Background: Menstruation and related problems are difficult issues for adolescent girls and are a common reason for consulting healthcare providers. Objectives: To study age at menarche and menstrual problems among school girls in Lucknow district of north India. Materials and Methods: A cross-sectional study was carried out in urban as well as rural schools of Lucknow district from October 2008 to September 2009. Multistage random sampling was used to select the requisite number of girls. A total of 847 school-going adolescent girls between 10 and 19 years of age were interviewed and examined. Statistical analyses were done using percentage and Chi-square test. Results: Out of 847 adolescent girls, 76.7% (650) girls had attained menarche. The overall mean age at menarche was 12.84 (1.4) years. The age at menarche and duration of menstrual flow were significantly associated with place of schools. About one-fourth of the girls in all the three age groups (10-13, 14-16 and 17-19 years) had irregular menstrual cycle. Overall, 73.7% (479/650) girls had dysmenorrhea, with 74.3% (323/435) girls in urban schools and 72.6% (156/215) girls in rural schools. There was no significant association between reproductive tract illnesses and place of schools. Conclusion: Menstruation is an important milestone for adolescent girls and menstrual problems are common among adolescent girls. So, there is a need to explain everything correctly about menstruation. It was suggested that a strong need exists for strong health educational activities among the adolescent girls, their parents, and teachers for effective management of menstrual problems among all adolescent girls.

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Background: Tuberculosis remains a global health problem and is an important cause of morbidity and mortality. Female genital tuberculosis (FGTB), though rare in western world, is relevant in developing countries like India. Aims and Objective: The aim of this study was to determine histologic findings of different parts of female genital tract affected by TB and to correlate it with clinical and other features. Materials and Methods: A total number of 110 cases of FGTB from 92 patients were included over a period of 15 years. (April, 1997 to March, 2012) The age range of the patients was 17 to 45 years with mean of 26.3 years. The diagnostic procedures used were curettage biopsy, hysterectomy, histologic examination, culture, Mycobacterium tuberculosis-polymerase chain reaction, laparoscopy, hysterosalpingography, and ultrasonography. Patients of FGTB presented with infertility (65-70%), pelvic/ abdominal pain (50-55%), and menstrual disturbances (20-25%). Results: FGTB involved vulva (2), vagina (1), cervix (5), endometrium (66), fallopian tube (24), and ovaries (12). Out of 66 endometrial TB, proliferative, secretory endometrium, and atrophic endometrium were seen in 53, 09, and 04 cases. HIV co-infection was found only in 5 cases, and acid-fast bacilli in tissue sections were detected in 7 cases. Conclusions: FGTB is not uncommon in developing countries and is an important cause of infertility. Though fallopian tube was the most common site in many studies, in this study, endometrium emerges as the commonest site.

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Background: Pregnancy in women with sickle cell anemia is associated with adverse outcome for mother and child, but with improvements in medical care, the outcome has greatly improved in developed countries. Despite being the most prevalent genetic disease in Africa, sickle-cell disease, along with its serious health problems in pregnancy, is largely neglected. Objective: To determine the effects of preconceptual care on pregnancy outcome among booked patients with homozygous sickle cell disease at Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: A cohort study of the pregnancy outcome, among booked 39 pregnant women with homozygous sickle cell disease (Hbss), who had preconception care, and an equal number of booked pregnant women with homozygous sickle cell disease (Hbss), who did not have preconception care (controls), at Aminu Kano Teaching Hospital, between January 2000 and December 2006. Results: There was no statistically significant difference in the occurrence of complications between the two groups, but complications occurred with less frequency among the cases compared to the controls. Conclusion: This study suggest that preconception care and effective prenatal care by a multidisciplinary team, and delivery in a hospital which is accustomed to management of sickle cell disease and its complications, is associated with good pregnancy outcome in women with sickle cell anemia in pregnancy.

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Background: Pregnant women infected with hepatitis B virus (HBV) can transmit the infection to their fetuses and newborns. Neonates who contract the HBV have about 90% risk of developing chronic HBsAg carriage (HBsAg: hepatitis B surface antigen) and chronic liver disease. Neonatal immunization interrupts this vertical and perinatal transmission. Objectives: To determine the seroprevalence of HBsAg among pregnant women attending the antenatal clinic at Aminu Kano Teaching Hospital (AKTH) and to identify potential risk factors associated with HBV infection. Materials and Methods: A case control study was conducted involving a total of 303 pregnant women attending the antenatal clinic at AKTH and 303 nonpregnant women of childbearing age. Blood sample was collected from each woman and the serum tested for the presence of HBsAg using latex rapid agglutination slide test kit (Cal-Tech Diagnostic Inc., USA) in the laboratory of the hospital. Reactive samples were stored at -20°C and further confirmed for HBsAg using enzyme-linked immunosorbent assay (ELISA) kits (Bio-Rad, France). HBsAg-positive samples were tested for hepatitis B e antigen (HBeAg) using ELISA kits (Orgenics, Israel). A pretested, structured questionnaire was used for the collection of sociodemographic data and possible risk factors. Results: The prevalence of HBsAg among pregnant women and nonpregnant women were 7.9 and 7.6%, respectively. There was no statistically significant difference in the prevalence of HBsAg in pregnant and nonpregnant women. The presence of HBeAg was statistically significant among both pregnant and nonpregnant women who tested positive for HBsAg. The risk factors associated with HBV infection were blood transfusion, ear piercing, history of an affected sibling with HBV infection, tattooing, and abortion among pregnant women. Conclusion: The prevalence of HBsAg in this study was not statistically different in pregnant and nonpregnant women. There was a high level of HBeAg infection among pregnant women who tested positive for HBsAg. History of an affected sibling with HBV infection, tattoo, and abortion were significant risk factors for HBV infection.

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Pyometra is the accumulation of pus in the uterine cavity. The reported incidence varies from 0.5% in young patients to 13.6% in elderly patients attending gynecological clinic. It is a common complication of malignancy of cervix and uterine body. The cause of pyometra is the occlusion of cervical canal by benign or malignant growth, stenosis following age-related atrophy, radiation treatment, or surgery on the cervix. A spontaneous rupture of pyometra causing diffuse peritonitis is very rare, with reported incidence of 0.01% to 0.5% in elderly women. Unless recognized in time, it can be a life-threatening condition. We present a case of 65-year-old woman who presented with this rare and life-threatening complication. She was treated by emergency exploratory laparotomy. Total abdominal hysterectomy with bilateral salpingo ophorectomy was performed. Patient had uneventful postoperative period.

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Background : Episiotomy -an incision of the perineum at the time of vaginal delivery is a common obstetric procedure. If the repair is inadequately done, it may leave the woman suffering from perineal pain and other long term conditions with serious impact on the woman's health and social wellbeing. The importance of skill in the obstetric procedure of episiotomy and its repair cannot be over emphasized. Objectives: The study aims to determine the interns' training and experience with episiotomy and its repair. Materials and Methods: A questionnaire study of medical interns' who had their houseman ship at the Federal Medical Centre Owerri, over a period of two years between 2003 and 2005. Results were analyzed with the SPSS version 10. Results : 70 (77.7%) of the 90 interns to whom the questionnaire was administered responded correctly. They had an average age of 28.81 ±3.36 years. 44 (62.9%) had a formal demonstration on episiotomy repair done at their medical training institution. 56 (80%) of the interns were comfortable with episiotomy repair while 14 (20%) were not. 10 (45.45%) of the females and 4 (8.33%) of the males were not comfortable with episiotomy repair. 30% of those who got their skill on episiotomy repair at the period of houseman ship were not comfortable with the procedure as opposed to 4.3% of those who had a formal training at their medical training institution. Discussion : A formal demonstration at the medical school of training does not appear to be a constant event in the medical schools as only 62.9% of the interns in this study accepted receiving such. However, despite the above, 80% of these interns' were comfortable with the repairs of episiotomy. Conclusions : It would be preferred if a formal demonstration is given on this procedure while a student is still in training.

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Background: Lower heart rate variability has been proven to be associated with a greater risk for developing hypertension among normotensive men, and hypertension is one of the major risk factor of coronary heart disease. Hormonal factors in premenopausal women may cause variance in heart rate variability and impact lipid profile. Objectives: The study was designed to evaluate the relationship of gender and lipid profile with cardiac parasympathetic reactivity. Materials and Methods: Sixty premenopausal and 60 postmenopausal women along with 60 young and 60 elderly, age and body mass index (BMI) matched men without any apparent illness were selected. Cardiac parasympathetic reactivity during Valsalva maneuver, deep breath test, and 30:15 R-R interval ratios were studied and lipid profile analyzed. Results: Lipid profile showed significant increase in values of total cholesterol, low density lipoprotein (LDL), triglyceride, and significant decrease in high density lipoprotein (HDL) values in younger males when compared with premenopausal females and no difference in these parameters were noticed when comparison was done between elderly males and females. Deep breath test and 30:15 R-R interval ratios showed significant decrease in values in younger males when compared with age matched premenopausal females. Total cholesterol, triglyceride, LDL were negatively correlated with parasympathetic function tests; whereas HDL was positively correlated with parasympathetic function tests. Conclusion: Sex hormone levels may alter the autonomic nervous system response and lipid metabolismand lipids play an important role in modulation of autonomic functions.

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Menopause and the climacteric period are associated with adverse risk factors for the development of vulvovaginal atrophy-related sexual dysfunction. Sexual dysfunction is a common problem in postmenopausal women, often underdiagnosed, inadequately treated, frequently overlooked, and most often impairing the quality of life of these women. To provide clinicians with current information on vulvovaginal atrophy-related sexual dysfunction in postmenopausal women. This study is a literature review on vulvovaginal atrophy-related sexual dysfunction in postmenopausal women. Relevant publications were identified through a search of PubMed and Medline, selected references, journals, and textbooks on this topic, and were included in the review. The prevalence of female sexual dysfunction increases with age. It is a common multidimensional problem for postmenopausal women that alter the physiological, biochemical, psychological, and sociocultural environment of a woman. Menopause-related sexual dysfunction may not be reversible without therapy. Estrogen therapy is the most effective option and is the current standard of care for vulvovaginal atrophy-related sexual dysfunction in postmenopausal women. Sexual dysfunction is a common multidimensional problem for postmenopausal women and often impairs the quality of life of these women. Estrogen preparations are the most effective treatment. Selective estrogen receptor modulators, vaginal dehydroepiandrostenedione, vaginal testosterone, and tissue-selective estrogen complexes are promising therapies, but further studies are required to confirm their role, efficacy, and safety.

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A rare case of aggressive angiomyxoma (AAM) is reported here for its unusual presentation as a cervical polyp, in a 45-year-old woman. It is a soft tissue tumor. Preoperative diagnosis was uterine cervical polyp. Surgical excision was done. Histopathology examination revealed vascular, poorly circumscribed tumor mass composed of spindle cells embedded in myxoid stroma. In the reviewed literature, a single case of AAM mimicking cervical polyp has been reported. Our case may be the second rare case of AAM presenting as a cervical polyp.

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Background : Acquired resistance to protein C in pregnancy has been established as one of the factors associated with thromboembolic phenomenon, an important cause of maternal mortality and morbidity. Objectives: To establish the mean levels of PCA ratio (measure of protein C resistance) of among our pregnant women since maternal mortality rate of the country is on the increase despite efforts to reduce this trend. Materials and Methods : A prospective study was carried out in a tertiary institution in Enugu State, Southeastern Nigeria over the 7 months period from May 2010 to November 2010. Two hundred pregnant women and 50 non pregnant female controls were recruited and PCA ratio, (coagulometric assay) were determined. Results : There was a non significant difference between the mean and standard deviation PCA ratio of the female non pregnant controls and pregnant women in 2 ^nd trimester 4.32±0.4 and 4.30±0.4 respectively. A significant difference was noted between the controls and pregnant women in 3 ^rd trimester 4.32±0.4 and 3.87±0.5 respectively also between the pregnant women in their 2 ^nd and 3 ^rd trimester 4.30±0.4 and 3.87±0.5 respectively. Conclusion : There is increased protein resistance C in our pregnant women. This may implicate thromboembolic disorders as one of the leading causes of increase maternal mortality despite a downward trend in the prevalence of post partum haemorrhage.

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Background: Cancer of the cervix remains an important health problem amongst women worldwide. Widespread comprehensive cervical cancer control programs have resulted in a marked reduction in the incidence and mortality in most developed countries. Developing countries bear over 80% of the global burden, with only 5% of the global resources for the control of cancer. Majority of the cases in these countries present late and are incurable at the time of diagnosis. Aim: To review the presentation and histopathological types of cervical cancer cases seen in Aminu Kano Teaching Hospital Kano, over a sixteen-year period (1995-2010). Materials and Methods: Case records of histopathologically diagnosed cases of cancer of the cervix were retrieved. Demographic data, stage of the tumor at presentation, and histopathologic type were extracted. The results were analyzed using descriptive statistics. Results: Six hundred and sixty gynecological cancers were seen during the study period, with cancer of the cervix accounting for 58.5% (386/660) cases. Among these cases with cancer of the cervix 71.1% (275/386) were grand multiparous and majority 89.7 % 346/386 presented with advanced disease. Squamous cell carcinoma (SCC) accounted for 86.3% (333/386) of the cancers, adenocarcinoma contributed 12.4%,(48/386) and others contributed 1.3% (5/386). Conclusion: Cancer of the cervix is the commonest gynecological cancer at Aminu Kano Teaching Hospital, Kano, Nigeria. SCC is the commonest histological type.

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Background: Abdominal pregnancy, a rare condition with high maternal mortality (up to 50%), and even higher perinatal mortality (40 - 95%), is often associated with diagnostic difficulties. Objectives: To determine the mode of presentation and management of abdominal pregnancy, from cases in the Usmanu Dan - Fodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: A retrospective review of the case records of all abdominal pregnancies managed in UDUTH, Sokoto, between January 2000 and December 2010. Results: During the 10-year study period, there were eight cases of abdominal pregnancies, 285 extrauterine pregnancies, and 25,506 total deliveries. All the patients were not booked for antenatal care and their ages ranged between 20 and 39 years (mean=28.1±3.4 years). The majority (88%) were grand multipara. The main presenting symptoms were persistent abdominal pain, vaginal bleeding, and prolonged pregnancy. Seven cases (87.5%) were diagnosed accurately by an ultrasound scan. There were seven perinatal deaths (87.5%) and one live birth. There was one maternal death (12.5%), which occurred in the patient whose placenta was left in-situ. Conclusion: Presence of persistent lower abdominal pain, vaginal bleeding, and prolonged pregnancy should raise the suspicion of abdominal pregnancy. Removal of the placenta, where feasible, improves the outcome of maternal health.

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Background: Anemia in pregnancy is common and morbidity is increased in the presence of sickle cell disease. There has been conflicting argument concerning routine iron replacement. However few, studies in Nigeria have comprehensively evaluated the iron status of these women. Objective: The study was carried out to determine the iron stores status of pregnant women with hemoglobin (Hb) Sickle cell S or Sickle cell C using the serum assay. C-reactive protein (CRP) was also assayed to rule out the effect of inflammation / infection on the serum level of ferritin. Materials and Methods: This was a prospective longitudinal study conducted at the University of Benin Teaching Hospital (UBTH), Benin City, over a period of eight months (from April 2011 to December 2011). The patients for the study were identified using the booking investigation results in the antenatal clinic records. Only those clinically stable pregnant women, in a healthy state, participated in this study.The hematological indices, serum ferritin assay, and the CRP were determined in both test (Hb SS / SC) and control (Hb AA) pregnant women. The data obtained were fed into a personal computer (PC) and analyzed using the Statistical Package for Social Sciences (SPSS) software version 16 for Windows. Categorical data were expressed as percentages and compared using the Chi-squared test, whereas, numerical data were expressed as mean (SD) and compared using the Student's t-test. The level of significance was set at P≤0.05. Results: A total of 23 Hb SS / SC pregnant women formed the test group. They were recruited for the study from the Sickle-Cell Center (attached to the Central Hospital, Benin City, the UBTH). The mean age, educational status, and the social class of both the test group and the control group were comparable. There was a significant difference in the mean hemoglobin concentration between the test group and control group, both at 16-20 weeks and 28 - 32 weeks of gestation (P<0.001), and the mean corpuscular volume (MCV) values at both gestational ages (GAs) (P=0.097 and 0.231, respectively). The values of the serum ferritin in the test group were also statistically and significantly higher than those of the control group (P<0.001 and P=0.009, respectively), at both GAs. Conclusion: This study demonstrated higher serum iron levels in Hb SS / SC pregnant women than in the controls (even after excluding those levels raised by the increased levels of CRP). In situations that may require iron supplementation, it may be reasonable to determine the iron status to ascertain the quantity that should be given.

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Endometriosis is defined as the presence of endometrial-like glands and stroma outside the uterine endometrial lining. Endometrial tissue can be rarely identified on abdominal wall following numerous surgical or procedure scars, including cesarean section and hysterectomy. Cytological diagnosis of scar endometriosis is difficult, as it can be easily misinterpreted as benign spindle cells tumor. We report three cases where patients presented with a chief complaint of nodule in parietal abdominal wall adjacent to previous cesarean section scars and associated with history of cyclical pain. Provisional clinical diagnosis of desmoid tumor was made in one patient while the other two were diagnosed as endometriosis and they were referred for Fine needle aspiration cytology which revealed endometrial-like epithelial cells, stromal cells and hemosiderin-laden macrophages. Based on the cytological findings, diagnosis of Endometriosis arising in scar tissue was made which was confirmed on histopathology and wide local excision was done.

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