Antichlamydia antibodies and sperm quality among male partners of infertile couples ins Nigeria.

Background: The impact of Chlamydia trachomatis on semen quality has been studied with varied results. Aim: To determine the prevalence of antichlamydial antibodies and their relationship with sperm quality among male partners of infertile couples in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional study of infertile male partners of couples attending infertility clinics at the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Nigeria. Their sera were assayed for antichlamydial antibodies, and semen analysis and culture were done for each participant. Results: Two hundred and eighty-two (282) male partners of infertile couples were studied. Infertility was commoner among participants aged 40 years or more (45.1%) and was mainly of the "primary type" (62.1%). Antichlamydia antibody was detected in 156 (55.3%) participants and was significantly associated with sperm quality (P = 002; OR = 2.294; 95% CI = 1.36-3.88). Overall, 81 (28.7%) had abnormal sperm quality. The sperm count, progressive motility, and vitality were significantly lower in participants with abnormal sperm quality than those with normal sperm quality (P < 0.001) while morphology, volume, and liquefaction time did not differ significantly (P > 0.05). Staphylococcus aureus was the predominant organism isolated from culture (122/282, 43.3%) while Streptococcus species were the least (4/262, 1.4%). There was significantly more Staphylococcus aureus isolated from the semen of participants that were seropositive to antichlamydial antibodies than those that were seronegative (80/156, 51.3% vs. 42/126, 33.3%; OR = 2.105; 95% CI = 1.30-3.42; P = 0.003). Conclusion: The prevalence of antichlamydial antibodies among male partners of infertile couples in Enugu, Nigeria is high and there is a significant association with sperm quality, sperm count, and bacterial isolates in seminal culture. Male partners of infertile couples in Enugu should be screened for antichlamydial antibodies and appropriate treatment offered wherever indicated. There is a need for increased public awareness and advocacy campaigns on the impact of Chlamydia infection on male factor infertility. This primary preventive measure may help in reducing the burden of Chlamydia infection and male factor infertility.

Trends of myomectomy at the University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria.

BACKGROUND: Uterine fibroid is the commonest female genital tumour occurring within the reproductive age group, and abdominal myomectomy is the most offered surgical treatment in our environment. There is need to audit this practice in our centre so as to observe the practice pattern and outcome of myomectomies in Enugu, Nigeria. OBJECTIVE: To audit myomectomies, the practice pattern and outcome at the University of Nigeria Teaching Hospital Enugu-Nigeria. METHODS: A 5-year retrospective study of myomectomies performed in UNTH Enugu between January 1, 2004 and December 31, 2008. Data relating to socio-demographic characteristics, indication for surgery, intraoperative haemostatic measures, estimated blood loss, use of drain, duration of hospital stay and complications were abstracted and analyzed. RESULT: A total of 122 abdominal myomectomies were performed and 70.5% of the patients were aged 30-39 years and 80% were nullipara. Lower abdominal swelling and discomfort were the commonest presentation and indication for the surgery. Tourniquet was used for haemostasis in 57.4% while postoperative drain was inserted in 52.6%. 24.6% received blood transfusion and the average duration of hospital stay was 8.6 days. Complications were mild, with pyrexia as the commonest complication (28.7%). There was no mortality. CONCLUSION: Though myomectomy is safe and tolerated in our centre, a consensus practice pattern through a prospective study is required to further improve outcome.

A five-year survey of caesarean delivery at a Nigerian tertiary hospital.

BACKGROUND: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques, caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus, the current emphasis is to limit the rising rate of caesarean section to as much as possible. OBJECTIVE: To determine the rate of caesarean section, pregnancy out-come, major indications and complications of caesarean section. METHODS: A five year (January 1(st) 2005 to December 31(st) 2009) retrospective analysis of clinical data from the ward admissions and discharge books, patients' folders and the operating theatre record books at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. RESULTS: Out of the 3,554 deliveries during the study period, 980 cases were by caesarean section, giving a rate of 27.6%. Most cases 918 (93.7%) were by emergency caesarean sections, with elective procedure accounting only for 6.3% of the cases. The age range of the women was between 16-48yrs. Four hundred and seven (41.5%) were primigravidae, 503(51.4%) were between para one and para four, while 70 (7.1%) were grand-multipara. The rate of caesarean section was higher amongst the booked patients, 563 (57.5%) than the unbooked patients 355 (36.2%). Two previous caesarean section was the commonest indication for caesarean section 211(21.5%), followed by cephalopelvic disproportion 198 (20.2%), and foetal distress188 (19.2%). A total of 1009 babies were delivered through caesarean section by the 980 women; 955 cases of singleton gestations and 25 cases of multiple gestations (21 twins and 4 triplets). Majority of the babies 918 (91%) were delivered by emergency procedure. More than half of the babies 582(57.7%) had birth asphyxia and there were 39 (3.9%) perinatal deaths. All the cases of perinatal deaths and 549 (94.3%) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7%. CONCLUSION: There is now a further rise in rate of caesarean section after a slight drop that followed the initial high 1.5fold rise from previous studies. The perinatal outcome is poor especially following emergency caesarean section. Reducing primary caesarean section rate and more encouragement of vaginal delivery after one previous caesarean section may reduce the prevalence of two previous caesarean sections which is the leading indication for caesarean section in the hospital.