A.A.E. Orhue

A comparison of two adjunctive treatments for intrauterine adhesions following lysis.

Objectives: To assess which treatment modality has a better outcome: the use of an intrauterine contraceptive device or the Foley catheter balloon, for the adjunctive treatment of intrauterine adhesion (IUA) in patients presenting with infertility. Methods: In a 4‐year initial period, patients with intrauterine adhesion were treated with the insertion of an intrauterine contraceptive device (IUCD) after adhesiolysis. In the next 4 years, a pediatric Foley catheter balloon was used after adhesiolysis instead of the IUCD. The postoperative treatment was the same throughout the 8 years. While the IUCD was removed after three consecutive withdrawal vaginal bleedings, the Foley catheter was removed after 10 days. Hysterosalpingography was repeated in all patients after the third withdrawal vaginal bleeding, and the procedure was repeated if the intrauterine adhesion still persisted. The χ2‐test was used for analysis. Results: There were 51 cases of IUA treated with the IUCD and 59 cases treated with the Foley catheter balloon. In the Foley catheter group, 81.4% of the patients had restoration of normal menstruation compared with 62.7% in the IUCD group (P<0.05). Persistent posttreatment amenorrhea and hypomenorrhea occurred less frequently in the Foley catheter group (18.6%) than in the IUCD group (37.3%) (P<0.03), and the conception rate in the catheter group was 33.9% compared with 22.5% in the IUCD group. The need for repeated treatment was also significantly less in the Foley catheter group. Conclusion: The Foley Catheter is a safer and more effective adjunctive method of treatment of IUA compared with the IUCD.

Abortion-related morbidity and mortality in Benin City Nigeria: 1973-1985.

In a 13‐year review of maternal deaths at the University of Benin Teaching Hospital, Benin City, abortion was one of the three major causes of death, accounting for 37 (22.4%) out of the 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage, inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis (including tetanus), hemorrhage and trauma to vital organs, complications directly attributable to faulty techniques by unskilled abortion providers, a by‐product of the present restrictive abortion laws. Total overhaul of maternal child health services and the family health education system, as well as integration of planned parenthood at primary health care level into the health care delivery system, are suggested. Contraceptive practice should be made available to all categories of women at risk, and the cost subsidised by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and a review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notably in the African continent, is overdue.

A randomized trial of 30-min and 15-min oxytocin infusion regimen for induction of labor at term in women of low parity

OBJECTIVE: To investigate in women of low parity (para 1, 2 or 3) whether induction of labor using a regimen of intravenous oxytocin, increasing incrementally at 30‐min intervals is safer than one increasing at 15‐min intervals. METHOD: Two hundred and forty‐five women of low parity requiring induction of labor by infusion of oxytocin were randomly allocated to incremental increases at 30‐min intervals (123 women) as experimental group or 15‐min intervals (122 women) as the control group. In both groups forewater amniotomy was performed synchronously with oxytocin infusion using the allocated regimen. RESULTS: The 30‐min incremental regimen resulted in less precipitate labor, uterine hyperstimulation and a reduced length of stay in hospital. The induction delivery interval was longer with the experimental group which also had less occurrence of postpartum hemorrhage, perineal tears and puerperal pyrexia. CONCLUSION: Oxytocin infusion regimen with 30 min incremental increases is safer than the regimen with 15‐min incremental increases.

In vitro fertilization at a public hospital in Nigeria

To assess the results of an in vitro fertilization program newly established within a conventional infertility program at a university hospital in Nigeria.

Outcome of cesarean section in twin pregnancy

In an 8‐year period (January 1978 to December, 1985), the 17,379 deliveries at the University of Benin Teaching Hospital (UBTH) consisted of 2089 cesarean sections (12.0%), 56 of which were associated with twin pregnancy. The main indications for cesarean section on the twin pregnancies were antepartum hemorrhage (placenta previa), malpresentation, cervical dystocia and previous cesarean section. The maternal mortality rate was 2% for all twin mothers delivered by cesarean section. There was no statistical difference in perinatal mortality rates (PMR) for all twin deliveries, vaginal twin deliveries and deliveries by cesareans section which were 111,113 and 100 per 1000 births, respectively. In the case of a retained second twin, however, recorded PMR was significantly higher (133 per 1000 births). Consideration of more liberal recourse to cesarean section in all cases of twins may reduce these unacceptably high perinatal death rates in twin pregnancy.

The Effect of Female Age on the Outcome of Intrauterine Insemination Treatment in a Public Hospital‑Assisted Reproduction Technology Unit

Objective: The objective of the study is to evaluate the effect of female age on the outcome of ovarian stimulation (OS) and intrauterine insemination (IUI) treatment. Methodology: This was a 36 months retrospective analysis of all IUI treatment cycles with prior OS. Based on the age of the women, 4 groups were identified for comparative analysis, namely women below 30 years, between 30 and 34; 35–39 years, and women aged 40 years and beyond. Results: Two hundred and seventeen IUI procedures were conducted during the study and 39 had a positive pregnancy test outcome (a pregnancy rate of 18%). Majority of the women were 35–39 years (41.5%), while 12% were 40 years and above. The pattern showed that the pregnancy rate was highest in the younger age group who were below 30 years, 6/18 (33.3%) and 30–34 years, 19/83 (22.9%) compared with women 35–39 years, 12/90 (13.3%) and ≥40 years, 2/26 (7.7%). The difference in the linear association of each age class compared to the next was significant (P = 0.06 and P = 0.007, respectively). The trend revealed that baseline follicle stimulating hormone increased with age and the youngest age group required significantly fewer units of human menopausal gonadotropin to achieve adequate response to OS compared to the oldest age group (P < 0.001). Conclusion: Advanced age negatively affects OS and IUI outcome. Treatment is associated with better pregnancy outcome in women under 35 years compared to women who were 40 years and beyond. This fact should be clearly emphasized at counseling of the 40-year-old that may opt for IUI treatment.

Successful triplet pregnancy in an African with pure gonadal dysgenesis: A plus for assisted reproduction

Abstract Gonadal dysgenesis represents a congenital developmental disorder of the reproductive system, with its main gynaecologic manifestations being amenorrhea and infertility. We present a unique case of pure gonadal dysgenesis in an ‘about to be’ married lady resident in a society where high premium and success in marriage is dependent on childbirth. With astute evaluation and counseling, assisted reproductive technology (ART) was safely and successfully used in this case with eventual triplet pregnancy and delivery. Our index experience shows that situations with compromised fertility the availability and access to ART aids effective treatment planning and births a re-invigorated hope for family life.