Genital tract infections and the specialist gynaecologist: a survey of perception, diagnosis and treatment.

The study was designed to investigate the attitude of gynaecologists to the management of genital tract infections in the North West Region of England. A postal questionnaire was sent to all members and fellows of The Royal College of Obstetricians and Gynaecologists with addresses in the region. A response rate of 71% was achieved. Of these 67% were male and more than 97% had been in the speciality for more than 5 years. Only 90.5% routinely obtain swabs from the posterior fornix; none from the pharynx. Forty-two per cent thought there might be a role for the genitourinary physician in the management of genital tract infections. Nineteen per cent engaged in consort tracing and only 22.6% carried out tests of cure before discharging the patients. Fifty-one per cent thought there could be grounds for litigation for not carrying out contact tracing and 27.4% agreed that not doing tests of cure may be regarded as negligence. This study revealed that there is a need for adequate training of gynaecologists with regards to the facilities available within the National Health Service.

Pregnancy outcome after illegal induced abortion in Nigeria: a retrospective controlled historical study.

The effect of illegal abortion on subsequent reproduction was studied in 46 Nigerian women who gave a history of illegal termination of pregnancy. There was a statistically significant increase in the incidences of premature rupture of membranes, premature labour and low birth weight when compared to 53 primigravida who gave no such history of abortion. The perinatal mortality was also significantly higher in the abortion group. In contrast, pre-eclampsia was less common in the abortion group. These findings indicate that illegal abortion has adverse effects on pregnancy outcome in Nigerian women.

PIP: Researchers compared data on 46 women with a history of illegal induced abortion with data on 53 women with no previous pregnancy to examine the effect of previous abortion(s) on subsequent pregnancy outcome. All 99 women delivered at the Obafemi Awolowo University Teaching Hospital in Ile-Ife, Nigeria, during January 1984-December 1988. The type of illegal induced abortion was dilatation and curettage (D&C) which tends to cause cervical incompetence. Controls were more likely to suffer from preeclampsia than cases (11.3% vs. 2.1%; p 0.05). Women with a history of induced abortion were more likely than the controls to suffer premature rupture of fetal membranes and preterm labor (23.9% vs. 1.8%, p 0.001 and 32.6% vs. 9.4%, p 0.0001, respectively). Gestational age was shorter in the study group than in the control group (median, 36 vs. 39 weeks; p 0.01). Cases were more likely than controls to have smaller newborns (2.2 vs. 2.8 kg; p 0.01) and more low birth weight newborns (41.3% vs. 17%; p 0.01). Perinatal mortality was 23.9% in the study group compared to 1.8% in the control group (p 0.001), mainly due to prematurity. Gestational age at termination did not effect the risks of premature rupture of membranes, preterm labor, low birth weight, or perinatal mortality. These findings show that illegal abortion has adverse effects on outcome of subsequent pregnancies. Physicians should determine whether a pregnant woman has had an illegal abortion. If so, they should monitor her for cervical incompetence so they can treat it early. Clinicians performing abortions should use vacuum aspiration rather than D&C to reduce the likelihood of premature labor and perinatal death in subsequent pregnancies.

Maternal sickle cell trait is not a cause of low birthweight in Nigerian neonates.

As a result of reports of reduced birthweight in neonates of mothers with hemoglobin AS (Hb-AS) in other populations, we compared birthweights in 57 Hb-AS primigravidas in Nigeria with 60 controls who were sickle negative. There was no statistically significant difference in mean birthweight or placental weight between the groups. This finding may be due to development of resistance against malaria infection by Hb-AS women in this population.

Congenital absence of an ovary in a Nigerian woman.

A case of unilateral absence of the left ovary in a 45-year-old grand multiparous Nigerian woman is reported. Congenital absence of a gonad is extremely rare and it indicates a genetic or chromosomal error in the formation of the urogenital ridge.