Initial experience with 3d-ultrasound as an adjunct to 2dultrasound in fetal anomaly diagnosis in a Nigerian diagnostic facility

Introduction: Two-Dimensional ultrasound (2DUS) has been the preferred screening method for fetal abnormalities for several decades.  Three-dimensional ultrasound (3DUS) is a technique that converts standard 2D grayscale ultrasound images into a volumetric dataset which allows visualization of the fetus in all three dimensions at the same time. It provides an improved overview and a more clearly defined demonstration of adjusted anatomical planes. The use of 3D imaging is however limited to being an adjunct to 2DUS in the  visualization of fetal anomalies. The objective of this study is to highlight the importance of adding three dimensional ultrasound (3DUS) to two-dimensional ultrasound (2DUS) during fetal anomaly screening.Methodology: This is a descriptive study conducted at a private fetal diagnostic center, in Nigeria between January 2014 and December  2016. The diagnosis of fetal anomalies was first made with 2DUS after which they were evaluated with 3D ultrasound images displayed on the monitor.Results: Nine fetuses with various fetal anomalies diagnosed on 2DUS were selected for further evaluation with 3DUS. These anomalies include a neck mass, lumbar spinal abnormality, bilateral cleft lip, thanatophoric dysplasia, anencephaly, omphalocele, posterior urethral valve with anhydramnios and ambiguous genitalia diagnosed. These anomalies were better demonstrated on 3DUS.Conclusion: 2DUS remains the mainstay imaging modality in screening for fetal anomalies. However, 3DUS may complement 2DUS by allowing better delineation of anomalies and gives the parents a better visualization and understanding of identified anomalies, thereby assisting in informed decision making

Outcome of Infertility Consultations in a tropical tertiary health institution in Nigeria

Aim: To examine the outcome of gynaecological consultations for infertility in a tropical Teaching Health facility.Material & Methods: This is a cross-sectional study of infertility cases seen at the Bowen University Teaching Hospital, Ogbomoso over a year (16 October, 2010 to 15 October, 2011). The patients were followed up for twelve months thereafter. Data collection was done using a designed profoma. All patients coming for gynaecological consultations because of infertility within the study period were included in the study after giving their informed consents. Patient information recorded in the profoma included age, parity, educational status, occupation, duration of infertility, investigations, modality of treatment and treatment outcome. Outcome was measured by the number of live births amongst treated patients.Results: A total of 195 patients presented for gynaecological consultations during the one year period; infertility was one of the commonest reasons for gynaecological consultation, accounting for 38.5% (75) of the cases. Tubal factor, 25(33.5%) was the commonest etiological cause. The treatment modality involved myomectomy (20, 26.6%), ovulation induction (20, 26.6%), laparoscopic adhesiolysis (8, 10.7%) and tubal surgery (5, 6.7%). Treatment of infertility resulted in 10 (13.3%) live births, with ovulation induction giving the highest percentage of live births (5, 50%).Conclusion: The outcome of treatment of infertility is poor. Therefore, establishing a standard assisted reproductive technology (ART) unit will be of immense value in improving the outcome.Keywords: Infertility, consultation, outcom

URETERIC INJURIES FOLLOWING PELVIC OPERATIONS

Background: Iatrogenic injuries to the ureter are hazardous complications of pelvicoperations, causing severe morbidity and even mortality.Objective: To present our 10 years experience in the management of such uretericinjuries.Design: A retrospective study carried out between January 1990 and December 1999.Setting: Two busy health institutions, namely Ife State hospital and Wesley GuildHospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex,Ile-Ife, Nigeria.Results: The incidence of iatrogenic injury was 0.4%. Ureteral transection was thecommonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operatedcases. Those diagnosed at the time of injury and treated with end-to-end anastomosishad the best results.Conclusion: The proper identification and, when necessary, isolation of the ureter duringoperations in which there is a risk is crucial in reducing the incidence of ureteral injurie

LOW DOSE INTRAVAGINAL MISOPROSTOL VERSUS INTRACERVICAL BALOON CATHETER FOR PRE-INDUCTION CERVICAL RIPENING

Background: The efficacy and safety of low dose misoprostol as a ripening agentcompared to the widely used balloon catheter in developing countries is undetermined.Objective: To compare the safety and efficacy of a low dose intravaginal misoprostoland intracervical Foley’s catheter for cervical ripening.Design: A prospective randomized controlled trial.Setting: Zonal General Hospital, Kwale, Nigeria from June 1, 1998 to May 30, 2001.Methods: Candidates for pre-induction cervical ripening were randomized to receiveeither 250 mcg of intravaginal misoprostol every four hours (n = 60) or intracervicalFoley’s catheter (n = 61).Main outcome measures: Failure to achieve cervical ripening within 24 hours, need foraugmentation, maternal and foetal complications.Results: Failure to achieve cervical ripening within two hours was reduced withmisoprostol (Relative Risk [RR] 0.63, 95% Confidence Interval [CI] 0.43 - 0.92). Needfor oxytocin augmentation was less in the misoprostol group (RR 0.76, 95% CI 0.64to 0.91). No significant differences existed in rates for uterine hyperstimulation,Caesarean section, maternal and neonatal morbidity.Conclusion: Intravaginal misoprostol in a low dose was compared to intracervical ballooncatheter for pre-induction ripening of the cervix

Low dose intravaginal misoprostol versus intracervical balloon catheter for pre-induction cervical ripening

Background:The efficacy and safety of low dose misoprostol as a ripening agent compared to the widely used balloon catheter in developing countries is undetermined. Objective:To compare the safety and efficacy of a low dose intravaginal misoprostol and intracervical Foley's catheter for cervical ripening. Design:A prospective randomized controlled trial. Setting:Zonal General Hospital, Kwale, Nigeria from June 1, 1998 to May 30, 2001. Methods:Candidates for pre-induction cervical ripening were randomized to receive either 250 mcg of intravaginal misoprostol every four hours (n = 60) or intracervical Foley's catheter (n = 61). Main outcome measures:Failure to achieve cervical ripening within 24 hours, need for augmentation, maternal and foetal complications. Results: Failure to achieve cervical ripening within two hours was reduced with misoprostol (Relative Risk [RR] 0.63, 95% Confidence Interval [CI] 0.43 - 0.92). Need for oxytocin augmentation was less in the misoprostol group (RR 0.76, 95% CI 0.64 to 0.91). No significant differences existed in rates for uterine hyperstimulation, Caesarean section, maternal and neonatal morbidity. Conclusion:Intravaginal misoprostol in a low dose was compared to intracervical balloon catheter for pre-induction ripening of the cervix. (East African Medical Journal: 2003 80(2): 91-94

URETERIC INJURIES FOLLOWING PELVIC OPERATIONS

ABSTRACTBackground: Iatrogenic injuries to the ureter are hazardous complications of pelvicoperations, causing severe morbidity and even mortality.Objective: To present our 10 years experience in the management of such uretericinjuries.Design: A retrospective study carried out between January 1990 and December 1999.Setting: Two busy health institutions, namely Ife State hospital and Wesley GuildHospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex,Ile-Ife, Nigeria.Results: The incidence of iatrogenic injury was 0.4%. Ureteral transection was thecommonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operatedcases. Those diagnosed at the time of injury and treated with end-to-end anastomosishad the best results.Conclusion: The proper identification and, when necessary, isolation of the ureter duringoperations in which there is a risk is crucial in reducing the incidence of ureteral injurie