Objective: To determine the trend and indications for the use of caesarean delivery in our environment. Method: A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. Results: During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically signifi cant (χ [2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. Conclusion: Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confi rmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate. Les grandes maternelle indications ont été cephalopelvic disproportion (15,5 %), chlorure précédente section (14,7 %), éclampsie (7,2 %), a échoué à induction du travail (5,5 %) et le placenta previa (5,1 %). Détresse foetale (9,6 %), présentation de breech (4,7 %), macrosomia foetal (4,3 %) /et de la grossesse compliquée par plusieurs foetus (4,2 %) ont été les indications du foetus majeures. Le taux de césarienne a montré une augmentation constante au fi l des ans (7.19 % en 2000 à 13.95 % en 2005) mais l'analyse annuelle des caractéristiques démographiques, type de césarienne et les indications majeures n'a révélé tout cohérentes modifi cations apportées à tenir compte de la tendance sauf pour la fréquence accrue des détresse foetale comme une indication de césarienne les années qui a été également pas statistiquement signifi catif (χ [2] = p 8.08 = 0,12) . Le mortalité périnatale globale dans la population de l'étude a été jugée 72.7 / 1000 naissance et malgré le hausse du taux de césarienne, les résultats périnatales ne pas améliorer au fi l des ans. conclusion: procès de naissance vaginal après une césarienne dans les cas appropriés et l'utilisation de cardiotocography pour la continu de fréquence cardiaque foetale surveillance du travail avec la Annals of African Medicine Vo...

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Background:Many women suffer from some degree of intrauterine adhesions (IUAs) presenting with various clinical symptoms and signs. Hysteroscopy is the mainstay of diagnosis, classification, and treatment of the IUA.Aim:This study was undertaken to review the clinical features and treatment outcome in patients diagnosed with Asherman's syndrome at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, over a 10 years period, 1997–2006.Subjects and Methods:This is a retrospective study of cases of Asherman's syndrome managed at the UMTH over a 10-year period, from January 1, 1997 to December 31, 2006. Case records of the patients were retrieved from medical records' Department. Sociodemographic and clinical information relating to clinical presentations, treatment modalities, and outcomes were collated. The data were analyzed using SPSS 16.0 Statistical Computer Package (SPSS Inc., IL, USA 2006). Chi-square and binary logistic regression were used for inferential statistics.Results:Asherman's syndrome constituted 8.1% (81/996) of all gynecological operations in UMTH during the study period. The case records retrieval rate was 96.3% (78/81 folders). Most of the patients, 59% (46/78) were in their third decade and majority 85.9% (67/78) were married. The most common risk factor was pregnancy-associated, accounting for 61.5% (48/78). Infertility and hypomenorrhea were the most common mode of presentations in 55.1% (43/78) and 32.1% (25/78) of cases, respectively. Most of the patients 85.9% (67/78) were treated by blind dilatation and curettage (D/C), Foley's catheter insertion and estrogen-progesterone combination. Correction of menses was seen in 37.2% (29/78) of the patients while the pregnancy rate was 32.1% (25/78). On binary logistic regression age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) emerged as the only respondent's related risk factors associated with the development of Asherman's syndrome.Conclusion:Asherman's syndrome is relatively common due to complications of pregnancy and delivery, and blind D/C has a relatively poor outcome. Age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) were associated with the development of Asherman's syndrome. Therefore, other methods of adhesiolysis such as hysteroscopic adhesiolysis should be explored.

One hundred and five consecutive women had transvaginal sonography (TVS) at less than 12 weeks gestation to establish the normal size and shape of the secondary yolk sac (YS) and to assess the YS measurements in predicting pregnancy outcome in the first trimester. A yolk sac diameter more or less than two standard deviation (2SD) from the mean predicted abnormal pregnancy outcome with a sensitivity of 91.4%, specificity of 66% and a positive predictive value of 88.8%. A normal YS size predicted normal pregnancy outcome with a sensitivity of 66%, specificity of 91.4% and a positive predictive value of 95.6%. It is recommended that patients at risk of poor pregnancy outcome should have routine TVS before 12 weeks gestation to assess their YS and those with an abnormal yolk sac should be followed-up closely to exclude fetal abnormalities before 24 weeks gestation.

There is a high recurrence of uterine fibroid after myomectomy in our environment. The risk is higher among women with positive family history, multiple uterine fibroids, and in those with multiple symptoms. Pregnancy and use of OCP are protective.