Joseph O. Ugboaja

Improving maternal mortality at a university teaching hospital in Nnewi, Nigeria

To evaluate the impact of the introduction of the Service Compact with all Nigerians (SERVICOM) contract on maternal health at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

Post‐cesarean vesicouterine fistula (Youssef syndrome): Report of two cases

Vesicouterine fistula (VUF) is a rare complication of cesarean section. We present two cases of VUF that were successfully managed by transperitoneal surgical repair. The first case presented with the Youssef classical triad: cyclical hematuria (menouria), amenorrhea and urinary continence, while the second case presented with total urinary incontinence with normal menstruation. In both cases, diagnosis was confirmed by hysterogram and both were managed by transperitoneal surgical repair. The clinical features, etiologic factors, diagnostic procedures and treatment modalities are discussed in relation to the case and others as reported in the literature.

A comparison of prophylactic intramuscular ergometrine and oxytocin for women in the third stage of labor.

To compare the efficacy and adverse effects of ergometrine and oxytocin given intramuscularly for the prevention of postpartum hemorrhage during the third stage of labor.

Perceptions of focused prenatal care among women attending two tertiary centers in Nigeria

To determine womens perceptions and expectations of focused prenatal care visits.

Tuboperitoneal anomalies among infertile women in Nigeria as seen on laparoscopy

To study the prevalence and pattern of tuboperitoneal pathologies among infertile women in Nigeria, using laparoscopy.

Highly active antiretroviral therapy and cervical cytologic abnormalities among women with HIV infection in a limited-resource setting

To examine the relationship between highly active antiretroviral therapy (HAART) and cervical cytologic abnormalities among women with HIV infection.

Audit of operative hysteroscopies among infertile women in a resource‐poor setting

To evaluate the operative hysteroscopy procedures performed among infertile women at two hospitals in Nigeria.

Clinico-hysteroscopic analysis of severe intrauterine adhesions among nigerian infertile women

Introduction Severe intrauterine adhesions are difficult to manage and are associated with poor reproductive outcomes following treatment. The objective was to study the clinical presentation and hysteroscopic findings of severe intrauterine adhesions seen at hysteroscopy in two fertility/gynaecological endoscopy units in Nigeria. Methods A prospective study of 19 out of 76 women managed for intrauterine adhesions in our units. Data were analyzed with STATA software, version 12.0 SE (Stata Corporation, TX, USA). Results Severe intrauterine adhesion accounted for 19 (25.0%) of 76 cases of intrauterine adhesions managed during the period. This constituted 11.9% of 160 infertile women who had diagnostic hysteroscopies in our units over the study period. The mean duration of symptom was 4.2 years +/-3.2. Amenorrhea in association with infertility (68.4%) was the main presenting complaint. Secondary dysmenorrhea and cyclical abdominal pain were found in 10.8% and 31.6% of the women respectively. The main aetiological events were complicated caesarean section (42.1%) and abdominal myomectomy (26.3%). The adhesions were mainly dense (52.6%) and multiple (94.7%) with complete involvement of the uterine cavity in all the cases. Obliterative lesions were seen in 63.2% of the women. Conclusion The main clinical presentation of severe IUA was amenorrhea and infertility while the major risk factors were complicated caesarean section and myomectomy. The adhesions were mainly multiple, dense, obliterative and complete.

O523 WOMEN'S VIEWS ON FOCUSED ANTENATAL CARE MODEL: A SURVEY IN TWO TERTIARY HOSPITALS IN NIGERIA

Materials: Between 1968 and 1974, 568 patients with endometrial cancer FIGO stage I primarily treated with abdominal hysterectomy and bilateral salpingo-oophorectomy were included in the study. Methods: Patients were postoperatively randomized to receive either vaginal radium brachytherapy followed by external pelvic radiotherapy 40 Gy (N=288) or not (N=280). The unique 11-digit identity number of Norwegian citizens enabled individual linkage of study participants to the Registry of Statistics Norway in order to obtain survival data. By the end of follow-up at 1st November, 2011, 45 (7.9%) patients were still alive. We used Cox proportional hazards model in order to estimate hazard ratios (HR) with 95% confidence intervals (95%CI). We also conducted analyses stratified by age groups. Results: After median 21 (range 0–43.4) years of follow-up there was no significant difference in overall survival or relapse free survival between treatment arms with HR of 1.12 (95%CI: 0.95– 1.33) and HR 0.88 (95%CI: 0.55–1.40), respectively. Patients treated with external radiation had significantly lower risk of developing locoregional relapse (p < 0.001). However, women younger than 60 years at diagnosis had a significant poorer survival after external radiation (HR 1.36; 95% Cl: 1.06–1.76). In this group of patients the risk of secondary cancer was significantly increased (HR 1.9; 95%CI: 1.23–3.03). Conclusions: We observed no survival benefit of external pelvic radiation in early stage endometrial carcinoma despite of better locoregional control. In younger women, additional external pelvic radiation decreased survival, probably due to increased risk for subsequent second neoplasms. Especially women younger than 60 years may be counselled for the risk of second cancers associated with external radiation. These women may eventually benefit from longer post treatment surveillance.