Effects of misoprostol in reducing blood loss during abdominal myomectomy in Nigeria.

Background: Despite using a tourniquet to reduce bleeding during abdominal myomectomy, the procedure is still complicated by significant intraoperative bleeding. Aim: To determine whether misoprostol and tourniquet compared with tourniquet alone would significantly reduce bleeding during abdominal myomectomy at two tertiary hospitals in Enugu. Materials and Methods: This study is an open-label randomized controlled trial. A total of 126 consenting participants were recruited from women booked for abdominal myomectomy at the study centers over 7 months. They were randomized into groups A (vaginal misoprostol 400 µg) and B (no misoprostol) one hour before surgery. Intraoperatively, all participants had a tourniquet application. Intraoperative and postoperative blood loss was compared between the two groups. Descriptive and inferential analyses were carried out using IBM SPSS Version 22.0. A P- value of < 0.05 was considered statistically significant. Results: An intention-to-treat analysis was carried out. All 63 participants (100%) and 56 (90%) completed the study according to the protocol in groups A and B, respectively. Socio-demographic characteristics were not significantly different in both groups. The mean intraoperative blood loss in the "misoprostol group" (522.6 ± 127.91 ml) was significantly lower than in the "no-misoprostol group" (583.5 ± 186.20 ml), with P = 0.028. The difference in mean hemoglobin (g/dl) was lower in the "misoprostol group" than in the "no-misoprostol group" (1.3 ± 0.79 vs. 1.9 ± 0.89, P < 0.001). The mean 48 hours postoperative blood loss (ml) between the two groups was 323.8 ± 221.44 vs. 549.4 ± 519.72), with P = 0.001. Conclusion: Among women receiving tourniquet during myomectomy in Enugu, the additional use of vaginal misoprostol 400 µg significantly reduced intraoperative blood loss.

Primary umbilical endometriosis coexisiting with multiple uterine fibroids: A case report.

INTRODUCTION: Uterine fibroids and endometriosis are independent causes of infertility/subfertility in women of reproductive age. Primary umbilical endometriosis is rare. PRESENTATION OF CASE: Here, we report a case of primary umbilical endometriosis coexisting with multiple uterine fibroids in a 35 year old nulliparous woman who presented with abdominal swelling as well as cyclical pain and swelling of the umbilicus without any previous surgery. She had abdominal myomectomy and excision of the umbilical lesion with histological confirmation of uterine fibroids and umbilical and peri-umbilical endometriosis. DISCUSSION: Primary umbilical endometriosis should be considered as a possible differential diagnosis in cases of umbilical disorders even if the patient has no typical symptoms of pelvic endometriosis. The clinical features include an umbilical swelling (90%), often associated with cyclical pain (81.5%) and bleeding or discharge (49.2%); while some patients may be asymptomatic. The diagnosis of umbilical endometriosis could be made based on clinical findings but histological confirmation is the gold standard for diagnosis. The definitive treatment for umbilical endometriosis is surgical excision. CONCLUSION: Although rare, primary umbilical endometriosis may coexist with uterine fibroids and should be suspected in women of reproductive age who complain of cyclical umbilical disorders in addition to abdominal swelling or other symptoms of uterine fibroids.

Effects of early oral feeding versus delayed feeding on gastrointestinal function of post-caesarean section women in a tertiary hospital in Enugu, Nigeria: A randomized controlled trial.

BACKGROUND: Initiation of oral intake after caesarean delivery influences return of bowel function, ambulation of patients, and time to recover from surgery. AIMS: To assess the effect of early versus delayed initiation of oral feeding after caesarean delivery on gastrointestinal function, pace of recovery, and maternal satisfaction at University of Nigeria Teaching Hospital (UNTH), Enugu. SETTINGS AND DESIGN: This was a randomized controlled study of women who had caesarean delivery from December 2012 to September 2013 at the Department of Obstetrics and Gynaecology UNTH, Enugu, Nigeria. In all, 282 participants were randomized equally into early and delayed oral feeding groups. Oral intake was commenced at 8 h post operation for those in early feeding group and at 48 h post operation for those in delayed feeding group. The primary outcome measure was the time interval from the end of surgery to the return of bowel sound. SUBJECTS AND METHODS: Analysis was by intention-to-treat. SPSS version 16 was used for data entry and analysis was done using cross tabulation and Fisher's exact test for categorical data and independent sample T-test for continuous data. P value of < 0.05 was regarded as statistically significant. RESULTS: Apart from gastrointestinal complications, there was significant difference between early and delayed feeding groups with respect to all the outcome variables: return of bowel sound (17.8 ± 4.3 h vs 35.2 ± 9.4 h; P < 0.001), return to regular diet 48.9 ± 5.2 h vs 85.5 ± 7.0 h; P < 0.001), postoperative time interval to ambulation (20.3 ± 7.0 h vs 30.9 ± 9.6 h; P < 0.001), and maternal satisfaction as estimated with visual analog scale (86.4 ± 10.4 mm vs 40.0 ± 25.9 mm; P < 0.001). CONCLUSION: Early initiation of oral feeding after caesarean delivery is safe and may be associated with earlier return of bowel functions, earlier ambulation, shorter postoperative time interval to become eligible for discharge, and high maternal satisfaction.

The role of ultrasonography in in-vitro fertilization and embryo transfer (IVF-ET).

BACKGROUND: Although ultrasonography was introduced into Obstetrics and Gynaecology by a British Gynaecologist over five decades ago, the requirements for formal training in its use by gynecologists in Nigeria is just beginning to catch on, despite its indispensible role in various aspects of our clinical practice. OBJECTIVE: To describe the role of ultrasonography in in-vitro fertilization and the indispensability of the instrument to reproductive medicine. METHOD: A review of literature written in English language on the use and application ofultrasonography. in in-vitro fertilization was done. The review covered articles published between 1980-2012. RESULTS: Ultrasound is the most versatile method for pre-treatment assessment in IVF being the dominant instrument for assessing ovarian reserve, pelvic pathologies and for assessing the uterine cavity. The ability of ultrasonography to measure endometrial thickness in addition to detecting uterine masses gives it an edge over laparoscopy/hysteroscopy as a diagnostic procedure in uterine cavity assessment, although hysteroscopy has the advantage of therapeutic potential. Similarly, ultrasonography is superior to biochemical methods for follicular monitoring because of its ability to demonstrate the number and sizes of follicles, and guide preparations for oocyte retrieval. The relative ease of ultrasound guided oocyte retrieval; its less technical demands and the possibility of conducting the procedure under local anaesthesia have made ultrasound guided oocyte retrieval more popular across the world. Randomized controlled trials show that ultrasound-guided transfer techniques have better outcomes than the clinical touch technique in terms of on-going pregnancies and Clinical pregnancies. Ultrasonography is now the key instrument for diagnosing and monitoring pregnancy following embryo transfer, biochemical methods being complimentary. CONCLUSION: Ultrasonography is now the single most important instrument in in-vitro fertilization .programmes and gynaecologists with interest in reproductive medicine need necessarily to obtain a formal training in its use.

Prevalence, presentation and management of polycystic ovary syndrome in Enugu, south east Nigeria.

BACKGROUND: Polycystic ovary syndrome is the most common gynaecological endocrine disorder in women of reproductive age yet, its prevalence and management has not been documented in our area. OBJECTIVE: To determine the prevalence, presentation and management of polycystic ovary syndrome among women in Enugu, south east Nigerian. METHOD: A prospective descriptive study of women with polycystic ovaries seen in two major Infertility Clinics in Enugu, South East Nigeria over a 2 year period. RESULT: A total of 342 women presented with infertility in the centres within the two year period, out of whom 62 had PCOS. PCOS occurred in 18.1% of women in the infertility clinics of the two institutions. The common modes of presentation were: inability to conceive (infertility) in 52 (83.9%), oligomenorrhoea in 45 (72.6%), obesity in 32 (51.6%), LH/FSH ratio > 2 in 28 (45.2%), hyperprolactinaemia in 26 (41.9%) and hirsuitism in 19 (30.6%) women. Ovulation induction was carried out in 42 of the 50 women with anovulatory infertility only. For those 42 women, the mean number of induced cycles was 2.6 = 1.7 (range: 1-6) with 33 (78.6%) of the women being able to do only 3 induced cycles or less. The ovulation induction agents used were clomiphene citrate and human menopausal gonadotrophin either singly or in combination with tamoxifen or bromocryptine. Adjunctive treatments offered consisted of weight reduction in 20 (40.0%) women, metformin in 11 (22.0%) women and dexamethasone in 10 (20.0%) women. CONCLUSION: PCOS is fairly common occurring in approximately one in six infertile Nigerian women. Infertility, oligomenorrhoea, obesity, LH/FSH ratio > 2, hyperprolactinaemia and hirsutism are the commonest presenting features. On individualized management, about two-fifths of them conceive either spontaneously or following ovulation induction, despite poor compliance to recommended drug regimen.