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Background: Endometriosis is the presence of active ectopic endometrial glands and stroma at other sites outside the uterine cavity. It is a common cause of chronic pelvic pain which is sometimes debilitating, and inflammation is one of the known triggers of endometriosis. Interleukins 6 and 16 (IL-6 and IL-16) are proinflammatory cytokines which play essential roles in inflammatory diseases. We therefore investigated the relationship between genetic polymorphisms of interleukins 6 and 16, and the development of endometriosis in Nigerian women. Method: One hundred and thirty (130) consenting women were consecutively enrolled, sixty-five (65) of whom had endometriosis and 65 age-matched women as reference group, surgically confirmed as not having endometriosis. Spectrophotometric determination of serum concentrations of Interleukins 6 and 16 was carried out and the genotyping of IL-6 (rs1800795) and IL-16 (rs4778889, rs11556218, rs4072111) genes were performed using TaqMan assays. Results: Serum IL-16 concentration was significantly higher in women with severe chronic pelvic pain compared to those with mild pain (p = 0.023). The C allele of rs4778889 was associated with endometriosis (OR: 1.80, 95% CI: 1.08 – 3.02, p = 0.024). Conclusion: Serum IL-16 and IL-16 rs4778889 may be important markers for endometriosis in Nigerian, and by extension, African women. Multicentre African studies would clarify this. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of vertical transmission of hepatitis B virus and the factors influencing it. Design: A prospective cohort study. Settings: Wesley Guild Hospital unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ilesha/Ile-Ife, Osun state, Nigeria. SUBJECTS: Hepatitis B surface antigen positive pregnant women. Results: A total of 51 pregnant hepatitis B surface antigen positive women completed the study. Their ages ranged between 18years-44years with a mean of 29.8 +/-5.1 years. Forty-nine (96.1%) of the women were hepatitis B envelope antigen (HBeAg) negative while 2 (3.9%) women were HBeAg positive. Out of the 51 babies born to these HBsAg positive mothers, only one (2%) of the babies was positive to HBsAg between 9-15months of age. There was a significant relationship between HBeAg status of the mothers and the HBsAg status of their babies (p =0.039). Twenty-nine (56.9%) of the babies had hepatitis B immunoglobulin at birth while 22 (43.1%) did not. There was no significant relationship in the HBsAg status between babies who had hepatitis B immunoglobulin administered at birth and those who did not have it (p=1.0). Conclusions: The prevalence of the vertical transmission of hepatitis B virus is low in this study. Also, the use of Hepatitis B immunoglobulin by the babies was also not significant in determining vertical HBV infection in this study. These findings are most likely due to the low prevalence of HBeAg in the mothers. [ABSTRACT FROM AUTHOR]

A new species of dorylaimid nematode, Aporcelinus abeokutaensis sp. n., collected from a watermelon field in Nigeria, is described, illustrated and molecularly (D2–D3 28S ribosomal DNA) studied. It is characterized by its 1.18–1.52-mm-long body, lip region offset by weak constriction, 15.5–17.5 μm broad with perioral liplets, odontostyle 18–21.5 μm long at its dorsal side or 1.1–1.3 times the lip region diameter, neck 333–401 μm long, pharyngeal expansion occupying 45–51% of total neck length, uterus simple and 0.7–1.5 times the corresponding body diameter long, V = 48–53, tail conical with finely rounded tip (33–52 μm long, c = 26–41, c′ = 1.3–1.9) and a variably distinct dorsal concavity, and male unknown. Molecular analysis reveals that the new species grouped with other species of Aporcelinus in a highly supported clade, confirming the monophyly of the genus. [ABSTRACT FROM AUTHOR]

A new species of the genus Aporcella collected from a watermelon field in Nigeria is described, including its morphological and molecular (small subunit (SSU) and large subunit (LSU) ribosomal DNA (rDNA)) characterization. Aporcella femina sp. n. is distinguished by its 3.21–3.64 mm-long body, inner cuticle layer with fine but distinct transverse striation, lip region offset by deep constriction, 22–25 μm broad, odontostyle 20–26 μm, neck 661–811 μm long, pharyngeal expansion occupying 52–56% of the total neck length, female genital system didelphic–amphidelphic, uterus 191–350 μm or 1.9–3.3 mid-body diameters long, V = 52–57, tail short and convex conoid (35–48 μm, c = 72–98, c′ = 0.7–0.9) and males absent. Phylogenetic analyses based on the partial sequence of SSU and LSU (D2–D3) rDNA revealed a close relationship of A. femina sp. n. with other Aporcella species, confirming the monophyly of the genus as well as its association to a clade made of several taxa characterized by the absence of pars refringens vaginae. [ABSTRACT FROM AUTHOR]

Summary: A new species of Aporcelaimellus , collected in a watermelon field in Nigeria, is described, including its morphological and molecular (D2-D3 28S-rDNA, 18r-DNA) characterisation. Aporcelaimellus nigeriensis sp. n. is distinguishable by its 2.76-3.55 mm length, very coarse ventral body pores, lip region offset by deep constriction and 24-27 μ m broad odontostyle 30-36 μ m long at its dorsal and 28-31 μ m at its ventral side, neck 648-779 μ m long, pharyngeal expansion occupying 54-60% of total neck length, uterus 300-473 μ m or 2.1-3.2 body diam. long and tripartite, V = 49-54, tail short and convex conoid (27-41 μ m, c = 72-115, c′ = 0.5-0.7), spicules 108-137 μ m long, and 9-10 spaced ventromedian supplements with hiatus. LSU analysis revealed a close relationship of A. nigeriensis sp. n. with other Aporcelaimellus species and questioned, once more, the monophyly of Aporcelaimidae. SSU phylogenetic tree was not able to resolve the relationship between the new species and other closely related species. [ABSTRACT FROM AUTHOR]

Introduction: Uterine involution, a physiological process in which the uterus reverts to prepregnant size, occurs during puerperium. The latter is a time of substantial maternal risk. Ultrasound is considered the most appropriate tool in monitoring the progression of uterine involution because it is cheap, convenient, and repeatable with no radiation risk. Aim: To sonographically evaluate the involution of the uterus and uterine cavity in postpartum women in Enugu, Nigeria. Materials and Methods: This was a prospective longitudinal cohort study on 400 postpartum women at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Transabdominal ultrasonography to measure uterine dimensions was done on day 1, day 3, and day 42 of puerperium using a 3.5-5 MHz curvilinear probe of a portable ALOKA ultrasound machine. Statistical analysis was done with the Statistical Package for Social Sciences (SPSS) software version 20.0. The uterine dimensions were expressed as mean±standard deviation and student's t-test analysis was used to compare the values for day 1, day 3, and day 42 of puerperium. Regression analysis was carried out to measure the relationship between uterine measurements on days 1, 3, and 42. A p-value of <0.05 was considered statistically significant. Results: The mean longitudinal, anteroposterior, and transverse diameters of the uterus at day 1 were 14.51 cm, 8.54 cm, and 10.97 cm, respectively. The corresponding values for day 42 were 8.27 cm, 4.78 cm, and 6.22 cm. The uterine diameters decreased significantly as puerperium advanced (p<0.001). The mean uterine cavity diameters also decreased significantly as puerperium advanced (p<0.001). There was significant regression between longitudinal diameters of both uterus and uterine cavity on days 1 and 3 but not between days 3 and 42. Conclusion: This study has established a normal range of diameters for the uterus and uterine cavity on day 1, day 3, and day 42 of puerperium. It can serve as reference data for further studies in the study area. [ABSTRACT FROM AUTHOR]

Thespesia garckeana (F. Hoffm.) Exell & Hillc. is called Gorontula (Kola of Tula) in Nigeria, Morojwa in Bostwana, and Thespesia garckeana in South Africa and is widely distributed across Africa. Its parts reportedly possess multiple medicinal properties and are employed for treating various diseases. In Tula, Gombe State, Nigeria, the ripe fruit decoction is taken as remedy for female infertility as documented by Ochokwu and co in the Journal of Biology, Agriculture and Healthcare in 2015. This research examined the effects of aqueous fruit extract of T. garckeana (F. Hoffm.) Exell & Hillc. (AFETG) on selected reproductive tissues and hormones in female rats and also evaluated the inhibitory potentials of its phytoconstituents against human 5-alpha reductase 2 (SRD5α2) using in silico approach. Twenty-five (25) sexually matured female rats were randomized into 5 groups (i.e. A - E). Oestrous in the rats was synchronized (subcutaneous oestradiol conjugate [10 μg/100 g BW]). Group A received distilled water (control). Group B received standard drug, clomiphene citrate (0.85 mg/kg BW), while groups C, D, and E received AFETG at 50, 100, and 200 mg/kg BW respectively. The animals were treated for five (5) days and sacrificed 24 h after. Their blood was collected and prepared for analysis of serum prolactin, oestradiol (E2), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) while ovaries, uteruses, and oviducts were studied for histological and histomorphometric changes. For the in silico study, the target protein, human steroid 5α-reductase 2 (SRD5α2) was prepared and its receptor grid was generated using Optimized Potential for Liquid Simulations-2005. The ligand 2D structures were prepared using LigPrep 2.4 software and docked using Glide. The binding energy of the ligands to the protein receptor was predicted using Molecular Mechanics/Generalized Born Surface Area (MM-GBSA) analysis. AFETG significantly increased serum levels of E2 but did not alter serum levels of prolactin, LH and FSH when compared with distilled water and clomiphene citrate. AFETG also significantly increased ovarian tertiary follicular diameter, oviductal epithelial height and serosa thickness as well as uterine endometrial epithelial height, endometrial thickness, and myometrial thickness when compared with control. Ovarian secondary follicular diameter and oviductal submucosa thickness and muscular thickness were significantly decreased by AFETG when compared with control. Two compounds in T. garckeana (F. Hoffm.) Exell & Hillc.; D-Melezitose (−12.55 kcal/mol XP GScore) and 1, 3, 4-trihydroxy-5-oxo cyclohexane-1-carboxylic acid (−9.136 kcal/mol XP GScore) exhibited higher binding affinities for SRD5α2 than the reference ligand, epristeride (−8.096 kcal/mol XP GScore). In conclusion, the ability of AFETG to increase serum E2 level, thickness of uterine endometrium and ovarian tertiary follicles size can be explored for the treatment of female infertility caused by thinning of the uterine endometrium and reduced follicular size. Two compounds in AFETG (i.e. D-Melezitose and 1, 3, 4-trihydroxy-5-oxo cyclohexane-1-carboxylic acid are potential inhibitors of SRD5α2, thus aiding the biosynthesis of E2. Available evidence therefore corroborate the traditional use of T. garckeana (F. Hoffm.) Exell & Hillc fruit as a female fertility enhancer in Northern Nigeria. [Display omitted] • T. garckeana aqueous fruit extract raised serum oestradiol in female rats. • It also raised ovarian tertiary follicular diameter and oviductal epithelial height. • Two of T. garckeana fruit phytoconstituests are potential inhibitors of SRD5α2. • The constituents elicited higher binding affinities for SRD5α2 than epristeride. [ABSTRACT FROM AUTHOR]

Background: Uterine rupture is an obstetric emergency associated with significant maternal and perinatal mortality and morbidity, especially in resource-constraint countries such as Nigeria., Objective: To determine the incidence and feto-maternal outcome of uterine rupture in a Nigerian teaching hospital., Methods: This was a retrospective review of all cases of uterine rupture managed over 21 years. The case notes of all affected women were retrieved, and information on sociodemographic and obstetric characteristics, clinical presentation, intraoperative findings, and fetal and maternal outcomes were extracted. Data were analyzed using SPSS version 23.0 and descriptive statistics were computed. Factors associated with maternal deaths secondary to rupture of the gravid uterus were determined using binary logistic regression analyses. Statistical significance was reported at P<0.05., Results: There were 31,616 deliveries during the review period, out of which were 182 cases of uterine rupture giving an incidence of 5.76 per 1,000 deliveries. Most of the cases of uterine rupture (65.2%) were treated by uterine repair. Maternal and fetal deaths were recorded in 8.1% and 82.7% of cases respectively. Women aged at least 35 years (P=0.035), women who had laboured at home or traditional birth attendant's (TBA) place (P=0.002), women who had multiple sites rupture (P=0.049) and those who developed hypovolemic shock (P=0.002) were more likely to die from uterine rupture., Conclusion: Ruptured uterus remains a significant cause of maternal and perinatal morbidity and mortality in Nigeria. Strategies for prevention include effective health education of the masses, the conduct of labour in a well-equipped health facility, and prompt referral of at-risk women., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Abstract: Ethnopharmacological relevance: Mistletoe extracts (decoctions) are used traditionally in eastern Nigeria for the management of bone pain, post menopausal syndrome and diabetes amongst several other ailments. While scientific evidence supporting its folkloric use as an antidiabetic agent has been documented, the age-long practice of its use in treatment of post menopausal syndrome has not been scientifically validated. Postmenopausal osteoporosis accounts for one of the prevalent disease conditions in aging population globally. This situation is exacerbated by the lack of osteogenic therapy. In search for plants of Nigerian origin with osteogenic potential, we evaluated eastern Nigerian mistletoe, having ethnotraditional claims of anti-diabetic, anti-hypertensive and anti-cancer activities as well as preventive effect in various post-menopausal syndromes. Materials and Methods: Methanolic extracts of mistletoe leaves harvested from three host tress – Kola acuminata (KM), Citrus spp (CM) and Garcinia kola (GKM) – were evaluated for osteoblast viability and osteogenic activities using primary rat calvaria culture. Lupeol (1) was isolated from the stem bark of Bombax ciba and its congener, dihydoxylupeol palmitate (2) in addition to three other compounds; 3-methoxy quercetin (3), 3,4,5-trimethoxy gallate (4), and friedelin (5) were isolated from the leaves of mistletoes species. Following their chemical characterization, the compounds were evaluated for osteogenic potential using validated models including alkaline phosphatase (ALP) assay, mineralization assay and expression of osteogenic genes – bone morphogenetic protein-2 (BMP2) and osteoblast transcription factor (RUNX2) – in primary calvarial cultures harvested from neonatal rats. Uterine estrogenicity of the extracts was tested in adult female Sprague Dawley rats. Results: Methanol extracts of mistletoe from three hosts exhibited increase in ALP activity (a marker of osteoblast differentiation) at lower concentrations (0.2–0.8μg/ml) and either no or inhibitory effect at higher concentrations (1.6 and 3.2μg/ml). None of the extract had cytotoxicity to osteoblasts at the concentrations tested. Five compounds viz. 1 from Bombax ciba, and 2–5 were isolated from the mistletoe leaves. Out of these, 5 exhibited significant loss of osteoblast viability and hence it was not considered further. All four compounds exhibited stimulatory effects on osteoblast differentiation as assessed by ALP assay and determination of osteogenic gene expression. Compound 2 was relatively more potent than its precursor, compound 1 in stimulating BMP2 upregulation. KM did not show uterine estrogenicity. Conclusion: Methanolic extracts from the three mistletoes species possess in vitro osteogenic activity, and from these extracts three new classes of compounds have been found to promote osteoblast differentiation in vitro. In light of these findings, we propose that mistletoe species may be developed as safer alternative(s) in the management of diseases where lack of bone formation is the pathology. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate the uteri of camels and cows slaughtered in north-eastern Nigeria with the aim of determining the reproductive efficiency of these species. Three hundred and twenty-two (322) camelids and 180 bovine uteri were examined bacteriologically and pathologically using standard protocols. The result showed that there were 86 bacteria isolated from camels with Staphylococcus aureus (46.5 %), Escherichia coli (33.8 %), and other coliform species (18.6 %) being the most prominent isolates; while in the cow, there were 92 isolates, with E. coli (57.6 %), S. aureus (15.2 %), and Streptococcus pyogenes (12.0 %) being the most frequently isolated. The major isolates from both species were similar, but higher isolation rate ( p < 0.05) was observed in cows (51.1 %) than in camels (26.7 %). The relative risks (RR) of infection with E. coli and S. pyogenes were significant ( p < 0.05) in cows than in the camelids. The gross pathological lesions observed were lower (17.4 %) in camels compared to cows (19.4 %). These lesions include mucometra ( n = 25, 7.8 %; n = 21, 11.7 %) and endometrial erosions ( n = 31, 9.6 %; n = 5, 2.8 %) being the most commonly observed in camels and cows, respectively, but the RR of occurrence of endometrial erosion was significant ( p < 0.05) in camels than in cows. The histopathological lesions observed include cellular vacuolation in endometrial glands, sloughing of endometrial epithelium, and neutrophilic infiltration, among others. It was concluded that S. aureus and E. coli were the major bacterial pathogens colonizing the uterine environment in these species, commonly associated with inflammatory and degenerative changes. These disorders may have far-reaching implications for lowered reproductive efficiency in these species. [ABSTRACT FROM AUTHOR]

Pregnant women managed by us after suture repairs for rupture of the pregnant uterus between 2006 and 2009 in Enugu, South-east Nigeria were reviewed. Five pregnancies were managed during the study period. Four had normal pregnancies. Three booked early in pregnancy and had repeat caesarean deliveries at 36 weeks'' gestation. One booked at another private hospital but had emergency caesarean section at 38 weeks'' gestation. The fourth woman had repeat rupture at 28 weeks'' gestation, suture repair and bilateral tubal ligation. Four healthy babies were discharged home. There was no maternal death. The outcomes of pregnancies after rupture of the pregnant uterus are good. Suture repairs should be the method of choice whenever preservation of future fertility is necessary. The woman and her family must be counselled on the associated risks and the need for hospital delivery by elective caesarean section in the subsequent pregnancies before discharge. [ABSTRACT FROM AUTHOR]

A retrospective study was conducted at a Nigerian tertiary hospital to assess the quality of emergency care provided to women managed for a ruptured uterus over an 11-year period. There were 76 cases of ruptured uterus and 4,770 deliveries (1.6%) during the period. Ten women died from a ruptured uterus, giving a case fatality rate of 13.2%. The mean admission–assessment interval by a senior clinician was 48.4 min. The mean decision–laparotomy interval was 6.9 h. Deviations from management protocol were noted in 66 women (86.8%) and underlying reasons were classified as patient-orientated (59.2%), medical personnel (13.2%) and administrative (22.4%) problems. Among women who died, there were more administrative problems, intraoperative and total blood losses were significantly more and preoperative haematocrit was significantly less compared with survivors. The poor quality of care for ruptured uterus in this centre is attributable to patients' financial limitations, which is compounded by administrative problems, particularly those regarding inefficient blood transfusion services. This study demonstrates the urgent need for implementation of a national health insurance scheme at this centre and reiterates the feasibility of employing detailed enquiry of peripartal circumstances to identify specific problems underlying major causes of maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Morphology of the uterus and mammary glands were studied in sexually matured female African giant rat. The uterus was identified as being duplex, having two separate uterine horns and two cervices. The two cervices were partially fused and separated by a mid-saggital septum. Their thick musculatures projected caudally into the vagina as the portio vaginalis uteri. The results also showed that eight mammary glands, distributed along the lateral aspects of thoracic and inguinal regions, were present. The thoracic and the inguinal regions had four mammary glands each and were arranged in two pairs of cranial and caudal rows. These findings fill some gaps created by the dearth of information on the reproductive biology of the female African giant rat. [ABSTRACT FROM AUTHOR]

This study was aimed to establish a nomogram for uterine roundness index (UTRI) for a Nigerian population. Seven hundred Nigerian girls and women in the premenarche, nulliparous, multiparous and postmenopausal groups with normal uteri were evaluated by pelvic ultrasound. The length, anteroposterior and transverse diameters of the uterus were measured and the UTRI calculated as the ratio of anteroposterior diameter to the length. The age, height, and parity of the subject were recorded. The mean UTRI ±SD were 0.44457±0.0629 for premenarche, 0.5880±0.1118 for nulliparous, 0.6005+0.1046 for multiparous and 0.5269±0.1037 for postmenopausal. Pearson's correlation analysis showed significant correlation between UTRI and age, height and weight in premenarche group and weight in the nulliparous, multiparous and postmenopausal groups (p< 0.05). Significant negative correlation between UTRI and age occurred only in the postmenopausal group (p< 0.05). The study has established a nomogram for UTRI in a Nigeria population which will be of gynaecological importance to sonographers and referring clinicians in assessing the normality of uterine shapes and contour. [ABSTRACT FROM AUTHOR]

Background: A reliable prediction of foetal birth weight aids in decision regarding time and mode of delivery., Aim: This study aimed to determine the accuracy of the product of symphysio-fundal height and abdominal girth in predicting birth weight among pregnant women in Keffi, Nigeria., Setting: The study involved pregnant women presenting for delivery at the Federal Medical Centre, Keffi, Nigeria from July to October 2017., Methods: One hundred and fifty-three pregnant women at term with singleton foetuses were recruited by systematic random sampling. An interviewer-administered questionnaire was used to obtain their socio-demographic data, past medical and obstetric history. Symphysio-fundal height and abdominal girth measurements were used to calculate the estimated foetal weight. This was compared with the actual birth weight. Absolute percentage error was used to determine the overall predictive error of Dare's formula. Data were analysed using SPSS version 20.0. Statistical significance was set at p 0.05 and 95% confidence level., Results: The mean age of the participants was 29.65 ± 5.15 years. The mean gestational age was 39.5 ± 1.2 weeks. There was a significant correlation (r = 0.52, p 0.001) between the estimated foetal weight and the actual birth weight. Ninety (66.2%) of the babies within normal weight and six (85.7%) of macrosomic babies were correctly predicted. None of the low birth weight babies was correctly predicted by the formula., Conclusion: Dare's formula accurately predicted normal weight and macrosomic babies, but less accurately predicted low birth weight babies.

Ethno-Pharmacological Relevance: Corchorus olitorius is reportedly used in ethno-medicine to arrest threatened miscarriage and other conditions associated with excessive uterine contractions. The plant is also used as a purgative, demulscent and an anti-inflammatory agent., Aim of the Study: Against the background of ethno-medicinal use, this current work was designed to evaluate the gastrointestinal and uterine smooth muscles relaxant and anti-inflammatory effects of Corchorus olitorius leaf extract (COLE)., Materials and Methods: Pieces of uterine and gastrointestinal tissues were suspended separately in organ baths containing ideal physiological salt solutions bubbled with air and were tested for responses to standard drugs and COLE, then repeated in the presence of antagonists. Anti-inflammatory study was carried out via the egg albumin-induced paw edema model in rats., Results: The application of COLE to pieces of uterine tissue significantly decreased the amplitudes of contractions in a dose dependent manner such that the highest dose applied (666.67 μg/ml) achieved a 100% inhibitory effect. Oxytocin induced contractions were also significantly inhibited by both salbutamol and COLE. On the isolated rabbit jejunum, the effect of COLE was also inhibitory and like atropine, significantly inhibited acetylcholine induced contractions. In the in vivo study, the extract inhibited charcoal meal movement in test rats when compared with control. Anti-inflammatory effect of COLE was significant and compared favourably with that of aspirin following in vivo trials., Conclusions: COLE therefore, may be a good tocolytic, anti-diarrheal and anti-inflammatory agent and offers hope of new drug discovery for such uses., (Copyright © 2019 Elsevier B.V. All rights reserved.)

A review of 7,211 endometrial biopsy reports in a University Teaching Hospital in Nigeria, over a 6 year period revealed that 90.5% of samples from 5,795 patients with infertility and 83.4% of 1,416 patients with abnormal uterine bleeding were essentially normal. The yield for tuberculosis endometritis (0.49%) and uterine corpus malignancy (0.58%) was low. Eighty percent of patients with uterine malignancy were aged 40 years and above. In an era of medical audit and scarce human and financial resources, the wisdom of routine endometrial biopsy in all women with infertility and those with abnormal uterine bleeding who are younger than 40 years, is called to question.

A 10-year review of ruptured uterus at the University of Nigeria Teaching Hospital disclosed an incidence of 1 in 500 deliveries. The average incidence for booked patients alone was 1 in 1271 deliveries. The maternal and perinatal mortalities were 17% and 91% respectively, while the contributions of ruptured uterus to the overall hospital maternal and perinatal mortalities for the period under review were 4.1 and 2.6% respectively. In 1978, the average incidence of ruptured uterus in all patients delivered at the hospital increased from 1 in 787 in the 1st 5 years to 1 in 330 in the 2nd 5 years, while the maternal mortality from ruptured uterus decreased from 27% in the 1st 1/2 to 10% in the 2nd 1.2 of the study. The decline in maternal mortality in this environment is due to better availability of stored blood and management which included subtotal hysterectomy in many cases.

Fertility and pregnancy outcome among 141 Nigerian women with uterine leiomyomas and 270 married gynaecological subjects matched for age and parity were studied. The preoperative spontaneous abortion incidence and fetal salvage among the 68 women in the study group who had previously been pregnant were 61.8% and 78.8%, respectively. Corresponding figures among women in the comparison group were 5.3% and 95.6%. Macroscopic evidence of pelvic sepsis was found at operation in 36.2% of all the women in the study group, and in 57.7% of those who complained additionally of infertility. The overall pregnancy rate following myomectomy was 37.9%, and 9.6% in those women whose presenting complaints included infertility. The mean operation-to-conception interval in the study group was 15.7 months. The fetal salvage increased to 93.5% in the women who conceived after myomectomy, and their incidence of abortion fell markedly, to 11%. Most of the deliveries (79%) in the women after myomectomy were by cesarean section. A reappearance of uterine leiomyomas occurred in 13.7% of the women. The relatively low incidence of pelvic sepsis in this series may partly be responsible for the finding of menorrhagia, rather than abdominal pain, as the commonest complaint of the women with leiomyoma.

Ruptured uterus continues to be a common obstetric hazard in under developed countries. The commonest cause is spontaneous rupture from obstructed labor in the multipara. There was not a single rupture in the primipara. Rupture following previous cesarean section scar is also common. The most effective way of management is to correct fluid and blood loss followed by laparotomy and subtotal hysterectomy. This method gave a lower mortality than either repair and sterilization or total hysterectomy. Adequate pre-operative resuscitation and time interval between rupture and operation also influences mortality rate. The experience of the surgeon is another vital factor in determining mortality rate.

Uterine rupture in the developing world remains a significant problem. We treated 45 such cases. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), hand presentation (50%), prolonged labor (42%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy.

Approximately 315 major surgical cases were treated in one year in a one-doctor 80-bed mission hospital in Nigeria. The hospital serves a population of 137,000. One hundred and forty-three of the cases were herniorrhaphies: 19 of these cases were strangulated, of which seven required bowel resection. A case of a strangulated inguinal hernia containing uterus, Fallopian tubes and ovaries is reported. Other interesting surgical cases are also discussed.