Cervical cancer is the most common female genital tract malignancy in Nigeria and majority of the patients present with advanced disease. It is a preventable cancer as there are well-defined treatable premalignant phases. The objective of the study is to review the burden of cervical cancer, its screening modalities, and practice of screening and treatment in low resource countries with emphasis on Nigeria. This is a review involving internet and literature search. While developed countries have recorded significant reduction in the incidence of cervical cancer owing to organized screening programs, treatment of premalignant cervical lesions, and follow-up of treated cases, developing countries including Nigeria are yet to optimally utilize screening services due to lack of organized population-based screening programs with only pockets of screening services which are at best opportunistic. This has not reduced the incidence of cancer because only a fraction of the target population is covered. Apart from this, loss to follow-up is rampant. The level of awareness of cervical cancer and its preventive strategies are low among the population and policymakers in Nigeria. There is no organized screening program, and the few services available are only opportunistic with little or no impact. Development of cervical cancer screening policy and institution of organized screening program targeted at covering ≥80% of population at risk is fundamental. There is also a need for widespread education of the populace on the burden of cervical cancer and the public health importance of the disease using the mass media, counseling at antenatal clinics, and the involvement of men will contribute immensely to reduction in the incidence of cervical cancer. Decentralization of services by incorporation of cervical screening and treatment in primary health care programs will ensure adequate rural-urban coverage.

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Introduction: Family planning is very important and confers huge benefits to the woman, her family and country. It helps reduce maternal morbidity and mortality among other benefits. In spite of these obvious benefits of and the huge expenditure on it, uptake by women continues to be very low. We conducted this study to find out the reasons for this low uptake in our practice environment. Methodology: This is a cross sectional study where structured pre-tested questionnaires were administered to women in Abakaliki, the capital of Ebonyi State from February to April 2015. Results: Of the 354 questionnaires administered, 330 (93.2%) were complete and used for analysis. Majority of the respondents, 285 (86.4%) were in the 26 to 30 years age bracket. All of them were Ibos. Sixty two(18.8%) of the participants had one of their pregnancies unplanned and 19(5.7%) had at least one of their pregnancies unwanted. Though 300 (90.9%) had heard of family planning and was aware of it, only 180(54.5%) had used a family planning method before with majority, 105(58.2%) using natural family planning method. Only 22.7% of the participants was using a family planning method at the time of the study. In majority of the women,166(50.3%) ,their fears about family planning was the troublesome side effects followed by 110(33.3%) whose husbands objected to their using family planning. Twenty seven women (8.2%) respectively did not use family planning because it is against their culture and religion. Conclusion: Though some progress have been made in family planning, a lot more will be achieved if new programmes are designed to involve the men more actively and address other identified fears among women with regards to family planning.

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Background: Cervical cancer, though preventable, remains the leading cause of cancer death among women in developing countries after breast. Lack of awareness and access to preventive methods remains a key factor contributing to high levels of cervical cancer in these populations. Objectives: The study aimed to assess the level of awareness of, and perception of risk for, cervical cancer among women attending Bowen University Teaching Hospital (BUTH) general outpatient clinic. Methodology: This was a cross-sectional study conducted at the BUTH, Ogbomoso. Data were obtained from 318 consenting women using systematic random sampling method. An interviewer-administered questionnaire was used to gather information about their sociodemographic characteristics, marital and reproductive history, and awareness and perception of risk for cervical cancer. Data were analyzed using Statistical Package for the Social Sciences version 23.0. The level of statistical significance was set at P < 0.05. Results: Awareness for cervical cancer and its screening tests were 22.6% and 17.9%, respectively, with major sources of information being from health talks and hospital staffs. About 5.7% believed that they may be at risk whereas only 1.6% had ever been screened. Perception of risk is significantly associated with age (χ² = 20.05, P = 0.005) and early coitarche (χ² = 10.46, P = 0.015). Overall, respondents' attitude was positive to cervical cancer screening. Conclusion: The level of awareness of cervical cancer and screening was low among the respondents. Increased media campaign about its risks and preventive measures is urgently needed.

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An abdominal pregnancy can be regarded as a form of an ectopic pregnancy where the embryo or fetus is growing and developing outside the uterus but within the abdominal cavity. While it is a very rare occurrence, abdominal pregnancies have a higher chance of maternal mortality, perinatal mortality, and morbidity compared to normal and ectopic pregnancies, but on occasion, a healthy viable infant can be delivered. We presented the case of a 40-year-old gravida 8 para 4⁺³ (4 alive) woman with intra-abdominal pregnancy who was first seen at 29 weeks' gestation with a history of abdominal pain and ultrasonographic findings of a live intra-abdominal fetus. She was managed conservatively till 34 weeks' gestation and was subsequently delivered by laparotomy with favorable maternal and fetal outcomes. The case is reported to highlight the successful outcome in spite of the difficulties in diagnosis and management in a low-resource setting.

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Background: Client preference and availability of contraceptives are important determinants of uptake in developing countries. In this study, we investigated the trend of contraceptive uptake and factors associated with client choice among women accessing family planning services in an urban tertiary hospital in Northwestern Nigeria. Subjects and Methods: Time-trend analysis was performed on registry data of contraceptives dispensed between January 2000 and December 2014 at the family planning unit of Barau Dikko Specialist Hospital, Kaduna, Northwestern Nigeria. Five-year periods (2000–2004, 2005–2009, and 2010–2014) were identified, and the prevalence of contraceptive methods for each period is expressed as moving averages. Predictors of client choice were determined by logistic regression expressed as odds ratio [OR] (95% confidence interval [CI]). Results: A total of 5992 family planning consultations were made during the 15-year study period. Compared with the intermediate 5 years, there was a rise from 1723 (2000 to 2004) to 2128 (2005–2009) and a decline in the final 5 years to 1912 (2010–2014). Cumulatively, the most preferred contraceptive was injectables (40.7%). Women aged ≥35 years showed significant positive association with contraceptive uptake (OR 2.243, 95% CI = 1.489–3.380; P < 0.05) for injectables (OR 13.609, 95% CI = 6.317–29.318 and OR = 0.019, 95% CI = 0.012–0.030; P < 0.05) for oral contraceptive pills. Women who had completed secondary school or more had greater odds of using intrauterine contraceptive device or implants, OR 2.278, 95% CI = 1.869–2.776, P < 0.05 and OR 5.012, 95% CI = 2.346–10.79, P < 0.05, respectively. Conclusion: Injectable contraceptive was the most common method used. Women's age and educational attainment were the major factors influencing choice and uptake of modern contraceptives.

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Background: Hysterectomy is a safe and a major gynecological operation. It could be performed using abdominal, vaginal, or laparoscopic approach. It is performed for different indications such as dysfunctional uterine bleeding, endometriosis, fibroids, or prolapse. This procedure is however not without complications especially in resource-poor countries. An overview of the outcome of the procedure is essential in facilities like ours that is located in resource-poor countries. Objectives: To determine the rate, indications, and complications of elective abdominal hysterectomy at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Methodology: This was a retrospective study of all cases of elective abdominal hysterectomies performed over an 8-year period (January 2009 to December 2016) at AKTH, Kano. Outcome measures were demographic characteristics, indication for surgery, type of hysterectomy, and postoperative complications. Results: During the period of study, there were 7632 major gynecological operations, among them were 251 cases of elective abdominal hysterectomy, giving a rate of 3.3%. The most common indication was uterine fibroid (51.8%). Total abdominal hysterectomy (TAH) was more commonly performed (93.0%) compared to subtotal hysterectomy (7.0%). Postoperative pyrexia (45.9%) was the most common complication, while ureteric injury (2.4%) was the least. Duration of hospital stay was 6–10 days in 89.2% of cases, and there was no mortality recorded. Conclusion: Elective abdominal hysterectomy is a fairly common and safe procedure in AKTH. Uterine fibroid and postoperative pyrexia was the most common indication and complication, respectively. TAH was commonly performed compared to subtotal hysterectomy.

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Over and underproduction of milk is the most common problem for lactating mothers in worldwide. Hyperlactation often unrecognized problem that can lead to array of distress symptoms for both mother and baby. There is lacuna of literature on hyperlactation syndrome in Asian region; this case reports present the management and outcome maternal hyperlactation syndrome.

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Background: There is a recent resurgence in the use of intrauterine insemination (IUI) in Nigeria. However, there is a need for a rational use of the procedure so that couples do not waste time and money on ineffective therapy if it is not indicated. Objective: The objective of this study was to identify the possible prognostic factors affecting outcome of IUI among patients undergoing the procedure. Patients and Methods: This is a retrospective review of the case files and treatment protocols of fifty consecutive couples who had IUI procedure following the established diagnosis of Infertility at the Paramount Fertility Center of Paramount Specialist Hospital Ondo, Nigeria, over a period of 1 year (February 2016 to January 2017). Results: There were ten (20.0%) pregnancies recorded, of which three (6%) clients had first-trimester miscarriages (between the 5^th and 13^th weeks), one (2%) had an ectopic pregnancy, whereas six (12%) were carried to the age of viability and delivered. Forty (80%) clients did not achieve pregnancy. The postwash concentration of sperm was noticed to be the only parameter significantly affecting the rate of pregnancy in our treatment cycles with P < 0.05. There was also a trend toward a reduction in pregnancy after the age of 40. Conclusion: This study shows that the postwash sperm count and age of the female have the most predictive value for IUI clinical pregnancy outcome in our center.

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Background: Artificial insemination by donor (AID) is specifically indicated in cases of incurable male infertility. Acceptability depends on perceptions largely influenced by religious and sociocultural perspectives. Male factor accounts for 20-50% of the causes of infertility and shows geographic variation in Nigeria. Method: A descriptive cross-sectional survey of all infertile women attending the gynecology clinic of the University College Hospital, Ibadan, between January and June 2014. 181 self-administered questionnaires were distributed to all consenting infertile women, however only 163 were suitable for analysis. Data analysis was descriptive and inferential at 95% confidence interval and a P value of less than 0.05 was considered statistically significant. Result: The mean duration of infertility was 5.7 ± 4.33 years. Fifty seven (35.0%) respondents were willing to accept artificial insemination by donor, while ninety three (57.1%) were unwilling to accept artificial insemination. Socio-cultural factor (48.1%) was the major reason for non-acceptability of artificial insemination by donor. Acceptability of AID was influenced by adequate knowledge about the procedure (P< 0.01). Sixty percent of the respondents had good knowledge and over half of them obtained the information from the news/print media. In this Study, acceptability of AID was not influenced by the age of the respondents, family structure, duration or type of infertility or educational status. (P > 0.05). Conclusion: This study revealed a low acceptance rate for Artificial insemination by donor. Providing information on AID as a treatment option during counseling and routine infertility management may be the needed drive to improve awareness and promote uptake when necessary.

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Giant fibroadenomas (GFs) occurring during pregnancy are extremely rare, and only a few cases have been reported. Although it is a benign condition, it often requires biopsy or even surgery to exclude malignancy. The authors report a new case of GF in a 29-year-old pregnant woman with a family history of breast cancer. She presented at 37 weeks of gestation with a large mass in her left breast. Tru-cut biopsy was suggestive of fibroadenoma. After delivery, enucleation of the mass was performed, and histology confirmed the previous diagnosis. Benign neoplasms should be suspected in any pregnant woman with a rapidly enlarging breast mass. Early surgical excision should be offered as a standard treatment to avoid structural damage to the breast and the need for reconstructive surgery.

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Dysgerminoma is the most common malignant germ cell tumor in children and adolescents. Most cases occur in the 2nd and 3rd decades of life, but 10% of cases occur in the 1st decade of life. The rarity of this malignancy in prepubertal children and the recognized controversies in its management prompted this case report. The case of a 6-year-old girl who had laparotomy and unilateral adnexectomy with subsequent histological diagnosis of an ovarian dysgerminoma was presented. Prognosis depends on the stage of the tumor at presentation, and conservative surgery should be the aim during the initial treatment. Adoption of multidisciplinary management within an oncology board with joint decision on the need for adjuvant chemotherapy for early stage diseases will confer good prognosis.

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Background: Early-onset Group B Streptococcal (GBS) infection is an important cause of perinatal morbidity and mortality. Policy of active prevention by antepartum screening and treatment is not a popular practice in resource-constrained settings. Objectives: This study determined the prevalence of asymptomatic GBS infection and antimicrobial sensitivity pattern. It also determined the outcome of Intrapartum antimicrobial prophylaxis (IAP). Methodology: It was a prospective and longitudinal study done in Ahmadu Bello University Teaching Hospital, Zaria, between June 2014 and April 2015. Two hundred and twenty consenting pregnant women with gestational ages between 35 and 37 completed weeks were participated in the study. Vagina and rectum were swabbed using different rayon swab sticks. Swabs were placed in Amies, nonnutritive transport medium. Bacteriological procedures to culture GBS and confirmation with biochemical tests and serological test were done. Antibiotic sensitivity pattern was determined. Participants who had GBS rectovaginal colonization had intrapartum antibiotic prophylaxis with penicillin G. All participants were followed up till to a week after birth. Results: Out of the 220 pregnant participants, 19 (8.6%) had GBS rectovaginal colonization. Antibiotic sensitivity pattern revealed that GBS isolates were all sensitive to penicillin, ampicillin, and cefazolin while 4 (21.1%) were resistant to ceftriaxone and 6 (31.6%) were resistant to both erythromycin and clindamycin. None of the isolates were resistant to erythromycin and sensitive to clindamycin or vice versa. Of the 19 participants with GBS rectovaginal colonization, 2 (10.5%) delivered low birth weight baby, but there was no incidence of early-onset GBS disease. Conclusion: The prevalence of GBS rectovaginal colonization in this study is similar to figures from other parts of the country. The GBS sensitivity pattern to penicillin was similar to those reported elsewhere. Fetal outcome following intrapartum antibiotic prophylaxis was good.

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Background: Majority of pregnant women, especially in remote rural areas still desire to be delivered by traditional birth attendants (TBAs) who neither have the skills nor the equipment to treat life-threatening complications. Objective: To determine the sociodemographic characteristics of TBAs and how they manage life-threatening obstetric cases. Methodology: This was a prospective study carried out over a 3-month period during the training of TBAs in the state on the reduction of maternal mortality. A total of 540 TBAs from 18 Local Government Area of the state participated in the study. Data obtained were sex, age, levels of education, number of deliveries conducted per month, difficult cases encountered, and how they managed them. The data were analyzed using Epi Info version-7 and presented in tables. Results: TBAs are mostly females, i.e. 538 (99.6%) and only 2 (0.4%) were males. Majority of the TBAs were above the age of 55 years, i.e. 488 (88.9%); had primary education 416 (77.0%); married 396 (71.6%); and grand multiparous 293 (54.3%). Most TBAs deliver 4 newborn monthly, i.e. 148 (22.6%), and the mean number of newborn delivered monthly was 3.9. Concerning the mode of handling of the difficult cases, majority, i.e. 338 (62.6%) have a nurse/midwife they always call for assistance while only 147 (27.2%) refer their life-threatening cases directly to the nearby hospital. Conclusion: TBAs still plays a role in deliveries in most rural and urban areas. Majority of TBAs do not refer their life-threatening cases directly to the nearby hospital. Therefore, TBAs should be trained on how to identify life-threatening cases and promptly refer to hospitals for better outcome.

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Objective: The purpose of this study is to classify the stillbirths (SBs) in our institution and to determine the avoidable contributors using a pro forma that was developed in our perinatal unit. Materials and Method: All mothers who delivered SBs at Obafemi Awolowo University Hospitals Complex Ile-Ife, Nigeria, from April 2014 to August 2015 were the subjects of this study. At our weekly perinatal mortality meeting, every SB was reviewed in detail to determine the cause of death and identify gaps in the care. The causes of fetal death were classified using three classification systems – Simplified CODAC, ReCoDe, and our newly developed Ife Perinatal Death Classification System. Remote contributors to fetal demise were assigned using a purpose–designed “Avoidable Factor Proforma” A SB was deemed avoidable if one or more factors were identified. Results: The total number of deliveries during the study was 2,142 with 109 SBs giving a gross SB rate of 51/1000 total births. The SB rate was significantly lower among booked patients than their unbooked counterparts (15 vs. 140 per 1000; P < 0.005). Antepartum death constituted 82.6% of SB among booked patients compared to 41.2% in the unbooked. The most common cause of SB among booked mother was intrauterine growth restriction (21.7%) while obstructed labor (23.3%) was the leading cause among unbooked mothers. Using our classification system, only 3.8% of SBs were unexplained, as against 5.7% for ReCode, and 26.4% for Simplified CODAC. Majority (81.7%) of the SBs were avoidable; and the most common avoidable factor was deficiency in health care. Access to the point of care was not associated with any of the avoidable deaths. Conclusion: Our SB rate remains unacceptably high, with a preponderance of antepartum deaths among booked patients. Majority of the SBs are avoidable dictating the need for training in modern methods of fetal surveillance and improved efficiency of our health-delivery systems.

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Background: In the past, the use of intrauterine contraceptive device (IUCD), in particular, Dalkon Shield was found to be associated with increased risk of pelvic infection. Recent literature illustrates that the risk of pelvic infection after insertion of an IUCD is low and that the risk peaks in the 1^st month after insertion. We set out to determine the incidence of genital infection among IUCD users after the 1^st and 3^rd months of insertion compared to users of other contraceptive methods; to determine the risk of genital infections among IUCD users compared to users of other contraceptive methods and to determine the organisms associated with genital infection among the contraceptive users. Materials and Methods: This was a cohort study involving new clients who chose various forms of contraceptives. Results: The incidence of genital infection was 3 (8.5%) at 1 month and 4 (12.1%) at 3 months. The incidence in non-IUCD contraceptive users was 2 (5.9%) at 1 month and 3 (8.8%) at 3 months. The relative risk was 1.44 and 1.5 at 1 and 3 months, respectively. The observed difference in the rate of infection between IUCD users and other contraceptive users was not statistically significant. Bacteria vaginosis and Trichomonas vaginalis were commonly observed in the two groups. Conclusion: The incidence of genital infection among IUCD users was relatively low compared to non-IUCD users. IUCD s do not significantly increase the of rate genital infection.

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Placental chorangioma is a rare tumor with a frequency of 1%. It presents as a solitary nodule or less frequently as multiple nodules on the fetal surface of the placenta or within the placental parenchyma. Placental chorangiomas are considered clinically significant when >4 cm. Fetal complications associated with placental chorangiomas include polyhydromnios, nonimmune fetal hydrops, fetal heart failure, cardiomegaly, intrauterine growth restriction, fetal anemia, thrombocytopenia, and fetal demise. Maternal complications such as preeclampsia, preterm delivery, and maternal mirror syndrome are also associated with placental chorangiomas. The pathophysiology behind the complications is yet to be fully elucidated, but a prominent role for arteriovenous shunting and sequestration of red blood cells and platelets by the chorangioma has been postulated. The case presented was a 20-year-old primipara at 36 weeks of gestation with live fetus and an incidental finding of mixed echogenic mass lesion within the placenta measuring 59 mm × 52 mm. She was planned for elective cesarean section but went into spontaneous labor and had uneventful vaginal delivery.

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Introduction: Genetic education and counseling give individuals an opportunity to make informed choices related to risks, benefits, and limitations of genetic testing for social and medical purposes. We aimed to assess the perception of female undergraduates of universities in Ibadan to genetic counseling and testing (GCT) for gynecological cancers and their willingness to participate in the twin procedure. Materials and Methods: This was a cross-sectional study involving consented female students from the two universities within Ibadan metropolis – University of Ibadan and Lead City University, Ibadan. Using a self-administered, semi-structured questionnaire, information on their understanding of GCT, perception of implications, and willingness to participate in the procedure were obtained. Results: There were 943 respondents with mean age of 20.0 ± 3.4 years, 908 (96.3%) had ever heard of cancers, but only 252 (26.7%) provided proper definition. Overall, 484 (51.3%) were aware of GCT although three-quarters, 712 (75.5%), wished to know their inheritable risk of developing gynecologic cancer. All the respondents were willing to participate in the counseling procedure, but only 815 (86.4%) would be willing to proceed with testing if indicated. Possible surgical intervention reduced willingness to test from 82.3% to 45.7%. Conclusion: The female undergraduates of universities in Ibadan were willing to partake in GCT provided there are no surgical interventions. There is a need for an increased awareness and encouragement of GCT for at-risk groups and also in the prevention and/or early detection to reduce the burden of familial gynecologic cancers.

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