Review of intrauterine adhesiolysis at the Aminu Kano Teaching Hospital, Kano, Nigeria.

BACKGROUND: Hysteroscopic adhesiolysis is shown to significantly improve the outcome of intrauterine adhesions (IUA). The Minimally Invasive Surgical Unit (MISU) of our Department recently acquired a hysteroscope which is being used for hysteroscopic adhesiolysis among others. MATERIALS AND METHODS: There were 57 patients diagnosed to have IUA of which 54 case notes were available for analysis, giving a retrieval rate of 95%. The information extracted includes age, parity, and menstrual pattern, predisposing factors, treatment option, outcome, complications and the year of the procedure. The data extracted were analyzed using Epi info Version 3.4.1. Chi squared test (Fisher's exact test) was used to test for statistical difference in the outcome of the modalities of treatment. P value of less than 0.05 was considered significant. RESULTS: There were 57 cases of IUA out of 4160 gynecological patients seen, giving a prevalence of 14/1000. The mean age was 28.9 years (SD 4.5) and mean parity was 1.4 (SD 1.4). Etiologic factors include Dilatation and curettage (D and C) (33.3%), Caesarean section (C/S) (31.5%), manual removal of placenta and Pelvic Inflammatory Disease (PID) (7.4% each), and unexplained (3.7%). Mode of presentation was secondary amenorrhoea (50%), oligomenorrhoea (22.2%), and hypomenorrhoea (10%). As for the management, 68% had blind procedure while 25.9% had hysteroscopic procedure. Lippes loop was used in all except three patients who had pediatric Foleys catheter instead. Upon follow-up 59.3% resumed normal menses, 11.1% had oligomenorrhoea, hypomenorrhoea 13% and amenorrhoea 5.6%. There was no statistical difference in the outcome of treatment between hysteroscopic adhesiolysis and the blind procedure when return to normal menses is considered as the end point, OR=2.27, CI 0.45-12.65, Fisher exact test (one-tailed) P=0.2184818. CONCLUSION: There was no significant difference between the blind and hysteroscopic procedures. Dilatation and curettage was found to be the commonest cause of IUA.

Knowledge of HIV prevention and willingness to collaborate in vaginal microbicides trials-survey of Nigerian gynecologists.

BACKGROUND: Gynecologists being the primary care physicians and advocates for women sexual and reproductive health are critical in delivering messages on effective intervention to prevent heterosexual HIV transmission. Their knowledge and opinions on the effectiveness of HIV prevention technologies may influence the acceptance and use of these technologies among women at risk. METHODS: A cross sectional survey was self-administered to Nigerian gynecologist attending an Annual Scientific conference; "Kanon Dabo" between November 17 and 21, 2009, in Kano, Nigeria. Their opinions on various HIV prevention strategies as well as their willingness to collaborate on vaginal microbicides trials were assessed on a Likert scale. The mean scores of the responses were tested using student's T-test. Statistical analyses were done with STATA version 11, College Station, Texas, USA. RESULTS: Of the 100 questionnaires distributed to the participants at the conference, we had a survey response rate of 74.0%. The mean age of the participants was 42.38 +/- 6.67 years with range 30-58 years. Male participants constituted 84.9%, and Female participants 15.1%. Twenty five percent (25%) of the surveyed participants were aware of vaginal microbicides, and only 3% correctly mentioned an example of a vaginal microbicide for HIV prevention. The willingness of the participants to collaborate on vaginal microbicides trials was not significantly related to their knowledge on vaginal microbicides (p = 0.475). CONCLUSION: We concluded that the current knowledge of Nigerian gynecologist on vaginal microbicides is poor. Efforts to create awareness among these women advocates on recent HIV prevention technology, particularly, vaginal microbicides are required.