RESUMEN

The study objective was to determine the relationship between serum progesterone level and the outcome of mifepristone-misoprostol regimen for medical management of missed miscarriage up to 12 weeks. A blood sample was collected just before mifepristone administration for serum progesterone assay. After 48 h, misoprostol 800 µg was administered vaginally; further 400 µg was administered 4 h later if necessary. Treatment was classed as a success if retained tissues were expelled within 72 h (Group 1), and a failure if this did not occur (Group 2). Of 52 analysed cases, complete medical evacuation occurred within 72 h in 40 (76.9%) women (serum progesterone ranged 13-90 nmol/l). Serum progesterone between the two groups were statistically significant (p < 0.001), by Mann-Whitney test. Of the 12 patients who did not respond, nine (75%) women had serum progesterone < 10 nmol/l. We found mifepristone-misoprostol regimen is less effective in missed miscarriage when serum progesterone is < 10 nmol/l.

Asunto(s)

RESUMEN

OBJECTIVE: To determine the efficacy and safety of a plastic suction curette (PSC) as uterine manipulator during combined surgical abortion and laparoscopic sterilization. METHODS: This prospective observational study was conducted between January 1996 and December 2003 in a university teaching hospital and a district hospital. All cases of combined first trimester surgical abortion and laparoscopic sterilization were performed under general anaesthesia in the day surgery unit. A straight or curved PSC with a diameter of 7-12 mm was used for surgical abortion and, afterwards, to manipulate the uterus at laparoscopic sterilization. The negative pressure of 600 mmHg or -80 kPa was maintained during manipulation. Any intra-operative trauma or difficulties in identifying the tubes and blood loss during sterilization were noted. RESULTS: A total of 531 cases of combined abortion and laparoscopic sterilization were performed. There was no failure to identify the tubes nor any uterine perforation; blood loss was minimal. No patient required hospital admission because of direct surgical complications. CONCLUSION: The plastic suction curette is a safe and efficient uterine manipulator at combined laparoscopic sterilization procedure.

Asunto(s)

RESUMEN

BACKGROUND: Medical treatment of endometriosis, a condition which significantly affects the quality of life in approximately 10-15% of women in the reproductive years, remains problematic. Although oral progestogens are effective and cheap, their efficacy is significantly influenced by poor compliance and systemic side effects. A progestogen (levonorgestrel) administered via an intrauterine system (Lng-IUS) has been demonstrated to improve symptoms of endometriosis; however, its effect on the staging of the disease has not been evaluated. The aims of this study were therefore to investigate the effectiveness of Lng-IUS in the symptomatic relief of minimal to moderate endometriosis and in the staging of the disease. METHODS: This was a prospective non-comparative observational study in which 34 women with clinically suspected and laparoscopically confirmed symptomatic minimal to moderate endometriosis had Lng-IUS inserted for 6 months. The symptom profile and stage of the disease before, during and after 6 months of treatment and patients' satisfaction with treatment and willingness to retain the device at the end of the study period were used to assess response to treatment. RESULTS: Of the 34 women recruited, 29 (85%) completed the study; five discontinued, for personal reasons (one), side effects of worsening of acne (one) and lower abdominal/ pelvic pain (three). Significant (P<0.05) improvements in severity and frequency of pain and menstrual symptoms as well as staging were achieved, with 68% (23) of cases electing to continue with the device after 6 months of therapy. CONCLUSION: The levonorgestrel intrauterine system is an effective hormonal option for treating symptomatic endometriosis (minimal to moderate). It also alters the American Fertility Society staging of disease. With a continuation rate of 68% after 6 months, it has the potential for providing long-term therapy in a substantial number of sufferers, although this would require further study and verification.

Asunto(s)

Asunto(s)

RESUMEN

A retrospective study was conducted involving 308 patients with previous caesarean sections and current singleton pregnancy. All the women delivered at the University Teaching Hospital Zaria, after having been in established labour. The aim was to determine any significant maternal and fetal risk attributable to labour in patients with more than one previous caesarean which may mitigate against a trial of vaginal delivery. The study analysis involved a group of patients with one previous caesarean section compared with those with more than one (multiple) caesarean section who delivered vaginally or abdominally after having been in established labour. The results showed that there was no significant difference in maternal and perinatal mortality rates and perinatal morbidity rates between the two groups. The patients with multiple caesarean sections who failed to deliver vaginally had increased rates of postoperative pyrexia (18.7%), anaemia (23.4%) and blood transfusion (35.3%). The study showed that the risk of fatal outcome related to labour in patients with multiple caesarean sections was low and could be eliminated by careful patient selection and close intrapartum care. A positive review of policy towards a trial of vaginal delivery in multiple caesarean sections is therefore advocated in view of the advances in patient management in contemporary obstetric care. The gains in terms of patient compliance towards hospital care and supervised delivery will be considerable. A multicentre, prospective case-controlled trial will clearly define the risks attributable to this policy change.

RESUMEN

Thirty-three pregnant women with pure P. falciparum parasitaemias (> or = 10(3) parasites/microliters blood), were each treated with a single, oral dose (12.5 mg/kg body weight) of mefloquine base (MQ), at Ahmadu Bello University Teaching Hospital, Zaria urban area, Nigeria. All 33 women were aparasitaemic by day 6 post-treatment and none became parasitaemic during the remaining 21 days of observation. Minimal side-effects were reported by the patients. The mean (S.D.) fever- and parasite-clearance times were 48 (17) and 50 (26) h, respectively. In standard microtests in vitro, schizont maturation was inhibited with MQ at 16 pmol/well (3.2 pmol/microliters). These findings indicate that, at least in the study area, semi-immune, pregnant women have high tolerability to relatively low doses of MQ and that such doses are fully effective against the local P. falciparum isolates.

Asunto(s)

RESUMEN

Mefloquine base, (12.5 mg/kg body weight), was administered as a single oral dose to 34 pregnant women with Plasmodium falciparum parasitaemia. They were followed up in vivo using the modified 28-day WHO extended field test. The sensitivity of P. falciparum isolates obtained from these women to mefloquine (MQ) was evaluated in vitro. All women were parasite negative by day 4 and remained aparasitaemic throughout the 28-day period of observation. Parasitological and clinical responses were well correlated in all the patients. Minimal side effects, after drug intake, were reported by these women, but they all resolved spontaneously. The determined Mean Parasite Clearance Time (MPCT) was 57.7 +/- 14 hours. Seventeen parasite isolates were cultured in vitro; 9 (53%) grew satisfactorily. Schizont growth inhibitions was obtained at mefloquine concentration of 32 pmol/well (6.4 pmol/mu L). The effective drug concentration that gave 99% parasite growth inhibition (EC99) was 25.6 pmol/well (5.1 pmol/mu L); which indicates high parasite susceptibility to the drug in vitro. However, low dose of MQ may be ineffective in clearing parasitaemia in areas with mefloquine resistant parasite strains.

Asunto(s)

Asunto(s)

RESUMEN

A bacteriological study of 114 infertile patients in Northern Nigeria revealed a prevalence rate for genital tuberculosis of 16.7%. The low incidence of a past history of pulmonary tuberculosis may relate to a gastro-intestinal sources of the infective organisms, illiteracy and delay in seeking medical advice. The presenting features are indistinguishable from those of chronic pelvic inflammatory disease. Since 94.7% of the patients are young (20 to 35 years of age) and the mean duration of infertility long (8.1 years), despite marriage in childhood, infertile women in this environment should be investigated without delay at an earlier age so as to improve diagnosis and subsequent prognosis.

Asunto(s)

RESUMEN

The in-vivo response of Plasmodium falciparum to a single dose of 25 mg pyrimethamine was evaluated in pregnant women in a semi-rural area of Zaria, northern Nigeria. Forty-four women were enrolled in the study and followed up for 14 days. Thirty-one (70%) of the women had cleared their parasitaemia by Day 7 and they remained parasite negative throughout the 14-day period of observation. The MPCT was 2.48 +/- 0.76 days. Thirteen (30%) of the 44 women were parasite positive either on Day 7 (7.16%) or Day 14 (6.14%) and re-treatment with a curative dose of chloroquine (25 mg kg-1 over 3 days) resulted in complete parasite clearance. Of the eight P. falciparum isolates successfully cultured from these women, seven (87.5%) were highly sensitive and one was resistant in vitro to the SDX/PYR combination.

Asunto(s)

RESUMEN

Thirty-five pregnant women with Plasmodium falciparum parasitaemia were treated with chloroquine 25 mg/kg body weight over 3 days. They were followed up in vivo by use of a modified 14-day WHO extended field test. In vitro sensitivity of the parasite isolates to chloroquine was assessed by using the WHO microtest method. All pregnant women were aparasitaemic by day 7 and there was no parasite reappearance throughout the 14-day observation period. The mean parasite clearance time (MPCT) was 3.2 +/- 1.4 days. Eleven parasite isolates obtained from the women were highly susceptible to chloroquine in vitro. The effective drug concentration that gave 99% parasite growth inhibition (EC 99) was 0.36 mumol/l.

Asunto(s)

RESUMEN

The unusual association of pre-eclampsia with a pregnancy in the rudimentary horn of the uterus in a multigravid patient is reported. The infrequent development of rudimentary horn pregnancy beyond the twentieth week of gestation may explain the rarity of this complication. The possible effect of rapid distension of the rudimentary horn with exposure of the myometrial surface to overwhelming fetal antigenic proteins may be of relevance in the development of pre-eclampsia in this case.

Asunto(s)

RESUMEN

Microbiological study of the endometrium of 114 infertile women cultured 48 organisms (42.2%) from 42 patients (36.8%). Mycobacterium tuberculosis (16.7%) and Group B Streptococcus (8.8%) were the commonest organisms isolated. These organisms were also most commonly isolated from patients between the ages of 20 and 30 years. There is, however, an overall increase in the frequency of bacterial isolation with age-cohorts. Of the colonised patients, 36.8% were of parity less than two and most (26.3%) were nulliparous. It is possible that multiple marriages and polygamy played a significant role in the bacterial colonisation of the endometrium in the Hausa-Fulani population of Zaria, Nigeria.

Asunto(s)

RESUMEN

Multiple celo-intestinal fistulae with the passage of fetal bones per rectum as a rare complication of advanced extra-uterine pregnancy is presented. This was further complicated by a recent intra-uterine pregnancy which culminated in obstructed labor and uterine rupture. The subsequent peritonitis was of etiological significance in the formation of the peritoneo- or celo-intestinal fistulae.

Asunto(s)

RESUMEN

The study conducted at Ahmadu Bello University Teaching Hospital, Zaria from January to December, 1984 showed that carcinoma of the cervix uteri occurred in 4.18% of new gynecological attendances; 68.9% of the cases occurred in the age range 40-55 years. Early age at marriage (80.0%), and at first pregnancy (77.8%) as well as multiple marriages (48.9%) and low contraceptive usage were identifiable associated factors. The parity of the patient did not seem to be of significance. The earliest presenting symptom was post-coital bleeding occurring 10.8 months prior to attendance for medical advice. However, late presentation (in Stages IIb-IV) in 86.7% of cases was due to illiteracy, shyness, male dominance and non-recognition of the importance of early warning symptoms.

Asunto(s)

RESUMEN

A study of uterine fibromyomata at the Ahmadu Bello University Teaching Hospital, Zaria indicates that the condition occurs in 7.8% of new gynecology cases. Infertility 87.2%, menstrual disturbance 70.4%, in association with chronic pelvic inflammatory disease 43.4%, anemia 25.0% and hypertension 25.5% were the commonest presentations. Total abdominal hysterectomy was commonly performed due to the high rate of chronic pelvic inflammatory disease. Post-operative morbidity was due to pyrexia in 28.6%, hemorrhage in 7.1% and wound infection in 6.6% of the series.

Asunto(s)

Asunto(s)

Asunto(s)