Application of ultrasonography in female infertility: a comprehensive review

The quest for detailed evaluation of the uterus, fallopian tubes, and ovaries that is radiation free, inexpensive, readily available, non-invasive, relatively less time consuming and easily repeatable in female infertility has resulted in further studies. However, ultrasonography (US) remains the first line indispensable tool for gynecologic workup, monitoring and treating infertility. The aim is to review the current knowledge regarding the application of ultrasonography in female infertility. This was a descriptive review of ultrasonography in female infertility. We searched several databases (Medline, Google scholar, PubMed) with keywords “ultrasonography and female infertility”, “evaluation of female infertility”, “role of ultrasonography in female infertility:, and imaging in female infertility”. Female infertility is multifactorial in origin. Ultrasonography is the most widely used imaging in gynecology and has revolutionized the management of female infertility worldwide. The recognition, evaluation and treatment of female infertility are complicated, complex, stressful and emotionally devastating for most couples. The couple’s emotional state should be supportive, informative and well tolerated. Female infertility is an immense stress to couples, families and relatives worldwide. The causes are multifactorial in origin with both congenital and acquired problems of the uterus, fallopian tubes and ovaries. Ultrasound plays an important role in female infertility workup with hysterosalpingography (HSG), sonohysterography (Sono-HSG) and magnetic resonance imaging (MRI), each playing a complimentary role in the screening, diagnosis and/or management of female infertility

Zika virus and birth defects: an obstetric issue

Zika virus is an emerging mosquito-borne virus that is relatively unknown, unstudied and under-diagnosed, but has potentials to spread to new geographical areas that favour survival of Aedes mosquitoes. It is associated with an alarming rise in babies with microcephaly that require much care and support with a lot of financial assistance. This is a review article on Zika virus and birth defects; a worrisome issue in today’s obstetric and medical practices. Since Zika’s discovery in Uganda, the virus was known to occur within a narrow equatorial belt from Africa to Asia with no or mild symptoms. It has emerged as a global public health threat over the last decade with accelerated geographic spread of the virus in the last nine years. The risk of Zika virus to the fetus is poorly understood, difficult to quantify and problematic. The causal link between Zika virus and microcephaly was initially speculative, strongly suspected and scientifically unproven. However, on 13th April, 2016, it was concluded that Zika virus is the cause of microcephaly and other severe fetal brain defects. The Center for Disease Control and Prevention (CDC) authors reviewed and weighed evidences using established scientific criteria to conclude after a careful review of the report published in the New England Journal of Medicine. There is no prophylaxis, treatment or vaccine to protect against Zika virus infection. However, preventive personal measures are highly recommended to avoid mosquito bites

Desire to practice postpartum contraception among antenatal women at Awka, Southeast Nigeria

Background: Postpartum contraception enables the nursing woman recover from the effects of pregnancy and childbirth before embarking on another pregnancy. It also promotes child welfare. The assessment of the desire by pregnant women to take up postpartum contraceptive service will help the planning of good delivery of this service.Methods: A cross-sectional study of antenatal clinic attendees at Chukwuemeka Odumegwu Ojukwu Teaching Hospital, Awka was done using a pretested interviewer-administered questionnaire. Data was analyzed with IBM SPSS version 20 software and associations between variables were tested with Chi square. Level of significance was set at P ≤0.05.Results: A total of 262 antenatal women were interviewed. The mean age of the respondents was 29.1±6.1 years while the mean parity was 2.5±1.5. Two hundred and one of the study women (76.7%) had the desire to practice postpartum contraception after the index pregnancy while only 9 (3.4%) were unsure whether they had the desire or not. Multiparous women are more likely to desire postpartum contraception (P <0.01). Also, previous use of contraception (P<0.01), desired index pregnancy (P=0.01) and being married or single (P=0.02) are all significantly associated with the desire to practice postpartum contraception.Conclusions: There was a high level of desire to practice postpartum contraception among antenatal clinic attendees at Awka. Parity, marital status, desired index pregnancy and previous practice of contraception all influence this desire

Awareness and perception of vasectomy among antenatal women in a tertiary health facility in southeast Nigeria

Background: Vasectomy is a safe alternative to bilateral tubal ligation (BTL) in achieving permanent sterilization but not popular in developing countries. As part of the efforts to increase popularity as well as acceptance of vasectomy in the developing countries, its awareness among women needs to be assessed. The study was undertaken to determine the awareness and perceptions of vasectomy among antenatal attendees in a tertiary health institution southeast Nigeria.Methods: This was a questionnaire-based cross-sectional study in which pregnant women visiting University of Nigeria Teaching Hospital, Enugu (UNTH) antenatal clinic from 1st June – 30th November 2017 were recruited. Data was collected using structured questionnaire. Two hundred (200) self-administered questionnaires were completely filled and analyzed by means of descriptive and inferential statistics including means frequencies and x^2-tests at the 95% confidence level (CL).Results: Of the 200 respondents, 146(73%) were completely unaware of the existence of vasectomy while 54(27%) were aware. Of those who were aware, 41(75.9%) accepted its use as a family planning method for men. The commonest reason for acceptance was the fear of infidelity among their husbands, 17(41.5%). The intention to use was however low as 24(44.4%) of those who accepted vasectomy disapproved of its use by their husbands and the main reason for disapproval was “weakens husband’s sexual performance,” (33.3%). Tertiary level of education of the respondents was 5.3 times independently associated with the acceptance of vasectomy.Conclusions: The awareness is low and there are several misperceptions about vasectomy among the women in Enugu. Tertiary education of the women however improves the choice of vasectomy as a permanent contraceptive option. There is the need for educational programmes in line with the numerous advantages of vasectomy so as to counteract the misperceptions especially those regarding sexual relationship

Successful quadruplet surrogate pregnancy after turbulent medical disorders in first trimester

Quadruplet surrogate pregnancy is a rare pregnancy but, has become common due to assisted reproductive technology (ART). Its management is a big challenge to obstetricians and co-clinicians worldwide. This was a pregnancy managed at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria in a 33 year old hypertensive surrogate mother with turbulent first trimester medical disorders that called for termination of the pregnancy by other co-managing clinicians. However, the pregnancy became stable in late 2nd trimester with emergency caesarean section at 33 weeks following preterm premature rupture of membranes (PPROM). Its management was a big challenge that necessitated multidisciplinary approach with successful outcome of four healthy live babies (three males and one female) and the controversial practice of surrogac

Case Report: Massive Ascites Complicating Uterine Fibroids:

A rare case of massive ascites complicating uterine fibroid is presented. At presentation, she was emaciated with grossly distended abdomen and a mass, which corresponded to 36 weeks gestation. At operation a large soft mass attached to the uterus by fibrous strands and to the omentum by large dilated new vessels was seen. It weighed 4.5kg and histology confirmed a degenerated leiomyoma. Key Words: Leiomyoma, Ascites, Nulliparity, Hysterectomy [Trop J Obstet Gynaecol, 2003, 20: 74-75

Factors associated with the use of maternity services in Enugu, southeastern Nigeria

The maternal mortality ratio and other maternal health indicators are worse for developing countries than for the developed world due to improved access to quality care during pregnancy and especially at delivery in the industrialized world. This study was carried out to identify the factors which influenced choice of place of delivery by pregnant women in Enugu, southeastern Nigeria, and to recommend ways to improve women's access to skilled attendants at delivery. A pre-tested questionnaire was administered by interviewers to women who had delivered within 3 months prior to date of data collection. The response rate was 75.5% (n=1098). Of the respondents, 52.9% delivered outside health institutions and 47.1% in health institutions. The major factors influencing choice of place of delivery included promptness of care, competence of midwife/doctor, affordability, health education, 24 h presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non-institutional deliveries and socio-demographic/economic factors such as place of residence (urban/rural), religion, educational status, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (pMaternity utilization Associated factors Enugu Nigeria

Perception of labour pain and desire for pain relief in labour among parturients in a tertiary health facility in south-eastern Nigeria

Background: There are varied perceptions about pain and its relief in labour among pregnant women in Africa.Objectives: This study aims to assess the perception of labour pain among parturients in a tertiary health institution in Nigeria. It also assessed the women’s awareness of and desire for labour analgesia.Methodology: One thousand, one hundred (1100) consecutive women who delivered at a University Teaching Hospital were studied using pretested researcher administered questionnaires. Data were entered into and analysed with SPSS 21. Statistical tests were done with Chi- square and T- test as appropriate. P-value of less than 0.05 was considered significant.Result: The mean age of the respondents was 29.2 + 5.89 while the mean parity was 2.43 + 1.59. One thousand and ninety respondents (99.1%) reported that labour was painful and majority (91.3%) of them graded pain as severe. The mean pain score was 85.1 + 16.2. Having antenatal care, partner support, attendance to antenatal classes, delivery by emergency C-section and induced labour were significantly associated with identifying labour as painful. Awareness of labour analgesia was poor as only 39.5% of the respondents reported so and only 1.4% of the parturients requested pain relief.Conclusion: The women generally reported labour as being very painful, yet they had poor knowledge of, and demand for labour analgesia. This poor knowledge exists despite the fact that majority of these women had antenatal care, suggesting that health information given to them may be deficient. Misconceptions were the main reasons for not requesting pain relief in labour.Keywords: Labour analgesia, Labour pain, Knowledge, Acceptanc

Desire to practice postpartum contraception among antenatal women at Awka, Southeast Nigeria

Background: Postpartum contraception enables the nursing woman recover from the effects of pregnancy and childbirth before embarking on another pregnancy. It also promotes child welfare. The assessment of the desire by pregnant women to take up postpartum contraceptive service will help the planning of good delivery of this service.Methods: A cross-sectional study of antenatal clinic attendees at Chukwuemeka Odumegwu Ojukwu Teaching Hospital, Awka was done using a pretested interviewer-administered questionnaire. Data was analyzed with IBM SPSS version 20 software and associations between variables were tested with Chi square. Level of significance was set at P ≤0.05.Results: A total of 262 antenatal women were interviewed. The mean age of the respondents was 29.1±6.1 years while the mean parity was 2.5±1.5. Two hundred and one of the study women (76.7%) had the desire to practice postpartum contraception after the index pregnancy while only 9 (3.4%) were unsure whether they had the desire or not. Multiparous women are more likely to desire postpartum contraception (P &lt;0.01). Also, previous use of contraception (P&lt;0.01), desired index pregnancy (P=0.01) and being married or single (P=0.02) are all significantly associated with the desire to practice postpartum contraception.Conclusions: There was a high level of desire to practice postpartum contraception among antenatal clinic attendees at Awka. Parity, marital status, desired index pregnancy and previous practice of contraception all influence this desire

Awareness and perception of vasectomy among antenatal women in a tertiary health facility in southeast Nigeria

Background: Vasectomy is a safe alternative to bilateral tubal ligation (BTL) in achieving permanent sterilization but not popular in developing countries. As part of the efforts to increase popularity as well as acceptance of vasectomy in the developing countries, its awareness among women needs to be assessed. The study was undertaken to determine the awareness and perceptions of vasectomy among antenatal attendees in a tertiary health institution southeast Nigeria.Methods: This was a questionnaire-based cross-sectional study in which pregnant women visiting University of Nigeria Teaching Hospital, Enugu (UNTH) antenatal clinic from 1st June – 30th November 2017 were recruited. Data was collected using structured questionnaire. Two hundred (200) self-administered questionnaires were completely filled and analyzed by means of descriptive and inferential statistics including means frequencies and x^2-tests at the 95% confidence level (CL).Results: Of the 200 respondents, 146(73%) were completely unaware of the existence of vasectomy while 54(27%) were aware. Of those who were aware, 41(75.9%) accepted its use as a family planning method for men. The commonest reason for acceptance was the fear of infidelity among their husbands, 17(41.5%). The intention to use was however low as 24(44.4%) of those who accepted vasectomy disapproved of its use by their husbands and the main reason for disapproval was “weakens husband’s sexual performance,” (33.3%). Tertiary level of education of the respondents was 5.3 times independently associated with the acceptance of vasectomy.Conclusions: The awareness is low and there are several misperceptions about vasectomy among the women in Enugu. Tertiary education of the women however improves the choice of vasectomy as a permanent contraceptive option. There is the need for educational programmes in line with the numerous advantages of vasectomy so as to counteract the misperceptions especially those regarding sexual relationship