BackgroundSeveral maternity units in the developing world lack facilities for caesarean section and often have to transfer patients in extremis. This case controlled study aimed to appraise predictive factors for caesarean section.MethodsOne hundred and fifty two consecutive women with singleton pregnancies who had caesarean section were studied. The next parturient with normal delivery served as control. Variables such as age, parity, marital status, booking status, past obstetric history, weight, height, infant birth weight were assessed. Data obtained were analysed using SPSS 16.0 Windows package.ResultsDuring the study period, there were 641 deliveries with 257 of them by caesarean section (40.1%).Logistic regression analysis showed that parity, booking status, maternal height; maternal weight, birth weight, previous caesarean section and ante-partum bleeding were significant predictive factors for caesarean section while maternal age was not.ConclusionsThese predictive factors should be considered in antenatal counseling to facilitate acceptance by at risk women and early referral.

Increasing concern has been expressed about the declining sperm count of humans and the potential environmental effects of both synthetic and natural estrogenic endocrine disruptors (EEDs) on human reproductive health in the last few decades. However, due to paucity of knowledge, we evaluate the chronic reproductive toxicity of sesame phytoestrogenic lignans on the male Sprague Dawley (SD) rats' testis. Thirty adult male SD rats weighing 150-200g were divided into three groups. Two treated groups received a daily dose of aqueous leaves extract of Sesamum radiatum at 14.0 mg/kg bw and 28.0mg /kg bw respectively via gastric gavage, while equal volume of normal saline was administered to the control group for six weeks. Seminal analysis and hormonal assay study were analyzed using SPSS software and P< 0.05 was considered statistically significant. The results showed significant (P< 0.05) body weight gains observed in all the animals with significant (P< 0.05) weight increase in their raw testicular weights compared to control. The relative testicular weight per 100g bw was significantly (P< 0.05) higher in control than treated. However, theweight gain was dose related with a reversal in their relative testicular weight. The cauda sperm count including the motility and morphology of the treated were significantly (P< 0.05) higher than control in a dose related manner. In addition, significant (P > 0.05) increases in testosterone and a significant decrease in FSH in the high dose (treated) compared to control. Sesame phytoestrogenic lignans improves spermatozoa quality in a dose related manner.

BackgroundAdoption as a treatment option for infertility amongst those that cannot access and/or afford assisted reproduction is not well accepted in developing countries. This study sets out to determine the willingness of infertile women in developing countries to adopt a child and factors that influence women’s attitude to adoption.MethodsWe conducted a questionnaire survey of consecutive infertile patients who attended the gynecological clinic of a regional teaching hospital over a 2-month period. Information on demographics, fertility history, and attitude to adoption was obtained, and the data were analyzed using SPSS version 16.0. Tests of statistical significance were used where appropriate at the 95% confidence level.ResultsThe majority of respondents were aware of child adoption, and the most common source of information was friends (47.8%), followed by the media (39.7%); 42.6% of respondents were willing to adopt if their infertility became intractable. The main reasons given by those unwilling to adopt were culture (78.3%) and family constraints (13.45%). On univariate analysis of factors associated with a favorable or unfavorable attitude to adoption, awareness of adoption (P = 0.002), duration of infertility > 5 years (P = 0.015), no living child (P = 0.007), tertiary education (P < 0.001), pressure from parents (P = 0.041), household yearly income ≥ $650 (P < 0.001), and belief that treatment will bring about the desired results (P < 0.001) were significant, and all except awareness of adoption turned out to be significant on multiple logistic regression analysis.ConclusionThere was a high level of awareness about child adoption among all respondents. However, the acceptability of adoption was significantly lower among poor women and those with limited education. Community advocacy and mobilization, especially through the media as well as via health care providers, will go a long way towards enlightening and enhancing the uptake of adoption among women in Nigeria.

Screening programmes for the early detection of premalignant lesions of the cervix are expensive and technically difficult, especially in resource-challenged settings. There is a need for cheaper and equally effective alternative screening methods. This study compared the efficacy of visual inspection of the cervix using acetic acid (VIA) with the Pap smear method. A total of 186 subjects had a Pap smear followed by visual inspection of the cervix using 3 - 5% acetic acid with biopsies taken from suspicious acetowhite positive lesions. Cases of abnormal cytology were recalled for biopsies. A total of 150 subjects were negative for both tests; 30 (16.2%) were positive for VIA, while six were positive for both VIA and Pap smear. VIA detected one lesion missed by Pap smear on biopsy. The sensitivity of VIA was 100%, while that of Pap smear was 85.7%. The negative predictive value of VIA was 100%, while the positive predictive value was 20%. The sensitivity of VIA equals the reported rates for Pap smear. VIA is proposed as a credible alternative to Pap smear in resource-challenged settings.

BackgroundHaemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies.MethodsCase records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed.ResultsThere were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units).ConclusionEven though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.