Thyroid Diseases In Pregnancy: A Review

Objective: To provide an overview of the pathophysiology of thyroid diseases in pregnancy and the various treatment methods currently available in its management.Data source: Review of literature was affected through index medicus search of major published journals and books.Data selection: Published data on thyroid diseases on women in the reproductive age group over the last four decades were utilised.Data extraction: Abstracts and full text of selected manuscripts were read and analysed to determine their contribution to this article.Data synthesis: All relevant articles were reviewed and contributions extracted. Conclusion: Thyroid diseases are the second most common endocrinopathies in pregnancy. Numerous hormonal changes and metabolic demands occur in pregnancy resulting in complex changes in maternal thyroid function. Thyroid diseases involves a multidisciplinary team approach to achieve good metabolic control and excellent obstetric care in order to ensure normal maternal and perinatal outcome

Significance of IgG-Avidity in Antenatal Rubella Diagnosis.

OBJECTIVE: A descriptive study was carried out to determine the significance of IgG-affinity in the serological diagnosis of rubella infections in pregnancy. MATERIALS AND METHODS: A total of 92 pregnant women who had never received antirubella vaccines were recruited by simple random selection and did not exceed 24 weeks of gestation were recruited from the antenatal clinics of the University of Ilorin Teaching Hospital. Rubella virus-specific IgG, IgG-affinity and IgM were tested, using the Indirect ELISA methods. RESULTS: IgG-Affinity tests showed that 2 (2.2%) out of the 92 pregnant women, who were in their first and second trimester pregnancies respectively, had primary Rubella infections, while 1 (1.1%) primigravidae had a re-infection with rubella virus. It was also discovered that out of the 13 multigravid subjects that reported to have lost previous pregnancies, 2 (15.4%) cases may have been due to rubella infections that occurred during organogenesis. CONCLUSION: Although the isolation of the whole virus or the viral nucleic material is the best basis for diagnosis, IgG-affinity is a proven supplementary serological diagnosis, to distinguish reinfection or viral persistence from primary exposure for prompt and accurate diagnosis. This is necessary for proper counselling of pregnant women especially in low economies where molecular diagnosis may not be affordable

Gynecological laparoscopic surgeries: A 4‑year audit at the University of Ilorin Teaching Hospital, Nigeria

Background: In addition to a shorter hospital stay and better cosmetic results, laparoscopic surgery also offers patients fewer postoperative complications compared to conventional open gynecological surgeries. With expertise and better facilities, it has come to stay as an alternative surgical approach to gynecological diagnosis and treatment.Aims and Objectives: The aim of this study was to assess the indications, intraoperative findings, and types of laparoscopic surgeries performed at the University of Ilorin Teaching Hospital, Ilorin.Materials and Methods: A retrospective observational study of 150 patients who underwent laparoscopic procedures between January 1, 2012 and December 31, 2015, at the Assisted Reproduction Technology (ART) unit of the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Results: Within the period of our review, there were 1,256 gynecological operations and 150 laparoscopies, thus giving a period prevalence of 11.2%. The patients were aged 20–59 years with a mean age of 32.1 ± 3.9 years. Of the 150 laparoscopies, 30 (20%) had diagnostic laparoscopies while 120 (80%) had therapeutic laparoscopies. Of the 30 patients who had diagnostic laparoscopies, 5 (16.7%) presented with primary infertility and 12 (40%) with secondary infertility. The commonest indication for therapeutic laparoscopy was clomiphene‑resistant polycystic ovary syndrome (PCOS) and was found in 81 (67.5%). One (0.7%) was converted to open surgery due to technical difficulties. There was a case of iatrogenic sigmoid colon injury and no mortality recorded.Conclusion: Laparoscopic surgery offers patients a novel choice of intervention that affords establishing definitive diagnosis, shorter hospital stay, better cosmetics, and reduced morbidities/mortalities compared to open gynecological surgeries.Key words: Gynecological; Ilorin; laparoscopy; Nigeria

A review of pregnancy outcomes following laparoscopic ovarian drilling for infertile women with clomiphene resistant polycystic ovarian syndrome (PCOS) at a public health facility in Ilorin, Nigeria.

Background: Polycystic ovarian syndrome (PCOS) is the common endocrine disorder in women and its prevalence is on the increase due to availability of diagnostic tools. It is usually managed medically but for some resistant cases may require surgical intervention in the form of laparoscopic ovarian drilling (LOD). LOD is a one-off therapy avoids the need of medical therapy and its attendant complications.Aim and Objectives: The objective of this study was to determine the impact of LOD on reproductive outcomes of infertile women with clomiphene resistance PCOS among clients attending the Assisted Reproduction Technology unit of University of Ilorin Teaching Hospital.Materials and Methods: This is a prospective / longitudinal study of twenty three (23) patients of clomiphene resistant PCOS who underwent LOD between January and December 2012.Results: The patients were aged 24-45years with a mean age of 31.7 ± 5.2 years. Twenty (87%) out of twenty three were nulliparous and majority (87%) belong to middle social class. Eleven (47.8%) had primary infertility while 12 (52.2%) had secondary infertility. The mean duration of infertility is 4.5 ± 2.9 years and the number of drills per ovary ranged from 4 to 15 (mean, right ovary=8.6±3.24; left ovary=9.3±3.4). Majority (95.7%) had at least one patent tube. The mean age of patients' husbands is 38.8 ± 5.7 years with majority (82.6%) having normozoospermia. In the follow-up period, all 23 patients (100%) resumed menstruation and achieved ovulation (ovulation rate= 100%). The mean time of menstruation and ovulation were 4.1± 1.9 days and 5.3 ± 3.2 weeks respectively. Seven pregnancies were recorded from 23 patients giving a cumulative pregnancy rate of 30.4%. Of the remaining four pregnancies, one of the patients had successfully delivered, giving a live birth rate of 14.3%, while others are on-going. The mean time interval from LOD to pregnancy was 4.7 ± 1.6 months. The pregnancy outcomes had no significant association with age of the women, parity, duration of infertility and types of infertility with p > 0.05. Conclusion: LOD is a safe and effective one-off treatment for PCOS related infertility in patients who failed to respond to CC with efficacy equal to gonadotrophins and metformin. We recommend the need for its domestication in our locality.Keywords: Anovulatory infertility, Laparoscopic ovarian drilling, Polycystic ovarian syndrome, Live birt

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Background. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C).Objectives. To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it.Methods. A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant.Results. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future  daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as  wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this.Conclusion. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C

Effectiveness of Vitamin C Consumption In Pregnancy On Dexamethasone Induced Low Birth Weight.

Synthet ic glucocor t icoids, including Dexamethasone have been shown to induce Intra Uterine Growth Retardat ion (IUGR) when administered in the last trimester of pregnancy. This study was designed to investigate the effect of Vitamin C on Dexamethasone induced low birth weight anexperimental model using theAlbino rats. Pregnant Sprague Dawley rats were divided into four groups of six rats each; group A- vehicle only,group B- Vitamin C treated (100mg/kg maternal body weight), group C-Dexamethasone treated (bolus dose of 100 micro grams of Dexamethasone/kg maternal body weight on day 13 followed by a daily dose of 200 micro grams/kg maternal body weight from day 14 tilldelivery) and group D -Dexamethasone and Vitamin C treated (100mg/kg maternal body weight of Vitamin C from day 7 of pregnancy to term; and on day 13 of pregnancy, were injected with a bolus dose of 100micro grams/kg maternal body weight of Dexamethasone and subsequently a daily dose of 200 micro grams/kg maternal body weight until term). The weight and size of the litters along with the gestationperiod and weight gain during the period of study were recorded.T h e r e s u l t s s h owe d t h a t t h o u g h Dexamethasone caused low birth weight, Vitamin C had no significant (p>0.05) effect on dexamethasone induced low birth weight, litter size or gestation period.It was hereby concluded that this was probably due to the inability of Vitamin C to influence the mechanisms by which dexamethasone induces low birth weight

Clinico-pathological presentation of primary cervical cancer seen in Ilorin, Nigeria

Background: Invasive cervical cancer remains the most common cancer in the developing countries and the second leading cause of cancer mortality in women worldwide. Methods: a 10-year retrospective review of histologically confirmed primary cervical cancers seen at the department of obstetrics and gynaecology of the university of ilorin teaching hospital, ilorin in 10 years. Results: Of the 236 confirmed gynaecological cancers, 147 (62.3%) cases were histologically confirmed primary cervical cancers. One hundred and thirty two patients (89.8%) were of low socio-economic status and 145 (98.6%) were married. Majority of the patients 102 (69.4%) were in the age range 40 – 69 years with highest frequency in 40 – 49 years. The study also revealed a steady rise in the incidence of the disease with increase in parity. Grandmultiparous women had the highest incidence 119 (80.9%). Most of the patients had multiple symptoms. The common symptoms include irregular vaginal bleeding 108 (73.5%), vaginal discharge 58 (39.5%) and post coital bleeding 31 (21.1%). Only 18 (12.3%) reported at the hospital within one month of onset of symptoms. About three-quarters of the patients had advanced disease (stage IIb to IVb) and Stage III was the most common 74 (50.3%). Squamous cell carcinoma accounted for 126 (85.7%) of the cases while Adenosquamous carcinoma and Adenocarcinoma were responsible for 13 (8.9%) and 8 (5.4%) cases respectively. Conclusion: This study has shown a high incidence of primary cervical cancer in our centre. The common presenting symptoms were irregular vaginal bleeding, vaginal discharge and postcoital bleeding in that order. Majority of the patients presented in advanced stage (stage IIb – IVb) of the disease. Key words: Cervical cancer, Clinico-pathological presentation Nig. J. of Surgical Research Vol.4(3-4) 2002: 89-9

Premenstrual dysphoric disorder among medical students of a Nigerian university

Background/Objective: This study aimed at estimating the prevalence and associated factors of premenstrual dysphoric disorder (PMDD) among medical students in a University in the North-Central State of Nigeria. PMDD is the severest form of premenstrual symptoms and is associated with impairment of social and role functioning.Methods: A cross-sectional study of female medical students of the  University of Ilorin College of Health Sciences (n=208), which involves completing a questionnaire to elicit socio-demographic and gynecological information as well as the GHQ-12 questionnaires. They were later interviewed with DSM-IV PMDD instrument.Results: Seventy-five (36.1%) of the respondents met the criteria for the diagnosis of PMDD. Sixty-five (%) of the PMDD cases reported having pain during menses among whom 14 (21.5%) reported mild, 32 (49.2%) moderate and 19 (29.2%) severe form of menstrual pain. Forty-two persons (20.2%) were categorized as having probable psychiatricmorbidity using a cut-off of . 3 on GHQ 12. There was neither a causal relationship between psychiatric morbidity (. 3 score), and PMDD, nor any association between gynecological factors and PMDD. However, menstrual pain was significantly associated with PMDD (P=0.019).Conclusion: The rate of PMDD in this study is high. Dysmenorrhoea of moderate/severe intensity correlated significantly with the possibility of having PMDD. Efforts should therefore be made to alleviate the pain associated with menses. In addition, the Collegefs health-care providers should take into account the issues of dysmenorrhoea and its management more seriously by intensifying health education on dysmenorrhoea and PMDD in order to improve the quality of life of the students

Premenstrual dysphoric disorder among medical students of a Nigerian university

Background/Objective: This study aimed at estimating the prevalence and associated factors of premenstrual dysphoric disorder (PMDD) among medical students in a University in the North-Central State of Nigeria. PMDD is the severest form of premenstrual symptoms and is associated with impairment of social and role functioning.Methods: A cross-sectional study of female medical students of the University of Ilorin College of Health Sciences (n=208), which involves completing a questionnaire to elicit socio-demographic and gynecological information as well as the GHQ-12 questionnaires. They were later interviewed with DSM-IV PMDD instrument.Results: Seventy-five (36.1%) of the respondents met the criteria for the diagnosis of PMDD. Sixty-five (%) of the PMDD cases reported having pain during menses among whom 14 (21.5%) reported mild, 32 (49.2%) moderate and 19 (29.2%) severe form of menstrual pain. Forty-two persons (20.2%) were categorized as having probable psychiatricmorbidity using a cut-off of . 3 on GHQ 12. There was neither a causal relationship between psychiatric morbidity (. 3 score), and PMDD, nor any association between gynecological factors and PMDD. However, menstrual pain was significantly associated with PMDD (P=0.019).Conclusion: The rate of PMDD in this study is high. Dysmenorrhoea of moderate/severe intensity correlated significantly with the possibility of having PMDD. Efforts should therefore be made to alleviate the pain associated with menses. In addition, the Collegefs health-care providers should take into account the issues of dysmenorrhoea and its management more seriously by intensifying health education on dysmenorrhoea and PMDD in order to improve the quality of life of the students

Mayer – Rokitansky Syndrome Type 1 With Karyotype XY Variant: A Case Study

No Abstract Keywords: primary ammenorrhea, coital laceration, karyotype Xy varian