Experience with the bonanno catheter in the management of OHSS from IVF-ET Cycles.

OBJECTIVE: To document our experience with the use of the Bonanno catheter as a closed abdominal drain for OHSS Methods: A retrospective study of all IVF embryo transfer (ET) treatment cycles carried out between May 2006 and April 2009 at a dedicated IVF centre. Case notes of patients with OHSS were retrieved and the outcome of the continuous closed abdominal drain with Bonanno catheter documented. RESULT: Within the period under review, 234 patients had controlled ovarian stimulation with ultrasound guided egg retrieval. Two hundred and twenty eight (228) got to the stage of embryo transfer with 72 clinical pregnancies. The clinical pregnancy rate was 31.58%. Fourteen (6%) of those who were stimulated developed OHSS and had a closed abdominal drain of the ascitic fluid using the Bonanno catheter. The average number of days of the abdominal drainage was 7.5days and the average volume of ascitic fluid drained from a patient per day was 2454.9 + 748mls. Eight (8) patients who had OHSS achieved clinical pregnancy (six intrauterine, one ectopic and one heterotopic pregnancies), giving a clinical pregnancy rate of 57.14% in patients with OHSS. Four patients had blocked Bonanno catheters and three of them had the catheter changed while the fourth had the catheter successfully flushed. Four patients had the insertion site dressing changed due to soaking with ascitic fluid. There was no incidence of injury to intra abdominal organs or broken catheter. CONCLUSION: Bonanno Catheter is both effective and safe in draining ascitic fluid following OHSS.

Surgical Proficiency of Obstetrics and Gynaecologic Residents in Nigeria.

BACKGROUND/OBJECTIVE: The aim of residency training is to produce competent and professional experts in their areas of specialty. Surgical proficiency is required to be able to offer patients a genuine choice of treatment options and safety of procedures performed. We assessed self-reported level of proficiency for common major gynaecological surgeries among trainee gynaecologists. METHODS: Pretested self- administered questionnaires were distributed to senior residents at the West African College of Surgeon's revision course in Obstetrics and Gynaecology. RESULTS: They were 42 respondents from 15 institutions in Nigeria; 66.7%were males. The mean number of years in residency was 5±1 years.The most commonly performed surgeries were salpingectomy, ovarian cystectomy, myomectomy where approximately 60%, 30% and 33% of residents had performed 10 or more of these surgeries respectively. The least performed surgeries were vaginal hysterectomy, fistula repair and laparoscopic surgeries because each of these surgeries had never been performed more than 60% of residents. These commonly performed surgeries were associated with self-reported average or more proficiency. Reported challenges to attaining surgical proficiency were trainer incapability (92.5%), theatre/hospital logistics (75%), inadequate cases (65%) and trainer unavailability (55%). CONCLUSION: Our findings suggest that majority of the senior residents of Obstetrics and Gynaecology assisted and performed insufficient number of gynaecological surgeries to attain proficiency in these procedures. A formal training curriculum needs to be utilized in the training of surgical residents.

Perineal trauma in Port Harcourt, Souh-south Nigeria.

BACKGROUND: Morbidities associated with vagina deliveries are many but under reported. Where data exist, women had been shown to suffer myriad of problems following vaginal birth. These include immediate trauma to the perineum from episiotomy and perineal laceration at vaginal deliveries. These women may also have other problems such as pelvic pain, uterine descent and incontinence to urine, stool or flatus as well as sexual, social and psychological dysfunction on the long term. The objective of the study was to determine the prevalence and predisposing factors of perineal trauma amongst women delivering at the University of Port Harcourt Teaching Hospital. METHODS: A retrospective study of vaginal births between 1st January 2005 and 31st December 2007 at the University of Port Harcourt Teaching Hospital was done. The delivery register at the labour ward was used to identify the parturient with injury to the perineum following a vaginal birth. Data was retrieved from their case notes, entered into an excel spreadsheet and analyzed with SPSS version 17 for Microsoft windows. RESULTS: A total of 2429 (53.8%) out of 54 parturient had trauma to their perineum at delivery. Episiotomies were in 1811 (40.1%) parturient and perineal tears occurred in 697 (13.7%) parturient. While the prevalence of episiotomy decreased with parity, the incidence of perineal tears was found to increase with parity. Assisted vaginal deliveries and high parity were risk factors for episiotomy and perineal tear respectively. CONCLUSION: The perineal trauma prevalence rate of 53.8% in Port Harcourt is unacceptably highly. Nulliparity, vaginal breech and instrumental vaginal deliveries are the major risk factors for perineal trauma.

Patients' perception of antenatal care at the University of Port Harcourt Teaching Hospital.

BACKGROUND: Antenatal care is considered an important aspect of maternity care and is generally believed to positively influence the outcome of pregnancies. This reason informs the regular antenatal attendance by expectant mothers. This study aims to determine the views of expectant mothers on the value and benefits of antenatal care and their satisfaction with the service delivery at the routine antenatal clinic. METHODOLOGY: Five hundred randomly selected antenatal clinic attendees at the University of Port Harcourt Teaching Hospital were surveyed using a pre-tested interviewer administered questionnaire from September to November 2005. Four hundred and forty four of the five hundred questionnaires were retrieved for analysis. Data management was done using SPSS 1 for Windows statistical software. RESULTS: Most of the respondents (98.4%) though antenatal care has benefits and could list at least one benefit. Majority (87.4%) felt the traditional antenatal clinic visits were adequate while 3.8% felt they were too frequent. More than two-thirds (72.3%) waited beyond 2 hours before consultation with the doctors. Fear possible industrial strikes which disrupts health services in the Teaching Hospital compelled patients to have parallel antenatal care with other health facilities. Twenty eight respondents (6.3%) felt the members of staff have a very hostile attitude towards antenatal patients. CONCLUSION: Expectant mothers agree there are health benefits derived from antenatal care. They are satisfied with the traditional antenatal visits. However long waiting time, industrial strikes and hostile staff attitude were the negative perceptions of the antenatal care in our hospital.

Knowledge, attitude, and practice of emergency contraception among medical doctors in Port Harcourt.

BACKGROUND: The contraceptive prevalence in our environment is very low with attendant increase in unwanted pregnancy and unsafe abortion. The use of emergency contraception (EC) in women with unprotected intercourse could be the only option that can avoid the unwanted pregnancy and unsafe abortion. OBJECTIVE: The objective was to assess the knowledge, attitude, and practice of emergency contraception among doctors in Port Harcourt. MATERIALS AND METHODS: This is a descriptive cross-sectional study of medical doctors practising in Port Harcourt. Self-administered questionnaires were completed by 100 participants randomly selected from medical doctors present at a general meeting in January 2006. Data collation and analysis was carried out with Microsoft Excel XP software and presented as percentages and proportions. RESULTS: The awareness of EC was high among the doctors in Port Harcourt. However knowledge about its use was poor. Although 98% of them were aware of emergency contraception, 58% could not identify correctly any type. Oral mifepristone (RU486) was the most recognized form of EC identified by 38% of the doctors. Rape would be the commonest indication for emergency contraception as reported by 76% of the doctors, ahead of missed pills by 36% and incestuous sexual intercourse by 46% of the doctors. Postinor (levonorgestrel) given within 72 hours and IUCD inserted within 5 days of intercourse were the commonest forms of EC administered by 26% each of the doctors interviewed. CONCLUSION: Although the awareness of EC is high among the doctors in Port Harcourt, the knowledge and use of EC is low. Therefore there is a need to improve both education and attitude to use of emergency contraception among medical doctors in Port Harcourt.

Knowledge; Attitude; and Practice of Emergency Contraception among Medical Doctors in Port Harcourt

Background: The contraceptive prevalence in our environment is very low with attendant increase in unwanted pregnancy and unsafe abortion. The use of emergency contraception (EC) in women with unprotected intercourse could be the only option that can avoid the unwanted pregnancy and unsafe abortion. Objective: The objective was to assess the knowledge; attitude; and practice of emergency contraception among doctors in Port Harcourt. Materials and Methods: This is a descriptive cross-sectional study of medical doctors practising in Port Harcourt. Self-administered questionnaires were completed by 100 participants randomly selected from medical doctors present at a general meeting in January 2006. Data collation and analysis was carried out with Microsoft Excel XP software and presented as percentages and proportions. Results: The awareness of EC was high among the doctors in Port Harcourt. However knowledge about its use was poor. Although 98of them were aware of emergency contraception; 58could not identify correctly any type. Oral mifepristone (RU486) was the most recognized form of EC identified by 38of the doctors. Rape would be the commonest indication for emergency contraception as reported by 76of the doctors; ahead of missed pills by 36and incestuous sexual intercourse by 46of the doctors. Postinor (levonorgestrel) given within 72 hours and IUCD inserted within 5 days of intercourse were the commonest forms of EC administered by 26each of the doctors interviewed. Conclusion: Although the awareness of EC is high among the doctors in Port Harcourt; the knowledge and use of EC is low. Therefore there is a need to improve both education and attitude to use of emergency contraception among medical doctors in Port Harcourt

A five year review of the complications of progestogen only injectable contraceptive at the University of Port-Harcourt Teaching Hospital.

BACKGROUND: The injectable progestogen only contraceptive is a widely accepted method of contraception in our environment and very Iittle has been reported on its complications in our environment. The aim of the study was to highlight the complications associated with use of injectable Medroxyprogesterone Acetate and Norethisterone Enanthate in dients at the University of Part-Harcourt Teachng Hospital, Port-Harcou, south-south Nigeria. METHODS: It was a 5 rear year retrospective study of the clients who accepted and used progestogen only injectable contraceptives (depot medroxyprogesterone acetate noerthistherone enantate) at the family planning units of the University of Port Horcowt Teaching Hospital between 1st January 2000 and 31st December 2004. The case flies of these clients were retrieved and their data extracted. The informolion included the dients sociodemographic characteristics, the types doses of of injectable contraceptives received and the side effects reported at the follow up visits. The data was coded and entered into a data bank and analysed using SPSS for windows 11.0 version. RESULTS: Seven hundred and seventy seven (777) injectable contraceptive acceptors out of the 1720 contraceptive acceptors during the study period. This accounted for 45.17% of the new acceptors over the 5 years period, making the injectable contraceptives the most commonly used method of birth control in UPTH. Five hundred and five (505) clients took depot medroxyprogesterone acetate (DMPA) while 272 used norethesterone enanthate (NE-ET). The mean age of the injectable contraceptive users was 31.31 +/- 5.5 years and the mean parity was 5.5 +/- 2.5 deliveries. The users reported multiple side effects with 579 episodes. Secondary amenorrhea was the commonest side effect occurring in 350 (45.34%) clients. Others were hypertension in 17 (2.94%) and metabolic disturbances in 14 (2.41%). CONCLUSION: Injectable progestogen only contraceptive is associated with multiple side effects, with secondary amenorrhoea being the most common. The contraceptive failure rate of this method in our women is low. CONCLUSION: Injectable progestogen only contraceptive is associated with multiple side effects, with secondary amenorrhoea being the most common. The contraceptive failure rate of this method women is low.