A Retrospective Review of the Outcome of Abdominal Myomectomies at a Fertility Centre in South-South Nigeria.

BACKGROUND: Abdominal myomectomy is a treatment modality for uterine fibroids. Its outcome depends on related variables which include the size, number and location of the fibroids, age of the patient, surgery and method used to secure haemostasis. OBJECTIVE: To determine the outcomes of abdominal myomectomies and related variables in a fertility centre in South-south Nigeria. METHODS: A retrospective study of the records of all cases of abdominal myomectomies performed between August 1, 2010 and July 31, 2017. Medical records of the 146 patients who had abdominal myomectomy during the period under review were retrieved and relevant data extracted. Information collected included the presence or absence of intra-abdominal adhesions, duration of tourniquet use, number and weight of enucleated fibroid seedlings, intraoperative blood loss, complications and the number of patients who achieved pregnancy after myomectomy. Data were analyzed using ANALYSE IT® statistical package. RESULTS: 146 patients underwent myomectomy during the period under review. The age range of the patients was 28-56 years (median 41 years). Almost all the patients (94.5%) had tourniquets applied to the uterus for hemostasis. The number of fibroids enucleated ranged from 1 to 154 and weighed between 0.02 and 2.8kg. Blood loss ranged from 100 to1500mls, 17.4% had post-operative fever, and one patient had bowel injury. Thirty-one patients (32.3%) who subsequently had in vitro fertilisation treatment achieved conception. CONCLUSION: Fibroids, weighing >0.5kg, are associated with increased blood loss during abdominal myomectomy, and a previous myomectomy significantly increases the risk of adhesions. Careful patient selection and meticulous surgical techniques are necessary to avoid morbidity in this setting with a high rate of large uterine fibroids.

RÉSUMÉ: La myomectomie abdominale est une modalité de traitement des fibromes utérins. Son résultat dépend de variables connexes qui incluent la taille, le nombre et l'emplacement des fibromes, l'âge du patient, la chirurgie et la méthode utilisée pour assurer l'hémostase. OBJECTIF: Déterminer les résultats des myomectomies abdominales et des variables associées dans un centre de fertilité du sud-sud du Nigéria. MÉTHODES: Une étude rétrospective des dossiers de tous les cas de myomectomies abdominales réalisées entre le 1er août 2010 et le 31 juillet 2017. Les dossiers médicaux des 146 patients ayant subi une myomectomie abdominale au cours de la période considérée ont été récupérés et les données pertinentes extraites. Les informations recueillies comprenaient la présence ou l'absence d'adhérences intra-abdominales, la durée d'utilisation du garrot, le nombre et le poids des plantules de fibromes énucléés, la perte de sang peropératoire, les complications et le nombre de patientes ayant obtenu une grossesse après myomectomie. Les données ont été analysées à l'aide du progiciel statistique ANALYZE IT®. RÉSULTATS: 146 patients ont subi une myomectomie au cours de la période sous revue. La tranche d'âge des patients était de 28 à 56 ans (médiane de 41 ans). Presque toutes les patientes (94,5%) avaient des garrots appliqués sur l'utérus pour l'hémostase. Le nombre de fibromes énucléés variait de 1 à 154 et pesait entre 0,02 et 2,8 kg. La perte de sang variait de 100 à 1500 ml, 17,4 % avaient de la fièvre postopératoire et un patient avait une lésion intestinale. Trente et une patientes (32,3%) qui ont eu par la suite un traitement de fécondation in vitro ont réussi à concevoir. CONCLUSION: Les fibromes, pesant > 0,5 kg, sont associés à une augmentation des pertes sanguines lors de la myomectomie abdominale, et une myomectomie antérieure augmente significativement le risque d'adhérences. Une sélection minutieuse des patientes et des techniques chirurgicales méticuleuses sont nécessaires pour éviter la morbidité dans ce contexte avec un taux élevé de fibromes utérins volumineux. MOTS CLÉS: fibrome, myomectomie abdominale, mesures des résultats.

Awareness and Utilization: Prevention of Mother-to-Child Transmission (PMTCT) Services among Primigravid Women attending Primary Health Care Facilities in Zaria, North-Western Nigeria.

BACKGROUND: Nigeria with an estimated population of 193 million is Second to South Africa in the number of people living with Human Immune Deficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) worldwide, representing 9% of the global burden of the disease. The objective of this study is to determine the awareness, knowledge and utilization of PMTCT services before first pregnancy in the study population, which is a critical prong 1 PMTCT strategy to prevent and control the vertical transmission of this pandemic infection. METHODS: An analytical cross-sectional study conducted in February-April 2016 among 300 Primigravid women selected by the cluster sampling technique from six Primary Health Care (PHC) facilities that offered PMTCT services out of a list of 25 PHC facilities in Zaria LGA at the time of the survey. Data were collected using interviewer administered, closed ended questionnaire. Bivariate and multivariate logistic regression analyses were done using the IBM SPSS version 20 and the Stata Corp STATA SE 14 to determine variables that were significantly associated with respondents' utilization of the PMTCT services. The level of significance was set at p<0.05. RESULTS: The mean age of the respondents and mean gestational age at booking were 21.1+3.54 years and 21.68 + 6.74 weeks, respectively. One-fifth of the respondents were not aware of any HIV preventive method, 81(27%) did not know that HIV can be transmitted from the mother to the fetus, 83 (27.7%) believed that transmission was by witchcraft, while 76%, 64% and 45% opined that use of condom, faithfulness to an HIV negative sexual partner and abstinence respectively were protective measures. Only 62(20.7%) were ever tested for HIV infection and 7(2.3%) of these were HIV positive. There were significant association between respondent age, awareness, perception and knowledge of MTCT, gestational age at booking, family setting and the prior utilization of PMTCT services (p<0.05). CONCLUSION: The awareness and utilization of PMTCT services before pregnancy was poor. There was a need to scale up programmes to improve the uptake of PMTCT services before pregnancy toward attaining the sustainable development goal 3.3.

Calabash pregnancy: a malingering response to infertility complicated by domestic violence.

This is a case report of a 20-year old para 0+0 who presented with an 11-month pregnancy. On evaluation, the pregnancy was found to be a fake made-up 'calabash pregnancy'. There were no pregnancy symptoms and she had just menstruated three weeks prior to presentation. This was a deliberate event in response to delayed pregnancy attainment complicated by domestic violence. Domestic violence was in the form of verbal and physical abuse and later was on a monthly basis precipitated by onset of her menstrual flow. The patient's age, monogamous union and the fact that she is an orphan made her vulnerable to domestic violence.

Calabash pregnancy: a malingering response to infertility complicated by domestic violence / Embarazo de calabaza: una respuesta de fingimiento a la infertilidad complicada con violencia doméstica

This is a case report of a 20-year old para 0+0 who presented with an 11-month pregnancy. On evaluation, the pregnancy was found to be a fake made-up 'calabash pregnancy There were no pregnancy symptoms and she had just menstruated three weeks prior to presentation. This was a deliberate event in response to delayed pregnancy attainment complicated by domestic violence. Domestic violence was in the form of verbal and physical abuse and later was on a monthly basis precipitated by onset of her menstrual flow. The patient's age, monogamous union and the fact that she is an orphan made her vulnerable to domestic violence.

Éste es un reporte de caso de una para 0 + 0 de 20 anos de edad, que se presentó con un embarazo de 11 meses. En la evaluación, se encontró que se trataba de un embarazo de calabaza, es decir, inventado, fingido. En realidad, no había ningún síntoma de embarazo, y había tenido la menstruación tres semanas antes de presentarse. Se trataba de un acontecimiento deliberadamente construido, en respuesta a una largamente demorada expectativa de lograr un embarazo, complicada con violencia doméstica. La violencia doméstica seproducía enforma de abuso verbalyfísico, precipitándose luego mensualmente con la aparición de cadaflujo menstrual. La edad de los pacientes, la unión monógama, y el hecho de que era huérfana, la hacía vulnerable a la violencia doméstica.

Burden and characteristics of domestic violence among males in a sub Saharan African setting.

BACKGROUND: Domestic violence has been a subject of interest worldwide. However, most studies document men as the culprits with little attention given to male victims. This study sought to find out the prevalence and characteristics of domestic violence experienced by men in a sub Saharan African setting. METHOD: This was a cross sectional study using questionnaires administered to 410 men aged 20 - >60 years. RESULTS: Two hundred and twenty-seven (55.4%) of the men have ever experienced domestic violence, and 82.4% of them were verbally and emotionally abused. In 49.8% cases the culprit was their wife/wives, while in others a girlfriend 33 (14.5%) or a mother-in law (11.5%) was responsible. In 90 (39.6%) men, their own parents were also verbally abused by the culprit. Thirty (13.2%) of the 227 men who had experienced abuse were physically abused. Victims usually report the abuse to a third party, mostly to family members. Men aged above 40 years and those educated below tertiary level were more likely to experience domestic violence (p = 0.0001 and 0.014). CONCLUSION: Men are also victims of domestic violence in this setting, but the violence is mostly verbal and psychological in nature. There is need to provide support services for male victims of domestic violence and also encourage them to report their experience of domestic violence in order to obtain help and assistance.

Obstetric outcome in pregnant women subjected to domestic violence.

OBJECTIVE: To determine the prevalence of domestic violence and its relationship to adverse obstetric outcomes amongst pregnant women who deliver at a tertiary level hospital in Zaria, Nigeria. METHOD: A cross-sectional study involving 310 women who delivered at the labour ward. Questionnaires were administered to parturient women. Details of their socio-demographic characteristics and obstetric outcome were compiled and the relationship to experiences of domestic violence studied. RESULTS: The prevalence of domestic violence was 28.4%. There was positive relationship between domestic violence during pregnancy, non-supervision of pregnancy and poor attendances to antenatal clinic (p<0.05). There was however, no statistically significant relationship between domestic violence, and complications of labour and neonatal outcome (p>0.05). CONCLUSION: The prevalence of domestic violence in pregnancy is high in this environment. Poor attendances to the antenatal clinic is a significant association.

Reproductive health in Nigeria.

BACKGROUND: Adolescents have special reproductive health needs, but these peculiar needs are often unmet in many cultures and countries. METHODS: A cross-sectional study involving adolescents in three secondary schools in a northern Nigerian setting. Demographic characteristics as well as reproductive health issues (adolescent sex, abortion, sexual experience) among the students were surveyed. RESULTS: Of the 1070 students that fully participated in the survey, 539 (50.4%) were girls and 531 (49.6%) boys. They were aged 10 - 27 years (median 16 Years). Five hundred forty three (50.7%) were Christians and 499 (46.6%) Muslims. Nine hundred and four (84.5%) of the students knew about abortion. On their view about reasons why adolescents indulge in premarital sex, 574 (53.6%) felt it was to please boyfriend/girlfriend, 391 (36.5%) to experiment with sex, 312 (29.6%) to test fertility and 239 (22.3%) felt it was to stop painful menstruation. One hundred thirty five (12.6%) have had sex and 15 - 19 years age group were more likely to be sexually active. Twelve (1.1%) of the girls had been pregnant once - four times before and all had an abortion. Children of civil servants were significantly more likely to be sexually active compared to other groups of children (p <0.05). All the respondents knew one or more complication of abortion to include inability to get pregnant in future 682 (63.7%), abdominal pain 589 (55%) and painful menstruation 427 (39.9%). CONCLUSION: Adolescents are unique in every way including issues of reproductive health. The age at sexual debut in this setting is early. There is a need to include reproductive health education in the curriculum of secondary schools. This should help the adolescents to obtain the correct information from the right source.

Timing of passage of first meconium and stooling pattern in normal Nigerian newborns.

BACKGROUND: The time of passing meconium and the subsequent stooling pattern is an important marker in the diagnosis of colonic motility problems in newborns, particularly in Hirschsprung's disease (HD). METHOD: A cross-sectional study of the passage of meconium and stooling pattern in 280 normal newborns was undertaken using questionnaires administered to mothers attending a postnatal clinic. RESULTS: There were 143 boys and 137 girls aged 6-49 days (median 19 days); 266 (95%) had been full-term infants, 252 (90%) normal deliveries and 28 (10%) delivered by caesarean section. The birthweight of 25 (9%) had been <2.5 kg. Of 267 infants whose mothers knew the time of first passing meconium, it had been delayed for up to 48 hours in 45 (16.9%) and up to 72 hours in 15 (5.6%), and six (2.2%) passed meconium after 72 hours. Overall, 201 (75.3%) passed meconium within 24 hours of birth, 246 (92.1%) within 48 hours and 261 (97.8%) within 72 hours. Irrespective of the time of passing meconium, 80 (31%) infants continued to pass stools at least once daily, 107 (42%) twice daily and 65 (24%) three or more times daily. Only 11 infants were on artificial milk along with breast milk; the remainder were exclusively breastfed. Mode of delivery, birthweight and artificial milk had no effect on time of passing meconium and the subsequent stooling pattern. CONCLUSION: This study has shown that only 76% of normal infants passed first meconium within 24 hours and, by 3 days of life, a small minority still had not passed meconium. Nearly all normal infants being breastfed should defaecate at least once daily. These findings should be useful in the evaluation of newborns suspected to have HD in this and similar settings.

Risk scoring for domestic violence in pregnancy.

BACKGROUND: Most studies and work on domestic violence against women are aimed at helping victims, Studies aimed at detecting those at risk of domestic violence are few. Risk identification has important implications for early detection and prevention. METHODS: A risk scoring tool was developed and tested on 466 antenatal clinic attendees at 3 levels of health care in Zaria, Nigeria. RESULTS: The prevalence of domestic violence was 11.8%. The sensitivity of the tool was 96.6% and specificity 11.8%. The positive predictive value and accuracy were 13.7% and 22.5% respectively. CONCLUSIONS: The tool has a high sensitivity and could be a good screening tool for identifying those at risk for domestic violence in pregnancy.

Contraceptive choices among women in Zaria, Nigeria.

AIMS/OBJECTIVE: To study the choice of contraceptive usage and the factors responsible for such choices in northern Nigeria. DESIGN: A cross-sectional study. SETTING: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. SUBJECTS: New clients attending the reproductive health centre. MAIN OUTCOME MEASURES: Choice of contraceptive, reason for choice, knowledge and source of knowledge about contraceptives. RESULTS: Four hundred and eighteen clients were interviewed. Three hundred and seventy two (89%) knew at least one method of contraception; 50.7% used injectable contraceptives, 22.5% intrauterine contraceptive devices, 13.9% Norplant and 10.3% oral contraceptive pills. One hundred and forty four (34.5%) were referred by midwives and 25.6% by other nurses. CONCLUSIONS: The most commonly used contraceptive in our environment is the injectable method.

Burden of domestic violence amongst infertile women attending infertility clinics in Nigeria.

BACKGROUND: Infertility affects about 20% or more of the population. Infertility can lead to domestic violence and any woman who experiences domestic violence because of infertility, has a double jeopardy. METHODS: This was a cross-sectional study involving 233 infertile women attending infertility clinics in 3 hospitals in Nigeria overa period of 12 months. RESULTS: Ninety seven (41.6%) of the women had experienced domestic violence because of their infertility state. The forms of domestic violence experienced were psychological torture 50 (51.5%), verbal abuse 38 (39.2%), ridicule 27 (27.8%), physical abuse 17 (17.5%) and deprivation 6 (6.2%). The main culprits were the husband 47 (48.5%) and female in-laws 31 (32%). Yoruba women were more likely to experience domestic violence than other tribes, although this difference did not reach statistical significance ( p > 0.05.) Educational level, parity, type of marriage and duration of infertility were not statistically significant (p > 0.05). CONCLUSION: In this setting, infertile women are prone to domestic violence. Prompt evaluation, counselling of the couple, as well as early treatment and prevention of infertility is necessary to avoid the problem and domestic violence. This should form part of efforts to meet the millennium development goals.

Herniated gravid uterus: clinical course and result of treatment.

Herniated gravid uterus in an incisional hernia of the anterior abdominal wall is relatively rare. A 30-year-old house wife presented with a six month gravid uterus that had herniated through an incisional hernia of the anterior abdominal wall. She had non-operative management till term, when she then had elective lower caesarian section. Physiotherapy of the anterior abdominal wall muscles to improve their tone was done. She subsequently had keel's repair of the hernia. Aggressive physiotherapy of the anterior abdominal wall muscles followed by keel's repair may be an alternative surgical technique in patients with a moderate defect of incisional hernia.

Tubal ectopic pregnancy after bilateral tubal ligation: A case report.

BACKGROUND: Tubal ligation is a common method of contraception, and pregnancy after this method of sterilization is uncommon. We here present a report of Tubal pregnancy after a Bilateral Tubal Ligation (BTL). METHOD: The case notes of a 35 year Nigerian female who presented with a tubal pregnancy after BTL and a review of literature on the subject was used. RESULT: A 35-year-old para 4=0 had bilateral tubal ligation during caesarean section for her last childbirth. She presented 3 years later with a six weeks history of irregular vaginal bleeding and lower abdominal pain and had a laparotomy for a right tubal ectopic pregnancy. CONCLUSION: Ectopic pregnancy after bilateral tubal ligation is uncommon. Females who undergo BTL should be adequately counseled on the possibility of failure of this procedure for contraception.