Leaking Ectopic Pregnancy Following In vitro Fertilization with Associated Acute Appendicitis.

BACKGROUND: Ectopic pregnancy associated with appendicitis is rare, with very few cases reported in the literature. It is unclear if appendicitis is coincidentally associated with ectopic pregnancy or a possible risk factor for the development of ectopic pregnancy. Ruptured ectopic pregnancy has also been postulated as a possible risk factor leading to appendicitis because of the probable inflammatory reaction involving the adjacent appendix. METHODS: We present a 34-year-old female who presented with right lower abdominal pain and bleeding per vaginam, three weeks after in-vitro fertilization and embryo transfer. RESULTS: A diagnosis of ectopic pregnancy was made following a positive ß-HCG and empty uterine cavity on pelvic ultrasound scan. Intraoperatively, the appendix was noted to be inflammed and it was removed and confirmed on histology examination as acute appendicitis. CONCLUSION: Ruptured ectopic pregnancy associated with acute appendicitis is rare, with few cases reported in the literature. We recommend an examination for other possible differentials of ruptured ectopic pregnancy like appendicitis during surgery for ectopic pregnancy on the right side.

CONTEXTE: L'association de la grossesse extra-utérine avec l'appendicite est rare, avec très peu de cas rapportés dans la littérature. Il n'est pas clair si l'appendicite est associée de manière fortuite à la grossesse extra-utérine ou si elle constitue un facteur de risque possible pour le développement de celle-ci. On a également postulé que la grossesse extra-utérine rompue pourrait être un facteur de risque conduisant à l'appendicite en raison de la probable réaction inflammatoire impliquant l'appendice adjacent. MÉTHODES: Nous présentons le cas d'une femme de 34 ans qui s'est présentée avec une douleur abdominale basse à droite et des saignements vaginaux, trois semaines après une fécondation in vitro et un transfert d'embryon. RÉSULTATS: Un diagnostic de grossesse extra-utérine a été posé suite à un test de ß-HCG positif et une cavité utérine vide à l'échographie pelvienne. En peropératoire, l'appendice a été noté comme étant inflammé et a été retiré. L'examen histologique a confirmé une appendicite aiguë. CONCLUSION: La grossesse extra-utérine rompue associée à une appendicite aiguë est rare, avec quelques cas rapportés dans la littérature. Nous recommandons un examen pour d'autres diagnostics différentiels possibles de la grossesse extra-utérine rompue, comme l'appendicite, lors de la chirurgie pour grossesse extra-utérine du côté droit. MOTS CLÉS: Grossesse extra-utérine hémorragique, Appendicite, Fécondation in vitro, Laparotomie.

Ethical challenges in obstetric emergencies in low- and middle-income countries.

Obstetric emergencies are challenging, requiring implementation of a rapid sequence of interventions in a very short time to optimize clinical outcome. Managing obstetric emergencies could evoke ethical dilemmas for the obstetrician because of limited time to adequately educate the patient about her condition; impaired consciousness of the patient to give consent; nonexistent prior patient -doctor relationship and the need to consider both the patient and the fetus. In Low- and middle-income countries (LMICs), poor access to appropriate emergency care, structural and financial barriers and a largely uneducated and a deeply cultural population contribute to the ethical challenges. In this article we review key ethical issues in obstetric emergencies in LMICs such as informed consent, refusal of life saving treatment, confidentiality, disclosure of patient medical information and discharge against medical advice. The duties and responsibilities of the state to disadvantaged pregnant women and the ethical imperative of the obstetrician to provide care under these circumstances are discussed.

An Analysis of Caesarean Sections in a Community Cottage Hospital in Nigeria's Niger Delta Using The Robson Classification.

Background: The Robson ten group classification is recommended for classifying and comparing Caesarean Sections. This study aimed to review and classify all CS done at Obio Cottage hospital in 2018 using the Robson classification and to also identify areas of possible intervetions in reducing the CS rates. Methodology: A retrospective review of all caesarean sections at Obio Cottage hospital from January to December 2018 using the Robson classification. Results: The CS rate was 32.4%. Three groups - Groups 1 (27.% ), 2 (11.2%) and 5 (30.1%) contributed 68.5% to the overall CS rate. Group 8 had the least contribution to CS with 3.4%. Women in Robson group 3 had the lowest group CS rate of 6.86%, while the group CS rate for group 1, and 5.1 were 26.34% and 70.49% respectively. Conclusion: The CS rate of 32.4% is comparatively high. This analysis of the CS using the Robson classification system has revealed areas for further scrutiny and intervention. There is need to review the package of care provided to women in labour and increase the number of women offered a trial of labour after a Caesarean birth.

Evaluation of the use of a Whatsapp Forum for the Daily Clinical Case Review in Obstetrics and Gynaecology at a Teaching Hospital during the COVID-19 Pandemic.

Background: This study aimed to evaluate the use of a Whatsapp forum for a daily clinical case review in Obstetrics and Gynaecology. Methodology: We used a Qualitative Action Research methodology, as the study involved an intervention; the introduction of a WhatsApp platform for daily morning case review; and exploration of what happened following the intervention using a feedback questionnaire. The 21 resident doctors and consultants who completed and returned the feedback questionnaire were the subjects of the study. Results: Twenty-one out of the 29 doctors in the department (72.4%) participated in the study. Of the participants, 66.7% agreed or strongly agreed that the Whatsapp forum was an appropriate way of conducting the daily morning case review. Also, 76.2% of participants said that the learning via WhatsApp platform was different and created a forum for everyone to be in attendance and participate at their convenience. Hence, the vast majority of participants (81%) said that they would recommend Whatsapp morning review to other departments. Eighty-one per cent agreed or strongly agreed that the WhatsApp morning review motivated them to learn but what the Registrars liked the least about the WhatsApp review was 'the stress of typing and responding to long questions'. However, the Registrars felt safe and relaxed and said the Whatsapp approach 'reduced harassment and abuse of the junior doctors'. Conclusion: The WhatsApp forum is an appropriate and safe method of conducting the obstetrics and gynaecology daily medical case review especially during a Pandemic. It may be worth looking at using the WhatsApp forum as an additional learning tool in the department even after the COVID-19 pandemic.

Ethical Issues in the Practice of Assisted Reproductive Technologies in Nigeria: Empirical Data from Fertility Practitioners.

The need to formulate practice guidelines and ethical framework to guide the practice of assisted conception in Nigeria has been highlighted severally. The Association for Fertility and Reproductive Health (AFRH) ethics committee is charged with the objective of producing ethical guidelines that would govern the practice of assisted conception in Nigeria. This study was a survey of attendees at the AFRH international conference that held in Abuja in September 2017. The aim of the study was to generate empirical data that would form the drafting of ethical practice guidelines in Nigeria. Ninety-seven (50%) of the respondents were of the view that performing IVF for unmarried couples was ethical while about 70 (36%) were of the contrary opinion. Respondents were equally divided (45.26% versus 44.21%) on the ethical standing of performing IVF for single ladies. About 128 (70.33%) of respondents agree that egg donors should be paid more in compensation besides reimbursement for personal expenditure incurred during the process of egg donation and that they should be an upper age limit for clients requesting ART with donor eggs. Several unethical practices ongoing in Nigeria were highlighted including inadequate provision of information and counselling and exploitation of egg donors. Majority agreed on the need for a regulatory framework to govern the practice of ART in Nigeria. The diverse range of views and ethical issues concerning ART practice in Nigeria obtained from this study demonstrates the need to recognise the local context in Nigeria when applying universal principles of ethics.

Huge Benign Ovarian Cystic Teratoma in a Patient with a History of Hansen's Disease.

Mature ovarian cystic teratomas are common benign ovarian neoplasm derived from germ cells. With increasing availability of ultrasound services even in developing countries, the diagnosis of benign ovarian tumour is made earlier and the size of the ovarian tumour at diagnosis is relatively small. It is unusual to find an ovarian cystic teratoma larger than 10 cm. We report a huge mature ovarian cystic teratoma in a multipara with a history of Hansen's disease. We conclude that, in circumstances where women have restricted access to health care, the unusual finding of mature ovarian cystic teratoma larger than 10 cm is possible due to delayed presentation for diagnosis and treatment.

Ethics of clinical trials in Nigeria.

The conduct of clinical trials for the development and licensing of drugs is a very important aspect of healthcare. Drug research, development and promotion have grown to a multi-billion dollar global business. Like all areas of human endeavour involving generation and control of huge financial resources, it could be subject to deviant behaviour, sharp business practices and unethical practices. The main objective of this review is to highlight potential ethical challenges in the conduct of clinical trials in Nigeria and outline ways in which these can be avoided. Current international and national regulatory and ethical guidelines are reviewed to illustrate the requirements for ethical conduct of clinical trials. Past experiences of unethical conduct of clinical trials especially in developing countries along with the increasing globalisation of research makes it imperative that all players should be aware of the ethical challenges in clinical trials and the benchmarks for ethical conduct of clinical research in Nigeria.

Misconduct in research: a descriptive survey of attitudes, perceptions and associated factors in a developing country.

BACKGROUND: Misconduct in research tarnishes the reputation, credibility and integrity of research institutions. Studies on research or scientific misconduct are still novel in developing countries. In this study, we report on the attitudes, perceptions and factors related to the work environment thought to be associated with research misconduct in a group of researchers in Nigeria - a developing country. METHOD: A survey of researchers attending a scientific conference was done using an adapted Scientific Misconduct Questionnaire-Revised (SMQ-R). Initial descriptive analysis of individual items using frequencies and proportions for all quantitative data was performed. Thereafter, Likert scale responses were transformed into dichotomous responses. Fisher exact test was performed for associations as appropriate. A two-tailed p-value of less than 0.05 was accepted as significant. RESULT: Half of the respondents (50.4%) were aware of a colleague who had committed misconduct, defined as "non-adherence to rules, regulations, guidelines, and commonly accepted professional codes or norms". Over 88% of the researchers were concerned about the perceived amount of misconduct prevalent in their institution and 96.2% believed that one or more forms of scientific misconduct had occurred in their workplace. More than half (52.7%) rated the severity of penalties for scientific misconduct in their work environment as low. Furthermore¸ the majority (56.1%) were of the view that the chance of getting caught for scientific misconduct in their work environment was low. CONCLUSION: Researchers in Nigeria perceive that scientific misconduct is commonplace in their institutions, but are however worried about the negative effects of scientific misconduct on the credibility of scientific research. We recommend that researchers be empowered with the knowledge and virtues necessary for self-regulation that advance research integrity. Research institutions should however also step into their role of fostering a responsible research ethic and discouraging misconduct.

Prevalence of scientific misconduct among a group of researchers in Nigeria.

BACKGROUND: There is a dearth of information on the prevalence of scientific misconduct from Nigeria. OBJECTIVES: This study aimed at determining the prevalence of scientific misconduct in a group of researchers in Nigeria. Factors associated with the prevalence were ascertained. METHOD: A descriptive study of researchers who attended a scientific conference in 2010 was conducted using the adapted Scientific Misconduct Questionnaire-Revised (SMQ-R). RESULTS: Ninety-one researchers (68.9%) admitted having committed at least one of the eight listed forms of scientific misconduct. Disagreement about authorship was the most common form of misconduct committed (36.4%) while plagiarism was the least (9.2%). About 42% of researchers had committed falsification of data or plagiarism. Analysis of specific acts of misconduct showed that committing plagiarism was inversely associated with years in research (Fisher exact p-value = 0.02); falsifying data was related to perceived low effectiveness of the institution's rules and procedures for reducing scientific misconduct (X(2) = 6.44, p-value = 0.01); and succumbing to pressure from study sponsor to engage in unethical practice was related to sex of researcher (Fisher exact p-value = 0.02). CONCLUSIONS: The emergent data from this study is a cause for serious concern and calls for prompt intervention. The best response to reducing scientific misconduct will proceed from measures that contain both elements of prevention and enforcement. Training on research ethics has to be integrated into the curriculum of undergraduate and postgraduate students while provision should be made for in-service training of researchers. Penalties against acts of scientific misconduct should be enforced at institutional and national levels.

A 30-year review of advanced abdominal pregnancy at the Mater Misericordiae Hospital, Afikpo, southeastern Nigeria (1976-2006).

PURPOSE: This analysis attempts to highlight the varied presentations, diagnostic difficulties, management and subsequent obstetric performances of women managed for advanced abdominal pregnancy. METHODS: A retrospective analysis of all 20 cases of abdominal pregnancies between 1976 and 2006, at the Mater Misericordiae Hospital, Afikpo, southeastern Nigeria was performed. RESULTS: There were 20 cases of abdominal pregnancy out of 58,000 deliveries, giving an incidence of 0.34 per 1,000 deliveries. The diagnoses were missed in 10 cases and there was one maternal death. There were four live births, two early neonatal deaths and four cases of lithopedion. The placenta was removed in 11 cases. Though the duration of hospital stay was longer in women in whom the placenta was left in situ compared to those in whom the placenta was removed, the observed difference was, however, not statistically significant (p value, 0.538). The majority of the women were lost to follow-up over the years; however, of the five women successfully followed up, only two (40%) had subsequent childbirth. CONCLUSION: The rate of 50% missed diagnosis in this study highlights the need for a high index of suspicion in the diagnosis of abdominal pregnancies as the clinical features are varied. It calls for vigilance on the part of the obstetrician. The maternal and fetal outcomes relate to early diagnosis and skilled management.

Liberalization of abortion and reduction of abortion related morbidity and mortality in Nigeria.

This study aimed at determining the knowledge and perception of physicians in Nigeria on abortion related deaths, and also to find out if they will support the liberalization of abortion as a means of reducing deaths from unsafe abortion. Physicians' willingness to offer abortion services was also explored. A self-administered questionnaire was distributed to a convenience sample of physicians in Delta state of Nigeria. Physicians were equally divided on whether legal liberalization of abortion would significantly reduce maternal mortality in Nigeria. Only 13.4% of the doctors were willing to offer abortion services if legally liberalized. The majority of the doctors considered promoting abstinence from pre-marital sex and contraceptive use as best effective strategies for reducing abortion-related deaths. However, liberalization of abortion law in Nigeria was not considered a very effective strategy.

Pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus: a case report.

Pregnancy in the rudimentary horn is rare and carries grave consequences for the mother and fetus. A case report is presented of a 26 year old single gravida 3 para 0(+2) lady with rupture of a rudimentary horn pregnancy at a gestational age of 20 weeks. Laparotomy was done and the rudimentary horn excised. Post-operative recovery was uneventful. The need for a high index of suspicion and the role of ultrasonography in the accurate diagnosis is highlighted.

Adolescent sexual and reproductive health in the Niger Delta region of Nigeria--issues and challenges.

There has been an increasing awareness of the need to pay special focus on the adolescent and their sexual and reproductive health. This article reviews the sexual and reproductive health of adolescents in the Niger Delta region (NDR) of Nigeria. The objective is to bring to focus these important issues in the region. Adolescents in the NDR engage in unhealthy sexual behaviour characterized by early age at sexual initiation, unsafe sex and multiple sexual partners. The local socioeconomic condition exerts extra pressure on the adolescent with negative reproductive health consequences. There is urgent need to develop a time bound strategic framework and plan to redress this situation. This will require the participation of all stake holders.

Pregnant Nigerian woman's view of her prenatal sex determination.

A questionnaire survey was conducted among 1000 pregnant Nigerian women to identify their knowledge and perception of prenatal sex determination using ultrasonography. Eighty-one per cent of the respondents were aware of the technology. Knowledge of it was associated with high parity and education. However, only 64% of respondents desired to know the sex of their fetus. Younger age, low parity and less number of existing male children influenced this desire. There was no indication of considering possible abortion of the fetus if the identified sex was not the desired one. It is suggested that as there seem no grave sequelae of revealing the sex of the fetus, sonologists should not withhold this information from mothers if they so desire.

Knowledge and perception of emergency contraception among female Nigerian undergraduates.

CONTEXT: The reproductive health hazards of unintended pregnancies and unsafe abortions are well documented. The potential of emergency contraceptives to prevent unwanted pregnancy in developed countries has been described, but in Nigeria, the awareness about the method is poor and no study has looked at efficacy. METHODS: Between September and October 2001, a randomly selected sample of female undergraduate students at the University of Benin, Nigeria, were surveyed about their demographic information, sexual history and contraceptive use, and their awareness and knowledge of emergency contraception. RESULTS: Of the 880 respondents, 43% were sexually active, 39% had ever practiced contraception and 34% had ever had an induced abortion. Overall, 58% of respondents reported knowing about emergency contraception; sexually active respondents were significantly more likely than those who were not and those who had ever practiced contraception were more likely than those who had not to be aware of emergency contraceptives. However, only 18% of respondents who reported knowing about emergency contraception knew the correct time frame in which emergency contraceptives must be used to be effective. CONCLUSION: There is an urgent need to educate Nigerian young people about emergency contraception, emphasizing available methods and correct timing of use.