Effects of speculum lubrication on cervical smears for cervical cancer screening: A double blind randomized clinical trial.

BACKGROUND: Speculum lubrication may help to reduce the pain experienced during Pap-smear collection and hence increase uptake of cervical cancer screening and repeat testing, but there are fears of its interference with cytological results. AIM: To determine and compare the adequacy of cervical cytology smears and the mean pain scores of women undergoing cervical cancer screening with or without speculum lubrication. METHODS: This was a randomised controlled study of 132 women having cervical cancer screening at a tertiary hospital in Nigeria. Sixty-six participants were randomly assigned to the 'Gel' and 'No Gel' groups, respectively. Pap smears were collected from each participant with a lubricated speculum ('Gel group') or a non-lubricated speculum ('No Gel group'). The primary outcome measures were the proportion of women with unsatisfactory cervical cytology smears and the mean numeric rating scale pain scores, while the secondary outcome measures were the proportion of women who were willing to come for repeat testing and the cytological diagnosis of Pap-smear results. RESULTS: The baseline socio-demographic variables were similar in both groups. There was no significant difference in the proportion of unsatisfactory cervical smear results between the two groups (13.6% vs. 21.2%, p = 0.359). However, the mean pain scores were significantly lower in the gel group than in the no gel group (45.04 vs. 87.96; p<0.001). An equal proportion of the participants in each group (90.9% vs. 90.9%; p > 0.999) were willing to come for repeat cervical smears in the future. CONCLUSION: Speculum lubrication did not affect the adequacy of cervical smears but significantly reduced the pain experienced during pap smear collection. Also, it did not significantly affect the willingness to come for repeat cervical smears in the future. TRIAL REGISTRATION: The trial was registered with the Pan-African Clinical Trial Registry with a unique identification and registration number: PACTR2020077533364675.

Emerging Predictors of Obstructed Labour in a Single Nigerian Centre Population of a Low Resource Setting.

Background and Objective: Despite the stigma attached to obstructed labour in Nigeria, it has remained largely uninvestigated. Study determined the prevalence, emerging predictors, management modalities and complications of obstructed labour, compare them with cases without obstructed labour who delivered within the same period. Materials and Methods: A retrospective study and case-controlled analysis of obstructed labour managed at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria were undertaken. One control per case was randomly selected from the remaining births by selecting the non-obstructed labour cases. Bivariate analysis was performed by the Chi-squared test and conditional logistic regression analysis was used to determine variables associated with obstructed labour. Statistical significance was accepted when the p<0.05. Results: Of all the 5,301 deliveries during the study period, 80 cases of obstructed labour were recorded, giving a prevalence of 1.5%. Only 73 case files were available with complete information for the study's further analysis. A conditional logistic regression analysis, the risk factors were teenage pregnancy (p<0.001, Adjusted Odds Ratio (AOR):5.43, 95% Confidence Interval (CI):1.20-8.05), unbooked status (p<0.001, AOR:0.01, 95%CI:0.00-0.02), nulliparity (p<0.001, AOR:4.15, 95%CI:2.42-7.25), short stature (p<0.001, AOR:44.74, 95%CI:19.51-113.53) and birth weight (p<0.001, AOR:4.52, 95%CI:2.69-7.71). The case fatality rate was 5.5% and the perinatal mortality rate was 21.9%. Conclusion: Majority obstructed labour have high maternal morbidity and perinatal mortality.

Tuboperitoneal anomalies among infertile women in Nigeria as seen on laparoscopy.

OBJECTIVE: To study the prevalence and pattern of tuboperitoneal pathologies among infertile women in Nigeria, using laparoscopy. METHODS: A prospective study was undertaken of infertile women who underwent diagnostic laparoscopy in two fertility clinics in Nigeria between November 2015 and April 2017. The rates of identified tuboperitoneal diseases were examined. RESULTS: The age of the 230 women ranged from 21 to 46 years, and most women had a parity group of 0-1 (87.8%; n=202). Secondary infertility accounted for 124 (53.9%) cases, and the mean duration of infertility was 4.6 ± 2.7 years. Tuboperitoneal pathologies were seen in 171 (74.4%) women and mainly comprised tubal occlusion (56.5%; n=130), hydrosalpinx (41.7%; n=96), pelvic adhesions (39.6%, n=91), and endometriosis (8.8%; n=19). Bilateral tubal occlusion was seen in 46 (20.0%) women, whereas proximal tubal occlusion accounted for 73 (56.2%) of all cases of tubal occlusion. CONCLUSION: There was a high rate of tuboperitoneal abnormalities in the studied population, which mainly comprised tubal occlusion, hydrosalpinx, pelvic adhesions, and endometriosis. The introduction of laparoscopy is recommended in the initial evaluation of all women with infertility in Nigeria.

Highly active antiretroviral therapy and cervical cytologic abnormalities among women with HIV infection in a limited-resource setting.

OBJECTIVE: To examine the relationship between highly active antiretroviral therapy (HAART) and cervical cytologic abnormalities among women with HIV infection. METHODS: A cross-sectional prospective study was undertaken of 110 women attending an HIV clinic in Nnewi, Nigeria, between January 2016 and January 2017. A cervical smear was obtained. A bivariate analysis was undertaken, and multiple logistic regression models were used to identify factors independently associated with cervical cytologic analysis. RESULTS: Cervical cytologic abnormalities were identified in 31 (28.2%) participants. On bivariate analysis, use of HAART for 2-5 years was associated with a reduction in the risk of cervical cytologic abnormalities (P=0.033), and this risk was further reduced when HAART was taken for more than 5 years (P<0.001). Other factors that significantly reduced risk of cervical cytologic abnormalities included a CD4 count of 300 cells per mL or more (P<0.001), age 30 years or older (P<0.001), and time since HIV diagnosis of more than 5 years (P=0.021). On multivariate analysis, risk of cervical cytologic abnormalities among the women were significantly reduced by use of HAART for more than 5 years (P=0.032) and CD4 count of 300 cells per mL or more (P<0.001). CONCLUSION: Long-term use of HAART and CD4 count of 300 cells per mL or more were associated with a reduced risk of cervical cytologic abnormalities.

Audit of operative hysteroscopies among infertile women in a resource-poor setting.

OBJECTIVE: To evaluate the operative hysteroscopy procedures performed among infertile women at two hospitals in Nigeria. METHODS: A prospective case series was undertaken among all patients with infertility who underwent operative hysteroscopy between November 2015 and April 2017. The outcome measures included the frequency and type of operative hysteroscopy and the reproductive outcome. RESULTS: The series included 159 women, 70.4% (n=112) of whom had abnormal findings at hysteroscopy. A total of 162 operative hysteroscopic procedures were performed; the most common procedures were adhesiolysis (76 [46.9%]), polypectomy (28 [17.3%]), and septum resection/incision (17 [10.5%]). The instruments used were mainly scissors (65 [40.1%]) and a resectoscope (52 [32.1%]). Complete removal of the lesions was achieved in 86.4% (n=140) of the procedures and a normal cavity in 87.0% (n=141). The complication rate was 6.8% (n=11); the most common complication was minor hemorrhage (5 [3.1%]). The main challenges included poor distention (10 [6.2%]) and poor vision (8 [4.9%]). Menstrual normalization was achieved in 64 (40.3%) of the patients, the cumulative pregnancy rate was 19.5% (n=31), and the live birth rate was 3.8% (n=6). CONCLUSION: Operative hysteroscopy was feasible and safe in the present resource-poor region. There is a need to build capacity for the performance of hysteroscopy to facilitate the management of infertility in the region.