Abieyuwa P Osemwenkha

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.

Adolescents' perspective regarding adolescent pregnancy, sexuality and contraception

Abstract Objective To investigate the attitudes and perceptions of youths regarding adolescent pregnancy, in order to appraise their understanding of sexuality, contraception and why adolescents failed to use contraceptives. Methods This is a descriptive survey of a group of 163 students in their junior clinical postings in the Department of Obstetrics and Gynaecology, University of Benin. The participants completed an anonymous self-administered questionnaire which elicited information on perceptions, attitude, beliefs and their knowledge about adolescent pregnancy, prevention and utilization of contraception. Results Overall, majority of the participants held a negative attitude about adolescent pregnancy with over 85% regarding it as wrong and considered it to be associated with medical, socio-economic and educational problems. Peer pressure to have sex (71.8%%) had the highest rating on participants perceptions pertaining to the causes of adolescent pregnancy, other items rated were ignorance on basics of sexuality and pregnancy (60.1%) and being forced or coerced/refusal by boys/men to use condoms (52.1%). Condom was reported as the most common method youths/adolescents used in attempting to prevent pregnancy (38.1%), albeit, majority (69.3%) reported poor uptake of contraception by adolescents. Common reasons cited why adolescent/youths do not use contraceptives were: feeling embarrassed or ashamed to use or purchase condom/contraceptives (68.7%) and male partner dislikes for condoms (50.3%). An overwhelming majority (87.1%) of respondents thought that private access to condoms would increase uptake. Conclusions Although youths have a negative attitude towards adolescent pregnancy, their perception and understanding of sexuality and contraception is poor. Useful strategies for empowering youth and changing perception/behavior should include peer education and access to simple non-judgmental information on family life. Adoption of strategies tailored to our socio-cultural background to make condoms accessible privately may improve uptake and consequently reduce the menace of adolescent pregnancy.

Cervical cerclage in a Nigerian tertiary hospital: A review

Aim: The aim of the following study is to document the outcome of cervical cerclage in pregnancy. Materials and Methods: A retrospective analysis was undertaken of patients who had cervical cerclage for cervical incompetence at the Obstetrics and Gynecology Department of the University of Benin Teaching Hospital, Benin-City, Nigeria from January 2007 to December 2012. The cerclage was termed successful if the pregnancy was carried to term. Multiple demographic and clinical characteristics and their relationship to cerclage outcome were analyzed. Results: The records of 123 patients who underwent cerclage over the 6 years period reviewed were analyzed. The mean age was 33.3 ± 3.9 and majority (68.3%) were multiparous, with most of them (90.2%) having had a previous miscarriage. Majority (90.2%) had elective cerclage and 4 (3.3%) had emergency cerclage. Overall majority of patients delivered at 37 and 38 weeks gestation 23.6% and 19.5% respectively. Outcome of cerclage was adjudged successful in 92 (74.8%) of cases and failed in 31 (25.2%) cases. The most frequent complication was pre-viable or preterm rupture of membranes (14.6%). Cerclage outcome was not influenced by age, parity, gestational age at cerclage or experience of the surgeon. The mean duration for which pregnancy was prolonged after an emergency cerclage was 2.6 ± 2.4 weeks and emergency procedure was significantly associated with a failed cerclage. Of the 111 patients with previous miscarriages who had cerclage procedure, 68 (61.3%) had term deliveries and 23 (20.7%) preterm births. Fetal salvage rate of 98 (79.7%) was observed. Conclusion: Use of cerclage for suspected cases of cervical incompetence can have an important beneficial effect in carefully selected cases of cervical incompetence even amongst pregnant black African women.

Ovarian hyperstimulation syndrome in a spontaneous pregnancy: A potential for missed-diagnosis

Ovarian hyperstimulation syndrome (OHSS) with the natural ovulatory cycle is extremely rare. We report a case of severe OHSS associated with a spontaneous normal singleton pregnancy in a 23-year-old woman presenting with severe abdominal pain, vomiting, and dyspnea. Ultrasonography revealed 10 weeks viable intra-uterine single fetus with bilateral multilocular cystic ovarian masses and ascites. She had supportive therapy inclusive of oral bromocriptine with complete resolution of OHSS and an eventual uncomplicated normal vaginal delivery at 39 weeks of pregnancy.

Transabdominal follicular aspiration in an in vitro fertilization cycle: experiences with an unusual but necessary intervention in a resource-limited setting

Controlled ovarian hyperstimulation is one of the major steps of in vitro fertilization. The inaccessibility or non-visualization of developing follicles on transvaginal sonography (the preferred imaging method) may be misjudged as a poor response, resulting in cycle cancellation. It is necessary to scrupulously appraise proxy indicators for ovarian response, such as estradiol levels, endometrial thickness, and other individual clinical characteristics. This can prompt meticulous transabdominal ultrasound follicular monitoring and oocyte retrieval with the goal of averting cycle cancellation and improving treatment outcomes.

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.

Maternal characteristics and timing of presentation following pre-labour rupture of membranes.

Background: To examine the influence of maternal characteristics on timing of presentation for intervention following pre-labour rupture of membrane (PROM) at term. Materials and Methods: This was a descriptive study of cases of term PROM with singleton births at the University of Benin Teaching Hospital (UBTH) from October 2011 to December 2012. Interval from onset of PROM to presentation to hospital was used as dependent variable. From the study population, two groups were identified based on time interval (≤24 hours or >24 hours) from PROM to presentation to hospital and their relationship to socio-demographic characteristic examined. Results: Over the study period, records of 110 women met the inclusion criteria and were selected for analysis. Their mean age was 29.26 ± 0.67 years; they were all married with 41.8% being nulliparous women. The mean gestational age at presentation with PROM was 38.5 ± 1.2. Over 50% had tertiary level of education. Overall, 38.2% were in social class 1. With regard to maternal response behaviour to PROM, 65.5% presented to the hospital within 24 hours while 34.5% presented after 24 hours of rupture of membranes. Majority of those that presented within 24 hours of PROM were in (upper) social class 1 and 2 and this differed significantly from those that presented after 24 hours, most of whom were in (lower) social class 3,4 and 5; [56 (77.8%) vs 16 (22.2%) and 14 (36.8%) vs 24 (63.2%)] P = 0.0001. Conclusion: Delay in presentation after PROM, illustrative of maternal under utilisation of BPACR package, is associated with being in a lower social class. Socio-economic and educational empowerment of women is advocated, while prospective research on maternal perception and attitude towards ANC is proposed.

Age at menarche among secondary school girls in an urban population of Nigeria

Background: Menarche signals the beginning of reproductive years in women. In recent times, the age at menarche has shown a downward trend, and this may be potentially influenced by biosocial factors. Objective: The objective was to determine the current mean age at menarche among secondary school girls in Benin-city and the influence of biosocial factors. Materials and Methods: The study was a cross-sectional descriptive study of secondary school girls in Benin-city. Data collection was by use of pretested self-administered questionnaires. Biophysical parameters of the respondents were also obtained. Age at menarche was compared with social and biophysical indices. Results: Of the 1,408 respondents, 952 (67.6%) had attained menarche. Mean age at menarche of 12.3 ± 1.18 years was estimated. About 16.0% of the respondents attained menarche while still at primary school. Mean menarcheal age was influenced by the social status of parents, being lowest among girls from social class 1 (11.8 ± 1.25 years) and highest among girls from social class 5 (14.1 ± 1.14 years), P = 0.0001. Other factors that influenced mean menarcheal age included family type and size. Anthropometric parameters of postmenarcheal girls were also higher than those of their premenarcheal colleagues. Conclusion: In line with a global trend the age at menarche in Benin-city is lower in this study with reference to previous reports. This was positively influenced by some biosocial factors (such as higher weight/body mass index and mid-arm circumference). Furthermore, the observation of menarche even among primary school girls suggests a need for early initiation of enlightenment and education in adolescent reproductive health.

Appraisal of repeat intrapartum human immunodeficiency virus screening in a prevention of mother-to-child transmission program in Nigeria

Introduction: As more and more people with human immunodeficiency virus (HIV) live longer and enjoy healthier lives because of antiretroviral therapy, there are an increasing number of sexual transmissions of HIV. It is exceedingly important to assess the proportion of unsafe sexual practices among people living with HIV/AIDS (PLWHAs) and their disclosure status so that behavioral intervention can be designed optimally for them in order to curb secondary HIV transmission and potential reinfection with different or drug resistant strain of HIV. Aim: To assess sexual behavior and serostatus disclosure of PLWHAs attending antiretroviral therapy (ART) center in Vadodara. Settings and Design: The current cross-sectional study was carried out at ART center of a tertiary care hospital - Shree Sayaji General (SSG) Hospital, Vadodara after taking necessary permissions and approval from institutional review board (IRB). Materials and Methods: A semistructured questionnaire was used for interview with PLWHA who are on ART after taking written and informed consent. Data was entered and analyzed using Epi Info software. Results: A total of 175 PLWHAs were enrolled in this study. Forty-three percent of the PLWHAs practiced premarital sex, while 15% of them practiced extramarital sex (EMS). Nearly 90% of these sexual practices were unsafe. Fifty-eight percent of the PLWHAs continued these unsafe sexual practices even after HIV diagnosis. Nearly 20% of the PLWHAs did not receive any counseling regarding sexual behavior. Ninety-five percent of respondents had disclosed their serostatus to their spouse. Conclusions: Still a remarkable proportion of PLWHAs indulge in unsafe sexual practices and the most common reason encountered among them was desire for child. Although majority of the participants had disclosed their serostatus to their spouse, many respondents did not mention their serostatus to other sexual partners. There is a need to stress on the importance of safe sex among PLWHAs not only to prevent transmission to their partners, but also to help them avoid receiving potentially resistant HIV strains in case of seroconcordant couples. A need-based sexual behavior-related motivational counseling needs to be focused on.Introduction: This study was carried out among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) receiving antiretroviral therapy (ART) in a tertiary health facility in Nigeria and it is aimed at determining practice of adherence among these patients. Materials and Methods: A total of 282 HIV positive patients receiving ART in Nnamdi Azikiwe University Teaching Hospital, Nnewi were selected by systematic random sampling technique and using a semi-structured, interviewer administered questionnaire, responses were elicited from them on knowledge and perception of ART and adherence. Practice of adherence was determined by self-report. Findings were analyzed using Statistical Package for the Social Sciences version 17 (IBM Corp, Chicago Illinois, USA). Results: Most of the respondents were females (66.3%) and their mean age of the respondents was 36.63 ΁ 8.56 years. Most of the respondents have good knowledge of ART and adherence, even though most of them (64.2%) thought that ART cures HIV/AIDS. Most patients still considered HIV/AIDS as a serious illness (78.0%). Only about half of them (50.7%) were of the opinion that ART reduces the risk of HIV transmission. However, the general perception of adherence was good. The mean level of adherence was 97.8%, however, about 86% of them attained optimal adherence level. Conclusion: The study revealed fairly good knowledge and perception of ART and adherence among the patients. The level of ART adherence was also high; however there is a need to address some gaps in knowledge identified as part of measures aimed at improving adherence in the long run.Context: Disclosing ones human immunodeficiency virus (HIV) status helps in reducing the spread of the disease. Intimate partners are encouraged to reveal their status to each other. Such strategies aid in determining discordance and also target proven interventions to the correct demographic. Objective: The objective was to determine the rates of discordance among HIV positive pregnant women and their partners attending Nnamdi Azikiwe University Teaching Hospital, Nnewi. Materials and Methods: Partners of HIV positive pregnant women who had been notified of their spouses status were invited, counseled, and those who accepted, were tested for HIV using the national testing algorithm. Pre- and post-test counseling was offered to all tested partners. Results: A total of 10,070 new patients booked for antenatal care during the study period. Eight thousand nine hundred and seventy-nine (89.2%) of them were counseled, with 8317 (92.6%) of them accepted to do the HIV test. Seven hundred and ninety-seven women tested positive giving a sero-prevalence of 9.6%. Although 84.4% (673) of the positive mothers stated their intent to notify their partners, only 21% (141) of the partners presented for counseling and testing. On the whole, 98.6% (139) of the partners who presented accepted the test with 45.3% (63) of them testing positive, giving a sero-discordance rate of 54.7%. Conclusion: The discordance rate among tested partners is high in our center and suboptimal counseling, and testing rates were observed in the male partners. Interventions aimed at increasing partner involvement should be devised and adapted for our region. This will yield more data, give a truer picture of discordance rates as well as the aid in better management of scarce resources in program implementation.Opportunistic fungal infections account for a significant amount of morbidity associated with human immunodeficiency virus (HIV) disease. Oral candidiasis is one of the earliest premonitory signs of HIV infection and its diagnosis may have grave prognostic implications for the eventual development of full blown acquired immunodeficiency syndrome (AIDS). It is considered as an important marker of immune suppression and may be the initial manifestation of the disease in about 10% of HIV-infected adults. Careful history taking and detailed examination of the patients oral cavity are important parts of the physical examination, and diagnosis requires appropriate investigative techniques. Early recognition, diagnosis, and treatment of HIV-associated oral lesions may reduce morbidity. This review is intended to provide information on clinical variants of oral candidiasis and management as dental care providers are likely to be among the first to recognize such manifestations.Motor neuron diseases (MND) are extremely rare neurological manifestations of human immunodeficiency virus (HIV). We report a case of a 33-year-old known HIV seropositive male who presented with progressive asymmetrical onset of weakness and wasting of both distal limbs along with dysphagia and difficulty in speech. Examination revealed significant atrophy with visible fasciculations in thenar and hypothenar areas of both hands and dorsum of both feet associated with brisk deep tendon reflexes and jaw jerks, but diminished gag reflexes. Electromyography revealed evidence of denervation pattern. Investigations for underlying causes of MND other than HIV were noncontributory. Administration of riluzole along with continuation of antiretroviral therapy brought significant relief to his limb weakness, but bulbar features continued to progress. The case report highlights the rare, but definite association between HIV and amyotrophic lateral sclerosis (ALS) and partial reversibility of disabling clinical features on highly active antiretroviral therapy, which mandates ruling out HIV in all cases of ALS.through implementation of option B+ would have various other benefits. The total fertility rate in Malawi is high, around five to six births per woman, which is unlikely to be much lower in HIV‑infected women. Soon after the breastfeeding period (median duration 23 months) many women become pregnant again. Thus, a stop‑start approach to ART administration is almost redundant. Many women present for antenatal care late in pregnancy—an estimated 50% are thought to attend after 28 weeks of gestation—and continuing prophylaxis with antiretroviral drugs would mean that the next pregnancy could be protected from conception. The stopping of ART after cessation of breastfeeding might lead to viral rebound, with the risk of transmission to a sexual partner or fetus being notably raised. In women in Zimbabwe even those with CD4 cell counts higher than 350 cells per μL had a risk of death around six times higher than that in noninfected women within 24 months post‑partum [2,3] , and early ART could reduce mortality by 50‑90%. [4] Prevention

Screening of Gynaecological Surgical Patients for HIV-1 Infection in Nigeria

Background : HIV infection in gynaecological surgical diseases (GSDs) is associated with higher complications but epidemiological data in Nigeria is scarce. Objective : To determine the proportion, pattern and factors associated with HIV-1 infections among GSDs patients and early linkage to HIV care and treatment. Materials and Method : This one-year prospective study enrolled consecutive volunteers admitted January 1 through December 31, 2007 for gynaecological surgeries in a tertiary Nigerian hospital. The women were pre- and post-test counselled and screened for HIV-1 antibodies using Abbott Determine for HIV- 1 and 2 (Abbott Laboratories, Illinois, USA) and Uni-Gold Recombigen HIV (Trinity Biotech, Wicklow, Ireland) in a serial test algorithm. Repeatedly reactive samples were considered positive. Discordant results were confirmed using HIV-1/2 Stat-Pak (Chembio, Medford, NY) as tie-breaker. The patients’ socio-demographic characteristics and associated factors were obtained using structured questionnaire. Seropositive women were linked to care. The outcome measures were proportion of women with HIV positive results, associated factors and mortality rate over a one year follow up period. Results : The overall proportion of HIV positive result was 6.3% (26/413) with women aged ≥ 45 years having the highest proportion (8.45%). Only 9.4 % (39/413) were aware of their HIV status prior to testing. Of the HIV positive patients, 7.7% (2/26) knew their status and were on antiretroviral drugs. They had not been sexually active in the last six months. Multiple sexual partners (p<0.000), STIs (p<0.000), traditional medications (p<0.003), pelvic abscess (p=0.008), cervical cancer (p<0.003), induced abortions (p<0.001) were HIV-associated factors. Previous blood transfusion, surgeries, benign tumors, non-cervical gynaecological malignancies were not. There were no mortalities over a one year follow up period. Conclusion : The proportion of HIV infection among women admitted for GSDs was high but prior knowledge of HIV status was low. The study has provided a window of opportunity for screening, diagnosis and early treatment. Integration of HIV counselling and testing into gynecological services would be desirable.