Int J Gynaecol Obstet 15: 428-432, 1978
Menstrual Regulation in Ibadan, Nigeria O. A. Ladipo1, O. A. Ojo1, Sylvia James2, and Karen Robb Stewart2 ^Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria International Fertility Research Program, Research Triangle Park, North Carolina, USA
2
ABSTRACT Ladipo, O. A., Ojo, O. A., James, S. and Stewart, K. R. (Dept. of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria, and the International Fertility Research Program, Research Triangle Park, North Carolina, USA). Menstrual regulation in Ibadan, Nigeria. Int J Gynaecol Obstet 15: 428-432, 1978 Menstrual regulation (MR) (i.e., vacuum aspiration of the uterus with a small diameter, flexible cannula before pregnancy can be determined by a conventional pregnancy test) has been proven safe and effective in many clinics around the world. The present study, which we believe is the first such study of MR in Subsaharan Africa, shows that, for women in an urban African setting, MR is an acceptable backup for other contraceptive methods. Data on 507 MR patients treated at the University College Hospital in Ibadan, Nigeria, between January 1974 and April 1976, showed that the procedure was both safe and effective for 93.4% of the study subjects: there was an overall complication rate of 3.4% and MR failed in seven cases (3.2%). Data also showed that MR is an effective method of recruiting new contraceptive acceptors, as well as an effective back-up procedure in case of contraceptive failure.
INTRODUCTION Menstrual regulation (MR) is the treatment of a delayed menstrual period by evacuation of the uterus to insure that the patient is not pregnant. The procedure is performed before pregnancy can be determined by a conventional pregnancy test. The usual method of evacuation is vacuum aspiration with a small diameter, flexible cannula, requiring neither dilation of the cervix nor anesthesia. Although this procedure is not yet widely available in African medical centers, it has been found very acceptable in developing countries in other regions. In areas where abortion is not yet legal, a safe, simple, and effective postcoital fertility control method is obviously needed. MR is of particular interest in developing countries because the procedure does not necessarily require a physician. Nurses and midwives have safely and effectively performed the procedure (2). From January 1974 to April 1976, a study was conducted at University College Hospital in Ibadan, Nigeria, to: 1. Evaluate the safety and effectiveness of MR 2. Compare the procedure when done within 14 days of expected onset of menses and when done Int J Gynaecol Obstet IS
after 14 days' delay 3. Study socio-demographic characteristics of MR acceptors. MATERIALS AND METHODS Data collection From January 11, 1974 through April 14, 1976, data on 507 MR procedures were collected. Data recorded on standard forms included patient characteristics, medical data, procedure descriptions, and patient status at follow-up. Follow-up data were obtained for 92.9% of the patients. The data were analyzed by the International Fertility Research Program (IFRP), Research Triangle Park, North Carolina, USA. Subjects All of the study subjects requested MR after missing one menstrual period. The early group (89.7%) was less than 14 days delayed, and the late group (10.3%) was more than 14 days delayed. No preexisting medical conditions were found in the late group, whereas 96% of the early group had no preexisting medical condition. At admission, 0.7% of the early group were anemic, 0.7% were febrile, 0.2% had pelvic disease, 2.0% had systemic disease, and 0.4% had a psychiatric disorder. (Multiple conditions could be recorded for the same patient.) Clinical procedure All MR procedures were performed in a standard manner. Before the procedure, a patient history was taken and a physical examination was performed. With the patient in the lithotomy position, the vagina was washed with an antiseptic solution. The cervix was visualized with a bivalve speculum and stabilized by grasping it with a long tissue forceps or tenaculum. The flexible cannula was used as a uterine sound and gently inserted until it touched the fundus. Suction was applied with a 50 ml hand syringe. Except for one patient with longer menstrual delay for whom the procedure was completed by dilatation and curettage (D&C), no cervical dilation was necessary in any of the MR procedures. The
Menstrual regulation in Ibadan
uterus was evacuated by moving the cannula inwards and outwards in the direction of the uterine axis and rotating it 180° in both directions about its own axis. The cannula was removed when the doctor believed the uterus to be adequately evacuated. (The signs of complete evacuation are a gritty feeling when the end of the cannula comes up against the uterine wall and the appearance of bubbles in the syringe.) The total operative time for each procedure varied from 2 to 12 minutes (mean, 7.9 minutes). All of the procedures were done without anesthesia.
RESULTS Socio-demographic characteristics Socio-demographic characteristics of the patients were analyzed for both the early and late groups (Table I). No significant differences (p > 0.05) were evident. The study population was almost entirely urban (99.0%), married (89.2%), and Christian (69.4%). Of the Christians, 10.1% were Catholic, and 59.3% were Protestant. Almost all of the rest of the women were Muslim (30.4%). Most of the women (82.8%) were gainfully employed. Close to one third (30.6%) of the women had no formal education, but the mean number of school years completed was 6.65.
Tabic I. Selected patient characteristics menstrual regulation acceptors Characteristics
of
429
Reproductive characteristics The reproductive characteristics of the study subjects are shown in Table II and Figs. 1 and 2. The median parity for women under 25 was very low. These women are included in the 28.6% of the patients shown in the low age, low parity segment of Fig. 2. Some women (12.0%) used MR to postpone or Table II. Reproductive characteristics of 507 menstrual regulation acceptors No.
%
Number of living children 0 1-2 3-4 5-6 7-8 9-10 Mean Median
61 99 203 122 21 1
12.0 19.5 40.1 24.1
Number of additional children wanted 0 1 2 3 4 5+ Unknown Mean Median
107 58 153 74 79 31 5
4.1 0.2 3.36 3.63
21.1 11.4 30.1 14.6 15.6
6.2 1.0 2.13 2.07
507
No.
%
Age
Menstrual Regulation in Ibadan, Nigeria O. A. Ladipo1, O. A. Ojo1, Sylvia James2, and Karen Robb Stewart2 ^Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria International Fertility Research Program, Research Triangle Park, North Carolina, USA
2
ABSTRACT Ladipo, O. A., Ojo, O. A., James, S. and Stewart, K. R. (Dept. of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria, and the International Fertility Research Program, Research Triangle Park, North Carolina, USA). Menstrual regulation in Ibadan, Nigeria. Int J Gynaecol Obstet 15: 428-432, 1978 Menstrual regulation (MR) (i.e., vacuum aspiration of the uterus with a small diameter, flexible cannula before pregnancy can be determined by a conventional pregnancy test) has been proven safe and effective in many clinics around the world. The present study, which we believe is the first such study of MR in Subsaharan Africa, shows that, for women in an urban African setting, MR is an acceptable backup for other contraceptive methods. Data on 507 MR patients treated at the University College Hospital in Ibadan, Nigeria, between January 1974 and April 1976, showed that the procedure was both safe and effective for 93.4% of the study subjects: there was an overall complication rate of 3.4% and MR failed in seven cases (3.2%). Data also showed that MR is an effective method of recruiting new contraceptive acceptors, as well as an effective back-up procedure in case of contraceptive failure.
INTRODUCTION Menstrual regulation (MR) is the treatment of a delayed menstrual period by evacuation of the uterus to insure that the patient is not pregnant. The procedure is performed before pregnancy can be determined by a conventional pregnancy test. The usual method of evacuation is vacuum aspiration with a small diameter, flexible cannula, requiring neither dilation of the cervix nor anesthesia. Although this procedure is not yet widely available in African medical centers, it has been found very acceptable in developing countries in other regions. In areas where abortion is not yet legal, a safe, simple, and effective postcoital fertility control method is obviously needed. MR is of particular interest in developing countries because the procedure does not necessarily require a physician. Nurses and midwives have safely and effectively performed the procedure (2). From January 1974 to April 1976, a study was conducted at University College Hospital in Ibadan, Nigeria, to: 1. Evaluate the safety and effectiveness of MR 2. Compare the procedure when done within 14 days of expected onset of menses and when done Int J Gynaecol Obstet IS
after 14 days' delay 3. Study socio-demographic characteristics of MR acceptors. MATERIALS AND METHODS Data collection From January 11, 1974 through April 14, 1976, data on 507 MR procedures were collected. Data recorded on standard forms included patient characteristics, medical data, procedure descriptions, and patient status at follow-up. Follow-up data were obtained for 92.9% of the patients. The data were analyzed by the International Fertility Research Program (IFRP), Research Triangle Park, North Carolina, USA. Subjects All of the study subjects requested MR after missing one menstrual period. The early group (89.7%) was less than 14 days delayed, and the late group (10.3%) was more than 14 days delayed. No preexisting medical conditions were found in the late group, whereas 96% of the early group had no preexisting medical condition. At admission, 0.7% of the early group were anemic, 0.7% were febrile, 0.2% had pelvic disease, 2.0% had systemic disease, and 0.4% had a psychiatric disorder. (Multiple conditions could be recorded for the same patient.) Clinical procedure All MR procedures were performed in a standard manner. Before the procedure, a patient history was taken and a physical examination was performed. With the patient in the lithotomy position, the vagina was washed with an antiseptic solution. The cervix was visualized with a bivalve speculum and stabilized by grasping it with a long tissue forceps or tenaculum. The flexible cannula was used as a uterine sound and gently inserted until it touched the fundus. Suction was applied with a 50 ml hand syringe. Except for one patient with longer menstrual delay for whom the procedure was completed by dilatation and curettage (D&C), no cervical dilation was necessary in any of the MR procedures. The
Menstrual regulation in Ibadan
uterus was evacuated by moving the cannula inwards and outwards in the direction of the uterine axis and rotating it 180° in both directions about its own axis. The cannula was removed when the doctor believed the uterus to be adequately evacuated. (The signs of complete evacuation are a gritty feeling when the end of the cannula comes up against the uterine wall and the appearance of bubbles in the syringe.) The total operative time for each procedure varied from 2 to 12 minutes (mean, 7.9 minutes). All of the procedures were done without anesthesia.
RESULTS Socio-demographic characteristics Socio-demographic characteristics of the patients were analyzed for both the early and late groups (Table I). No significant differences (p > 0.05) were evident. The study population was almost entirely urban (99.0%), married (89.2%), and Christian (69.4%). Of the Christians, 10.1% were Catholic, and 59.3% were Protestant. Almost all of the rest of the women were Muslim (30.4%). Most of the women (82.8%) were gainfully employed. Close to one third (30.6%) of the women had no formal education, but the mean number of school years completed was 6.65.
Tabic I. Selected patient characteristics menstrual regulation acceptors Characteristics
of
429
Reproductive characteristics The reproductive characteristics of the study subjects are shown in Table II and Figs. 1 and 2. The median parity for women under 25 was very low. These women are included in the 28.6% of the patients shown in the low age, low parity segment of Fig. 2. Some women (12.0%) used MR to postpone or Table II. Reproductive characteristics of 507 menstrual regulation acceptors No.
%
Number of living children 0 1-2 3-4 5-6 7-8 9-10 Mean Median
61 99 203 122 21 1
12.0 19.5 40.1 24.1
Number of additional children wanted 0 1 2 3 4 5+ Unknown Mean Median
107 58 153 74 79 31 5
4.1 0.2 3.36 3.63
21.1 11.4 30.1 14.6 15.6
6.2 1.0 2.13 2.07
507
No.
%
Age
