Ayodele O. Arowojolu

Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians

Emergency contraception was introduced in Nigeria over two decades ago, but few women have used this method even in emergency situations because of the side effects. To find an acceptable levonorgestrel regimen for emergency contraception in our community, the two-dose regimen 0.75-mg levonorgestrel 12 h apart (group A) and the single dose 1.5-mg levonorgestrel (group B) were studied in 1118 volunteers. Mild side effects such as nausea, vomiting, lower abdominal pains, menorrhagia, dizziness, headache, and breast tenderness were reported. Significantly more women in the high-dose group reported headache, breast tenderness, and heavy menstrual flow. Eleven pregnancies (1.0%) were reported (7 in group A and 4 in group B). The crude relative risk of pregnancies was similar in the two groups (RR = 0.71, 95% CI = 0.32-1.55; p > 0.05) [corrected]. On the other hand, the estimated effectiveness rate of 86.80% in group A was significantly lower than the 92.99% for group B (p < 0.05). The pregnancy rates increased with delay in starting treatment and if further acts of unprotected sexual intercourse took place after treatment. It was concluded that both regimens were effective and safe.

Sexuality, Contraceptive Choice and AIDS Awareness among Nigerian Undergraduates

A survey of 2388 Nigerian undergraduates revealed that 87% were sexually active and 66% had more than one sexual partner, while 17.5% have had clandestine abortions. All respondents were quite knowledgeable about HIV/AIDS but few sexually active ones took precautions to prevent HIV transmission. Majority (87.5%) were knowledgeable about contraception and approved of its use, but only 34.2% were current users of contraceptives. About 58% of these cited pharmacy shops as their source of contraceptives. The attitudes of the students were below expectation. Specially designated centres for the provision of appropriate contraceptive services to students by trained personnel are needed in the institutions in order to tackle their reproductive health problems.

Oral misoprostol for the prevention of primary post-partum hemorrhage during third stage of labor.

Aim:  To assess the effectiveness of oral misoprostol compared with methylergometrine in the prevention of primary post‐partum hemorrhage during the third stage of labor.

Perception and Practice of Emergency Contraception By Post-Secondary School Students in Southwest Nigeria

A survey of 1500 students in post-secondary institutions in southwest Nigeria showed that the concept of emergency contraception (EC) was well known. Respectively, 32.4%, 20.4% and 19.8% knew that combined pills, progesterone only pills and intrauterine contraceptive device (IUCD) were usable for EC, while 56.7% mentioned the use of traditional methods. Only 11.8% had ever used either pills or IUCD and 10.7% had used a traditional method. Few students (11.5% and 2.3% respectively) knew the correct timing of EC pills and IUCD. The respondents reported varying circumstances under which EC was indicated but the majority cited condom breakage and sexual assault. The popular media represent the commonest source of information while hospitals/clinics were the commonest sources of procurement. About 37% of the respondents planned to use EC in future while 58% would not and 4.7% were uncertain. Reasons for these responses were explored.

Selenium status of idiopathic infertile nigerian males

Selenium concentration in the sera and seminal plasma of 60 infertile males (40 oligospermia and 20 azoospermia) and 40 males with proven evidence of fertility (normospermia; control group) were estimated using atomic absorption spectrophotometry. Results were correlated with spermatogram and hormonal levels in order to determine their relationship and significance in male infertility. The mean serum concentrations of selenium was found to be significantly increased in oligospermic compared to azoospermic subjects and controls (p<0.01), whereas the seminal plasma level was significantly higher in azoospermic compared to oligospermic subjects and controls (p<0.001). Thus, the ratio of serum selenium to seminal plasma selenium was 1∶1 in controls, 4∶1 in oligospermia, and 1∶2 in azoospermic subject.A significant inverse correlation was observed between serum selenium level and sperm count (p<0.01). Similarly, seminal plasma selenium correlated with spermatozoa motility, viability, and morphology. Serum selenium level shows positive correlation with the serum testosterone level (p<0.01). In conclusion, there appears to be a physiological balance in the distribution of selenium in serum and seminal plasma compartment of control males. A disturbance in this balance has a significant influence on spermatogenesis. Selenium appears to have a positive influence on Leydig cells, thus influencing the secretion of testosterone.

Effect of sublingual misoprostol versus intravenous oxytocin on reducing blood loss at cesarean section in Nigeria: A randomized controlled trial

Aims:  The aim of this study was to compare the effectiveness and safety of sublingual misoprostol with i.v. oxytocin infusion administered after delivery in reducing blood loss at cesarean section in Nigeria.

Knowledge and practice of emergency contraception among Nigerian youths

The knowledge and use of regular or emergency contraceptives (ECs) among Nigerian youths were assessed by a survey conducted among students with previous clandestine abortions in five higher institutions in Southwest Nigeria. 1000 questionnaires were distributed with a response rate of 75.8%. Analysis was made of the records of 166 respondents with previous clandestine abortions. Sexual intercourse was first experienced at a mean age of 15.7 +or- 3.6 years (range 11-24 years) while the mean number of induced abortions was 2.2 +or- 1.8 (range 1-14). Although most of the respondents were aware of the concept of EC only 30.1% knew about emergency contraceptive pills (ECPs) and 10.2% knew about the IUD. The percentage of those knowledgeable about ECPs and the IUD was highest among student nurse/midwives students in 26-30 years age group single respondents and Protestants. These results suggest that awareness and use of ECPs and the IUD by the respondents are inadequate but could be improved through readily available information.

Perinatal mortality following umbilical cord prolapse

Umbilical cord prolapse which occurred in 0.6% of deliveries in 1932 now complicates only approximately 0.2% of deliveries. The reduced incidence probably reflects changes in obstetric practice especially the increased use of elective cesarean section (CS). Intrapartum CS in cases of noncephalic presentation and a more active intrapartum management of the very preterm fetus also account for the decreased incidence. This retrospective study was designed to determine the prevalence and perinatal outcome of deliveries complicated by cord prolapse at University College Hospital Ibadan Nigeria. A total of 78 cases of umbilical cord prolapse were recorded in the 16596 deliveries performed from January 1 1995 to December 31 2005 for a prevalence of 0.47%. When cord prolapse occurs immediate delivery should be performed if the fetus is sufficiently mature. Good antenatal care prompt hospital care if needed appropriate delivery mode and prompt and appropriate interventions when the delivery is vaginal are extremely important for perinatal and maternal outcome. (excerpt)

Serum and seminal plasma prolactin levels in male attenders of an infertility clinic in Ibadan

Serum and seminal plasma prolactin and testosterone were studied in 51 healthy-looking men who presented at the infertility clinic. They included 20 men with normospermia, 20 with oligospermia and 11 with azoospermia. The mean serum prolactin and gonadotrophin levels of the oligospermics and azoospermics were similar but significantly higher than those of the normospermics. The mean seminal plasma prolactin levels in the three groups were similar. The mean serum testosterone of the azoospermics was significantly higher than those of the oligospermics and normospermics who had similar levels. The seminal plasma testosterone of the oligospermics was similar to that of the azoospermics but significantly higher than that of the normospermics. A significant correlation occurred between serum prolactin and sperm motility. No correlation occurred between the serum and seminal plasma prolactin levels, and seminal plasma testosterone or between serum and seminal plasma testosterone. Seminal prolactin has no correlation with any biophysical parameters. It was concluded that poor spermatogenesis is associated with high serum prolactin in patients with infertility. Serum but not seminal plasma prolactin assay is useful in assessing male infertility.

Three decades of acquired gynaetresia in Ibadan: clinical presentation and management

A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively.The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Reads two stage vaginplasty, separation of labial agglutination, Williamss operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively. The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Reads two stage vaginplasty, separation of labial agglutination, Williamss operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.