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

Atypical tuberculosis presenting with primary infertility and endometrial calcification

Tuberculosis (TB) is caused by mycobacterium tuberculosis. It remains a public health concern especially in developing country. Pulmonary infection is the main presentation. However, genitourinary TB is common especially with the increase in Human Immunodeficiency virus (HIV) infection. Genitourinary TB is one of the most common causes of extrapulmonary tuberculosis which affects 12% patients with pulmonary tuberculosis. It is common in women less than 40 years of age and rarely occurs in post-menopausal. Therefore it is more likely to affect women in reproductive years leading to infertility. Fallopian tube involvement in genital TB is at least 95-100% of cases and is mainly from haematological spread and this leads to infertility. This is a case of a woman who presented a diagnosis of primary infertility and tuberculous endometritis with endometrial calcification

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

Beckwith-Wiedemann Syndrome in assisted reproductive techniques: Case report

Assisted Reproductive Techniques (ART) is a crucial treatment for infertile couples and is frequently common. ART entails  manipulation of oocyte and sperm in a laboratory: in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).The key  objective of ART is to yield superior quality embryos that are competent for implantation with good perinatal outcome. In spite of widespread acceptability of ART, concerns have been raised on the long-term safety of removal and manipulation of the gametes and embryos. High incidence of imprinting disorders like Beckwith-Wiedemann syndrome (BWS) have been noted in babies conceived after ART. The case report discusses BWS encountered after conception with ART and a review of other imprinting disorders associated with ART

Prevalence of cervical cytology abnormalities among HIV infected women at Rwanda Military Hospital

Objectives: To establish the prevalence of cervical cytology abnormalities, determine the correlation between CD4+ cell count and abnormal Pap smear, determine the correlation between WHO-HIV staging and abnormal pap smear among HIV infected women attending HIV clinic at Rwanda Military Hospital.Design: Cross-sectional descriptive studySetting: Rwanda Military Hospital Kigali, RwandaSubjects: All HIV-positive women, 18-69 years who had been or were sexually active and were attending the HIV-clinic and consented to participate in the study.Results: Two hundred and ninety three women infected with HIV had cervical smear taken for cytology. Of the 293 women who were recruited for the study, cervical Squamous Intra epithelial Lesion (SIL) were present in 58 (20%). Of those with cervical SIL, 33 (56.89%) women had low-grade SIL, 15(25.86%) had Atypical Squamous Cells of Undetermined Significance (ASCUS), six (10.34%) had high-grade SIL, three (5.17%) had Squamous cell carcinoma ( SCC) and one (1.72%) had Atypical Glandular Cells of Undetermined Significance (AGUS). In the current study, use of ARV drugs was not associated with a reduction in the risk of cervical SILConclusion: A high prevalence of cervical SIL was found among HIV-infected women at Rwanda Military Hospital. Increased immune suppression was significantly associated with cervical SIL

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

Regulation of informed consent: a focus on fertility treatments in Kenya

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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

Laparoscopic myomectomy in Kenya : A 15 year retrospective review

Objectives: To evaluate the indications,operative techniques, outcomes, limitations and fertility outcomes following laparoscopic myomectomy.Design: Retrospective case analysisSetting: Various Private Hospitals in KenyaSubjects: One thousand and forty three patients who underwent laparoscopic myomectomyResults: The main indications for laparoscopic myomectomy in our review were Menorrhagia (52.1%), Primary Infertility (22.6 %), Secondary Infertility (14.3 %), Abdominal pain ( 8.2 % ) and pressure symptoms (2.8 %). The dominant myomas that were removed were intramural ( 45.4 %), subserous (34.6 %) and sub-mucous (19.9 %) of the cases respectively.Conclusions: Laparoscopic Myomectomy can be performed safely and effectively by adequately trained and skilled Surgeons and offers all the advantages of laparoscopic surgery including less haemorrhage, quicker recovery and return to work. The clinical outcomes are good and there were no major complications. The fertility outcomes are comparable to open myomectomy with better outcomes for sub mucous fibroids and deep intra-mural fibroids indenting the uterine cavity

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