ABSTRACT
BACKGROUND: Cervical cancer is the most common genital tract malignancy in the developing countries of the world. Interestingly, it has a pre-invasive stage, which can be detected through screening. The etiological organism of the disease is the human papilloma virus (HPV) that is sexually transmitted and sexually transmitted infections play a major role in the causation of infertility in developing countries. AIM: The aim of this study is to determine the prevalence of abnormal cervical smear among infertile women at Usmanu Dan-Fodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria. MATERIALS AND METHODS: This is a cross-sectional study involving the assessment of cervical smears taken from infertile women attending the gynecological out-patient clinic of UDUTH sokoto over a 12-month period. cross-sectional study involving the assessment of the cervical smears taken from infertile women attending the gynecological out-patient clinic of UDUTH Sokoto over a 12-month period. Statistical analysis of the results was carried out using the EPI-INFO 3.5.1 (CDC, Atlanta Georgia, USA). Chi square test was used for association at p-value< 0.05 at 95 % confidence interval. RESULTS: A total of 162 patients were screened during the study period. Their ages ranged from 15 to 46 years with a mean of 27.9 (6.2) years and modal age of 25-34 years. Majority of the subjects 88/159 (55.4%) were in the lower socio-economic class and 75/159 (47.2%) of the women were nullipara. Out of the 159 subjects with adequate smears, 58/159 (36.8%) were normal while 44/159 (27.8%) had inflammatory lesions. Cervical intraepithelial lesions were observed in 18/159 (11.3%) of the smears while 25 (15.7%) had evidence of HPV infection. CONCLUSIONS: Considering the relatively high incidence 18/159 (11.3%) of cervical intraepithelial lesions seen among the subjects, there is the need to integrate cervical smear in the general infertility work-up.
ABSTRACT
BACKGROUND: Caesarean Delivery on Maternal Request (CDMR) is increasingly seen as a viable option to vaginal delivery even in the absence of medical or obstetric contraindications to vaginal delivery. MATERIAL AND METHODS: Self administered questionnaires were instituted to Senior Consultant Obstetricians attending the examiners' meeting of the faculty of obstetrics and gynaecology of the West African College of Surgeon in Ibadan, Nigeria on 17(th) April, 2013 and 23(th) October, 2013. This was to assess their experience and attitudes toward CDMR. The data were analysed with SPSS version 16.0 RESULTS: The majority of the consultants, 94.4%(85/90) have had antenatal client(s) ask for CDMR and 81.2%(69/85) of them have operated on at least a patient for CDMR. The reasons for the CDMR were: precious pregnancy/infertility, previous traumatic delivery and to avoid the stress of labour in 33%, 20.7% and 16.2% respectively. Eighty percent(68/85) consultants have counseled the women but only 11.8%(10/85) of them have had their patients change their minds and opted for vaginal delivery. Eighty eight(97.8%) of the obstetricians sampled are aware of the FIGO stand on Caesarean section however, 80(88.9%) of them opined that it is important to accommodate the feelings of the women and offer CDMR for the respect of the patient's autonomy. CONCLUSION: There are cases of CDMR in the West African sub region and increasing willingness of the consultants to oblige to the request. There is need to develop a treatment guidelines/protocols for CDMR that will suit our environment in order to avoid over burdening of the limited health resources.
ABSTRACT
BACKGROUND: Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality. OBJECTIVES: This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto. MATERIALS AND METHODS: This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the χ(2) test was used to analyze some of the results with the confidence limit set at 95%. RESULTS: During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively. CONCLUSION: The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.