Homozygous sickle cell anemia at the University College Hospital, Ibadan, revisited.

The outcome of 78 pregnancies in 47 patients with homozygous sickle cell anemia managed at the University College Hospital, Ibadan between January 1, 1975 to December 31, 1984 is reviewed. There were two maternal deaths giving a maternal mortality rate of 25 per thousand. Abortion rate was 155 per thousand. The overall perinatal mortality rate was 188 per thousand. Forty-five percent of the babies were of low birthweight and 29% were preterm. Anemia was the commonest antenatal complication and the highest indication for hospitalization. The data were compared with previous ones from this hospital and with similar reports by other investigators outside Nigeria. A need for meticulous antenatal care and prenatal diagnosis to eliminate the homozygous sickle cell anemia is stressed.

Pregnancy in hemoglobin sickle cell patients at the University College Hospital, Ibadan.

A retrospective review of pregnancy outcome in hemoglobin (Hbsc) patients managed at the University College Hospital, Ibadan over a 5-year period (1984-1988) was carried out. The main antenatal complications included anemia (51.2%), bacterial infection (22.0%), bone pain crisis (7.3%) and preeclampsia (2.4%). Intrapartum complications included anemia (29.2%), bone pain crisis (12.2%) and pseudotoxemia (4.9%). The maternal and perinatal mortality rate were 48 and 195 per 1000, respectively. The duration of labor and operative delivery rate were not different from the general population.

Massive ascites associated with endometriosis in a Nigerian African.

A case of endometriosis with massive ascites in a 19-year-old Nigerian African is reported. This is an unusual combination and it is likely that most gynecologists and general physicians would never see such a case. The presentation and management of this entity is discussed.

Clinical observations of malignant trophoblastic disease.

We studied the clinical records of 64 women with malignant trophoblastic disease. Fifty-five patients (68%) were aged 25-50 years. The current pregnancy was preceded by abortion in 24 cases, by molar pregnancy in 23 cases and by normal pregnancy in 17 cases. The most common presenting symptoms were vaginal bleeding, abdominal mass and abdominal pain. Pulmonary lesions were mostly silent, but hemoptysis occurred in seven patients. Metastases were found in 39 patients. Treatment was mainly chemotherapy. Remission for over 12 months occurred in 40 patients, and 21 patients died.

Effect of saline and glucose infusions of oxytocin on neonatal bilirubin levels.

OBJECTIVE: To ascertain the effect of isotonic saline and glucose infusions of oxytocin on neonatal bilirubin levels. METHOD: Eighty-two parturient Nigerian women requiring oxytocin infusion in labor were randomized into two groups receiving 0.9% saline or 5% glucose, respectively. A group of 82 women not requiring oxytocin were recruited for comparison. All had sodium and bilirubin estimations in cord plasma and neonatal bilirubin assay on Day 3. RESULT: Analysis of variance revealed higher mean cord and neonatal bilirubin levels in the glucose group compared with the other two (P < 0.05). Significant inverse correlation was observed between cord plasma sodium and neonatal bilirubin levels in all groups. Hyperbilirubinemia occurred in 55% of babies in the glucose group compared with 21% and 22% in the saline and control groups, respectively (P < 0.001). CONCLUSION: The use of isotonic saline rather than 5% glucose solution as vehicle for oxytocin infusion in labor appears to be associated with lower neonatal bilirubin levels.

Perineovulvovaginal preoperative preparation in minor gynecological surgery.

Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued.

Perineovulvovaginal preparation in labor.

Seventy-four patients who received antenatal care and whose deliveries were supervised in our hospital were studied. Most of them were from the low socioeconomic class. Forty patients were shaved and all patients had the same routine perineal, vulval and vaginal swabbing during the first stage of labor. Puerperal morbidity was low. Even in developing countries where patients often have poor personal hygiene, shaving the vulval, pubic and perineal hair is unnecessary for patients whose pregnancies and deliveries are supervised in hospital. We suggest that the procedure should be reserved for patients who have complications of pregnancies which may necessitate instrumental or abdominal deliveries.

Primary elective cesarean section in Ibadan, Nigeria.

A total of 13,692 deliveries were conducted at University College Hospital, Ibadan. These included 2,764 (22%) cesarean sections, 63 (2.3%) of which were primary elective sections. The case records of 44 of these patients have been analyzed to determine the place of primary elective cesarean section in modern obstetric practice in Nigeria. No maternal deaths occurred and morbidity attributable to the operation was low and not serious. One perinatal death occurred and morbidity was low and less serious than maternal morbidity. There was no record of a uterine scar rupture occurring in subsequent pregnancies in any of these patients. Primary elective cesarean section, if used discriminately, will reduce difficult labor with the attendant risks of maternal and fetal mortality and morbidity in Nigeria and developing countries. The role which improved socioeconomic conditions and health education plays is emphasized.

Cesarean section for twin pregnancy in Ibadan, Nigeria.

During an 11-year period, 23,524 deliveries were conducted at the University College Hospital, Ibadan; 4,360 (18.5%) were delivered by cesarean section, 49 of which were associated with twin pregnancy. The main indications for this operation in twin pregnancy were prolapsed umbilical cord, previous cesarean section scar and malpresentation of the second twin with the membranes already ruptured. The perinatal mortality of 18.2% was mainly attributable to prematurity. Obstetricians in this community have adopted a conservative attitude towards cesarean section because of the general aversion to this operation by our patients and the risk of subsequent rupture of the uterine scar in women who wish to deliver themselves at home in subsequent pregnancies. Cesarean section is therefore performed in twin pregnancy for the same absolute indications as for single pregnancy.

Effects of using either saline or glucose as a vehicle for infusion in labour.

Seventy pregnant Nigerian women requiring oxytocin for the induction or augmentation of labour were randomized into two groups, one administered 5% glucose, and the other 0.9% saline as vehicle for oxytocin. Another group of seventy women who did not receive intravenous fluids in labour were included for comparison. Sodium ion concentration in maternal antepartum and postpartum plasma as well as umbilical cord plasma samples were estimated in all the patients. There was a statistically significant fall in the maternal postpartum plasma sodium concentration relative to the ante-partum values only in patients receiving 9% glucose solution (P less than 0.001). There was also a significant correlation between the sodium levels in maternal postpartum and cord plasma samples, suggesting that these changes were transmitted to the fetus transplacentally. The use of normal saline as a vehicle for oxytocin administration in parturient women can prevent the hyponatraemia associated with the use of 5% glucose for this purpose.

Coitally--related morbidities in the non-pregnant female.

The consequences of coital experience in the non-pregnant female are varied and are occasional diagnostic puzzles. They range from those typified by manifest or concealed haemorrhage, to those revealed by immunologic, neurologic or pharmacologic phenomena and to those, whose patho-physiology is as yet, unclear. Observations are made of the likelihood of recurrence, and that, most patients would typically not readily admit to the preceding act of coitus.

Invasive cervical carcinoma in two sisters.

The occurrence of pre-invasive cervical carcinoma among siblings and in mother-daughter pairs has been reported previously in Europe. Invasive cervical cancer diagnosed in two Nigerian sisters within a period of three months is reported. It is suggested that sisters and daughters of patients with cervical cancer may be at a higher risk of developing the lesion because of similar socio-economic and cultural backgrounds and should therefore have regular cervical screening.

Hysterography after lower-uterine-segment caesarean section.

A radiological method of assessment of Caesarean-section wound healing is described. A total of fifty-eight cervico-hysterosalpingograms were performed, ten as controls and forty-eight on patients each of whom had primary or multiple Caesarean sections. Radiological changes were noted in the cervix, isthmus, uterus and the fallopian tubes. The exact significance of some of the radiological changes demonstrated in the cervico-hysterosalpingograms is not yet clear but it is believed that the follow-up of these patients in subsequent deliveries will amplify the significance of these changes which may revolutionize the present policy of delivery following lower-segment Caesarean section in our community.

Comparison of single serum progesterone and endometrial biopsy for confirmation of ovulation in infertile Nigerian women.

Infertility remains a medico-social problem in Nigeria and it accounts for a large percentage of outpatient gynecological consultations. The evaluation of the infertile couple remains a continuing challenge to the practising doctor in this part of the world. The need to evaluate the two methods commonly used for determining ovulation in these patients is indicated. Endometrial biopsy specimen and a single sample for serum progesterone estimation were obtained simultaneously in the luteal phase from 50 normally menstruating infertile Nigerian women. Subsequent analysis showed that a serum progesterone value of 6.6 nmol/l (2.2 ng/ml) or above was always associated with a secretory endometrium. Forty-six cycles yielded sufficient information to compare the two methods for confirmation of ovulation. Patients who ovulated with a progesterone value of 6.6 nmol/l (2.2 ng/ml) were 91.3% (42/46) or above, while 89% (41/46) showed secretory endometrium. Forty-six of the cases 86.9% (40/46) were judged to have ovulated by both parameters while 6.5% demonstrated anovulatory cycle using both criteria. From the study, a significant correlation was obtained between endometrial biopsy and progesterone assay methods in confirming ovulation.

Prognostic value of histological grading of hydatidiform moles.

Histological study of materials from 282 patients with hydratidiform moles showed no correlation between the degree of trophoblastic proliferation and the subsequent development of choriocarcinoma. A significant number of invasive moles, however, showed a marked degree of trophoblastic proliferation. All patients with molar pregnancy should continue to have adequate and mandatory clinical follow-up.