts in seminal fluid and urine for each subject were determined. Thereafter, the sperm concentration in urine (SCU) and sperm concentration in seminal fluid(SCSF) were determinedrespectively thus: sperm count in urine/volume of urine; sperm count in seminal fluid/ volume of seminal fluid. The Retrograde ejaculation ratio (RER) was calculated thus: sperm count in urine / sperm count inseminal fluid. A questionnaire containing the bio-data and risk factors associated with retrograde ejaculation was completed for each subject.Results: Of the 70 cases included in the analysis, 32(45.7%) had primary infertility while 38(54.3%) had secondary infertility. The age range was 28-65(mean for primary and secondary infertility were 36 and 42.1respectively) years. The duration of infertility ranged from 1-16 years (mean4+ 2.92). Based on the WHO criterion previously stated, only 1/70(1.42%) of the cases was positive with a retrograde ejaculatory ratio(RER) of infinity as he had azoospermia. This was in a 47 year old man with secondary infertility who had no identifiable risk factor prior to the study. There were 8/70(11.42%) of the cases studied with azoospermia but only 1/8 (12.5%) of those azoospermic had retrograde ejaculation.Conclusion: To make a diagnosis of male factor infertility, semen analysis remains the cornerstone of all the laboratory assays. However, to make acategorical diagnosis of retrograde ejaculation, focused laboratory testing is imperative. The incidence of retrograde ejaculation appeared low (1.42%) in our environment but this is in consonance with studies elsewhere. It is strongly advisable that cases of azoospermia and severe oligozoospermia be screened for retrograde ejaculation as there are manymodalities of therapy to aid the affected males fulfil their wishes of becoming fathers. Lastly, when the retrograde ejaculation ratio (RER) is > 1 with the presence of a cloudy urine, the diagnosis is highly probable.Key words: Retrograde ejaculation, azoospermia, male infertility

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Female genital mutilation: are we winning?

Background: For more than 25 years, efforts have been geared towards curtailing the practice of female genital mutilation (FGM) in countries like Nigeria. This study was designed to see if all these efforts have made any impact in reducing the prevalence of FGM appreciably in the south-West of Nigeria.Objective: To determine the prevalence of female genital mutilation and profiling the trends of FGM affected patients.Design: A prospective study based on direct observation of the external genitalia by health-care workers.Subjects: Five hundred and sixty five females less than 15 years of age.Setting: The children emergency and gynaecological wards of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st of January to December 31st 2007.Results: Forty one point nine percent of the patients examined had female genital mutilation, 93.2% of these had the procedure before attaining the age of one year. Type 2 FGM predominated (58.22%). The procedure was performed predominantly (64.6%) by traditional birth attendants. The decision to have the procedure done was influenced in 78% of cases by mothers and grandmothers. In 35.4% of cases, there were immediate and short term complications. Demands of tradition  predominated (59.1%) as the most important reason for the practice of female genital mutilation.Conclusion: The practice of FGM appears to be still highly prevalent and resistant to change probably due to deep rooted socio-cultural factors. Strategies such as public education campaigns highlighting its negative impact on health and disregard for human rights should be evolved

Effect of prolonged birth spacing on maternal and perinatal outcome

Background: Researchers have held varied opinions on the effect of prolonged birth spacing on maternal and perinatal outcome. Objectives: To determine the reasons for prolonged birth spacing and to compare the maternal and perinatal outcome compared to shorter normal birth spacing. Design: Comparative case - controlled study between January 1st, 2001 to December 31st, 2002. Setting: Obstetric Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile- Ife, Nigeria. Subjects: Fifty cases consisted of multiparae with prolonged birth spacing (³6 years) and controls consists of similar number of multiparae with shorter normal birth spacing (2 - 5 years) matched for age, parity and socio-economic status. Main Outcome Measures: Labour outcome, Apgar scores, operative and vaginal delivery rates, perinatal and maternal outcome, reasons for prolonged birth spacing. Results: There was no significant difference observed with respect to spontaneous onset of labour, induction or argumentation of labour, duration of labour, spontaneous vaginal delivery rates, Caesarean section rates, instrumental vaginal deliveries, analgesic requirement, postpartum haemorrhage, and Apgar scores in both groups. There were no perinatal or maternal deaths. The commonest reason adduced for prolonged birth spacing is failed contraception (56%), followed by secondary infertility (24%) and to a lesser extent re-marriage, improved income and sheer desire. Conclusion: There was no significant difference in maternal and perinatal outcome in pregnancy between women with prolonged birth spacing and those with normal shorter birth spacing. East African Medical Journal Vol.81(8) 2004: 388-39