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Objectives: To compare the effectiveness of single-dose sublingual misoprostol to manual vacuum aspiration in the treatment of incomplete spontaneous abortion in Enugu, Nigeria.Design: Multi-centre randomized controlled trialSetting: A teaching hospital, the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu and a private specialist hospital, Julius Memorial Specialist Hospital Enugu, Nigeria were used for the studyParticipants: In all, 212 consecutive consenting women with sonologically confirmed, first-trimester incomplete spontaneous abortion at the gynaecological emergency departments of the study centers were recruited but, 203 women completed the study and their results analysed.Intervention: Single-dose of sublingual misoprostol 400mcg with the participant followed-up at the gynecology clinic one week after with an ultrasound scan for the completeness of the uterine evacuation. Main outcomes measures: The primary outcome measure was the incidence of complete uterine evacuation (complete abortion) after one week of treatment while the secondary outcome measures included incidence, types, and tolerability of treatment side effects as well as participants’ satisfaction with the treatment receivedResults: Two hundred and three eligible women were randomised into the intervention group (n = 102) that received single-dose sublingual misoprostol 400mcg and the control group (n = 101) that received manual vacuum aspiration. Incidence of complete abortion was 86.3% for the misoprostol group and 100.0% for the control group, RR = 0.86, (CI 95%: 0.80 - 0.93), p <0.001. The most common side effect was abdominal pain with an incidence of 27.5% versus 48.55 for the misoprostol and control groups respectively (p = 0.002). Most participants in each group (81.1% versus 77.6% for the misoprostol and control groups respectively) considered the side effects as tolerable. The mean visual analogue scale score for maternal satisfaction was higher in the misoprostol group (86.7 ± 14.11) than the control group (81.36 ± 11.10), p < 0.001. Conclusions: The treatment of incomplete spontaneous abortion with single-dose sublingual misoprostol 400mcg produced a high rate of complete abortion among women in Enugu, Nigeria. Despite having a lower complete abortion rate, maternal satisfaction was higher when compared with women that had manual vacuum aspiration of the uterus. Trial registration: Trial registration number - PACTR202009857889210, date of registration - 23 September 2020. Retrospectively registered

Uterine leiomyoma is common among black women of reproductive age in Africa and is associated with infertility. Its definitive means of treatment is myomectomy which can be approached by laparoscopy or laparotomy. There is a need to know if any of these two modes of treatment affects the chances of achieving pregnancy or its outcome in women with background infertility. Objective: To assess the proportion of women who achieved pregnancy after laparoscopic and laparotomic myomectomy with background infertility, their pregnancy outcome and a comparison of the two groups. Materials and Method: The study retrospectively reviewed 36 out of 188 women that had either laparoscopic (n=86) or laparotomic myomectomy (n=102) and achieved pregnancy over a period of 30 months. Result: There was pregnancy in 21 out of 86 women that had laparoscopy and 15 among the 102 women that had laparotomic myomectomy. This gave the pregnancy rates of 24.4% and 14.7% respectively. The pregnancy outcome was favourable and similar between the two groups with the laparoscopic group having a lower caesarean delivery rate of 76.2% compared to100% in the laparotomy group. The duration of hospital stay was significantly lower in the laparoscopy group. Conclusion: Laparoscopic or laparotomic myomectomy improves the chances of pregnancy in women with background infertility below 35 years. The laparoscopic group had a significantly lower caesarean section rate and a shorter duration of hospital stay than the laparotomic group, however, both groups had a similar and favourable pregnancy outcome.

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The management of coexisting uterine fibroid in pregnancy is controversial. There is the need to know the labour outcome of women with coexisting fibroid in pregnancy in our environment. Objective: To ascertain the labour outcome of coexisting fibroid in pregnancy and the prevalence. Materials and Method: The study is a retrospective one that reviewed 48 women with coexisting fibroid in pregnancy over a 30 month period. Result: Out of 612 women that had antenatal care and delivery in our area of study, 48 of them had coexisting fibroid in pregnancy giving a prevalence of 7.8%. The mean age of the parturients was 32.38 ± 5.22 years and most of the parturients were primiparous (56.3%). Up to 89.5% of them delivered at term and 89.6% of their babies had normal birth weight with good APGAR score in 79.2% of them. Their caesarean delivery rate was 79.2% and 2 successful caesarean myomectomies were done. Conclusion: Fibroid can coexist with pregnancy with good outcome but they are prone to high caesarean delivery rate and at risk of uterine rupture. A low prevalence was recorded in our study and caesarean myomectomy is feasible in selected cases.

Hysterosalpingography (HSG) is a diagnostic modality still commonly used to evaluate tubal occlusion in infertility management. We evaluated the treatment benefit in achieving tubal patency and spontaneous pregnancy in women with bilateral tubal occlusion in our resource poor setting using water soluble contrast medium. Objective: To assess the proportion of women that achieved tubal patency and spontaneous pregnancy following a repeat HSG in the evaluation of infertility and the associated factors. Materials and Method: This is a retrospective study of 37 out of 180 women who achieved tubal patency and pregnancy after repeat HSG in the course of infertility evaluation over a period of 18 months. Result: Out of 180 patients with bilateral tubal occlusion that had the repeat HSG, 37 achieved tubal patency (20.5%) and from which 24 became pregnant. This gave a pregnancy rate of 13.3%. The mean age of the participants was 35.76 ± 4.72 years. The age group of 36-40 years had the highest frequency while most of them were nulliparous and had left tubal occlusion at the distal portion. Conclusion: Tubal patency and spontaneous pregnancy were achieved following repeat HSG in women with bilateral tubal occlusion undergoing infertility evaluation. HSG has both diagnostic and treatment uses in infertility management and it is cost effective.

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