Seroprevalence of microbial organisms during routine infertility evaluation at University of Benin Teaching Hospital, Benin-City, Nigeria

Background: The association of genital microorganism with infertility has been documented but no consensus exists. Understanding their prevalence amongst infertile clients may assist in facilitating better screening protocols. The objective of this study is to determine the prevalence of microorganisms routinely screened among women undergoing infertility evaluation at the University of Benin Teaching Hospital. Methods: A three year (January 2015 to December 2017) retrospective survey of all patients evaluated for infertility at the assisted reproduction unit of the hospital was undertaken. Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, cytomegalovirus (CMV), hepatitis B (HBV), hepatitis C (HCV) virus and the human immunodeficiency virus (HIV) were microorganisms serologically assayed at the unit. We analyzed data containing patients' demography and results of serological assay of these microorganisms. Results: There were 576 patients (288 couples) who completed their microbiological evaluation during the study period. The mean age (years) of female partners was 38.2±5.7, while the mean age of the male partners was 42.7±6.1. The frequency of CMV positive assay for infertile couples was 129 (22.4%); C. trachomatis 125 (21.7%); M. hominis 92 (15.9%) and U. urealyticum 76 (13.2%). Overall, more women (50.7%) were seropositive compared to men (26%). HIV was positive in 10 patients (1.73%) with 60% being women. HBV was seropositive in 8 (1.4%) (women 62.5% and men 37.5%) while HCV was positive in only 2 (0.3%) patient. Majority (over 80%) of couples were sero-discordant with 20% (2) concordance rate for HIV and 12.5% (1) for hepatitis B. Conclusion: Despite a relatively high seroprevalence rate of the studied microorganisms, the documented uncertainty on their association with infertility or its treatment limits justification for incorporation of routine screening of microbiological organisms into standard protocols for evaluation of infertile couples. A robust study on the impact of genital microorganism on specific infertility variables with comparison to fertile controls is recommended

Condom-catheter tamponade for the treatment of postpartum haemorrhage and factors associated with success: a prospective observational study.

OBJECTIVE: To determine the outcomes and factors associated with postpartum haemorrhage (PPH) treatment with condom-catheter uterine balloon tamponade (C-UBT). DESIGN: Prospective observational study. SETTING: A secondary healthcare facility in Nigeria. POPULATION: Women with PPH refractory to first-line treatment. METHODS: Demographic and clinical characteristics were compared in women with successful and unsuccessful treatment. Univariate and multivariate logistic regression analyses were used to examine the association of these characteristics with successful treatment. MAIN OUTCOME MEASURES: The success rate of C-UBT, factors associated with success, and maternal morbidity rates in both successful and unsuccessful treatment groups. RESULTS: Overall, 203/229 (88.6%) women had successful treatment. Women with successful treatment had lower mean blood loss (1248.8 ± 701.3 ml versus 3434.6 ± 906.6 ml; P < 0.0001), lower occurrence of blood transfusion [139 (68.5%) versus 26 (100%); P < 0.0001], lower intensive care unit admission rates [5 (2.5%) versus 20 (76.9%); P < 0.0001], and lower occurrence of infectious morbidities [3 (1.5%) versus 7 (26.9%); P < 0.0001]. In the regression model with two factors, caesarean section (adjusted odds ratio, aOR 0.17; 95% confidence interval, 95% CI 0.07-0.40) was associated with lower success rates compared with vaginal delivery. In the regression model with three factors, advanced maternal age (aOR 0.31; 95% CI 0.11-0.90) and caesarean section (aOR 0.17; 95% CI 0.07-0.41) were associated with lower success rates in comparison with younger maternal age and vaginal delivery, respectively. CONCLUSIONS: Second-line PPH treatment with C-UBT is effective, and is associated with low maternal morbidity rates. Advanced maternal age and caesarean section are associated with lower success rates. TWEETABLE ABSTRACT: Condom-catheter tamponade is a useful second-line treatment modality for intractable postpartum haemorrhage.

Sleep disorders in women attending antenatal care at a tertiary hospital in Nigeria.

AIMS AND OBJECTIVES: To determine the prevalence of sleep disorders in a population of Nigerian women during pregnancy and to evaluate the frequency of these sleep disorders according to the three trimesters of pregnancy. SUBJECTS AND METHODS: A prospective cross-sectional design. Participants' were interviewed at the antenatal clinic with a questionnaire to evaluate their sleep during and before pregnancy and to appraise disturbance in their sleep according to the trimester. RESULTS: Two hundred and three pregnant women participated in the survey and were evaluated at one of three points in pregnancy: 1st trimester (n=57), 2nd trimester (n=71) and 3rd trimester (n=75). Overall, the prevalence of sleep disorder in the population surveyed was 35.5% (72/203), more women experienced sleep disturbances in the first (42.1%) and third (40%) trimester of pregnancy compared to the second (25.3%). In terms of types of sleep disorders; 96(47.3%) reported insomnia, 32(15.8%) sleep breathing disorders, 86(42.4%) excessive daytime sleepiness, 172(84.7%) mild sleepiness and 64(31.5%) significant specific awakenings. The most common reason for specific awakening was frequent urination (78.6%). These sleep disorders were more common in the third trimester of pregnancy but only insomnia and specific awakenings showed statistical significance, p=0.007 and 0.031 respectively. Logistic regression model showed that nulliparity, increased BMI and previous adverse obstetric events had significant independent associations with sleep disorders. CONCLUSION: Sleep disorders are common in pregnancy, notably in the first and third trimesters.

Plasma vitamin C levels and risk of preterm prelabour rupture of membranes.

PURPOSE: Preterm prelabour rupture of membranes (PPROM) is a leading cause of preterm births. Its attendant contribution to maternal and perinatal morbidity and mortality makes it imperative to identify factors that may help prevent this condition. This study examined the association between plasma vitamin C concentration and the risk of (PPROM) amongst pregnant women in a tertiary hospital setting. METHODS: This was a prospective cross sectional study conducted at the Obstetric and Gynaecology Department of University of Benin Teaching Hospital (UBTH), Benin City. The study was in two phases, first a pilot study to determine baseline plasma vitamin C concentration amongst pregnant women in UBTH was conducted. In the main study 80 pregnant women were recruited into two groups of those with PPROM (40 cases) and those without PPROM (40 controls) matched for gestational age. Plasma vitamin C concentration was determined for all study participants and their sociodemographic characters were used to generate a database for analysis. RESULTS: In the pilot study, plasma vitamin C concentration decreased with increasing gestational age of pregnancy. In the main study plasma vitamin C concentration was significantly lower in women with PPROM than controls without PPROM, 0.53 ± 0.05 vs. 0.58 ± 0.05 mg/dl; P = 0.0001. Both groups (case and control) were comparably matched in age, parity and social class. There was a significant association between low vitamin C levels and the occurrence of PPROM (95% CI 1.53-11.88; P = 0.008). CONCLUSION: Plasma vitamin C was found to be lower in women with PPROM. Low plasma vitamin C concentration may thus be an associated risk factor for PPROM. Hence improved dietary or drug supplements may be a useful adjunctive strategy to reducing the incidence of PPROM and its attendant adverse sequelae. While this intervention is advocated, further multicentre investigation of the effects of vitamin C on risk of preterm PROM is suggested.