Intramural Pregnancy: An Intriguing Diagnosis in a Resource Constraint Practice.

A 30-year-old G4P1+2(1 alive) woman with a history of cervical incompetence initially presented at a gestational age (GA) of 10 weeks and 6 days with lower abdominal pain and was managed conservatively as a case of threatened miscarriage. She re-presented two weeks later and was admitted on account of lower abdominal pain and spotting per vagina of 4hrs duration. An obstetric ultrasound revealed an intrauterine pregnancy invading the posterior myometrium with thinning of the uterine wall and hemoperitoneum. She subsequently had an exploratory laparotomy, evacuation of the hemoperitoneum, separation of the fetus from the myometrium, and repair with no. 2 vicryl suture. The patient recovered satisfactorily and had two units of whole blood transfused. She was managed with analgesics, hematinics and broad-spectrum antibiotics. She was discharged on the 4th post-operative day to be followed up at the gynaecological clinic.

CONTEXTE: Une femme de 30 ans, G4P1+2(1 vivant) avec des antécédents d'incompétence cervicale, s'est initialement présentée à un âge gestationnel (AG) de 10 semaines et 6 jours avec des douleurs abdominales basses et a été prise en charge de manière conservatrice pour une menace de fausse couche. Elle s'est à nouveau présentée deux semaines plus tard et a été admise en raison de douleurs abdominales basses et de saignements vaginaux depuis 4 heures. Une échographie obstétricale a révélé une grossesse intra-utérine envahissant le myomètre postérieur avec amincissement de la paroi utérine et hémopéritoine. Elle a ensuite subi une laparotomie exploratrice, une évacuation de l'hémopéritoine, une séparation dufœtus du myomètre, et une réparation avec un fil de suture vicryl n° 2. La patiente a récupéré de manière satisfaisante et a reçu deux unités de sang total en transfusion. Elle a été prise en charge avec des analgésiques, des hématiniques et des antibiotiques à large spectre. Elle a été autorisée à sortir le 4ème jour post-opératoire avec un suivi prévu à la clinique gynécologique. MOTS-CLÉS: Grossesse intramurale, Dilemme, Pratique à ressources limitées.

A Comparative Study of Uterine Artery Doppler Parameters and Endometrial Characteristics in Women with Unexplained Infertility and Fertile Women at a Nigerian Teaching Hospital.

OBJECTIVES: To investigate the uterine artery Doppler parameters and endometrial characteristics in women with unexplained infertility. METHODS: A prospective case-control study of 42 women with unexplained infertility and 42 fertile controls. Their mid-luteal phase transvaginal Doppler parameters of both uterine arteries and endometrial characteristics (endometrial blood flow, thickness and volume) were investigated and analysed. P values < 0.05 was statistically significant. RESULTS: The mean uterine artery pulsatility index (PI) and resistivity index (RI) of the cases (women with unexplained infertility) were significantly higher compared to the values in the fertile controls (PI = 2.81±0.61 vs 2.15±0.65; p=0.001) (RI= 0.87±0.08 vs 0.82±0.07; p=0.003). In addition, the end-diastolic volume (EDV) (6.12±4.17 vs 9.37±5.14; p=0.007) and endometrial-subendometrial blood flow (p=0.036) were significantly lower in the cases compared to the controls. Multivariate logistics analysis showed that PI was independently associated with infertile status (p=0.006). There was no significant difference in the mean PSV (48.69±10.9 vs 50.58±11.30; p=0.602), endometrial thickness (10.30+3.13 vs 10.72+3.10; p=0.544), endometrial volume (7.82+1.56 vs 8.23+1.71; p=0.323), mean age (32.28±4.062 vs 31.91±3.58 years; p=0.502), body mass index (26.15±2.71kg/m2 vs 25.24±2.85 kg/m2; p=0.18) menstrual bleeding days (4.07±0.89 days vs 4.02±0.95 days; p=0.481) duration of menstrual cycle (28.02±1.09 days vs 27.64±1.36 days; p= 0.162), smoking history (p=0.909) and alcohol intake (p=0.507) of the infertile women compared with the fertile controls, respectively. CONCLUSION: Women with unexplained infertility have increased uterine artery Doppler PI and RI and reduced endometrial-subendometrial perfusion compared with fertile controls.

OBJECTIFS: Étudier les paramètres Doppler de l'artère utérine et les caractéristiques de l'endomètre chez les femmes atteintes d'infertilité inexpliquée. MÉTHODES: Une étude cas-témoins prospective de 42 femmes atteintes d' infertilité inexpliquée et 42 témoins fertiles. Leur phase mi-lutéaleles paramètres Doppler transvaginaux des artères utérines et des caractéristiques de l'endomètre (flux sanguin de l'endomètre, épaisseur et volume) ont été étudiés et analysés.Les valeurs P d ¼ 0,05 étaient statistiquement significatives. RÉSULTATS: L'indice moyen de pulsatilité de l'artère utérine (IP) etindice de résistivité (IR) des cas (femmes atteintes d'infertilité inexpliquée)étaient significativement plus élevées par rapport auxvaleurs des témoins fertiles(PI = 2,81±0,61 vs 2,15±0,65; p = 0,001) (RI = 0,87±0,08 vs0,82±0,07; p=0,003). De plus, le volume diastolique final (EDV)(6,12±4,17 vs 9,37±5,14; p = 0,007) et endométrialesous-endomètrele débit sanguin (p = 0,036) était significativement plus faible dans les cas comparésaux contrôles. L'analyse logistique multivariée a montré que PI était indépendamment associé au statut infertile (p = 0,006).Il n'y avait pas de différence significative dans le PSV moyen (48,69±10,9 vs50 h 58±11 h 30; p=0,602), épaisseur de l'endomètre (10,30+3,13 vs10.72+3.10; p = 0,544), volume de l'endomètre (7,82 + 1,56 vs 8,23 + 1,71;p=0,323), âge moyen (32,28±4,062 vs 31,91±3,58 ans; p=0,502),indice de masse corporelle (26,15±2,71 kg/m2 vs 25,24±2,85 kg/m2; p=0,18)jours de saignements menstruels (4,07±0,89 jours vs 4,02±0,95 jours; p = 0,481)durée du cycle menstruel (28,02±1,09 jours vs 27,64±1,36 jours;p= 0,162), antécédents de tabagisme (p = 0,909) et consommation d'alcool (p = 0,507)des femmes infertiles par rapport aux témoins fertiles, respectivement. CONCLUSION: Les femmes atteintes d'infertilité inexpliquée ont augmentation significative de l'artère utérine Doppler PI et RI et réduction perfusion endométriale-sous-endoudo-endométrique par rapport aux témoins fertiles. Mots-clés: Infertilité inexpliquée, Artère utérine, Doppler, Caractéristiques de l'endomètre.

Retained surgical needle post myomectomy, an uncommon mishap.

BACKGROUND: Retained foreign bodies are relatively uncommon and probably underreported in the tropics. Largely preventable errors, they cause harm to both the patient and the medical practitioner. CASE PRESENTATION AND MANAGEMENT: A 32 year old primigravida with recurrent lower abdominal pain in pregnancy. She had myomectomy a year earlier at a private hospital in which the endometrium was inadvertently breached. She subsequently had an elective caesarean section at 38 weeks and 2 days gestational age. Intra-operative findings were adhesive bands between the uterus and loops of bowel and a round bodied surgical needle attached by adhesions anteriorly to the lower segment. Her post operative care was uneventful and she was discharged home on the 3rd day post operation. CONCLUSION: Retained surgical foreign body (RSFB) could pose a diagnostic dilemma as in the case of this patient with recurrent lower abdominal pain in pregnancy. Meticulous instrument count should include sutures and needles.

An audit of interval female sterilisation by minilaparotomy at the University College Hospital, Ibadan, Nigeria.

Female sterilisation is a widely accepted and practiced family planning method. This study aimed at ascertaining the complications that followed interval minilaparotomy at the University College Hospital, Ibadan, over a 5-year period. Only women who requested sterilisation for family planning purposes were included in the study. There were 135 patients who had interval female sterilisation. Of these, 119 (88.1%) case files were available for analysis. The mean age at sterilisation was 38.2 ± 3.8 years, mean parity of 7 ± 2.0 and the mean number of living children at the time of the procedure was 6.5 ± 1.4. The mean duration of the procedure was 42.35 ± 13.07 min. The most receptive clientele for interval female sterilisation were 35 years or older and were grand multiparous. Women in the lowest Class (V) were least likely to accept female sterilisation in this study. Complications arising from the procedure were mostly minor, hence it is adjudged safe. There were no failed procedures in this study and only one of the patients had regrets about the procedure.

COVID-19 PANDEMIC: IMPACT ON GYNAECOLOGICAL ENDOSCOPY AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN.

The impact of the COVID-19 pandemic on endoscopic services in a low resource economy is formidable. With the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there has been genuine concerns about the risk of transmission during gynaecological endoscopy via the diffusion of contaminated aerosols generated from CO2 leakage and smoke created by energy devices. A pragmatic step in mitigating transmission at the University College Hospital, Ibadan, resulted in the closure of the Endoscopic unit for 3 months whilst deploying increased hygienic methods coupled with social distancing. This however had its unintended consequences of delay and increased backlog of cases aside the economic losses. Developing a unit-based policy/protocol in response to any future unforeseen occurrence should take front stage in the planning and administration of the unit. Adopting global best practices and guidelines from researched evidence is not only imperative but desirable especially in the context of limited resources.

Male participation in pregnancy and delivery in Nigeria: a survey of antenatal attendees.

This was a cross-sectional study carried out on 462 pregnant women attending antenatal care in Ibadan, Nigeria. The study's aims were to assess the level of participation of Nigerian men in pregnancy and birth, the attitude of the women and likely targets for improved care delivery. Three hundred and forty-nine women (75.5%) were aware that husbands could participate in childbirth. Most women did not think it was their husbands' place to attend antenatal clinic (48.3%) or counselling sessions (56.7%). Nearly all husbands (97.4%) encouraged their wives to attend antenatal clinic - paying antenatal service bills (96.5%), paying for transport to the clinic (94.6%) and reminding them of their clinic visits (83.3%). Three hundred and thirty-five husbands (72.5%) accompanied their wives to the hospital for their last delivery, while 63.9% were present at last delivery. More-educated women were less likely to be accompanied to the antenatal clinic, while more-educated men were likely to accompany their wives. Yoruba husbands were less likely to accompany their wives, but Yoruba wives with non-Yoruba husbands were 12 times more likely to be accompanied. Women in the rural centre were less likely to receive help with household chores from their husbands during pregnancy, while educated women were more likely to benefit from this. Monogamous unions and increasing level of husbands' education were associated with spousal presence at delivery. It appears that male participation is satisfactory in some aspects, but increased attendance at antenatal services and delivery would be desirable.

A CASE REPORT OF PREMENARCHIAL TRANSVERSE VAGINAL SEPTUM AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

Premenarchial Transverse vaginal septum is a benign condition. The septum may be found in the upper, middle or lower vagina. A case report of a premenarchial girl with transverse vaginal septum managed at the university college hospital, Ibadan, in January 2009. Diagnosis was made following a history of primary amenorrhea, cyclical low abdominal pain and pelvic examination which revealed a vaginal septum. She had surgical resection of the vaginal septum and a vaginal stent was left in-situ to keep the vagina patent during the healing process. The procedure was uneventful and she was able to achieve menstrual flow following surgery. Follow up visits were essentially unremarkable.

Right ampullary ectopic pregnancy following bilateral tubal ligation using spring clips.

Pregnancy is unlikely to occur in women who have undergone sterilization. However when it occurs, there is a substantial risk that it will be an ectopic pregnancy. We report a case of right unruptured ampullary ectopic gestation following tubal sterilization with spring clips 6 years prior to presentation. The likely aetiology may be spontaneous reanastomosis.

An appraisal of retained placentae in ibadan: a five year review.

OBJECTIVES: To determine the frequency of retained placenta at the University College Hospital Ibadan (UCH). and to describe the socio-demographic characteristics of the patients and examine the risk factors predisposing to retained placenta. METHODS: This is a descriptive study covering a period of 5 years from January 1(st) 2002 to December 31(st) 2006. During the study period, 4980 deliveries took place at the University College Hospital, Ibadan and 106 cases of retained placenta were managed making the incidence 2.13 per cent of all births. RESULTS: During the five year period, there were 106 patients with retained placenta; of these, 90 (84.9%) case notes were available for analysis. The mean age was 29.37 ± 4.99 years. First and second Para accounted for 52 per cent of the patients. Majority of the patient were unbooked for antenatal care in UCH with booked patients accounting for 27.8 per cent of the cases. The mean gestational age at delivery was 34.29 ± 6.02. Three patients presented to the hospital in shock of which 2 died on account of severe haemorrhagic shock. Fifty-eight patients (64.8%) presented with anaemia (packed cell volume less than 30 per cent) and 35 patients (38.8%) had blood transfusion ranging between 1-4 pints. 1 patient required hysterectomy on account of morbidly adherent placenta. Eleven patients (12.2%) had placenta retention in the past, 28 patients (31%) had a previous dilatation and curettage, 14 patients (15.5%) had previous caesarean sections and 47 patients (41.3%) had no known predisposing factors. CONCLUSION: Retained placenta still remains a potentially life threatening condition in the tropics due to the associated haemorrhage, and other complications related to its removal. The incidence and severity may be decreased by health education, women empowerment and the provision of facilities for essential obstetric services by high skilled health care providers in ensuring a properly conducted delivery with active management of the third stage of labour.