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.

Comparison of IVF/ICSI outcome in patients with polycystic ovarian syndrome or tubal factor infertility.

BACKGROUND: One of the recognized treatment options for patients with polycystic ovarian syndrome (PCOS) is in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Fears are however sometimes raised concerning the likely outcome of treatment in such patients compared with their counterparts with tubal factor infertility. OBJECTIVE: To compare the IVF/ICSI performance in women with PCOS and those with tubal factor infertility. MATERIALS AND METHODS: A retrospective analysis. Case notes of 30 patients, 35 years and below, with PCOS and who underwent 33 IVF/ICSI cycles and those of 42 age-controlled patients with tubal factor infertility and who had 43 cycles between December 2004 and April 2008 were retrieved. Data including duration of down-regulation, dose of human Menopausal Gonadotropin (hMG), number of cancelled treatments, endometrial thickness, number of oocytes retrieved and fertilization rate, in addition to the number of embryos transferred with resultant pregnancy outcome were compared between the two groups. The main outcome measures were response to gonadotropin stimulation, fertilization rate and clinical pregnancy rate. RESULTS: There was no significant difference between the PCOS group and the tubal factor infertility group in the hMG dose (2.7 vs. 3.4 vials, respectively), endometrial thickness (10.5 vs. 10.1 mm, respectively) and embryos transferred (3.1 vs. 2.9, respectively). The fertilization rate was significantly higher in the tubal factor infertility group, which was 81.48% as against 63.24% for the PCOS group ( P < 0.0001). While more cases of ovarian hyperstimulation syndrome (OHSS) occurred in the PCOS group ( P = 0.049), overall clinical pregnancy rate per embryo transfer was similar (45.45% vs. 42.85%; P = 1), with similar miscarriage rates. CONCLUSION: IVF/ICSI performance in patients with PCOS is probably similar to their counterparts with tubal factor infertility with, however, a reduced fertilization rate and higher incidence of OHSS.

Patients' preference for number of embryos transferred during IVF/ICSI: a Nigerian experience.

BACKGROUND: The Human Fertilization and Embryology Authority is considering limiting the number of embryos that can be transferred to single embryo per cycle as has been done in several European countries, with the aim of reducing the rate of multiple pregnancies and its attendant complications following in vitro fertilization (IVF) / Intracytoplasmic sperm injection (ICSI). OBJECTIVE: To determine the number of embryos patients' attending a fertility clinic in Nigeria, would prefer transferred during IVF/ICSI. MATERIALS AND METHODS: Fifty four consecutive female patients who underwent IVF/ICSI procedures between May 2006 and April 2007 at the Port Harcourt Fertility Centre, Rivers State were interviewed using structured questionnaires. They were informed of all the obstetric and perinatal complications of multiple pregnancies and the advantages and trend towards single embryo transfer and then asked to choose the number of embryos (one, two or three) they would prefer transferred assuming similar implantation rates. Each respondent was allowed to give reason(s) for their choice. DESIGN: Prospective, descriptive study. RESULTS: Fifty one (94.4%) of the respondents preferred the transfer of multiple (2 or 3) embryos. Only three (5.6%) patients opted for single embryo transfer. Majority of the patients (31 or 60.8%) preferred multiple embryo transfer because of their desire for twins while twenty (39.2%) cited cost of IVF as their reason. Fifteen (29.4%) patients saw multiple pregnancies as a compensation for their long periods of infertility. CONCLUSION: With the desire for twins and high poverty level in Nigeria, a policy of single embryo transfer might be difficult to implement. Health economic studies would be required to determine if the accumulative cost of taking care of twins/triplets is less, equal or outweighs the cost of several single embryo transfers.

Patients' Preference for Number of Embryos Transferred During IVF/ICSI a Nigerian Experience

Background: The Human Fertilization and Embryology Authority is considering limiting the number of embryos that can be transferred to single embryo per cycle as has been done in several European countries; with the aim of reducing the rate of multiple pregnancies and its attendant complications following in vitro fertilization (IVF) / Intracytoplasmic sperm injection (ICSI). Objective: To determine the number of embryos patients' attending a fertility clinic in Nigeria; would prefer transferred during IVF/ICSI. Materials and Methods: Fifty four consecutive female patients who underwent IVF/ICSI procedures between May 2006 and April 2007 at the Port Harcourt Fertility Centre; Rivers State were interviewed using structured questionnaires. They were informed of all the obstetric and perinatal complications of multiple pregnancies and the advantages and trend towards single embryo transfer and then asked to choose the number of embryos (one; two or three) they would prefer transferred assuming similar implantation rates. Each respondent was allowed to give reason(s) for their choice. Design: Prospective; descriptive study. Results: Fifty one (94.4) of the respondents preferred the transfer of multiple (2 or 3) embryos. Only three (5.6) patients opted for single embryo transfer. Majority of the patients (31 or 60.8) preferred multiple embryo transfer because of their desire for twins while twenty (39.2) cited cost of IVF as their reason. Fifteen (29.4) patients saw multiple pregnancies as a compensation for their long periods of infertility. Conclusion: With the desire for twins and high poverty level in Nigeria; a policy of single embryo transfer might be difficult to implement. Health economic studies would be required to determine if the accumulative cost of taking care of twins/triplets is less; equal or outweighs the cost of several single embryo transfers

Reverse engineering of pelvic bone for hip joint replacement.

Research into fabrication of hip joint replacements combines knowledge from distinct domains, such as engineering, materials and medical fields. Recent computer assisted technologies have played an important role in the medical field. Unlike the modelling of most of the human bones, the creation of an accurate 3D model of a pelvic bone has been a challenging task. The main source of difficulties in this case has proven to be the complexity of the structure of the pelvis, having basically a free-form shape with a hole in the middle constituting some over-shadowed areas (undercuts), various cavities, areas with high form curvature, variable wall thickness with some very thin sections and inside layers with different mechanical properties. In this research work, a pelvic bone is generated using reverse engineering, rapid prototyping and rapid tooling techniques. The geometric data obtained from reverse engineering through laser scanning are used and manipulated to create accurate 3D CAD representations of these devices. These CAD models can be used for various virtual tests and simulations, as well as for reproduction through rapid manufacturing processes and then used as prototypes in tooling, physical tests and planning of surgical operations.

The effect of endometrial thickness on in vitro fertilization (IVF)-embryo transfer/intracytoplasmic sperm injection (ICSI) outcome.

The value of measuring the endometrial thickness and studying the endometrial receptivity in the context of assisted conception remains a contentious issue. A prospective analysis was carried out to determine the effect of endometrial thickness on IVF - embryo transfer/ICSI outcome in dedicated Assisted Reproductive Technology (ART) units in Abuja and Rivers State, Nigeria. Two hundred and fifty one patients who met the inclusion criteria were analysed. They were grouped on the basis of endometrial thickness into 3 groups; <7 mm, 7 - 14 mm and >14 mm. The main outcome measure was clinical pregnancy. There were significantly more pregnancies in the 7 - 14 mm endometrial thickness group compared to the <7 mm and >14 mm groups, p=0.004 and p<0.0001 respectively. The findings suggest that following IVF/ICSI, significantly more pregnancies occurred when the endometrial thickness was between 7 and 14 mm.

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.

Cancer of the Cervix at the University of Benin Teaching Hospital (UBTH); Benin City; Nigeria; in the Last Decade of the Last Millennium

Objective: To evaluate the incidence and clinical presentation of cervical cancer in a Nigerian tertiary health institution. Methods: A review of retrieved retrospective data relating to patients managed for cancer of the cervix at the University of Benin Teaching Hospital (UBTH); Benin City between January 1991 and December; 2000 was done and is presented as frequency tables. Results: Cancer of the cervix constituted 72.9of all gynaecological malignancies seen at the University of Benin Teaching Hospital (UBTH) and accounted for 4.8of all new gynaecological admissions. The mean age at presentation was 49.1+5.7 years; with a peak age of 41 years to 50 years. Commonest presenting feature was abnormal vaginal bleeding while the modal stage at presentation was IIIB. The squamous cell variety was commonly encountered. Conclusion: Cancer of the cervix is of Public health importance in Benin City; Nigeria. Late presentations render curative protocols ineffective. Public enlightenment targeting sexually active women in the lower socio economic strata to boost uptake of screening services should be undertaken

Socio-cultural barriers to voluntary blood donation for obstetric use in a rural Nigerian village.

Availability of blood for transfusion is of utmost importance in the fight against maternal morbidity and mortality. This study was conducted to identify the socio-demographic characteristics and reasons of persons declining voluntary blood donation. Patients' relatives declining blood donation in rural Ebonyi State were randomly recruited and interviewed using standardised questionnaire after obtaining informed consent from each of them. Responses were ranked according to frequency of positive respondents. Illiteracy was prevalent among the population: over 76% had no formal education. 'Not being strong enough' and 'not having enough blood' were the two major reasons for declining blood donation, while loss of manhood/libido and exposure of blood to witchcraft were the other reasons given. Respondents' level of awareness of HIV/AIDS was appreciable. Socio-cultural barriers to voluntary blood donation exist in predominantly illiterate rural communities of the country. Most of the reasons given were based on misconception, misinformation and ignorance about the effect and safety of blood donation.

Maternal and fetal outcome in eclamptic patients in Benin City, Nigeria.

Eclampsia is a well-recognised major cause of maternal death and perinatal morbidity and mortality. The incidence of eclampsia, its presentation patterns, maternal and perinatal outcomes were investigated in a retrospective study conducted at the University of Benin Teaching Hospital, Nigeria over an 8-year period, 1995 - 2002. There were 103 cases of eclampsia of 7835 deliveries, giving an incidence of one in 76 (1.32%). The mean age of the women was 27.1 +/- 5.6 years. Eclampsia significantly (P < 0.001) occurred in nulliparous and unbooked mothers. Eighty-nine (86.4%) of the patients developed fits in the predelivery stage; 85 (83%) of the patients had at least one premonitory symptom including headache (82.4%) visual disturbance (10.6%) and epigastric pain (7%). There were nine stillbirths and 16 early neonatal deaths for a perinatal mortality rate of 214/1000. The major causes of perinatal mortality were prematurity and birth asphyxia. Eleven maternal deaths occurred with a maternal case fatality rate of 10.7% and a maternal mortality ratio from eclampsia of 140/100 000. The clinical causes of deaths were cardiopulmonary failure, acute renal failure, haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and cerebrovascular accident. Timely referral of high-risk patients coupled with availability of emergency obstetric and neonatal care services would reduce the incidence eclampsia associated mortality and morbidity in our facility.