Obstetric complications of cervical stenosis: Case report

A case of cervical stenosis is presented. We present a case of a patient who despite experiencing irregular scanty menses, was able to get pregnant.The enigma is that she did not experience any lochia loss post partum.Cervical stenosis is a known predisposing factor to infertility, but it can also have other presentations as are described in this case report

An aberrant uterus: Case report

A case of an aberrant uterus is presented and literature reviewed. The patient presented with abnormal uterine bleeding, left iliac fossa pain and was managed by excising the aberrant uterus. This case was an enigma as it didn’t present in the classical way one with anomalies of the uterus would present. Despite knowledge on the classical types of uterine anomalies, awareness of other possibilities is important

Endometriosis in unicornuate uterus with non-communicating rudimentary horn

Endometriosis, defined as the presence of endometrial tissue outside the uterine cavity, is itself an enigmatic  and multifaceted pathology, a puzzle whose manifold piece remain largely disconnected despite some decades  of investigation. Its medical history and clinical presentation is heterogeneous. Endometriosis affects  approximately 10% of women of reproductive age, given its high prevalence and that women with endometriosis may have severe pelvic pain and infertility, endometriosis poses a significant health problem.  Evaluating and understanding the pathogenesis, clinical presentation, diagnosis of the endometriosis is critical  in the management of this debilitating disease. A rare case of endometriosis in a patient with congenital  anomaly-Unicornuate uterus with one unconnected rudimentary horn is presented

Knowledge, attitudes and practices of infertile couples on male participation in infertility management at the Kenyatta National Hospital

Objective: To determine knowledge, attitudes and practices of infertile couples on male involvement in the management of infertility.Design: Hospital based cross-sectional study.Setting: Kenyatta National Hospital, Nairobi, Kenya.Subjects: One hundred sixty three infertile couples attending the gynaecological and infertility clinics at the Kenyatta National Hospital.Main outcome measures: Knowledge, attitudes and practices of infertile couples on male participation in infertility management.Results: A total of 163 infertile couples(with only 34 men accompanying their wives in this study period) were recruited into the study. Sixty nine point nine percent(114) of the women who participated in this study were ever accompanied to the clinic by their spouses, but only 20.9%(34) were accompanied during the study period. Couple awareness on male participation in infertility was 61.8% by the men and 67.5% by the women but they all agreed that it would improve the care given. The male partners who came to the clinic were more involved in the care of their partners, in terms of paying hospital bills, having investigations performed on them, participating in the decision making process and accepting treatment (p<0.05). On multiple logistic regression, it was found that male partners of accompanied women were paying the medical bills (p value = 0.017, OR=3.0[1.2-7.4]), being investigated (p-value=0.011, OR=3.1[1.3-7.5]), helping decide the treatment the partner receives (p-value = 0.04, OR=2.5[1.0-5.9]) and accepting treatment if found to have a problem (p-value=0.005, OR=4.0[1.5-10.5]).Conclusion: Male participation in infertility management was low 34(20.9%) and structures need to be put in place to improve male partner participation in infertility management

Pregnancy outcome among adolescents and non-adolescents delivering at Kiambu Country Hospital, Kenya

Objective: To determine the pregnancy outcome among adolescents and non-adolescents.Design: A retrospective cross sectional study.Setting: Kiambu County Hospital, Kenya.Subjects: Three hundred and thirty six patients who delivered at Kiambu County Hospital.Main outcome measures: Maternal and foetal morbidity and mortality.Results: More adolescent were single and of lower level of education than the nonadolescents with a statistical significance of 0.025 and 0.031 respectively. Anaemia occurred in 16.0% of adolescents compared to 2.4% among the non-adolescents with a statistical significance of p(<0.001). Cepholopelvic Disproportion (CPD) occurred in 8% of the adolescents vs.1.6% among the non-adolescents vs. 1.6% among the non –adolescents with a statistical significance (P<0.018). Preterm deliveries occurred in 5.6% of the adolescents compared to 0.8% with a statistical significance of 0.031. Postpartum haemorrhage occurred in 7.2% of the adolescents compared to 0.8% of the non-adolescents with a statistical significance of P<O.O1. Puerperal sepsis occurred in 7.2% of the adolescent vs 1.6% among the non-adolescents (P<0.031). The mean birthweight of the adolescents was 2.9 kgs compared to 3.1 kgs with the difference being statistically significant with a P-value of 0.015.Conclusion: Socio-economic status was worse among the adolescents. Intra-partum complications like malpresentation, cephalopelvic disproportion and preterm deliveries were more common among the adolescents than the non-adolescents. Mean birth weight was lower for the adolescents. Post-partum complications like haemorrhage and sepsis were also more common in the group. Adolescent pregnancy is high risk and should be prevented but if it occurs, comprehensive antenatal follow-up is mandator

Successful IVF-ICSI with live baby in an azoospermic patient with cryopreserved sperms: Case report

Male factor is one of the most frequent cause of infertility and presents a variety of endocrine, genetic and immunological etiologies, as well as sexual malfunction, varicocele and genital infections. A case of a couple with primary infertilityfor two years is presented. Both partners were evaluated thoroughly, with a finding of male infertility. The man was found to be azoospermic after two semenalysis were performed. The Follicle Stimulating hormone (FSH) was raised with low testosterone levels indicating testicular failure. The recommended treatment was testicular biopsy with cryopreservation of the sperm and subsequent Intra cytoplasmic Sperm Injection (ICSI). This treatment option was undertaken with successful implantation and live baby delivery. The case study presents the diagnostic modalities and management of male infertility with azoospermia

Influence of early booking for antenatal care on antenatal and early pregnancy outcomes at Kenyatta National Hospital

Objective: To determine whether mothers who book early experience better birth preparedness, ANC investigations and pregnancy outcomes compared to those who book late.Design: A retrospective cohort study.Setting: Kenyatta National Hospital, Nairobi, Kenya.Study population: An exposed group of patients who had early booking (<16 weeks) for antenatal care and an unexposed group of patients who had late booking (> 28weeks). Sample size: A total of 300 participants, 150 for each group.Results: Late booking was associated with lower odds of birth preparedness evidenced by: lower knowledge of expected date of delivery (OR 0.26; P=0.005; 95% CI 0.1-0.66), and lower likelihood of having a birth plan in terms of desired place of delivery, preferred skilled birth attendant, birth companion, means of transport and blood donor (OR 0.24; P=0.006; 95% CI 0.09-0.67). Late booking was also associated with lower odds of emergency preparedness like knowledge of danger signs during pregnancy (OR 0.09; P=<0.001; 95% CI 0.05-0.18) and postpartum emergency preparedness like knowledge of danger signs in puerperium (OR 0.16; P=<0.001; 95% CI 0.08-0.33) and during infancy (OR 0.05; P=<0.001; 95% CI 0.03-0.09). Late booking was associated with lower knowledge on modern family planning methods (OR 0.17; P=0.001; 95% CI 0.1-0.29), and childhood immunization (OR 0.1; P=<0.001; 95% CI 0.06-0.17). Late booking was associated with lower likelihood of interventions like: Folic acid supplementation (OR 0.02; P=<0.001; 95% CI 0.01-0.03) and iron supplementation (OR 0.39; P=0.001; 95% CI 0.23-0.66).Conclusion: Early booking for antenatal care confers better birth preparedness and better antenatal care interventions compared to late booking. Hence need for structures to be put in place to increase early antenatal bookings

Socio-cultural factors impacting male involvement in the management of infertile couples at the Kenyatta National Hospital

Objective: To determine socio-economic and cultural factors that may influence male participation in the management of infertility.Design: A hospital based cross-sectional descriptive study.Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya.Subjects: One hundred and sixty three infertile couples attending gynaecological and infertility clinics at the Kenyatta National Hospital.Main outcome measures: The socioeconomic and cultural factors that may influence male participation in the management of the infertile couples attending the KNH Infertility Clinic.Results: A total of 163 women and 34 men were recruited into the study. At least 114 (69.9%) of the women who participated were ever accompanied to the clinic by their spouses. There was no statistical significance between accompanied and unaccompanied women in terms of education and employment. Majority of the male participants (55.9%) had received pressure from the community to get children.Conclusion: There is need to address the negative pressure from family and community about a couple’s childlessness