Michael Aziken

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.

Perceptions and attitudes of pregnant women towards caesarean section in urban Nigeria

Objectives. To determine the perceptions and attitudes towards caesarean section [CS] among women attending maternity care at the University of Benin Teaching Hospital in Nigeria. Methods. Some 413 consecutive women, attending antenatal care in the hospital, were interviewed with a structured questionnaire that solicited information on their socio‐demographic characteristics, their previous pregnancy and delivery history, and their knowledge and attitudes towards CS. Additional focus group discussions and in‐depth interviews were held with women who recently underwent CS in the hospital, to gain further insights into attitudes and perception about CS in the women. Results. The women had good knowledge of CS; however, only 6.1% were willing to accept CS as a method of delivery, while 81% would accept CS if needed to save their lives and that of their babies. Up to 12.1% of women would not accept CS under any circumstances. Logistic regression showed that womens low level of education, and past successful vaginal and instrumental deliveries, were most likely to be associated with womens non‐acceptance of indicated caesarean section. Further analysis showed that this was mainly due to inaccurate cultural perceptions of labour and caesarean section in the cohort of women. Conclusion. There is a need for programs to increase womens and community understanding and perceptions of CS as a method of delivery in Nigeria.

Efficacy of intermittent preventive treatment with sulfadoxine–pyrimethamine on placental parasitemia in pregnant women in midwestern Nigeria

To assess the effect of intermittent preventive treatment with sulfadoxine and pyrimethamine (IPT‐SP) on placental parasitemia and maternal and perinatal outcome.

Experience with a comprehensive university hospital-based infertility program in Nigeria

To assess outcome at an infertility management center in Nigeria.

Septic abortion: a review of social and demographic characteristics.

Septic abortion is a significant health problem with short- and long-term complications that affect the quality of life of those fortunate enough to avoid mortality. Both spontaneous and induced abortion can result in septic complications, with the latter disproportionately higher. Its incidence is high in environments with restrictive abortion laws, as clandestine procedures by non-doctors in unhygienic settings are prevalent. This study shows that it is still more common among teenagers and mainly performed by health professionals, which means that health care interventions should be re-evaluated and appropriately directed to preserve the reproductive health status of this vulnerable population.

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.

Pregnancies complicated by uterine fibroids: A case series on myomectomy in early pregnancy

Background: Myomectomy during pregnancy is rare, however, for patients with failed response to conservative management (and are ardent at preservation of pregnancy) the need for surgery becomes imperative. This scenario may be common in a dedicated fertility treatment centre; hence the need for proficiency in gravid myomectomy. Objective: To document our experience with myomectomy during pregnancy. Methods: Report of three cases of gravid myomectomy is presented. The format of the case series included clinical presentation and surgical management. Conclusion: Our experience shows that scrupulous adherence to basic surgical principles of good exposure, minimal tissue handling, speed but careful closure/hemostasis in addition to judicious post operative care can guarantee a successful pregnancy sparing myomectomy.

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.