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

An Appraisal of Retained Placenta in Sokoto: a five-year review

Background: Retained placenta is one of the major causes of primary and secondary postpartum haemorrhage associated with increased risk of maternal morbidity and mortality.Objective: To determine the incidence, method of treatment and maternal outcome of patients with retained placenta.Methodology: This is a retrospective study covering a period of 5years, January 1st, 2007 to December 31st, 2011, in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Results: During the 5-year period, there were 144 cases of retained placenta out of 8569 total deliveries, giving an incidence of 1.7%. However, only 118 patients’ case records were available for analysis. Majority of the patients 88 (74.6%) were unbooked for antenatal care in UDUTH and 104 (88.1%) patients had home delivery. The identified risk factors included previous history of retained placenta 32 (27.1%) and previous uterine surgery 13 (11.0%). Fifty per cent of the patients were in hypovolaemic shock at presentation. Manual removal of the placenta was the most common mode of treatment 91 (77.1%). There were 7 maternal deaths giving a case fatality rate of 5.9%.Conclusion: Retained placenta is a significant cause of maternal mortality and morbidity due to the associated haemorrhage and other complications related to its removal. Antenatal care, skilled birth attendant at delivery and provision of emergency obstetrics care services will help to reduce the incidence and severity.Keywords: Morbidity, mortality, post-partum haemorrhage, Sokot

The age at menarche amongst secondary school girls in Sokoto metropolis, North-West Nigeria

Background: Several studies suggest that menarche tends to appear earlier in life as sanitary, nutritional and economic conditions of a society improve.Aim / Objective: To determine the age at menarche amongst secondary school girls in Sokoto metropolis and the influence of socio-economic status on this parameter.Methodology: This is a cross-sectional study involving four different secondary schools in Sokoto metropolis, conducted between September and October 2010. Systematic sampling method was used to select 460 adolescent girls, and a pre-tested questionnaire was used to gather data. The 460 girls cooperated by completing the questionnaire under the supervision of members of the research team, but only 381 of the girls were finally recruited for the study.Results: The age range at menarche was 10-16years and the mean was 13.67 ± 1.2years. The average age at menarche, based on social class, was 13.20 ± 1.1years (class I), 13.37 ± 1.3years (class II), 13.88± 1.5years (III), 13.92± 1.2years (class IV) and 13.98 ± 1.1years (class V).There was no significant difference in the average menarcheal age at different social classes (P>0.05).Conclusion: The average age at menarche, in this study, is comparable to that of most previous reports in Nigeria, and socio-economic status appears to have no significant influence on the age at menarche.Keywords: Age, menarche, Sokoto, Nigeria

Pregnancy Outcomes Following Assisted Reproduction Technologies For Infertile Women At A Public Health Institution In Nigeria

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Myomectomy in a case of von Willebrand’s disease in a low resource setting

Von Willebrand’s disease (vWD) is an inherited bleeding disorder with an estimated prevalence of 1% in the general population. It is caused by deficiency or dysfunction of von Willebrand’s factor. Surgical procedure on patients with vWD is usually associated with increased haemorrhage.Keywords: Clotting Factors, Coagulation Disorder, Fibroids, von Willebrand’s Facto

Caesarean morbidity and mortality in a tertiary health institution in Sokoto, North-West Nigeria

Background: Caesarean section is the most common major surgical procedure performed in obstetrics. There is a need to frequently assess the safety of this operation.Objective: To determine the rate and complications of caesarean sections.Patients and Methods: A retrospective review of the caesarean sections performed at Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2007 to December 2010.Results: During the study period, there were 7986 deliveries and 819 caesarean sections, giving a caesarean section rate of 10.3%. Six hundred and eleven cases were available for analysis. The major indication was previous caesarean section (19.7%), cephalo-pelvic disproportion (15.4%), pre-eclampsia and eclampsia (14.7%). One hundred and thirty-five patients (20.4%) had post-operative complications, sepsis (36.3%) being the most common complication. All were cases of emergency caesarean section in unbooked patients. There were 19 maternal deaths (287.4/100,000), and the major cause of death was sepsis (57.9%).Conclusion: There is a high level of morbidity and mortality following caesarean section mainly due to sepsis

Female surgical sterilization at University of Ilorin Teaching Hospital, Ilorin: 10-year review

Background: Given technological advances over the past few decades, female surgical sterilization has become a safe, convenient, easy, and highly effective birth control method for the long term.Objective: This study aims at determining the uptake, indications, timing, surgical technique and complications of voluntary surgical sterilization in Ilorin.Methodology: A retrospective study involving all clients who have undergone female sterilization by mini-laparotomy at the University of Ilorin Teaching Hospital Family Planning Clinic between January 2002 and December 2011. Clinical data were retrieved from the case notes and the information obtained was analyzed with SPSS version 16 of the computer. All the case notes had adequate information for the study, and none was missing.Results: There were 25,418 deliveries with 205 cases of female surgical sterilizations out of which 95 were through mini-laparotomy, giving an incidence of 8% and 3.7 per 1000 deliveries, respectively. The mean age at sterilization was 38.9years. Grand-multiparity and completed family size were the main indications. Seventy-nine percent of the clients had interval procedure and Pomeroy’s method was used among 70.5% of the clients. Local infiltration was used for most (60%) of the clients. Complication attributable to the procedures occurred in 5.3% of the clients. These include, wound sepsis (2.1%), urinary tract infection (1.05%) and one failed sterilization (1.1%).Conclusion: Concerted efforts at female reproductive health education and counseling will help to dispel some of the rumours and misconceptions associated with the procedure

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

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