Diagnosis of fallopian tube patency.

OBJECTIVES: To evaluate and compare the diagnostic value of hysterosalpingography (HSG) and laparoscopic chromopertubation (LCP), in the diagnosis of fallopian tube patency. DESIGN: A comparative prospective study. SETTING: The infertility clinic of the Department of Obstetrics and Gynaecology, Ga-Rankuwa hospital (Medical University of Southern Africa), Pretoria, South Africa. SUBJECTS: Fifty patients were initially diagnosed with either unilateral or bilateral tubal block using HSG. Six to eight weeks later the same women were subjected to LCP to assess tubal patency. MAIN OUTCOME MEASURES: Diagnostic accuracy of HSG to establish tubal patency, site of occlusion and the presence of other pathologies was compared with results obtained after laparoscopic chromopertubation (LCP). RESULTS: Hysterosalpingography diagnosed bilateral proximal, bilateral distal and mixed (i.e. one side proximal and the other distal) tubal occlusion in 15(40.5%); 13(35.1%) and five (13.5%) cases respectively. Diagnostic laparoscopy confirmed the above sites of occlusion in nine (24.3%), 71(45.9%) and three (8.1%) cases. Laparoscopy detected bilateral tubal patience in three (8.1%) patients, in whom HSG had diagnosed tubal occlusion. USG was able to detect peritubal Adhesion in only four (10.8%) patients as compared with 11 patients when LCP procedure was used. In comparison with HCP, hysterosalpingography demonstrated 70% specificity for accurately diagnosing proximal tubal occlusion. CONCLUSION: On a comparative scale, HSG demonstrated reduced positive predictive value especially for bilateral proximal tubal occlusion. However, in spite of its relatively limited value for accurately identifying tubal patency, HSG should still serve as a useful primary investigation.

Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra-uterine foetal death.

OBJECTIVE: To compare the efficacy of vaginal and oral misoprostol for the induction of labour in women with intra-uterine foetal death (IUFD). DESIGN: A prospective randomised clinical trial, comparing 200 microg oral and 200 microg vaginal misoprostol, six hourly for a maximum of four doses for the induction of labour in women with IUFD. SETTING: Ga-Rankuwa hospital (Department of Obstetrics and Gynaecology), Pretoria, South Africa. It is a tertiary institution serving predominantly black indigenous population. MAIN OUTCOME MEASURES: The primary outcome measure was the induction to delivery time, and secondary outcome measures were the number of patients requiring augmentation with oxytocin and all complications were noted. RESULTS: Twenty women were randomised to the vaginal route and 18 to the oral route. The induction to delivery time was shorter with vaginal misoprostol (13.5 +/- 8.3 hrs) compared to oral misoprostol (21.4 +/- 13.9 hrs; p < 0.05). There was no significant difference in the amount of misoprostol needed to achieve successful induction in the two groups. More women (10/18) who received oral misoprostol required oxytocin augmentation to complete the induction of labour compared with 4/20 women in the vaginal group (p < 0.05; Odds Ratio 2.8; 95% Cl 1.36 - 4.24). There were no cases of failed induction. The systemic side effects (shivering, diarrhoea, vomiting and pyrexia) were more common with oral misoprostol (44.5%) compared to vaginal misoprostol (20%). This difference gives an overall Odds Ratio of 2.2 at 95% Cl of 1.6-2.8(p < 0.05). CONCLUSION: Vaginal misoprostol achieved successful induction of labour in women with IUFD in a shorter time than oral misoprostol with significantly less side effects.

Umbilical cord venous progesterone at term delivery in relation to mode of delivery.

OBJECTIVE: To determine whether the umbilical cord venous progesterone at term delivery is related to the mode of delivery. METHODS: Thirty-nine pregnant patients at term were divided into three groups: elective cesarean section (control), spontaneous vaginal delivery, and emergency cesarean section. Umbilical cord venous and maternal serum progesterone were measured by radioimmunoassay. Statistical analysis was carried out using Student's t-test, with the level of significance set at P < 0.05. RESULTS: Umbilical cord venous progesterone was significantly higher in babies delivered by emergency cesarean section (P < 0.001) and in those who had spontaneous vaginal delivery (P < 0.02), compared with the control group. Maternal serum progesterone concentrations showed no significant differences between the three groups. The Apgar scores of the stressed group of babies were significantly lower (P < 0.001). CONCLUSION: The findings demonstrate that the fetuses exposed to stress during labor produce higher progesterone secretion. This could be one possible way the fetus protects itself against the sequelae of hypoxia.

Discrepancies in sperm count using improved Neubauer, Makler, and Horwells counting chambers.

Semen analysis still remains an important diagnostic procedure in male infertility evaluation. For the purpose of standardization and uniformity in the interpretation of sperm count results, the accuracy of three different counting chambers (improved Neubauer (IMN), Makler, and Horwells) were evaluated. Semen samples produced by 50 men were analyzed with the three different counting chambers using World Health Organization guidelines. The overall precision values of sperm count were: IMN 9.7%, Makler 5.9%, and Horwells 7.1%. The mean sperm counts (+/- SEM) were 78.6 (+/- 10.1), 119.1 (+/- 14.1), and 211.5 (+/- 27.5) million spermatozoa/ml respectively. Statistically significant differences were revealed when the sperm count results obtained with the different counting chambers were compared, i.e., IMN vs Makler (P < 0.05), IMN vs Horwells (P < 0.001), and Makler vs Horwells (P < 0.01). The sperm count results obtained from the 50 samples were classified into four subgroups (A = 1-20, B = 21-50, C = 51-100, and D = > 100 million spermatozoa/ml) using IMN as a reference chamber. Errors reflected as progressively poor SEM of sperm count (A = 1.1, 3.2, 4.1; B = 3.0, 6.1, 12.4; C = 3.4, 17.0, 23.9; and D = 14.1, 21.3, 46.3) were observed for IMN, Makler, and Horwells counting chamber respectively in each group. This study revealed that inherent errors abound when different counting chambers are used for sperm count. While IMN gave the lowest sperm count, Horwells recorded the highest. Makler counting chamber gave midway values and conforms with recommendations in the literature about its accuracy.

Effects of Norplant contraceptive subdermal implants on serum lipids and lipoproteins.

A longitudinal, short-term study of women using NORPLANT (levonorgestrel implants) was conducted. Cholesterol content of the major lipoproteins along with total cholesterol and triglycerides were measured in fasting blood samples from 32 women volunteers. Results for lipids and lipoproteins determined 6 and 12 months post-NORPLANT insertion were compared with values obtained for samples taken just before implantation. Total serum triglycerides was significantly reduced (p < 0.01) from 1.14 +/- 0.44mmol/l (mean +/- SD) to 0.89 +/- 0.25mmol/l at six and to 0.89 +/- 0.34mmol/l at twelve months post-insertion. Serum total cholesterol was 3.97 +/- 0.53mmol/l at the time of insertion while at six and twelve months post-insertion, they were 3.65 +/- 0.49mmol/l and 3.56 +/- 0.71mmol/l, respectively. These changes in values from the time of insertion to twelve months, were statistically significant (P < 0.02). As regards lipoprotein fractions, high density lipoprotein-cholesterol (HDL-chol) exhibited statistically significant reduction (P < 0.001) from 1.38 +/- 0.34 mmol/l to 0.71 +/- 0.30 mmol/l (mean +/- SD) six months post-insertion. Although the value had improved to 1.14 +/- 0.38mmol/l by twelve months, the value was still significantly different from the pre-insertion value. The low density lipoprotein-cholesterol (LDL-chol) had a mean value (+/- SD) of 2.08 +/- 0.45 mmol/l at the time of insertion. This was significantly elevated (P < 0.001) at six months to 2.54 +/- 0.48mmol/l (mean +/- SD). The twelve-month post-insertion value of LDL-chol (2.02 +/- 0.79) was similar to the pre-insertion value. The shift in HDL-cholesterol and LDL-cholesterol within six months followed by a virtual return to the pre-insertion values may represent only a transient change in metabolism of lipids and lipoproteins consequent upon NORPLANT contraception.

Sexually transmitted diseases and medico-social factors associated with male infertility in Nigeria.

Medico-social factors such as type of infertility, sexually transmitted diseases (STD), drug abuse, erectile dysfunction, divorce, and polygamy were evaluated among 64 infertile men (i.e. 32 oligo-asthenozoospermic and 32 azoospermic) and 23 men of proven fertility in Jos University Teaching Hospital, Jos, Nigeria. Of the 64 infertile men, 27 (42%) and 37 (58%) had primary and secondary infertility respectively. A history of STD, indicated by purulent urethral discharge, was recorded among 40 (63%) with 22 (55%) of this number having had repeated exposures to STD. While 17 (43%) of the infected infertile men were treated by qualified medical doctors, 23 (57%) either had self-medication or received treatment from quacks. Five (8%) of the 64 infertile men used hard drugs, 11 (17%) had erectile dysfunction, 15 (23%) were re-married due to broken marriage relationship or divorce, and 7 (11%) were polygamous. All the fertile men were monogamous with no history of either erectile dysfunction or usage of hard drugs. One (4%) of the fertile men had a history of a broken marriage relationships. Six (26%) had a history of STD with 5 (26%) of them having received treatment from qualified medical doctors. Although the study population is small, the results obtained in this study reveal higher incidences of STD, marital instability, and multiple marriage partnerships (polygamy) among infertile men than the fertile in Jos.

Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin.

One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria. All gonococcal strains were isolated from appropriate pre-treatment swabs. Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates. In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15%. Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit. Seventy-three (100%) patients showed clinical cure and elimination of N. gonorrhoeae from the respective site of infection. Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females. No adverse reactions were reported by any patient. Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Effects of oral contraceptive pills on serum lipoproteins and triglycerides.

Possible effects of a combined oral contraceptive (femenal) on blood triglycerides and high-density-lipoprotein-cholesterol (HDL-Chol) were studied in 25 women who had opted for hormonal contraception. Total serum triglycerides of 64.60 +/- 12.39 mg/dl (mean +/- SD) obtained prior to the commencement of hormonal contraception, did not reveal any statistical difference from the value of 65.49 +/- 7.96 mg/dl obtained after 9 months contraception. Similarly, precontraception HDL-Chol value of 58.05 +/- 6.58 mg/dl was also not statistically different from the treatment value of 58.82 +/- 5.42 mg/dl. Regression analysis of the values between control (precontraception) and treatment (9 months contraception) showed high correlation coefficients: (1) serum triglycerides, R2 = 0.5201; P less than 0.001; (2) serum HDL-Chol, R2 = 0.6590; P less than 0.001. Both the mean body weight and blood pressure of the study subjects remained unchanged after 9 months continuous use of femenal for contraception.

Determination of gestational age by beta-subunit HCG measurement.

The accurate knowledge of gestational age is important in most Obstetric decisions near term. Gestational age estimation by a single measurement of beta-subunit HCG in early pregnancy was assessed in 164 Nigerian Women attending the antenatal clinic of Jos University Teaching Hospital. The mean difference between estimated gestational age by HCG concentrations and by recorded dates of last menstrual period was 2.8 +/- 1.6 days (mean +/- SD). This relationship was valid only for samples randomly selected between 35 and 56 days of gestation. We conclude that single measurement of HCG in early pregnancy provides accurate estimation of gestational age.

Total phospholipid choline concentration of amniotic fluid in the assessment of foetal gestational and lung maturity. II. Correlation study.

Analysis of total phospholipid choline concentration was carried out on amniotic fluid samples obtained from 20 pregnant Nigerian women in established labour to determine the correlation of amniotic fluid phospholipid choline concentration with the gestational ages and maturity of the infants. There was a positive correlation between phospholipid choline concentration and gestational age. All infants whose gestational ages were estimated to be over 36 weeks had a total phospholipid concentration greater than 50 mumols/l. Four infants whose gestational ages were less than 36 weeks had total phospholipid choline concentration less than 30 mumols/l. None of these infants showed any evidence of Respiratory Distress Syndrome.

Levels of human chorionic gonadotropin in healthy pregnant Nigeria women.

Serum levels of human chorionic gonadotropin (hCG) were measured in venous blood samples of 100 healthy pregnant Nigerian women from weeks 5 to 40, using a batasubunit, hCG--specific radioimmunoassay. By week 5 hCG concentration was 3.39 +/- 2.35 Iu/ml (mean +/- SEM). An exponential rise occurred from week 5 to 8, during which period a direct relationship was observed between serum hCG levels and the gestational age (r2 = 0.996; p less than 0.001). The calculated mean doubling-time of hCG concentration, during this period of exponential increase was 5.08 days. A peak hCG concentration of 62.61 +/- 0.81 Iu/ml was attained at week 8, followed by a progressive decrease in concentration from week 9. The decrease in concentration reached a nadir by week 17 with a value of 4.77 +/- 2.48 Iu/ml. Between weeks 17 and 40 no significant difference in weekly mean values was detected. The respective mean values of hCG for the three trimesters were 25.79 Iu/ml for the first (n = 32), 8.91 Iu/ml for the second (n = 86) and 5.18 Iu/ml for the third (n = 110). There was no secondary peak of hcG concentration during the third trimester. The significance of these data is discussed.

Oestrone sulphate in plasma from postmenopausal women and the effects of oestrogen and androgen therapy.

The concentration of oestrone sulphate in peripheral plasma from postmenopausal women was investigated using a method which involved extraction of the conjugate, which was then hydrolysed with acid, and determination (by radioimmunoassay) of the purified oestrone fraction obtained. The concentration of unconjugated oestrone in the same plasma samples was also measured. Postmenopausal women had concentrations of oestrone sulphate in plasma (1.1 +/- 0.36 nmol/l, mean +/- SD, n = 39) similar to those found in women in the follicular phase of the menstrual cycle and less than those found in males (3.2 +/- 0.61 nmol/l, n = 21). The mean ratio of the concentration of oestrone sulphate to that of oestrone in plasma from postmenopausal women (7.9 +/- 3.3) was significantly lower (P less than 0.001, t test) than the mean ratio in men (19.8 +/- 3.8). Treatment with conjugated oestrogens, oestradiol in a cream, oestradiol valerate or ethinyl oestradiol, increased the concentration of oestrone sulphate in the peripheral circulation. In contrast, chronic corticosteroid therapy reduced the level of oestrone sulphate (0.5 +/- 0.11 nmol/l, n = 10) but this was partly restored (to 0.7 +/- 0.13 nmol/l) by concomitant oral dehydroepiandrosterone. Ingestion of piperazine oestrone sulphate (Harmogen, 1.5 mg) by three fasting postmenopausal women was followed 4 h later by oestrone sulphate concentrations five to ten times those found at midcycle.