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ANNOTATED SURGICAL CASES

Date:17/4/04

OPERATIVE FINDINGS: DENSE PELVIC AND INTESTINAL ADHESIONS, MULTIPLE INTRAMURAL AND SUBMUCOUS FIBROIDS (22 FIBROIDS). BILATERAL TUBAL BLOCKADE. ADHERENT OVARIES TO POSTERIOR UTERINE WALL AND POUCH OF DOUGLAS. ADHERENT ASCENDING COLON TO ANTERIOR PERITONEUM AND BLADDER DOME. ADHERENT OMENTUM TO PELVIC ORGANS AND PERITONEUM.

Date:2/7/04

OPERATIVE FINDINGS: DENSE PELVIC ADHESIONS, MULTIPLE INTRAMURAL AND SUBMUCOUS FIBROIDS (17 FIBROIDS). BILATERAL TUBAL BLOCKADE AT THE CORNUAL ENDS. ADHERENT OVARIES AND TUBES TO POSTERIOR UTERINE WALL AND POUCH OF DOUGLAS. ALL PALPABLE FIBROIDS WERE EXTRACTED. ADHESIOLYSIS PERFORMED.

Date:5/7/04

FIBROIDS AND APPENDIX SONOHYSTEROGRAPHY



OPERATIVE FINDINGS: THERE IS EVIDENCE OF DYE SPILLAGE FROM THE TUBES INDICATING BILATERAL TUBAL PATENCY. MINIMAL PELVIC ADHESIONS, MULTIPLE INTRAMURAL AND SUBMUCUS FIBROIDS (8 FIBROIDS). RIGHT OVARY APPEAR NORMAL WITH MINIMAL FOLLICLES. LEFT OVARY APPEAR NORMAL WITH FEW FOLLICLES. DISTAL TUBAL SEGMENTS AND FIMBRIAE APPEAR NORMAL EXTERNALLY AND FREE OF DISEASE. ALL PALPABLE FIBROIDS WERE EXTRACTED. APPENDECTOMY WAS PERFORMED AT THE REQUEST OF THE HUSBAND AND THE STUMP BURIED.

Date:28/7/04

SONOHYSTEROGRAPHY TRANSVAGINAL SONOGRAM(TVS) showing submucous fibroid

TRANSVAGINAL SONOGRAM(TVS) showing multiple uterine fibroids

FIBROIDS AND APPENDIX



OPERATIVE FINDINGS: THERE IS NO EVIDENCE OF DYE SPILLAGE FROM THE TUBES INDICATING BILATERAL TUBAL BLOCKADE. NO PELVIC ADHESIONS SEEN EXCEPT AT THE CECCAL-APPENDICEAL REGION. MULTIPLE INTRAMURAL AND SUBMUCUS FIBROIDS (10 FIBROIDS). THE RIGHT FUNDAL SUBMUCOUS FIBROID HAS OCCUPIED RT TUBAL CORNUA AND A LARGE SEGMENT OF THE ENDOMETRIUM WHICH WAS CAREFULLY FREED DURING EXTRACTION. BOTH RIGHT AND LT OVARIES APPEAR NORMAL WITH GOLDEN YELLOW APPEARANCE AND MINIMAL FOLLICLES.. BOTH DISTAL TUBAL SEGMENTS AND FIMBRIAE APPEAR NORMAL EXTERNALLY AND FREE OF DISEASE. FIBROTIC SMALL FIBROIDS NOTED AT CORNUAL SEGMENT OF LT TUBE. ALL PALPABLE FIBROIDS WERE EXTRACTED. APPENDECTOMY WAS PERFORMED AT THE REQUEST OF THE SISTER MERCY AND THE STUMP BURIED.

Date:2/8/04



OPERATIVE FINDINGS: THERE IS EVIDENCE OF DYE SPILLAGE FROM THE TUBES INDICATING BILATERAL TUBAL PATENCY. THERE IS MINIMAL PELVIC ADHESIONS SEEN AT THE RIGHT POSTERIOR LOWER UTERINE WALL REGION. MULTIPLE INTRAMURAL AND SUBMUCUS FIBROIDS (25 FIBROIDS). THE LEFTFUNDUS HOUSED THE LARGEST FIBROID MASS. THE SECOND LARGEST FIBROID WAS POSTERIORLY LOCATED. SUBMUCOUS FIBROID HAS OCCUPIED POSTERIOR FUNDAL POSITION. RT TUBAL CORNUM HOUSED TWO FIBROIDS.WHICH WERE CAREFULLY FREED DURING EXTRACTION. LT TUBE HAS INTRAMURAL FIBROIDS CLOSED TO ITS CORNUM AS WELL. BOTH RIGHT AND LT OVARIES APPEAR NORMAL SOME FOLLICLES.. BOTH DISTAL TUBAL SEGMENTS AND FIMBRIAE APPEAR NORMAL EXTERNALLY AND FREE OF DISEASE.. ALL PALPABLE FIBROIDS WERE EXTRACTED.



Date:14/8/04



OPERATION: PRIMARY CESAREAN SECTION FOLLOWING PREVIOUS MULTIPLE MYOMECTOMIES. OPERATIVE FINDINGS: TERM LIVE MALE INFANT WITH NUCHAL CORD X 2. EXTRACTED IN CEPHALIC PRESENTATION. APGAR 8 AND 9 IN 1 AND 5 MINUTES RESPECTIVELY. RECURRENT LEIOMYOMATA UTERI. MULTIPLE UTERINE MYOMAS CAREFULLY EXTRACTED. TUBES AND OVARIES APPEAR NORMAL.



Date:28/8/04

Date:10/11/04

Date:13/11/04



OPERATIVE FINDINGS: THERE IS NO EVIDENCE OF DYE SPILLAGE FROM THE TUBES INDICATING BILATERAL TUBAL BLOCKADE. THERE IS MODERATE PELVIC ADHESIONS AND MULTIPLE INTRAMURAL FIROIDS (11 FIBROIDS). THE FUNDAL UTERINE SEGMENT HOUSED THE LARGEST FIBROID MASS. SEVERAL MODERATELY SIZED FIBROIDS WERE LOCATED INTRAMURALLY IN THE ANTERIOR BODY OF THE UTERUS .THE POUCH OF DOUGLAS AND POSTERIOR UTERINE WALL WERE DENSELY ADHERENT WITH OMENTUM, BOWEL, AND BOTH OVARIES STUCK TOGETHER. CAREFUL DISECTION FREED THEM AND REVEALED ENDOMETRIOTIC CYST ON THE LT OVARY. BOTH FALLOPIAN TUBES WERE GROSSLY STRETCHED BUT APPEAR INTACT.. BOTH RIGHT AND L T OVARIES WERE NOTED TO BE ADHERENT TO POSTERIOR LOWER UTERINE WALL.THERE THERE WAS A SMALL CYST ON THE RT OVARY WHICH WAS EXCISED. THERE WAS ENDOMETRIOMA WITH THICK DENSE LT OVARIAN SROMAL REACTION WHICH WERE EXCISED. FEW FOLLICLES WERE NOTED ON BOTH OVARIAN CORTEX. INCIDENTAL APPENDECTOMY WAS PERFORMED. ADEQUATE HEMOSTASIS WAS SECURED.

Date:28/12/04

INDICATION FOR OPERATION: TERM PREGNANCY IN LABOR AND HX OF UTERINE FIBROIDS PRIOR TO CONCEPTION. LACK OF LABOR PROGRESSION (NO FETAL DESCENT AND CERVICAL DILATATION). FETAL DISTRESS.

Date:11/01/05

34 Y.O. PRESENTED W/ HX OF PROGRESSIVE WEIGHT LOSS, ANEMIA, PELVIC PAIN, RECURRENT UTERINE FIBROIDS AND BILATERAL TUBAL OBSTRUCTION AND REQUESTING SURGERY. ANEMIA WAS CORRECTED .

Date:11/12/04

Date:/1/05/2008

29 Y.OLD FEMALE G0 P0 PRESENTED WITH HX OF INFERTILITY FOR 2 YEARS AND SYMPTOMATIC FI BROIDS, MENORRHAGIA, AND ANEMIA. PATIENT PRESENTED FOR SURGERY.

-Date:11/2/05

37 Y.OLD FEMALE G7 P0 PRESENTED WITH HX OF INFERTILITY FOR 6 YEARS AND SYMPTOMATIC FIBROIDS, MENORRHAGIA, AND ANEMIA. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:21/2/05

41 Y.OLD FEMALE G2 P0 PRESENTED WITH HX OF INFERTILITY FOR 21/2YRS. SHG REVEALED SUBMUCUS FIBROID. PATIENT PRESENTED FOR SURGERY.

Date:25/2/05

34 Y.OLD FEMALE G1 P0 PRESENTED WITH HX OF INFERTILITY FOR 13 YEARS AND SYMPTOMATIC FIBROIDS, MENORRHAGIA, AND ANEMIA. APPENDECTOMY 2002. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:27/2/05

29 Y.OLD FEMALE G3 P0 PRESENTED WITH HX OF ECTOPIC GESTATION. TVS REVEALED RT CORNUAL ECTOPIC AND LAB SHOWED ANEMIA. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:03/3/05

43 Y.OLD FEMALE P2 PRESENTED WITH HX OF INFERTILITY FOR 10 YEARS FOLLOWING HER LAST DELIVERY IN 1994. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI AND ANEMIA. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:09/3/05

33 Y.OLD FEMALE G1. P0 PRESENTED WITH HX OF INFERTILITY FOR 8 YEARS. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI AND BILATERAL TUBAL BLOCKADE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:11/3/05

47 YEAR OLD FEMALE G5. P5 PRESENTED WITH HX OF PROLONGED UTERINE BLEEDING – (MENORRHAGIA). INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE WITH SOME ENCROACHING THE ENDOMETRIAL CAVITY BUT NOT INSIDE IT. THERE ARE NO SUBMUCOUS FIBROIDS IDENTIFIED. BLOOD WORK-UP REVEALED ANEMIA. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

-Date:14/3/05

35 Y.OLD FEMALE G1. P0 PRESENTED WITH HX OF INFERTILITY FOR 11 YEARS. INVESTIGATIONS REVEALED LESION WITHIN THE ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI AND BILATERAL TUBAL BLOCKADE WITH FIMBRIAL HYDROSALPINGES. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:16/03/2005

36 Y.OLD FEMALE G4. P0 PRESENTED WITH HX OF INFERTILITY FOR 10 YEARS. INVESTIGATIONS REVEALED SUB-MUCOUS LESION WITHIN THE ENDOMETRIAL CAVITY AND OTHER LEIOMYOMATA UTERI AND BILATERAL DISTAL TUBAL BLOCKADE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:18/03/2005

33 Y.OLD FEMALE G1. P0 PRESENTED WITH HX OF INFERTILITY FOR 7 YEARS. PAST SURGICAL HX OF MYOMECTOMY 2002 AT AIR-FORCE BASE HOSPITAL, LAGOS. CURRENT INVESTIGATIONS AT M&M HOSPITAL REVEALED SUB-MUCOUS LESION WITHIN THE ENDOMETRIAL CAVITY AND OTHER LEIOMYOMATA UTERI AND BILATERAL DISTAL TUBAL BLOCKADE. BLOOD WORK REVEALED ANEMIA WITH HB OF 63%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:8/04/2005

33 Y.OLD FEMALE G1. P0 PRESENTED WITH HX OF INFERTILITY FOR 10 YEARS. CURRENT INVESTIGATIONS REVEALED LEIOMYOMATA UTERI AND RT PROXIMAL TUBAL PATHOLOGY WITH BLOCKADE. LT TUBE APPEARED PATENT WITH SOME SPILLAGE.BLOOD WORK REVEALED ANEMIA WITH HB OF 67%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:19/4/05

34 Y.OLD FEMALE G3 P0 PRESENTED WITH HX OF INFERTILITY FOR ONE YEAR AND SYMPTOMATIC FI BROIDS, MENORRHAGIA, AND ANEMIA-67%. PATIENT PRESENTED FOR SURGERY.

Date:30/4/05

38 Y.OLD FEMALE G3. P4 PRESENTED WITH HX OF MENOMETRORRHAGIA OF MORE THAN ONE YEAR DURATIOIN WITH MENSTRUAL FLOW LASTING 10 TO 15 DAYS. SHE FEELS WEAK AND TIRED FOLLOWING EACH EPISODE OF BLEEDING. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI AND BILATERAL TUBAL BLOCKADE AND WITH HB OF 55% INDICATIVE OF ANEMIA. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:02/05/05

47 Y.OLD FEMALE G8. P1 PRESENTED WITH HX OF INFERTILITY OF 5 YEARS DURATION. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI AND BILATERAL TUBAL BLOCKADE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:07/05/05

52 YEAR OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY FOR 22 YEARS AND SYMPTOMATIC FIBROIDS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERI WITH SOME ENCROACHING ON THE RECTUM/VAGINA AND WITH THE TUMOR EXTENDING CEPHALAD BETWEEN THE UMBILICUS AND THE XIPHOID PROCESS. THERE ARE NO CERVIX IDENTIFIED. BLOOD WORK REVEALED ANEMIA. CXR, EKG, AND INTRAVENOUS PYELOGRAPHY WERE OBTAINED. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT COUNSELED THAT HYSTERECTOMY WITH BSO WERE THE PROCEDURE OF CHOICE FOR OPTIMAL MANAGEMENT AND OUTCOME OF HER CONDITION. .

Date: 06/05/05

45 Y.OLD FEMALE G3. P1 PRESENTED WITH HX OF INFERTILITY SINCE THE BIRTH OF HER ONLY CHILD IN 1990. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI AND BILATERAL TUBAL BLOCKADE AND WITH HB OF 55% INDICATIVE OF ANEMIA. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date:8/5/05

36 Y.OLD FEMALE G1 P1 PRESENTED WITH HX OF SYMPTOMATIC FI BROIDS, MENORRHAGIA, AND ANEMIA. PATIENT PRESENTED with request FOR SURGERY.



-Date: 10/06/05

28 Y.OLD FEMALE G0. P0 PRESENTED WITH HX OF symptomatic PELVIC DISCOMFORT. CURRENT INVESTIGATIONS REVEALED LEIOMYOMATA UTERI AND BILATERAL TUBAL PATHOLOGY. BLOOD WORK REVEALED HB OF 70%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



Date: 13/06/05

52 YEAR OLD FEMALE G1. P0 PRESENTED WITH HX OF LEFT SCIATICA, RECTAL AND BLADDER PRESSURE WITH FREQUENCY OF URINATION, AND SYMPTOMATIC FIBROIDS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED LARGE MULTIPLE LEIOMYOMATA UTERINE WITH SOME ENCROACHING ON THE RECTUM/VAGINA AND WITH THE TUMOR EXTENDING CEPHALAD BETWEEN THE UMBILICUS AND THE XIPHOID PROCESS. PATIENT HAS SIGNIFICANT MEDICAL HX OF DIABETES POORLY MANAGED WITH GLUCOPHAGE. BLOOD WORK-UP REVEALED FASTING BLOOD SUGAR OF 261MG/DL, ABNORMAL LIVER FUNCTIONS AND NORMAL KIDNEY FUNCTIONS AND ARE WITHIN NORMAl VALUES. CXR, EKG, AND INTRAVENOUS PYELOGRAPHY WERE OBTAINED. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT COUNSELED THAT HYSTERECTOMY WITH BSO WERE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION.



Date: 29/06/2005

38 Y.OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY FOR 6 YEARS. INVESTIGATIONS REVEALED SUB-MUCOUS LESION WITHIN THE ENDOMETRIAL CAVITY AND OTHER LEIOMYOMATA UTERI AND BILATERAL DISTAL TUBAL BLOCKADE. PT ALSO HAS A RT BREAST MASS. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



Date: 25/06/05

28 Y.OLD FEMALE G0. P0 PRESENTED WITH HX OF symptomatic PELVIC DISCOMFORT. CURRENT INVESTIGATIONS REVEALED LEIOMYOMATA UTERI AND BILATERAL TUBAL PATENCY. BLOOD WORK REVEALED HB OF 63%. PATIENT PRESENTED WITH REQUEST FOR SURGERY



-Date: 18/7/05

38 Y.OLD FEMALE GRAVIDA 4 PARA 1 PRESENTED WITH HX OF INFERTILITY SINCE 6 YEARS OF MARRIAGE. PT DELIVERED HER DAUGHTER IN 1985. PT UNDERWENT EXPLORATORY LAP. FOR RUPTURED APPENDIXIN 1987. EVALUATION REVEALED SYMPTOMATIC FIBROIDS INCLUDING MENOMETRORRHAGIA. LABORATORY INVESTIGATION SHOWED HB 70%. PATIENT PRESENTED FOR SURGERY.



Date: 25/07/05

35 Y.OLD FEMALE G3. P1 PRESENTED WITH HX OF INFERTILITY FOLLOWING HER LAST DELIVERY IN 1993 OF A FEMALE INFANT. CURRENT INVESTIGATIONS REVEALED LEIOMYOMATA UTERI AND BILATERAL TUBAL PATHOLOGY. THERE IS SEVERE MALE FACTOR INFERTILITY. BLOOD WORK REVEALED HB OF 69%. PATIENT PRESENTED WITH REQUEST FOR SURGERY



date: 05/08/05

25 Y.OLD FEMALE G0. P0 PRESENTED WITH HX OF MENOMETRORRHAGIA CURRENT INVESTIGATIONS REVEALED LEIOMYOMATA UTERI AND BILATERAL TUBAL PATHOLOGY. BLOOD WORK REVEALED HB OF 35%. PATIENT PRESENTED WITH REQUEST FOR SURGERY



date:16/08/05

31 Y.OLD FEMALE G0. P0 PRESENTED WITH HX OF MENOMETRORRHAGIA CURRENT INVESTIGATIONS BY TRANSVAGINAL SONOGRAM REVEALED LEIOMYOMATA UTERI, HSG SHOWED CENTRAL SUBMUCOUS LESION IN THE ENLARGED ENDOMETRIAL CAVITY AND BILATERAL TUBAL PATHOLOGY. SONOHYSTEROGRAPHY REVEALED A LARGE MASS OCCUPYING THE ENTIRE ENDOMETRIUM SUGESTIVE OF SUBMUCOUS FIBROID. BLOOD WORK REVEALED HB OF 43%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



date:20/08/05

29 Y.OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY OF FOUR YEARS. CURRENT INVESTIGATIONS REVEALED FUNDAL LEIOMYOMATA UTERI WITH SUBMUCOUS LESIONS AND BILATERAL TUBAL PATHOLOGY. BLOOD WORK REVEALED HB OF 68%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



date:22/08/05

33 Y.OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY FOR TWO YEARS. CURRENT INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERI WITH BILATERAL TUBAL PATHOLOGY. BLOOD WORK REVEALED HB OF 68%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



date:23/08/05

35 YR. OLD FEMALE G4. P0 PRESENTED WITH HX OF INFERTILITY FOR FIVE YEARS. CURRENT INVESTIGATIONS REVEALED VERY LARGE LEIOMYOMATA UTERI WITH BILATERAL TUBAL PATHOLOGY. BLOOD WORK REVEALED SEVERE ANEMIA WITH HB OF 40%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



date:25/08/05

35 YR. OLD FEMALE G3. P0 PRESENTED WITH HX OF INFERTILITY FOR NINE YEARS. CURRENT INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERI WITH LT TUBAL BLOCKADE AND HYDROSALPINX. BLOOD WORK REVEALED HB OF 67%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



date:29/08/05

37 YR. OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY FOR 14 YEARS. CURRENT INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERI WITH BILATERAL TUBAL BLOCKADE. LARGE LT ADNEXAL CYST. PRIOR HX OF MYOMECTOMIES X 2, CYSTECTOMY AND ADHESIOLYSIS, TUBOPLASTY AND POLYPECTOMY. BLOOD WORK REVEALED HB OF 50%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



date:05/09/05

31 YR. OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY FOR 3 YEARS. HAD MYOMECTOMY PERFORMED AT ABUJA IN 2003. CURRENT INVESTIGATIONS REVEALED RECURRENT LEIOMYOMATA UTERI WITH BILATERAL TUBAL BLOCKADE AND HYDROSALPINX. BLOOD WORK REVEALED HB OF 52%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



date:09/09/05

34 YR. OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY FOR TWELVE YEARS. CURRENT INVESTIGATIONS REVEALED LARGE LEIOMYOMATA UTERI WITH RT TUBAL DISTAL PATHOLOGY AND FREE SPILLAGE OF CONTRAST MEDIA FROM THE LEFT TUBE. BLOOD WORK REVEALED 67%. PATIENT WAS COUNSELED AND PRESENTED FOR SURGERY.



date: 1709/05

38 YR. OLD FEMALE G2. P0 PRESENTED WITH HX OF INFERTILITY FOR 10 YEARS. HAD

MYOMECTOMY PERFORMED AT JOS IN 1998. CURRENT INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERI WITH SUBMUCOUS TYPE AND RT TUBAL BLOCKADE. LT TUBE APPEARS PATENT WITH SPILLAGE. BLOOD WORK REVEALED HB OF 60%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



-Date: 21/09/05

TOTAL ABNORMAL HYSTERECTOMY WITH BILATERAL SALPINGO-OOPHORECTOMY (TAH & BSO)

49YEAR OLD FEMALE G4. P3013 PRESENTED WITH HX OF MENOMETRORRHAGIA OF 2 YEARS DURATION, WEAKNESS AND DIZZINESS AND SYMPTOMATIC FIBROIDS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE. PATIENT HAS SIGNIFICANT MEDICAL HX OF HYPERTENSION OF LONG STANDING DURATION. BLOOD WORK-UP REVEALED HB OF 72%. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT COUNSELED THAT HYSTERECTOMY WITH BSO WAS THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION.



date: 23/09/05

43 YR. OLD FEMALE G1. P1 PRESENTED WITH HX OF UNABLE TO HAVE ANOTHER PREGNANCY FOLLOWING HER ONLY DELIVERY OF A MALE CHILD IN 1994.

CURRENT INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERI WITH SUBMUCOUS TYPES AND BILATERAL TUBAL BLOCKADE. THE LEFT OVARY HARBORS A CYST. BLOOD WORK REVEALED HB OF 55%. PATIENT PRESENTED WITH REQUEST FOR SURGERY

Date:27/09/05

HSG WITH INTRACAVITARY LESION GLOBULAR UTERUS

UTERUS,TUBES OVARIES AND DYE SPILLAGE SPECIMEN FROM SURGERY





41 Y.OLD FEMALE G7. P3 PRESENTED WITH HX OF INFERTILITY FOLLOWING HER LAST DELIVERY IN 1995. INVESTIGATIONS REVEALED ENLARGED AND DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS LESION. PATIENT PRESENTED WITH REQUEST FOR SURGERY.



Date:29/09/05

SUBMUCOUS LESION SEEN ON HSG OVER DISTENSION WITH DYE

SUBMUCOUS LESION SEEN ON SONOHYSTEROGRAPHY SUBMUCOUS LESION AT SURGERY


38 Y.OLD FEMALE G0. P0 PRESENTED WITH HX OF RECURRENT UTERINE FIBROIDS, MENORRHAGIA AND DESIRE TO GET PREGNANT. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI WITH SUBMUCOUS LESION. LABORATORY INVESTIGATIONS REVEALED HB 46%. PATIENT PRESENTED WITH REQUEST FOR SURGERY

Date: 06/10/05

ELONGATED & DISTORTED ENDOMETRIUMON HSG RT ADNEXAL CYST

UTERINE FIBROIDS AFTER ADHEIOLYSIS UTERUS FOLLOWING ADHESIOLYSIS & MYOMECTOMY


43 Y.OLD FEMALE G1. P0 PRESENTED WITH HX OF RECURRENT UTERINE FIBROIDS, MENORRHAGIA AND DESIRE TO GET PREGNANT THROUGH IVF. INVESTIGATIONS REVEALED CERVICAL STENOSIS, ELONGATED & DISTORTED ENDOMETRIAL CAVITY AND LEIOMYOMATA UTERI AND DENSE PELVIC RESTRICTION WITH ADHESIONS. LABORATORY INVESTIGATIONS REVEALED HB 56%. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date: 04/11/05

ELONGATED & DISTORTED ENDOMETRIUM HSG SUBMUCOUS FIBROID SHG

UTERINE

FIBROIDS

SPECIMEN FROM MYOMECTOMY
45 Y.OLD FEMALE G1. P1 PRESENTED WITH HX OF UTERINE FIBROIDS, MENORRHAGIA AND ANEMIA. INVESTIGATIONS REVEALED, ELONGATED & DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE AND LEIOMYOMATA UTERI. LABORATORY INVESTIGATIONS REVEALED HB 60%. PATIENT PRESENTED WITH REQUEST FOR SURGERY

Date: 07/01/06

UTERINE MASS BEFORE SUBTOTAL ABDOMINAL HYSTERECTOMY (TAH)
45YEAR OLD FEMALE G6. P5014 PRESENTED WITH HX OF MENOMETRORRHAGIA and INTERMENTRUAL SPOTTING , WEAKNESS AND DIZZINESS AND SYMPTOMATIC FIBROIDS. PAST MEDICAL AND SURGICAL HISTORY INCLUDED HYPERCHOLESTEROLEMIA, APPENDECTOMY, AND TWO PREVIOUS CESAREAN SECTIONS. PT HAD LEFT BREAST LUMPECTOMY FOR A BENIGN MASS. MEDICATIONS INCLUDE LIPITOR. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE. BLOOD WORK-UP REVEALED SEVERE ANEMIA WITH HB OF 46%. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT WAS COUNSELED THAT HYSTERECTOMY WITH POSSIBLE BILATERAL SALPINGOOPHORECTOMY WERE THE PROCEDURE OF CHOICE FOR OPTIMAL MANAGEMENT OF HER CONDITION. SHE CONSENTED AND PRESENTED FOR SURGERY. SHE WAS GIVEN A SHORT COURSE OF THERAPY WITH GnRH-ANALOG AND HEMATINICS PRIOR TO SURGERY. ECG AND CXR WERE WITHIN NORMAL LIMITS. RENAL AND LIVER FUNCTION STUDIES WERE WITHIN NORMAL PARAMETERS.

SPECIMEN AT SURGERY (WT 920 GMS)



Date: 25/02/06

BILATERAL CORUNAL SUBMUCOUS FIBROID SHG

TUBAL BLOCKADE HSG

UTERINE FIBROIDS

43 Y.OLD SINGLE FEMALE G0. P0 PRESENTED WITH HX OF MENOMETRORRHAGIA FOR TWO YEARS AND UTERINE FIBROIDS. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH LARGE SUBMUCOUS AND INTRAMURAL FIBROIDS AND BILATERAL TUBAL BLOCKADE. LABORATORY INVESTIGATIONS REVEALED HB 65%, HIV NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. CXR, ECG, LFT AND RENAL FUNCTIONS WERE ALSO PERFORMED

SPECIMEN FROM SURGERY

Date: 24/03/07


53 YEAR OLD FEMALE G5. P3 PRESENTED ON 12/03/07 WITH HX OF POST MENOPAUSAL BLEEDING OF THREE WEEKS DURATION. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE WITH SOME SUBMUCOUS TYPES. PATIENT HAS SIGNIFICANT MEDICAL HX OF HYPERTENSION MANAGED WITH ZESTRIL. BLOOD WORK-UP REVEALED NORMAL LIVER FUNCTIONS AND NORMAL KIDNEY FUNCTIONS. HB 58%, GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE, HIV –NEGATIVE. CXR, AND EKG WERE WITHIN NORMAL LIMITS. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT COUNSELED THAT HYSTERECTOMY WITH BSO WERE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION.

INTRA CAVITARY FIBROID CAUSING BLEEDING SPECIMEN FROM SURGERY



Date: 24/03/07

SALINE INFUSION SONOGRAPHY SHOWING SUB-MUCOUS FIBROID

42 YEAR OLD MARRIED FEMALE G2 P0 PRESENTED FIRST ON 22/01/07 WITH HX OF 20 YEARS OF MARRIAGE WITHOUT A VIABLE CHILD. PATIENT GAVE A HISTORY OF TWO PREVIOUS MISCARRIAGES THAT TERMINATED IN EARLY PREGNANCIES MORE THAN 10 YEARS AGO. SHE HAS BEEN IN A STATE OF AMENORRHEA SINCE 1999. SHE PRESENTED WITH A DESIRE TO ACHIEVE PREGNANCY THROUGH IVF TECHNOLOGY. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERI WITH SOME SUBMUCOUS TYPES CONFIRMED BY SALINE INFUSION SONOGRAPHY. BLOOD WORK REVEALED HB 70%, GENOTYPE As, BLOOD GROUP/RH 0-POSITIVE AND HIV –NEGATIVE. PATIENT WAS COUNSELED ON HER OPTIONS AND SHE OPTED FOR SURGERY BEFORE TRIAL OF IVF.

FIBROID SPECIMEN FROM SURGERY



-Date: 30/05/07

SUB-MUCOUS LESION (SIS)

UTERNE FIBROIDS



35 YEAR OLD MARRIED FEMALE NULLIGRAVIDA PRESENTED FIRST ON 22/05/07 WITH HX OF 7 YEARS OF MARRIAGE WITHOUT A PREGNANCY. SHE PRESENTED WITH A DESIRE TO ACHIEVE PREGNANCY THROUGH IVF TECHNOLOGY. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERI. HSG SHOWED UTERINE CAVITY WITH ILL-DEFINED LESION WHICH WAS CONFIRMED BY SALINE INFUSION SONOGRAPHY. BOTH TUBES SHOWED SOME DEGREE OF OPACIFICATION. THE LEFT TUBE HAD FIMBRIAL LOCULATION AND THE RIGHT TUBE HAD MID ISTHMIC BLOCKADE. BLOOD WORK REVEALED ANEMIA WITH HB OF 59%, GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV –NEGATIVE. PATIENT WAS COUNSELED ON HER OPTIONS AND SHE OPTED FOR SURGERY BEFORE TRIAL OF IVF.

FIBROID SPECIMEN FROM SURGERY



-Date: 29/05/07

HSG


29 YEAR OLD MARRIED FEMALE NULLIGRAVIDA WHO PRESENTED FIRST ON 02/04/07 WITH HX OF 3 YEARS OF MARRIAGE WITHOUT PREGNANCY. SHE EXPERIENCES SEVERE PELVIC PAINS DURING HER MENSES. PATIENT GAVE A HISTORY OF PLEURAL EFFUSION OF RT LUNGS DIAGNOSED IN 2006 AND TREATED AT NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL NNEWI. SHE HAS EXPERIENCED RECURRENT EPISODES ASSOCIATED WITH HER MENSTRUAL CYCLES AND SUSPECTED TO BE ECTOPIC SITE OF ENDOMETRIOSIS. SHE PRESENTED WITH A DESIRE TO ACHIEVE PREGNANCY. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED IMMOBILE AND FIXED UTERUS WITH A LARGE PELVIC CYST SUSPICIOUS FOR ENDOMETRIOMA. BOTH OVARIES COULD NOT BE IMAGED ON ULTRASOUND. HSG SHOWED OPACIFICATION OF BOTH TUBES WITH DISTAL PATHOLOGY. CXR SHOWED LOWER RT LUNG OPACIFICATION. PT WAS REFERRED BACK TO HER SURGEON AT NNEWI WHO REVIEWED THE CXR AND DECLARED HER FIT TO UNDERGO SURGERY. BLOOD WORK REVEALED HB 66%, GENOTYPE AA, BLOOD GROUP/RH 0-POSITIVE AND HIV –NEGATIVE. PATIENT WAS COUNSELED ON HER OPTIONS AND SHE OPTED FOR SURGERY.

FIBROID SPECIMEN FROM SURGERY



Date: 14/06/07

UTERUS WITH FIBROIDS, OVARIES AND FALLOPIAN TUBE


45 YEARS OLD MARRIED FEMALE G1. P1 PRESENTED ON 12/06/07 WITH HX OF MENOMETRORRHAGIA, WEAKNESS, WATERY AND YELLOWISH VAGINAL DISCHARGE. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE WITH SOME SUBMUCOUS TYPES. PATIENT HAS SIGNIFICANT MEDICAL HX OF HYPERTENSION AND OBESITY. BLOOD WORK-UP REVEALED NORMAL LIVER FUNCTIONS AND SLIGHTLY ELEVATED CREATININE IN HER KIDNEY FUNCTIONS STUDIES. HB 60%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV –NEGATIVE. CXR AND EKG APPEARED WITHIN NORMAL LIMITS. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT WAS COUNSELED THAT HYSTERECTOMY IS THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION. THE COUPLE ALSO REQUESTED FOR BSO (BILATERAL SALPINGO-OOPHORECTOMY).

INTRA CAVITARY FIBROID CAUSING BLEEDING SPECIMEN FROM SURGERY



Date: 14/06/07

SUBMUCOUS FIBROIDS (SIS)

FIBROID UTERUS WITH ADHESIONS


37 YEAR OLD MARRIED FEMALE G2. P0 PRESENTED ON 23/04/07 WITH HX OF INFERTILITY SINCE FOUR YEARS OF MARRIAGE. SHE UNDERWENT MYOMECTOMY IN 1998 AT P.H. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING BEYOND THE UMBILICUS AND RELATIVELY IMMOBILE. HSG REVEALED ENLARGED ENDOMETRIAL CAVITY AND BILATERAL TUBAL PATHOLOGY. SALINE INFUSION SONOGRAPHY SHOWED SUBMUCOUS LESIONS SUSPICIOUS FOR BOTH FIBROIDS AND POLYPS. LABORATORY INVESTIGATIONS SHOWED HB 63%, GENOTYPE As, BLOOD GROUP/RH O-NEGATIVE, HIV –NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT.



-Date:03/07/07

HSG SHOWING TUBAL BLOCKADE FIBROID UTERUS WITH ADHESIONS


34 YEAR OLD MARRIED FEMALE G0. P0 PRESENTED ON 02/06/07 WITH HX OF INFERTILITY SINCE THREE YEARS OF MARRIAGE. SHE UNDERWENT MYOMECTOMY PROCEDURE AT OWERRI IN 2002. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING THE UMBILICUS AND RELATIVELY IMMOBILE. HSG REVEALED ENLARGED AND DISTORTED ENDOMETRIAL CAVITY AND BILATERAL TUBAL PATHOLOGY WITH ONE TUBE SHOWING OPACIFICATION AND NO SPILLAGE. SALINE INFUSION SONOGRAPHY SHOWED LACK OF EXPANSION OF THE ENDOMETTRIAL CAVITY. LABORATORY INVESTIGATIONS SHOWED HB 67%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV –NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT.

SPECIMEN FROM SURGERY



Date: 18/07/07

UTERINE FIBROIDS



34 YR.OLD MARRIED FEMALE G1. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 23/06/07 WITH HX OF INFERTLITY FOLLOWING 4 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF IRREGULAR MENSTRUAL CYCLES, MODERATE PELVIC PAIN AND MULTIPLE UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS UP TO THE XIPHOID. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. LABORATORY INVESTIGATIONS REVEALED ANEMIA (HB 58%), HIV NEGATIVE. SHE IS GENOTYPICALLY AA and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY



Date: 18/07/07

HSG SHOWING TUBAL BLOCKADE

FIBROID UTERUS (SIS)



36 YEAR OLD MARRIED FEMALE G0. P0 PRESENTED ON 30/06/07 WITH HX OF INFERTILITY SINCE THREE YEARS OF MARRIAGE. SHE UNDERWENT QUESTIONABLE MYOMECTOMY PROCEDURE AT P.HO IN 2004. SHE ALSO HAD AN IVF PROCEDURE AT BRIDGE CLINIC IN 2006 WHICH FAILED. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE THAT WAS RELATIVELY IMMOBILE. HSG REVEALED NARROW AND DISTORTED ENDOMETRIAL CAVITY AND BILATERAL TUBAL BLOCKADE WITH HYDROSALPINX. SALINE INFUSION SONOGRAPHY SHOWED LACK OF EXPANSION OF THE ENDOMETTRIAL CAVITY. LABORATORY INVESTIGATIONS SHOWED HB 70%, GENOTYPE AA, BLOOD GROUP/RH AB-POSITIVE, HIV –NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT.



Date: 19/07/07

HSG WITH BILAT.TUBAL BLOCKADE UTERUS AND FIBROID AT SURGERY

SPECIMEN UTERUS WITH FIBROIDS


39 Y.OLD MARRIED FEMALE G? SEVERAL P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING EIGHT YEARS OF MARRIAGE (1999). CURRENT INVESTIGATIONS REVEALED LEIOMYOMATA UTERI AND BILATERAL TUBAL BLOCKADE. SIS REVEALED MINIMAL ENDOMETRIAL EXPANSION. BLOOD WORK REVEALED HB OF 70%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

Date: 28/07/07

ADHESIONS

UTERINE FIBROIDS



39 YR.OLD MARRIED FEMALE G1. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 20/07/07 WITH HX OF INFERTLITY FOLLOWING 2 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF REGULAR MENSTRUAL CYCLES, THREE DAYS OF FLOW AND MULTIPLE UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS UP TO THE UMBILICUS. INVESTIGATIONS REVEALED ENLARGED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL PATENCY. LABORATORY INVESTIGATIONS REVEALED HB 70%, HIV NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY

SPECIMEN FROM SURGERY





date: 02/08/07

SONOGRAM OF LT BREAST MASS

EN-BLOC EXCISION OF MASS





PT IS A 36 Y.O.MARRIED FEMALE G3 P1 WHO FIRST PRESENTED TO OUR MEDICAL CENTER FOR EVALUATION OF LEFT BREAST LUMP WHICH SHE NOTED ABOUT TWO MONTHS PRIOR TO PRESENTATION. SHE IS NURSING A FOUR MONTHS OLD MALE INFANT. INITIAL EVALUATION WITH SONOGRAM REVEALED A30MM MASS THAT IS SOFT TISSUE IN CONSISTENCY LOCATED AT THE INNER UPPER QUADRANT. PALPATION REVEALED THE MASS TO BE SMOOTH, RELATIVELY MOBILE AND WITH NO SKIN DIMPLES OR RETRACTION.

THE PATIENT WAS COUNSELED ON OPTIONS OF MANAGEMENT AND THE NEED TO SECURE A PATHOLOGICAL DIAGNOSIS AND SHE CONSENTED TO EXCISIONAL BIOPSY.

UNDER CONSCIOUS SEDATION, AN EXCISIONAL BIOPSY WAS PERFORMED AND THE MASS REMOVED EN-BLOC. THE SUB-AREOLAR TISSUES WERE SUTURED WITH -3-0- DEXON TO ACHIEVE HEMOSTASIS, THE PERI-AREOLAR SKIN WAS CLOSED IN A SUB-CUTICULAR FASHION WITH -6-0- VICYL SUTURES. THE PATIENT TOLERATED THE PROCEDURE WELL.

THE SPECIMEN IS BEING SENT TO PROF ONUIGBO AT ORTHOPEDIC HOSPITAL ENUGU FOR PATHOLOGICAL DIAGNOSIS.



Date: 1/08/07

TVS FIBROID

HSG WITH SUBMUCOUS

SALINE INFUSION SONOGRAPHY UTERUS AND FIBROID AT SURGERY




31 Y.OLD MARRIED FEMALE G4 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING two YEARS OF MARRIAGE. INVESTIGATIONS REVEALED LEIOMYOMATA UTERI. HSG REVEALED LARGE SUBMUCOUS FIBROID. THE RT TUBE APPEARED OPACIFIED WITH NO DEMONSTRABLE SPILLAGE AND THE LEFT TUBE SHOWED CORNUAL BLOCKADE. SIS REVEALED LARGE INTRACAVITARY MASS. BLOOD WORK REVEALED HB OF 60%. GENOTYPE As, BLOOD GROUP/RH A-POSITIVE AND HIV NEGATIVE. AFTER CONSULTATION WITH HER HUSBAND WHO LIVES IN LONDON, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

ENDOMETRIAL CAVITY WITH METHYLENE BLUE SPECIMEN AT SURGERY


Date: 11/08/07

TVS HSG WITH MYOMETRIAL CYST

MYOMETRIAL CYST AT SURGERY





36 Y.OLD MARRIED FEMALE G3 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING FIVE YEARS OF MARRIAGE. COUPLE FIRST PRESENTED FOR EVALUATION ON 13 /01/07. THERE IS HISTORY OF MALE FACTOR INFERTILITY. PRIOR HSG IN 2003 REVEALED RT TUBAL BLOCKADE. INITIAL TRANS-VAGINAL SONOGRAM REVEALED A 33MM CYST ON THE POSTERIOR LOWER UTERINE SEGMENT WHICH IS WITHIN THE MYOMETRIUM. HSG PERFORMED ON 16/03/07 REVEALED ILL DEFINED LESION AT THE LOWER UTERINE SEGMENT AND RT TUBAL OBSTRUCTION. SALINE INFUSION SONOGRAPHY REVEALED PERSISTENT MYOMETRIAL CYST WITH LACK OF ENDOMETRIAL EXPANSION. ASPIRATION OF THE CYST WAS SUCCESSFULLY PERFORMED UNDER SONOGRAPHIC GUIDANCE TRANSVAGINALLY WITH COOK 33CM 17 GUAGE COOKE OOCYTE RETRIEVAL NEEDLE. CLEAR FLUID WAS ASPIRATED AND SENT FOR CYTOLOGY. CYTOLOGICAL REPORT REVEALED NO CELLLS IN THE ASPIRATE. SHE WAS FOLLOWED WITH PERIODIC TRANS-VAGINAL SONOGRAM WHICH REVEALED RECURRENCE OF THE CYST. BLOOD WORK REVEALED HB OF 71%, GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE AND HIV NEGATIVE. THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

MYOMETRIAL CYST AND UTERINE FIBROIDS SPECIMEN AT SURGERY




-Date: 11/08/07

HSG SHOWING TUBAL BLOCKADE UTERUS AND FIBROID AT SURGERY




47 Y.OLD MARRIED FEMALE G4 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING SEVEN YEARS OF MARRIAGE. INVESTIGATIONS REVEALED MULTIPLE PEDUNCULATED UTERINE FIBROIDS AND SEVERE CERVICAL STENOSIS. HSG REVEALED BOTH TUBES TO BE BLOCKED AT THE CORNUAL ENDS. SALINE INFUSION SONOGRAPHY SHOWED LACK OF ENDOMETRIAL EXPANSION. HORMONAL PROFILE REVEALED ANOVULATORY PATTERN. BLOOD WORK REVEALED HB OF 63%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV NEGATIVE STATUS. LIVER AND KIDNEY FUNCTION STUDIES WERE NORMAL. CXR AND ECG WERE ALSO NORMAL. THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY





Date: 19/08/07

HSG UTERUS AND FIBROID AT SURGERY




36 Y.OLD MARRIED FEMALE G2 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING Six YEARS OF MARRIAGE. THERE IS HISTORY OF MALE FACTOR INFERTILITY. PATIENT’S INVESTIGATIONS BY SONOGRAM AND PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED OPACIFICATION OF BOTH TUBES WITH THE RT TUBE SHOWING ISTHMIC PATHOLOGY. SALINE INFUSION SONOGRAPHY SHOWED ENDOMETRIAL EXPANSION WITH NO INTRA-CAVITARY LESIONS. BLOOD WORK REVEALED HB OF 64%. GENOTYPE AS, BLOOD GROUP/RH O-POSITIVE AND HIV NEGATIVE STATUS. THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY



(39Yrs) #14605 date: 20/08/07

SURGERY SPECIMEN ON 29/08/2005

Civf

icsi

icsi

THE THREE (D-3) EMBRYOS TRANSFERRED ON 09/12/2006




39 YR. OLD FEMALE G3. P0 PRESENTED TO OUR FERTILITY CENTRE WITH HX OF INFERTILITY FOR 14 YEARS IN 2005. OUR INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERI WITH BILATERAL TUBAL BLOCKADE. LARGE LT ADNEXAL CYST WAS ALSO IDENTIFIED. PT HAD PRIOR HX OF MYOMECTOMIES X 2, CYSTECTOMY AND ADHESIOLYSIS, TUBOPLASTY AND POLYPECTOMY. PATIENT WAS COUNSELED AND SHE PRESENTED WITH REQUEST FOR MYOMECTOMY WITH CONSERVATION OF UTERUS.

ON 29/08/2005, THE PT UNDERWENT MYOMECTOMIES, DENSE ADHESIOLYSIS AND LT OVARIAN CYSTECTOMY. HER POST OP COURSE WAS UNEVENTFUL.

IN 2006, THE COUPLE REQUESTED FOR IVF-ET. THEY WERE COUNSELED ON THEIR PROGNOSIS AND POSSIBLE OPTIONS. THEY CONSENTED TO THE PROCEDURE. FOLLOWING OUR STIMULATION PROTOCOL, THREE DAY 3 EMBRYOS WERE TRANSFERRED UNDER ULTRASOUND GUIDANCE ON 09/12/2006. PATIENT WAS SUCCESSFUL WITH IMPLANTATION OF SINGLE SAC. SHE WAS STABILIZED FOR TWO WEEKS AND DISCHARGED FOR ANTENATAL MANAGEMENT AND DELIVERY AT PH. HER ANTENATAL COURSE WAS UNEVENTFUL. PT NOW AT TERM RETURNED HERE WITH REQUEST FOR HER DELIVERY. BLOOD WORK REVEALED HB OF 65%, HIV NEGATIVE, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE.

BABY BOY-DOB: AUGUST 20, 2007 WEIGHT 4.0 KG





Date: 22/08/07





APPENDIX AT SURGERY

The patient is a 44 year old black female G0 P0, been married since 1992 and has a history of infertility. She voluntarily postponed family building and pregnancy by using protection until 2002 when she started seeking consultation for inability to get pregnant. Her initial investigations included ultrasound that revealed multiple uterine fibroids, elevated FSH, and anemia from menometrorrhagia.

In 2003, the patient underwent exploratory laboratory with extraction of 12 fibroid masses.

Follow up ultrasound revealed recurrent uterine fibroids and saline infusion sonography identified endometrial distortion with a 2.5 cm sub mucous component.

The patient was advised, counseled and underwent a laparoscopy with dye instillation. Operative findings revealed- recurrent multiple uterine fibroids, dense pelvic adhesions, left tubal blockade and right tubal patency with dye spillage. Hysteroscopy was performed at same operation that showed a 4 CM sub mucous fundal fibroid and no other intra-cavitary lesion or abnormality.

She was medically managed with lupron injections for her fibroids and menometrorrhagia. This placed her in a medically induced amenorrhea state for about 6-8 months. Induction of menses was initiated.

Her FSH levels continue to be elevated. TSH and T4 are normal. THE PATIENT’S OTHER INVESTIGATIONS INCLUDED SONOGRAM AND PHYSICAL EXAMINATION THAT REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED INTRACAVITARY LESION, OPACIFICATION OF BOTH TUBES WITH THE RT TUBE SHOWING PERITONEAL SPILLAGE AND LT TUBE SHOWING DISTAL PATHOLOGY AND NO SPILLAGE. SALINE INFUSION SONOGRAPHY SHOWED ENDOMETRIAL EXPANSION WITH INTRA-CAVITARY SUB-MUCOUS FIBROID MASS. BLOOD WORK REVEALED HB OF 70%. GENOTYPE AS, BLOOD GROUP/RH B-POSITIVE AND HIV NEGATIVE STATUS. THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY


DR PROSPER IGBOELI MD; F.A.C.O.G (USA); F.W.A.C.S (WA) INFERTILITY SPECIALIST/CONSULTANT GYNECOLOGIST. CHIDINMA OGBONNA ABSUTH CLINICAL SCHOOL



(53YRS) #15849-Date:23/08/07

TVS WITH SUBMUCOUS FIBROID

UTERUS AT SURGERY SPECIMEN AT SURGERY


42 YEAR OLD MARRIED FEMALE G4. P4 PRESENTED FOR EVALUATION AND MANAGEMENT ON 21/08/07 WITH HX OF ABNORMAL UTERINE BLEEDING WITH SEVERE DYSMENORRHEA OF FIVE YEARS DURATION. SHE WAS DIAGNOSED WITH FIBROIDS SINCE 2001.PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED LEIOMYOMATA UTERINE WITH SOME SUBMUCOUS COMPONENT. PATIENT HAS SIGNIFICANT MEDICAL HX OF HYPERTENSION. BLOOD WORK-UP REVEALED NORMAL LIVER FUNCTIONS AND NORMAL KIDNEY FUNCTIONS. HB 52% INDICATIVE OF SIGNIFICANT ANEMIA, GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE, HIV –NEGATIVE. CXR, AND EKG WERE ABNORMAL WITH EVIDENED OF CARDIOMEGALY. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT COUNSELED THAT HYSTERECTOMY WITH PRESERVATION OF BOTH OVARIES WOULD BE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION.

(43Yrs) #15819-Date: 25/08/07

HSG SALINE INUSION SONOGRAPHY

UTERUS AND FIBROID AT SURGERY





43 YR.OLD MARRIED FEMALE G3 P3000, PRESENTED WITH DESIRE FOR PREGNANCY. PATIENT’S INVESTIGATIONS BY SONOGRAM AND PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED ENLARGED ENDOMETRIAL CAVITY WITH INTRA-CAVITARY LESIONS. THERE WAS NO OPACIFICATION OF BOTH TUBES INDICATING BILATERAL TUBAL BLOCKADE. . SALINE INFUSION SONOGRAPHY SHOWED ENDOMETRIAL EXPANSION WITH INTRA-CAVITARY LESIONS. BLOOD WORK REVEALED HB OF 67%. GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE AND HIV NEGATIVE STATUS. THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY





Date: 30/08/07

TVS

HSG

SALINE INFUSION SONOGRAPHY UTERUS AND FIBROID AT SURGERY




40 Y.OLD MARRIED FEMALE G6 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING SEVEN YEARS OF MARRIAGE. INVESTIGATIONS REVEALED LEIOMYOMATA UTERI. HSG REVEALED LARGE DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS FIBROID. THE RT TUBE APPEARED FAINTLY OPACIFIED WITH NO DEMONSTRABLE SPILLAGE AND THE LEFT TUBE SHOWED OPACIFICATION BUT NO OBVIOUS SPILLAGE INDICATIVE OF BLOCKADE. SIS REVEALED LARGE INTRACAVITARY MASS. PT HAS HX OF HYPERTENSION. BLOOD WORK REVEALED ANEMIA WITH HB OF 52%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV NEGATIVE. LIVER AND KIDNEY FUNCTIONS WERE WITHIN NORMAL LIMITS. ECG WAS BORDERLINE WITH NON SPECIFIC T-WAVE ABNORMALITY. AFTER OUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

UTERUS AND TUBES FIBROID SPECIMEN AT SURGERY




(33Yrs) #15851-Date: 05/09/07

UTERUS AND FIBROID AT SURGERY

HSG

FIBROID SPECIMEN AT SURGERY



(41Yrs) #15651-Date: 06/09/07

TVS

SIS



HSG

UTERUS AND FIBROID AT SURGERY



41Y.OLD MARRIED FEMALE G2 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING THREE YEARS OF MARRIAGE AND AMENORRHEA SINCE JULY 2006. HORMONAL ASSAY REVEALED ELEVATED FSH. THE PATIENT WAS PLACED ON ESTRADIOL AND PROVERA TO INDUCE MENSES. PAST HX IS SIGNIFICANT FOR RT SALPINGO-OOPHORECTOMY IN 1984 F0R ? RT TUBO-OVARIAN MASS AT OWERRI. INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERI WITH SUBMUCOUS LESION. HSG REVEALED ENLARGED DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS LESIONS AND BOTH TUBES WERE BLOCKED AT THE CORNUA. SIS REVEALED NARROW ENDOMETRIAL CAVITY THAT LACKED ANY DEGREE OF EXPANSION WITH INTRA-CAVITARY LESION. BLOOD WORK REVEALED ANEMIA WITH HB OF 67%. GENOTYPE AS, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. LIVER AND KIDNEY FUNCTIONS WERE NORMAL VALUES. AFTER OUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

REPAIRED UTERUS , LT TUBE & OVARY FIBROID SPECIMEN AT SURGERY



(33Yrs) #15811-Date: 08/09/07

HSG

UTERUS AND FIBROID AT SURGERY

FIBROID SPECIMEN AT SURGERY

(35Yrs) #15824-Date: 08/09/07

HSG

UTERUS, ADHESIONS AND FIBROIDS



35 Y.OLD MARRIED FEMALE G2 P0 PRESENTED FOR THE FIRST TIME ON 09/08/07 WITH HX OF INFERTILITY FOLLOWING NINE YEARS OF MARRIAGE. COMPLAINED OF CYCLE IRREGULARITIES AND PELVIC PRESSURE OF SEVERAL MONTHS DURATION. INVESTIGATIONS REVEALED LARGE SINGLE INTRA-CAVITARY LEIOMYOMATA UTERI. HSG REVEALED ENLARGED AND DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. SIS REVEALED HUGE SUBMUCOUS FIBROID OCCLUDING THE ENDOMETRIAL CAVITY. BLOOD WORK REVEALED ANEMIA WITH HB OF 56%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING TEST WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

FIBROID SPECIMEN AT SURGERY



(36Yrs) #15864-Date: 18/09/07

UTERUS AND FIBROID AT SURGERY




36 Y.OLD SINGLE FEMALE NULLIGRAVIDA PRESENTED WITH HX OF DISTENDING INTRA-ABDOMINAL MASS OF SEVERAL YEARS DURATION. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED VERY LARGE LEIOMYOMATA UTERI EXTENDING FROM PUBIC SYMPHYSIS TO THE XIPHOID STERNUM AND EXERTING PRESSURE ON THE LEFT ABDOMINAL WALL. RESPIRATORY DISTRESS, TACHYCARDIA AND EDEMA OF THE LOWER EXTREMITIES WERE EVIDENT ON PHYSICAL ASSESSMENT. HSG REVEALED LONG AND NARROW DISTORTED ENDOMETRIAL CAVITY. BOTH TUBES APPEARED BLOCKED AT THE CORNUA. SIS REVEALED NARROW ENDOMETRIAL CAVITY. BLOOD WORK REVEALED SIGNIFICANT ANEMIA WITH HB OF 57%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING TEST WAS NEGATIVE. LIVER AND KIDNEY FUNCTIONS WERE WITHIN NORMAL LIMITS. CXR WAS NORMAL. AFTER EXTENSIVE COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

FIBROID SPECIMEN AT SURGERY



(44 YRS) #15897--Date: 26/09/07



44 YEARS OLD MARRIED FEMALE G0. P0 PRESENTED ON 19/09/07 WITH HX OF INFERTILITY SINCE TWELVE YEARS OF MARRIAGE. SHE UNDERWENT MYOMECTOMY IN 1995 AT OSINA, IDEATO LGA, IMO STATE. SHE HAS EXPERIENCED AMENORRHEA SINCE JUNE 2007. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERI WHICH ARE RELATIVELY IMMOBILE. PRIOR HSG REVEALED ENLARGED ENDOMETRIAL CAVITY AND BILATERAL TUBAL BLOCKADE . SALINE INFUSION SONOGRAPHY SHOWED SUBMUCOUS LESION DISTORTING THE ENDOMETRIAL CAVITY SUSPICIOUS FOR FIBROID. LABORATORY INVESTIGATIONS SHOWED HB 67%, GENOTYPE AA, BLOOD GROUP/RH O-NEGATIVE, HIV SCREENING TEST WAS–NEGATIVE. EKG AND CXR WERE INTERPRETED AS WITHIN NORMAL LIMITS. LIVER AND KIDNEY FUNCTIONS WERE WITHIN NORMAL VALUES. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT FOLLOWING THE OPERATION.

SPECIMEN FROM SURGERY

: 23/10/07

33 YR. OLD FEMALE G4. P1 PRESENTED TO OUR FERTILITY CENTRE WITH HX OF TERM PREGNANCY WITH REQUEST FOR REPEAT CESAREAN SECTION. HER PREVIOUS HISTORY INCLUDED MYOMECTOMY X 2, BILATERAL TUBAL RECONSTRUCTION FOR BILATERAL TUBAL BLOCKADE AND HYDROSALGINGES. SHE UNDERWENT THESE PROCEDURES ON 05/09/05. HER FIRST PREGNANCY OCCURRED TWO MONTHS AFTER HER SURGERY AND SHE GAVE BIRTH TO A BABY GIRL BY CESAREAN SECTION ON 14/07/06. HER CURRENT ANTENATAL COURSE WAS UNEVENTFUL. PT NOW AT TERM RETURNED HERE WITH REQUEST FOR HER DELIVERY. BLOOD WORK REVEALED HB OF 47%, HIV NEGATIVE, GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE.

24 HRS AFTER BIRTH

BABY BOY -DOB: OCTOBER 23, 2007 WEIGHT 3.0 KG


23/10/07

36 YR. OLD FEMALE G7. P1 PRESENTED TO OUR FERTILITY CENTRE WITH HX OF TERM PREGNANCY . HER PAST HISTORY IS SIGNIFICANT FOR PREVIOUS CESAREAN SECTION, MULTIPLE MYOMECTOMIES, ADHESIOLYSIS, AND RT ECTOPIC PREGNANCY WITH RT SALPINGECTOMY. HER CURRENT ANTENATAL COURSE WAS UNEVENTFUL. PT NOW AT TERM RETURNED HERE WITH REQUEST FOR REPEAT CESAREAN SECTION. BLOOD WORK REVEALED HB OF 64%, HIV NEGATIVE, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE.

24 HRS AFTER BIRTH

BABY BOY-DOB: OCTOBER 23, 2007 WEIGHT 3.7 KG


#15626

SUBMUCOUS

40 Y.OLD MARRIED FEMALE G0 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING TEN YEARS OF MARRIAGE. SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 19-04-2007.

HER PREVIOUS INVESTIGATIONS INCLUDED HSG, SONOGRAPHY, LAPAROSCOPY AND A TREATMENT ATTEMPT OF INSEMINATION AT ABUJA WHICH FAILED. OUR INVESTIGATIONS REVEALED LEIOMYOMATA UTERI. HSG REVEALED DISTORTED ENDOMETRIAL CAVITY . BOTH TUBES APPEARED TORTIOUS WITH ? SPILLAGE AND PELVIC ADHESIONS. SALINE INFUSION SONOGRAPHY REVEALED NARROW ENDOMETRIAL CAVITY WITH HUGE FUNDAL FIBROID. BLOOD WORK REVEALED HB OF 68%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY



27/10/07

SALINE INFUSION SONOGRAPHY



44 YR.OLD MARRIED FEMALE G1 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING THREE YEARS OF MARRIAGE. SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 2-10-2007. HER PAST SURGICAL HX INCLUDED A RT PARA-MEDIAN EXPLORATORY LAPAROTOMY FOR UNDEFINED REASON. OUR INVESTIGATIONS REVEALED ENLARGED ABDOMEN WITH MULTIPLE UTERINE FIBROIDS. HSG REVEALED LARGE DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS FIBROID. THE TUBES DID NOT OPACIFY INDICATIVE OF BILATERAL OCCLUSION. SALINE INFUSION SONOGRAPHY REVEALED LARGE INTRACAVITARY MASS SUSPICIOUS FOR SUB-MUCOUS FIBROID. BLOOD WORK REVEALED SEVERE ANEMIA WITH HB OF 35%. GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY. HER FOLLOW-UP HB WAS 40%. SHE RECEIVED TWO UNITS OF BLOOD PRE-OPERATELY.

FIBROID SPECIMEN AT SURGERY



07/11/07

HSG- DISTORTED UTERUS



44 Y.OLD MARRIED FEMALE G6 P3031 PRESENTED FOR THE FIRST TIME ON 06/08/07 WITH DESIRE FOR MORE PREGNANCIES FOLLOWING FOURTEEN YEARS OF MARRIAGE. PT GAVE HX OF THREE TERM PREGNANCIES IN 1994, 1996 AND 2001 BUT ONLYONE CHILD IS ALIVE AND WELL.SUBSEQUENTLY, SHE HAD THREE MISCARRIAGES. PT COMPLAINED OF CYCLE IRREGULARITIES, WAIST PAIN, AND QUESTIONABLE UTERINE PROLAPSE. RELEVANT PSHX INCLUDED A DILATION AND CURRETAGE IN 1998 FOLLOWING HER FIRST MISCARRIAGE. PHYSICAL EXAM WAS SIGNIFICANT FOR BILATERAL GALACTORRHEA. TRANSVAGINAL SONOGRAM INVESTIGATIONS REVEALED ANTEVERTED UTERUS, WITH POSTERIOR FUNDAL FIBRIOD MEASURING 30.1MM, ANTERIOR FIBROID MEASURING 13.4MM. RT OVARY WAS VISUALIZED WITHOUT FOLLICLE; LT OVARY WAS VISUALIZED WITH SOME FOLLICLES. HSG REVEALED ENLARGED AND DISTORTED ENDOMETRIAL CAVITY WITH QUESTIONABLE BILATERAL TUBAL BLOCKADE. SIS REVEALED MODERATELY ENDOMETRIAL EXPANSION WITH NO OBSERVABLE LESION. HORMONAL ASSAY REVEALED INCREASED FSH AND LH. BLOOD WORK REVEALED HB OF 72%. GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE AND HIV SCREENING TEST WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY



(40Yrs) (#15772) Date: 07/11/07

BILATERAL CHOCOLATE CYSTS



40 YR.OLD MARRIED FEMALE NULLIGRAVIDA PRESENTED WITH HX OF INFERTILITY FOLLOWING EIGHT YEARS OF MARRIAGE. SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 14-07-2007, DESIRING CHILDREN. PT COMPLAINED OF HX OF INTERMITTENT AMENORROHEA AND IRREGULAR CYCLES. HER PAST MEDICAL HX INCLUDES TYPHOID FEVER SOME YEARS AGO. PAST SURGICAL HX INCLUDED A LT OVARIAN CYSTECTOMY FOR QUESTIONABLE ENDOMETRIOSIS IN 2003 AT A HOSPITAL IN LAGOS. PHYSICAL EXAM WAS SIGNIFICANT FOR BILATERAL GALACTORRHEA AND ILL DEFINED ABDOMINAL MASS. OUR INVESTIGATIONS REVEALED ENLARGED ABDOMEN WITH SMALL MULTIPLE UTERINE FIBROIDS. HSG OF 6/07 BROUGHT BY PT REVEALED RT TUBAL HYDROSALPINX. SALINE INFUSION SONOGRAPHY REVEALED SEVERE CERVICAL STENOSIS AND MODERATE ENDOMETRIAL CAVITY EXPANSION. BLOOD WORK REVEALED ANEMIA WITH HB OF 66%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY

(37Yrs) #14030-Date: 17/11/07

SALINE INFUSION SONOGRAPHY

LT OVARY ADHERENT TO UTERUS SUB-MUCOUS FIBROID AND ENDOMETRIUM


37 YR.OLD MARRIED FEMALE G1 P1 PRESENTED WITH HX OF RECURRENT UTERINE FIBROIDS AND MENOMETRORRHAGIA. SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 18-07-2004. HER PAST SURGICAL HX INCLUDED A MYOMECTOMY IN 2004. OUR INVESTIGATIONS REVEALED ABDOMEN WITH MULTIPLE UTERINE FIBROIDS. NO HSG WAS DONE. SALINE INFUSION SONOGRAPHY REVEALED INTRACAVITARY MASSES SUSPICIOUS FOR SUB-MUCOUS FIBROIDS. BLOOD WORK REVEALED ANEMIA WITH HB OF 55%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

FIBROID SPECIMEN AT SURGERY



20/11/07

UTERINE FIBROIDS AT SURGERY WITH DENSE ADHESIONS


35 YR.OLD MARRIED FEMALE G2 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING FOUR YEARS OF MARRIAGE. SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 16-10-2007. HER PAST SURGICAL HX INCLUDED A MYOMECTOMY IN 1999. OUR INVESTIGATIONS REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS EXTENDING BEYOND THE UMBILICUS. HSG REVEALED LARGE DISTORTED ENDOMETRIAL CAVITY. BOTH TUBES WERE SEEN BUT WIDELY SPREAD WITH NO PERITONEAL SPILLAGE. SALINE INFUSION SONOGRAPHY REVEALED LITTLE ENDOMETRIAL EXPANSION. BLOOD WORK REVEALED HB OF 70%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

FIBROID SPECIMEN AT SURGERY



37Yrs) #13540-Date: 21/11/07

SALINE INFUSION SONOGRAPHY UTERINE FIBROIDS AT SURGERY


37 YR.OLD MARRIED FEMALE G3 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING TWO YEARS OF MARRIAGE . SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 12-9-2003. HER PAST SURGICAL HX INCLUDED AN APPENDECTOMY IN 1989. OUR INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS . SALINE INFUSION SONOGRAPHY REVEALED LARGE AND DISTORTED ENDOMETRIUM WITH SUBMUCOUS FIBROID. BLOOD WORK REVEALED HB OF 69%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

FIBROID SPECIMEN AT SURGERY



4/12/07

UTERINE FIBROIDS AT SURGERY



33 YR.OLD MARRIED FEMALE G0 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING NINE YEARS OF MARRIAGE. SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 5-7-2007. OUR INVESTIGATIONS REVEALED ENLARGED UTERUS WITH MULTIPLE UTERINE FIBROIDS . HSG REVEALED LARGE DISTORTED ENDOMETRIAL CAVITY. BOTH TUBES APPEARED BLOCKED AT THE CORNUAL ENDS. SALINE INFUSION SONOGRAPHY REVEALED MULTIPLE SUBMUCOUS FIBROIDS WITHIN THE ENDOMETRIUM AND LITTLE ENDOMETRIAL EXPANSION. BLOOD WORK REVEALED ANAEMIA WITH HB OF 43%. GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

FIBROID SPECIMEN AT SURGERY


08/12/07

UTERUS WITH FIBROIDS



39 Y.OLD MARRIED FEMALE G1 SEVERAL P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING TEN YEARS OF MARRIAGE (1997). CURRENT INVESTIGATIONS REVEALED LEIOMYOMATA UTERI BY TVS AND BILATERAL TUBAL PATENCY FROM HSG. SIS REVEALED MINIMAL ENDOMETRIAL EXPANSION. BLOOD WORK REVEALED HB OF 70%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY


#15844 (39YRS)-Date: 11/12/07

UTERINE FIBROIDS

39 YR.OLD FEMALE G4. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 18/08/07 WITH HX OF PROGRESSIVE ABDOMINAL SWELLING. PATIENT GIVES A HISTORY OF MODERATE PELVIC PAIN AND MULTIPLE UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS UP TO THE XIPHOID. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. LABORATORY INVESTIGATIONS REVEALED HB 70%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


(39Yrs) #14820 date: 3/01/08

Civf

icsi

THE TWO (D-2) EMBRYOS TRANSFERRED ON 16/04/2007

39 YR. OLD FEMALE G3. P1 PRESENTED TO OUR FERTILITY CENTRE WITH HX OF INFERTILITY FOR 14 YEARS ON 27/1/2007. HER FIRST PREGNANCY WAS A LIVE BIRTH (FEMALE) IN 1992 BUT LATER DIED IN 1995. HER SECOND PREGNANCY ENDED AS INTRA UTERINE DEATH IN 1995. HER THIRD PREGNANCY WAS IN 1996 AND ENDED AS MISCARRIAGE AT THREE MONTHS. SHE HAD D&C FOLLOWING HER LAST TWO PREGNANCIES. SINCE THEN, THERE HAS BEEN NO PREGNANCY. OUR INVESTIGATIONS REVEALED POORLY DEVELOPED ENDOMETRIUM AND DECREASED OVARIAN RESERVE. HORMONAL ASSAY SHOWED NORMAL PROFILE.
THE COUPLE REQUESTED FOR IVF-ET. THEY WERE COUNSELED ON THEIR PROGNOSIS AND POSSIBLE OPTIONS. THEY CONSENTED TO THE PROCEDURE. FOLLOWING OUR STIMULATION PROTOCOL, TWO DAY 2 EMBRYOS WERE TRANSFERRED UNDER ULTRASOUND GUIDANCE ON 16/04/2007. PATIENT WAS SUCCESSFUL WITH IMPLANTATION OF SINGLE SAC. SHE WAS STABILIZED FOR TWO WEEKS AND DISCHARGED FOR ANTENATAL MANAGEMENT AND DELIVERY AT UMUAHIA. HER ANTENATAL COURSE WAS UNEVENTFUL. PT NOW AT TERM RETURNED HERE WITH REQUEST FOR HER DELIVERY. BLOOD WORK REVEALED HB OF 69%, HIV NEGATIVE, GENOTYPE AS, BLOOD GROUP/RH B-POSITIVE.


05/1/08

UTERUS WITH FIBROIDS



35 Y.OLD MARRIED FEMALE G1 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 2/08/07 WITH HX OF INFERTILITY FOLLOWING SEVEN YEARS OF MARRIAGE (2000). PT UNDERWENT A CYCLE OF IVF AT HOPE VALLEY CLINIC IN MAY/JUNE 2006 WHICH FAILED. HE HAS HX MALE OF OLIGOZOOSPERMIA. CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS BY TVS AND BILATERAL TUBAL PATENCY FROM HSG. SIS REVEALED MINIMAL ENDOMETRIAL EXPANSION. BLOOD WORK REVEALED HB OF 68%. GENOTYPE AS, BLOOD GROUP/RH B-POSITIVE AND HIV NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY


Date: 05/1/08

UTERUS WITH FIBROIDS



36 Y.OLD MARRIED FEMALE G2 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 26/12/07 WITH HX OF INFERTILITY FOLLOWING FIVE YEARS OF MARRIAGE . THERE IS HX OF SEVERE MALE FACTOR INFERTILITY. COUPLE ARE CONSIDERING IVF OPTION TO ACHIEVE CONCEPTION. CURRENT INVESTIGATIONS REVEALED UTERINE FIBROID BY TVS . SIS REVEALED HUGE FUNDAL FIBROID WITH NO ENDOMERTIAL LESION SEEN. BLOOD WORK REVEALED HB OF 75%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY



(40Yrs) #16068 date: 08/2/08

40 Y.OLD MARRIED FEMALE P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 17/01/08 WITH HX OF INFERTILITY FOLLOWING SIX YEARS OF MARRIAGE . CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS, NARROW ENDOMETRIUM AND LT OVARIAN CYST BY TVS . SIS REVEALED MULTIPLE FIBROIDS WITH MINIMAL ENDOMERTIAL EXPANSION. BLOOD WORK REVEALED HB OF 64%. GENOTYPE AS, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY



Date: 12/2/08

FIBROIDS AND ADHESIONS

38 Y.OLD MARRIED FEMALE G3 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 11/01/08 WITH HX OF INFERTILITY .PATIENT HAS BEEN LIVING WITH HER HUSBAND SINCE 2004 . CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS, AND RT OVARIAN CYST BY TVS . HSG REVEALED RT CORNUAL TUBAL BLOCKADE AND LT WAS FAINTLY OPACIFIED WITHOUT PERITONEAL SPILLAGE. SIS REVEALED MULTIPLE FIBROIDS WITH MODERATE ENDOMERTIAL EXPANSION. BLOOD WORK SHOWED HB OF 74%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY

DR PROSPER IGBOELI MD; F.A.C.O.G (USA); F.W.A.C.S (WA INFERTILITY SPECIALIST/CONSULTANT GYNECOLOGIST.
CHIDINMA OGBONNA ABSUTH CLINICAL SCHOOL I11



Date: 12/2/08

UTERINE FIBROIDS AT SURGERY



35 Y.OLD MARRIED FEMALE NULLIPARA WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 01/07/2004 WITH HX OF INFERTILITY FOR 10 YEARS . PT WAS LOST TO FOLLOW –UP AND REPRESENTED FOR RE-EVALUATION 0N 5/01 2008. CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS WITH FUNDAL DEPRESSION. HSG REVEALED SMALL ENDOMETRIAL CAVITY WITH LT TUBAL BLOCKADE WITH HYDROSLAPINX AND MINIMAL RT TUBAL SPILLAGE . SIS SHOWED MINIMAL ENDOMETRIAL EXPANSION WITH SUBMUCOUS LESION SEEN. BLOOD WORK SHOWED HB OF 64%. GENOTYPE AS, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY



32 Y.OLD MARRIED FEMALE NULLIGRAVIDA WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 01/02/08 WITH HX OF INFERTILITY FOLLOWING EIGHT YEARS OF MARRIAGE . SHE ATTEMPTED IVF PROCEDURE AT ABUJA IN 2004 WHICH FAILED. HAD TUBO-PLASTY IN 2000. CURRENT INVESTIGATIONS INCLUDED HSG WHICH REVEALED BILATERAL TUBAK BLOCKADE WITH HYDROSALPINGES. SIS REVEALED GOOD ENDOMETRIAL EXPANSION WITH SMALL FUNDAL POLYP. BLOOD WORK REVEALED HB OF 66%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY PROIR TO ANOTHER IVF PROCEDURE.

SPECIMEN AT SURGERY


13/2/08

UTERINE FIBROIDS AT SURGERY



39 Y.OLD MARRIED FEMALE G1 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 07/02/08 WITH HX OF INFERTILITY FOLLOWING FIFTEEN YEARS OF MARRIAGE . PT PRESENTED WITH HX OF BILATERAL TUBAL BLOCKADE AND UTERINE FIBROIDS. SHE HAD ATTEMPTED THREE CYCLES OF IVF –TWO ATTEMPTS IN LAGOS-NIGERIA AND ONE IN LONDON. ALL FAILED. SHE HAD A TUBAL PLASTY IN 1994. CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS AND PELVIC ADHESION. SIS REVEALED MULTIPLE FIBROIDS WITH MINIMAL ENDOMERTIAL EXPANSION. BLOOD WORK REVEALED HB OF 69%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND IVF.

SPECIMEN AT SURGERY


(33Yrs) #15959 date: 19/2/08

UTERINE FIBROIDS AT SURGERY



33 Y.OLD SINGLE FEMALE G1 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 30/10/2007 WITH HX OF ABDOMINAL SWELLING AND HUGE PELVIC MASS OF LONG STANDING DURATION. PHYSICAL EXAMINATION REVEALED ILL-LOOKING FEMALE WITH MASSIVE ASCITES AND RELATIVELY FIXED LOWER ABDOMINAL MASS THAT EXTEND TO THE SPLEENIC ANGLE. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS, ASCITES AND PELVIC ADHESION. HSG REVEALED MULTIPLE FIBROIDS WITH DISTORTED ENDOMERTIAL EXPANSION. ASCITIC FLUID WAS TAKEN AND SENT FOR CYTOLOGY. IT WAS REPORTED AS NEGATIVE FOR MALIGNANCY. BLOOD WORK REVEALED HB OF 64%. GENOTYPE AS, BLOOD GROUP/RH B-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNSELED THAT HYSTERECTOMY MAY BE AN OPTION IF THE TUMORS ARE NON RESECTABLE.

SPECIMEN AT SURGERY


(49YRS) #15845- Date: 04/03/08

UTERUS, OVARIES AND FALLOPIAN TUBES



49 YEAR OLD MARRIEED FEMALE G6. P4 WHO PRESENTED TO OUR FACILITY FIRST ON 20/08/07 WITH HX OF IRREGULAR BLEEDING AND UTERINE FIBROIDS. PHYSICAL EXAMINATION REVEALED PELVIC MASS EXTENDING UP TO THE UMBILICUS. INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE . PATIENT HAS SIGNIFICANT MEDICAL HX OF HYPERTENSION. BLOOD WORK-UP REVEALED NORMAL LIVER FUNCTIONS AND NORMAL KIDNEY FUNCTIONS. HB 67%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV SCREENING WAS NEGATIVE. CXR WAS WITHIN NORMAL LIMITS. ECG WAS ABNORMAL WITH LEFT ATRIAL ENLARGEMENT. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT COUNSELED THAT HYSTERECTOMY WITH POSSIBLE PRESERVATION OF OVARIAN FUNCTION WERE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION. SHE IS OF JEHOVAH WITNESS RELIGIOUS SECT REFUSED BLOOD TRANSFUSION. SHE AND HER SON SIGNED A STATEMENT EXONERATING THE HOSPITAL AND THE STAFF FROM ANY COMPLICATIONS ARISING FROM NON USE OF BLOOD IF THE NEED ARISES DURING HER MANAGEMENT.

FIBROIDS CAUSING BLEEDING

HYSTERECTOMY SPECIMEN FROM SURGERY

04/03/08

UTERUS AT SURGERY



36 YR.OLD MARRIED FEMALE G4 P0 PRESENTED FOR THE FIRST TIME TO OUR FERTILITY CLINIC ON 13/2/2008 WITH HX OF INFERTILITY FOLLOWING TWO YEARS OF MARRIAGE. HER PAST SURGICAL HX INCLUDED A MEDIAN INFRA-UMBILICAL EXPLORATORY LAPAROTOMY FOR AN UNCOMPLETED MYOMECTOMY PROCEDURE AT OWERRI IN OCTOBER 2005. OUR INVESTIGATIONS REVEALED ENLARGED ABDOMEN WITH MULTIPLE UTERINE FIBROIDS AND SEVERE PELVIC RESTRICTIONS DUE TO ADHESIONS. HSG REVEALED DISTORTED ENDOMETRIAL CAVITY. THE TUBES DID NOT OPACIFY INDICATIVE OF BILATERAL OCCLUSION. SALINE INFUSION SONOGRAPHY REVEALED RESTRICTED ENDOMETRIAL EXPANSION. BLOOD WORK REVEALED ANEMIA WITH HB OF 62%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

FIBROID SPECIMEN AT SURGERY

DR PROSPER IGBOELI MD; F.A.C.O.G (USA); F.W.A.C.S (WA)
INFERTILITY SPECIALIST/CONSULTANT GYNECOLOGIST.

Date: 08/03/08

UTERINE FIBROIDS AT SURGERY



35 Y.OLD MARRIED FEMALE NULLIPARA WHO PRESENTED TO OUR FERTILITY CENTRE WITH HX OF MENOMETRORRHAHIA FOR TWO YEARS. PT WAS INTRODUCED TO OUR CENTRE BY HER BROTHER AND SHE PRESENTED FOR THE FIRST TIME ON 23/02/08 FOR EVALUATION. CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS AND SEVERE ANEMIA. HSG REVEALED ELONGATED NARROW ENDOMETRIAL CAVITY WITH FUNDAL DISTORTION AND WITH BILATERAL TUBAL BLOCKADE AT THE CORNUAL ENDS . SIS SHOWED MINIMAL ENDOMETRIAL EXPANSION WITH SUBMUCOUS LESION SEEN.

SPECIMEN AT SURGERY


--Date:11/03/08

FIBROID UTERUS WITH ADHESIONS AND HYDROSALPINGES



47 YEAR OLD MARRIED FEMALE NULLIGRAVIDA PRESENTED FIRST TO OUR FERTILITY CENTRE ON 02/03/07 WITH HX OF MENORRHAGIA . INVESTIGATIONS WERE RECOMMENDD, BUT SHE WAS LOST TO FOLLOW-UP UNTIL SHE RETURNED ON 21/2/2008 WITH REQUEST TO RESUME HER EVALUATION. SHE GAVE A HISTORY OF INFERTILITY SINCE 26 YEARS OF MARRIAGE. SHE UNDERWENT MYOMECTOMY IN JAN. 1997 AT P.H. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING THE UMBILICUS AND RELATIVELY IMMOBILE SUGGESTIVE OF DENSE PELVIC ADHESIONS. HSG REVEALED ENLARGED ENDOMETRIAL CAVITY AND BILATERAL TUBAL PATHOLOGY. SALINE INFUSION SONOGRAPHY SHOWED SUBMUCOUS LESIONS SUSPICIOUS FOR FIBROIDS. LABORATORY INVESTIGATIONS SHOWED SEVERE ANEMIA WITH HB 35%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV SCREENING WAS –NEGATIVE. ECG AND CXR WERE INTERPRETED AS WITHIN NORMAL LIMITS. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT. SHE WAS THOROUGHLY COUNSELED THAT THE OPTIMAL MANAGEMENT OF HER CONDITION BASED ON HER AGE, SEVERE ANEMIA, RECURRENT MULTIPLE FIBROIDS AND DENSE PELVIC ADHESIONS WILL BE HYSTERECTOMY BUT SHE PREFERRED MYOMECTOMY. SHE RECEIVED TWO UNITS OF COMPATIBLE BLOOD PRIOR TO OPERATION.

SPECIMEN FROM SURGERY


Date: 13/03/08

UTERINE FIBROIDS AT SURGERY



33 Y.OLD MARRIED FEMALE G1 P0 WHO PRESENTED TO OUR FERTILITY CENTRE WITH HX OF INFERTILITY FOLLOWING FOURTEEN YEARS OF MARRIAGE. SHE FIRST FOR THE FIRST TIME ON 02/02/08 FOR EVALUATION. CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED ENLARGED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE AT THE FIMBRIAL ENDS . THE RIGHT TUBE HAS HYDROSALPINX. SIS SHOWED MINIMAL ENDOMETRIAL EXPANSION. BLOOD WORK SHOWED HB OF 65%. GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. SHE COMPLAINED OF PERITONEAL IRRITATION AND PAIN FOLLOWING HER HSG PROCEDURE.

SPECIMEN AT SURGERY


-Date:17/03/08

FIBROID UTERUS WITH ADHESIONS AND HYDROSALPINGES



40 YEAR OLD MARRIED FEMALE G2 P0 FIRST TO OUR FERTILITY CENTRE ON September 2006 BUT WAS LOST TO FOLLOW UP UNTIL 16/02/2008 WHEN SHE RETURNED TO THE HOSPITAL WITH REQUEST TO CONTINUE HER EVALUATION AND TREATMENT. SHE PRESENTED WITH HX OF INFERTILITY, SEVERE DYSMENORRHEA, RECURRENT UTERINE FIBROIDS, AND A DESIRE FOR CONCEPTION. SHE GAVE A HISTORY OF INFERTILITY SINCE 9 YEARS OF MARRIAGE. SHE UNDERWENT INCOMPLETE MYOMECTOMY IN 1997 AT LAGOS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING ABOVE THE UMBILICUS AND RELATIVELY IMMOBILE SUGGESTIVE OF DENSE PELVIC ADHESIONS. HSG REVEALED ENLARGED DISTORTED ENDOMETRIAL CAVITY AND BILATERAL TUBAL PATHOLOGY. SALINE INFUSION SONOGRAPHY SHOWED NARROW ENDOMETRIAL PATHWAY WITH HUGE FIBROID COMPRESSING THE ENDOMETRIAL CAVITY WITH SUBMUCOUS LESIONS SUSPICIOUS FOR FIBROIDS. LABORATORY INVESTIGATIONS SHOWED SEVERE ANEMIA WITH HB 30%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV SCREENING WAS –NEGATIVE. ECG AND CXR WERE INTERPRETED AS WITHIN NORMAL LIMITS. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT. SHE WAS THOROUGHLY COUNSELED THAT THE OPTIMAL MANAGEMENT OF HER CONDITION BASED ON HER AGE, SEVERE ANEMIA, RECURRENT MULTIPLE FIBROIDS AND DENSE PELVIC ADHESIONS WILL BE HYSTERECTOMY BUT SHE PREFERRED MYOMECTOMY. SHE RECEIVED TWO UNITS OF COMPATIBLE BLOOD PRIOR TO OPERATION.

SPECIMEN FROM SURGERY


Date: 18/03/08

UTERINE FIBROIDS AT SURGERY



39 Y.OLD MARRIED FEMALE G4 P2 ONE ALIVE WHO PRESENTED TO OUR FERTILITY CENTRE WITH HX OF INFERTILITY FOLLOWING TWO MONTHS OF MARRIAGE. SHE PRESENTED FOR THE FIRST TIME ON 22/02/08 FOR EVALUATION. CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED ENLARGED ENDOMETRIAL CAVITY DUE TO MYOMA AND WITH LT TUBE SHOWING POOR PERITONEAL SPILLAGE . THE RIGHT TUBE WAS NOT SEEN. SIS SHOWED ENLARGED ENDOMETRIAL CAVITY WITH LARGE MYOMA OVERLYING THE CAVITY. BLOOD WORK SHOWED HB OF 62%. GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY


Date: 19/03/08

UTERINE FIBROIDS AT SURGERY



38 Y.OLD MARRIED FEMALE G7 P1 (MALE) ALIVE WHO PRESENTED TO OUR FERTILITY CENTRE WITH HX OF INFERTILITY FOLLOWING HER LAST MISCARRIAGE IN 2004. SHE PRESENTED FOR THE FIRST TIME ON 19/01/08 FOR EVALUATION. SHE HAS BEEN MARRIED FOR TEN YEARS. SHE DELIVERED A BABY BOY IN 2001 AND HAD TWO MISCARRIAGES FOLLOWING HER DELIVERY. CURRENT INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED SMALL ENDOMETRIAL CAVITY DUE TO MYOMA AND WITH BILATERAL TUBAL PATENCY WITH PERITONEAL SPILLAGE . SALINE INFUSION SONOGRAPHY SHOWED NARROW ENDOMETRIAL CAVITY WITH LARGE MYOMA OVERLYING THE CAVITY. BLOOD WORK SHOWED HB OF 69%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY


--Date: 27/03/08

FIBROID UTERUS AND CYST OF THE CLITORIS


36 YEAR OLD MARRIED FEMALE G4 P0 PRESENTED FIRST TO OUR FERTILITY CENTRE ON 05/12/08 WITH HX OF INFERTILITY SINCE 9 YEARS OF MARRIAGE. SHE HAD USED LOCAL HERBAL VAGINAL INSERTIONS IN ATTEMPTS TO DISSOLVE THE FIBROIDS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE REACHING THE UMBILICUS AND RELATIVELY IMMOBILE SUGGESTIVE OF DENSE PELVIC ADHESIONS. THE VAGINA AND CERVIX WERE COMPLETELY SCLEROSED . BOTH HSG AND SIS PROCEDURES WERE UNSUCCESSFUL. THE CERVIX WAS STENOSED. LABORATORY INVESTIGATIONS SHOWED ANEMIA WITH HB 55%, GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE, HIV SCREENING WAS –NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT. SHE WAS THOROUGHLY COUNSELED THAT THE OPTIMAL MANAGEMENT OF HER CONDITION BASED ON HER CLINICAL FINDINGS AND DENSE PELVIC ADHESIONS WILL BE HYSTERECTOMY BUT SHE PREFERRED MYOMECTOMY.

SPECIMEN FROM SURGERY


-Date: 03/04/08

UTERUS, OVARIES AND FALLOPIAN TUBES

44 YEAR OLD FEMALE G4. P2 PRESENTED ON 08/03/08 WITH HX OF IRREGULAR BLEEDING AND INFERTILITY. SHE HAD AN IVF AT ABUJA IN 2003 WHICH FAILED. AT THAT TIME SHE WAS DIAGNOSED WITH UTERINE FIBROIDS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE WITH SOME SUBMUCOUS TYPES EXTENDING ABOVE THE UMBILICUS. PATIENT HAS SIGNIFICANT MEDICAL HX OF GASTRIC ULCER MANAGED WITH ANTACIDS. BLOOD WORK-UP REVEALED HB 40%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV –SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT COUNSELED THAT HYSTERECTOMY WITH BSO WERE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION.

SPECIMEN FROM SURGERY


Date: 12/04/08

UTERINE FIBROIDS



48 YR.OLD FEMALE G?1. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 1/09/07 WITH HX OF NO CONCEPTION SINCE 14 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF AMENORRHEA SINCE MARCH 2006. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS, DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. LABORATORY INVESTIGATIONS REVEALED HB 67%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 12/04/08

UTERINE FIBROIDS



39 YR.OLD FEMALE G3. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 12/06/07 WITH HX OF PROGRESSIVE ABDOMINAL SWELLING. PATIENT GIVES A HISTORY OF MODERATE PELVIC PAIN AND MULTIPLE UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS TO ABOVE THE UMBILICUS. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. LABORATORY INVESTIGATIONS REVEALED HB 75%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY

DR PROSPER IGBOELI MD; F.A.C.O.G (USA); F.W.A.C.S (WA)
INFERTILITY SPECIALIST/CONSULTANT GYNECOLOGIST.


30Yrs) #16157 date: 15/04/08

UTERINE FIBROIDS AT SURGERY



30 Y.OLD MARRIED FEMALE G1 P1 A0 WHO PRESENTED TO OUR FERTILITY CENTRE WITH HX OF INFERTILITY FOLLOWING FIVE YEARS OF MARRIAGE. SHE PRESENTED FOR THE FIRST TIME ON 05/03/08 FOR EVALUATION. CURRENT INVESTIGATIONS REVEALED POSTERIOR-FUNDAL UTERINE FIBROID. HSG REVEALED DEPRESSED FUNDAL UTERINE CAVITY AND BOTH TUBES BLOCKED AT THE CORNUAL SEGMENTS. SIS SHOWED SUBMUCOUS LESION,FUNDO-POSTERIOR FIBROID INDENTING AND DISTORTING THE ENDOMETRIAL CAVITY. BLOOD WORK SHOWED HB OF 62%. GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN AT SURGERY


Date: 22/04/08

UTERINE FIBROIDS



39 YR.OLD FEMALE G2. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 31/03/08 WITH HX OF NO CONCEPTION SINCE NINE YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF MENOMETRORRHAGIA . INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS, DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. SIS SHOWED INTRACAVITARY ADHESIONS. LABORATORY INVESTIGATIONS REVEALED HB 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 30/04/08

UTERINE FIBROIDS, RT OVARY AND RT TUBE



35 YR.OLD FEMALE nulligravida WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 4/03/08 WITH HX OF NO CONCEPTION SINCE 11 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF MENSTRUAL CYCLES OF 24-28 DAYS. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS, NARROW ENDOMETRIAL CAVITY WITH BILATERAL TUBAL PATENCY AND RIGHT OVARIAN COMPLEX CYST. LABORATORY INVESTIGATIONS REVEALED HB 64%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 02/05/08

UTERINE FIBROIDS, RT OVARY AND RT TUBE

27 YR.OLD SINGLE FEMALE WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 21/01/08 WITH HX OF UTERINE FIBROIDS AND DESIRING MYOMECTOMY. PATIENT GIVES A HISTORY OF HEAVINESS OF THE LOWER ABDOMEN. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS EXTENDING BEYOND THE UMBILICUS, NARROW ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. SIS REVEALED LACK OF ENDOMETRIAL EXPANSION DUE TO THE LARGE FIBROIDS. LABORATORY INVESTIGATIONS REVEALED HB 62%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 05/05/08

UTERINE FIBROIDS



35 YR. OLD MARRIED FEMALE G1 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 16/01/08 WITH HX OF INFERTILITY FOLLOWING 10 YRS OF MARRIAGE . THIS MARRIAGE TERMINATED TWO YEARS AGO. PATIENT DESIRED A THOROUGH CHECK-UP. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS.HSG REVEALED BILATERAL TUBAL BLOCKADE. SIS REVEALED ENDOMETRIAL CAVITY WITH SUBMUCOUS FIBROIDS. LABORATORY INVESTIGATIONS REVEALED HB 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 05/05/08

UTERINE FIBROIDS



37 YR. OLD MARRIED FEMALE G3 P3 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 03/05/08 WITH HX OF SUDDEN ONSET OF SEVERE PELVIC PAIN OF TWO WEEKS DURATION. SHE GAVE A HX OF INABILITY TO URINATE AND REQUIRING A N INDWELLING CATHETER. PATIENT DESIRED A THOROUGH CHECK-UP. PAST HX IS SIGNIFICANT FOR APPENDECTOMY IN 1987 AND MYOMECTOMY IN 2002. INVESTIGATIONS REVEALED A LARGE PELVIC MASS LOCATED IN THE POSTERIOR CUL-DE SAC. AN ATTEMPT AT A TRANS-VAGINAL ASPIRATION OF THIS MASS FAILED. LABORATORY INVESTIGATIONS REVEALED HB 65%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and B+ BLOOD GROUP AND RHESUS FACTOR. FOLLOWING COUNSELLING THE PATIENT CONSENTED FOR EXPLORATORY LAPORATOMY.

SPECIMEN FROM SURGERY


Date: 10/05/08

UTERINE FIBROIDS

35 YR. OLD MARRIED FEMALE G4 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 29/04/08 WITH HX OF INFERTILITY FOLLOWING 10 YRS OF MARRIAGE . PATIENT DESIRED INVESTIGATION AND TREATMENT FOR PREGNANCY. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS.HSG REVEALED BILATERAL TUBAL PATENCY. SIS REVEALED LACK OF ENDOMETRIAL EXPANSION DUE TO COMPRESSION OF A LARGE ANTERIOR FIBROID. LABORATORY INVESTIGATIONS REVEALED HB 66%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 14/05/08

UTERUS, OVARIES AND FALLOPIAN TUBES

36 YEAR OLD MARRIEED FEMALE G5. P2 WHO PRESENTED TO OUR FACILITY FIRST ON 12/05/08 WITH HX OF IRREGULAR HEAVY UTERINE BLEEDING AND UTERINE FIBROIDS. PHYSICAL EXAMINATION REVEALED PELVIC MASS EXTENDING UP TO THE UMBILICUS. INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE . PATIENT HAS TWO CHILDREN (MALES) WHO ARE ALIVE AND WELL. BLOOD WORK-UP REVEALED SEVERE ANEMIA WITH HB 49%, GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE, HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT WAS COUNSELED THAT HYSTERECTOMY WITH POSSIBLE PRESERVATION OF OVARIAN FUNCTION WERE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION.

FIBROIDS CAUSING BLEEDING

HYSTERECTOMY SPECIMEN FROM SURGERY

-Date: 14/05/08

UTERINE FIBROIDS



37 YR. OLD MARRIED FEMALE G1 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 18/04/08 WITH HX OF INFERTILITY FOLLOWING 10 YRS OF MARRIAGE . PATIENT DESIRED INVESTIGATION AND TREATMENT FOR PREGNANCY. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED BILATERAL TUBAL BLOCKADE. SIS REVEALED LACK OF ENDOMETRIAL EXPANSION DUE TO COMPRESSION BY THE FIBROIDS. LABORATORY INVESTIGATIONS REVEALED HB 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


-Date: 22/05/08

UTERUS, OVARIES AND FALLOPIAN TUBES

     42 YEAR OLD MARRIEED FEMALE G12. P2 WHO PRESENTED TO OUR FACILITY FOR THE FIRST TIME ON 18/05/08 WITH HX OF IRREGULAR HEAVY UTERINE BLEEDING AND UTERINE FIBROIDS. PHYSICAL EXAMINATION REVEALED PELVIC MASS . INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE . PATIENT HAS TWO CHILDREN (MALES) WHO ARE ALIVE AND WELL. BLOOD WORK-UP REVEALED SEVERE ANEMIA WITH HB 58%, GENOTYPE AA, BLOOD GROUP/RH B-NEGATIVE, HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT WAS COUNSELED THAT HYSTERECTOMY WITH POSSIBLE PRESERVATION OF OVARIAN FUNCTION WERE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION

FIBROIDS CAUSING BLEEDING

HYSTERECTOMY SPECIMEN FROM SURGERY

-Date: 24/05/08

40 YR. OLD FEMALE G2. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 04/11/06 WITH HX OF NO CONCEPTION SINCE 11 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF MENOMETRORRHAGIA AND IRREGULAR CYCLES. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS, DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS FIBROIDS. HSG REVEALED BOTH TUBAL OPACIFICATION AND RESTRICTED DYE SPILLAGE SUGGESTIVE OF PELVIC ADHESIONS. SURGERY WAS RECOMMENDED BUT THE PATIENT POSTPONED IT UNTIL SHE REPRESENTED ON 01/05/2008 TO RESUME MANAGEMENT. LABORATORY INVESTIGATIONS REVEALED ANEMIA WITH HB 56%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 30/05/2008

33 YR. OLD MARRIED FEMALE G8. P1 PRESENTED TO OUR FERTILITY CENTRE WITH HX OF TERM PREGNANCY WITH REQUEST FOR CESAREAN SECTION TRANSVERSE LIE. HER PREVIOUS HISTORY INCLUDED MISCARRIAGES X 2, RT ECTOPIC WITH SALPINGECTOMY IN 2004 AND APPENDECTOMY IN 2002. HER FIRST TERM PREGNANCY OCCURRED TWO MONTHS AFTER HER INFERTILITY EVALUATTION AND TREATMENT HERE AT OUR FERTILITY CENTRE. SHE GAVE BIRTH TO A BABY BOY (3.4 KG) BY CESAREAN SECTION FOR FETAL DISTRESS AT FMC YENOGOA IN 2006. HER CURRENT PREGNANCY AND ANTENATAL COURSE WAS NOT MANAGED BY US BUT WAS UNEVENTFUL. PT NOW AT TERM RETURNED HERE WITH REQUEST FOR REPEAT CESAREAN DELIVERY. BLOOD WORK REVEALED HB OF 60%, HIV SCREENING WAS NEGATIVE, GENOTYPE AA, BLOOD GROUP/RH AB-NEGATIVE. SHE REQUIRES RHO-GAM (HUMAN IMMUNOGLOBULIN) WITH ANY PREGNANCY WHERE THE BABY IS RH-POSITIVE OR ANY MISCARRIAGE.

BABY AT BIRTH

FIBROID

BABY GIRL-DOB: 30-05-2008 WEIGHT 3.5 KG

#16250 (41YRS)-Date: 02/06/08

UTERINE FIBROIDS



41 YR. OLD MARRIED FEMALE G1 PI WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 01/05/08 WITH HX OF INFERTILITY FOLLOWING THE DELIVERY OF HER ONLY CHILD (MALE) IN 1997. SHE HAD A SPONTANEOUS VAGINAL DELIVERY WITHOUT COMPLICATIONS. SHE COMPLAINEDOF SEVERE DYSMENORRHEA SINCE 2004 TILL DATE. SHE EXPERIENCED MENARCHE AT 15 YRS, CYCLES 30-31DAYS WITH 4-5 DAYS OF MENSTRUAL FLOW. PATIENT WENT TO SOUTH AFRICA WHERE SHE WAS INVESTIGATED AND FOUND TO HAVE BILATERAL TUBAL BLOCKADE. SHE WAS OFFERED IVF AND STARTED A STIMULATION CYCLE BUT NEVER COMPLETED THE TREATMENT. SHE PRESENTED HERE WITH A REQUEST TO UNDERGO A THOROUGH CHECK-UP PRIOR TO IVF TRIAL. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. HSG WAS NEVER PERFORMED TO CONFIRM BILATERAL TUBAL BLOCKADE. SIS REVEALED ENDOMETRIAL CAVITY WITHOUT INTRA-CAVITARY LESIONS BUT NARROWED BY THE FIBROIDS. LABORATORY INVESTIGATIONS REVEALED HB 68%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. THE PATIENT AND HER HUSBAND WERE COUNSELED ON THEIR OPTIONS FOR TREATMENT INCLUDING TRIAL OF IVF WITH THE FIBROIDS IN SITU OR REMOVING THEM PRIOR TO IVF. THEY OPTED FOR THE FIBROID REMOVAL AND THEN IVF PROCEDURE. THE PATIENT NOW PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY


-Date: 24/06/08

UTERINE FIBROIDS



37 Y.OLD MARRIED FEMALE G4. P0 PRESENTED WITH HX OF INFERTILITY FOR NINE YEARS OF MARRIAGE AND UTERINE FIBROIDS. PT HAD PAST HX OF VAGINAL APPLICATION OF HERBAL MATERIAL. INVESTIGATIONS REVEALED ENDOMETRIUM THAT APPEARED HAZY WITH DISTORTED ENDOMETRIAL CAVITY DUE TO ATTACHED ANTERIOR FUNDAL FIBROID. HSG SHOWED NARROW CAVITY WITH BILATERAL TUBAL PATENCY AND SIS REVEALED HIGHLY RESTRIVE AND NON DISTENSIBLE ENDOMETRIAL CAVITY. LABORATORY INVESTIGATIONS REVEALED HB 56 %. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR A-POSITIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. TWO UNITS OF BLOOD WAS PROVIDED BY THE PATIENT FOR SURGERY IF NEEDED.

SPECIMEN FROM SURGERY


-Date: 21/07/08

45YR OLD MARRIED FEMALE G4. P0 PRESENTED WITH HX OF INFERTILITY FOR TWENTY-TWO YEARS OF MARRIAGE . SHE HAD EXPLORATORY LAPORATOMY IN 1994. SHE HAD UNDERGONE IVF PROCEDURES FOUR TIMES WITHOUT SUCCESS. INVESTIGATIONS REVEALED UTERINE FIBROIDS. SIS REVEALED DIFFICULT EXPANSION OF THE ENDOMETRIAL CAVITY WITH SUBMUCOUS LESION. LABORATORY INVESTIGATIONS REVEALED HB 64 %. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR A-POSITIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. TWO UNITS OF BLOOD WAS PROVIDED BY THE PATIENT FOR SURGERY IF NEEDED.

SPECIMEN FROM SURGERY


Date: 1/08/08

47YR OLD MARRIED FEMALE WHO IS A NULLIGRAVIDA PRESENTED WITH HX OF INFERTILITY FOR TWENTY-TWO YEARS OF MARRIAGE . SHE HAD MYOMECTOMY AND LT LUMPECTOMY IN 1994. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. HSG SHOWED REASONABLE ENDOMETRIAL CAVITY WITH RT TUBE SEEN WITH DISTAL OBSTRUCTION. LT TUBE WAS NOT SEEN. SIS REVEALED RESTRICTED ENDOMETRIAL EXPANSION. THERE WAS NO SUBMUCOUS LESION SEEN. LABORATORY INVESTIGATIONS REVEALED HB 60%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR A-POSITIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. TWO UNITS OF BLOOD WAS PROVIDED BY THE PATIENT FOR SURGERY IF NEEDED.

SPECIMEN FROM SURGERY


Date: 14/08/08

   YR. OLD FEMALE G3. P1 PRESENTED TO OUR FERTILITY CENTRE WITH HX OF LIVE BIRTH (FEMALE) IN 1992 BUT LATER DIED IN 1995. HER SECOND PREGNANCY ENDED AS INTRA UTERINE DEATH IN 1995. HER THIRD PREGNANCY WAS IN 1996 AND ENDED AS MISCARRIAGE AT THREE MONTHS. SHE HAD D&C FOLLOWING HER LAST TWO PREGNANCIES. SINCE THEN, THERE HAS BEEN NO PREGNANCY. OUR INVESTIGATIONS REVEALED POORLY DEVELOPED ENDOMETRIUM AND DECREASED OVARIAN RESERVE. HORMONAL ASSAY SHOWED NORMAL PROFILE.r


Date: 16/08/08

  30YR OLD MARRIED FEMALE G2 P0 PRESENTED WITH HX OF INFERTILITY FOR FOUR YEARS OF MARRIAGE . INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. HSG SHOWED BILATERAL TUBAL BLOCKADE. SIS REVEALED GOOD ENDOMETRIAL EXPANSION WITH A CERVICAL LESION. THERE WAS NO SUBMUCOUS LESION SEEN. LABORATORY INVESTIGATIONS REVEALED HB 60%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR O-POSITIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. TWO UNITS OF BLOOD WAS PROVIDED BY THE PATIENT FOR SURGERY IF NEEDED.

SPECIMEN FROM SURGERY



-Date: 31/8/08

UTERINE FIBROIDS

33 YR.OLD FEMALE G1. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 25/08/08 WITH HX OF PROGRESSIVE ABDOMINAL SWELLING AND INFERTILITY FOLLOWING 6 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF SEVERE MENOMETRARRHAGIA, PELVIC PAIN AND MULTIPLE UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS UP TO ABOVE THE UMBILICUS. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH LARGE SUBMUCOUS LESION. LABORATORY INVESTIGATIONS REVEALED SEVERE ANEMIA WITH HB 20%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR STABILIZATION AND SURGERY. THE PATIENT WAS ADMITTED AND RECEIVED 4 UNITS OF BLOOD PRE-OP.

SPECIMEN FROM SURGERY



20/09/08

ADHESIONS AND UTERINE FIBROIDS



35 YR.OLD MARRIED FEMALE G1. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 13/06/05 WITH HX OF INFERTLITY FOLLOWING 3 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF REGULAR MENSTRUAL CYCLES, WITH 4 TO 5 DAYS OF FLOW AND RECURRENCE OF MULTIPLE UTERINE FIBROIDS. SHE UNDERWENT MYOMECTOMY IN 2002 AT NNEWI TEACHING HOSPITAL. INVESTIGATIONS REVEALED SEVERE MALE FACTOR . HSG SHOWED BILATERAL TUBAL PATENCY. TVS SHOWED SMALL MULTIPLE UTERINE FIBROIDS. SEVERAL ATTEMPTS AT TDI FAILED. COUPLE OPTED FOR A TRIAL OF IVF THROUGH WHICH PREGNANCY OCCURRED BUT SHE MISCARRIED. COUPLE NOW RETURNED WITH REQUEST FOR REPEAT MYOMECTOMY. LABORATORY INVESTIGATIONS REVEALED HB 67%, HIV NEGATIVE. SHE IS GENOTYPICALLY AS and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY



--Date: 29/09/08 

    56 YEAR OLD FEMALE G3. P0 WHO PRESENTED ON 26/08/08 WITH HX OF MENOMETRORRHAGIA , RECURRENT UTERINE FIBROIDS AND LARGE INCISIONAL HERNIA. SHE UNDERWENT MYOMECTOMY PROCEDURE AT PORT HARCOURT IN 1990. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING PAST THE UMBILICUS AND RELATIVELY IMMOBILE WITH DENSE PELVIC ADHESIONS. LABORATORY INVESTIGATIONS SHOWED HB 70%, GENOTYPE AS, BLOOD GROUP/RH O-POSITIVE, HIV –SCREENING WAS NEGATIVE. FASTING BLOOD SUGAR WAS 201MG/DL PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT. CXR SHOWED CARDIOMEGALY WITH NO FOCAL LUNG LESIONS. ECG SHOWED LT VENTRICULAR HYPERTROPHY.KIDNEY FUNCTIONS WERE NORMAL VALUES EXCEPT FOR POTASSSIUM OF 3.3MMOL/L. LIVER FUNCTIONS SHOWED NORMAL PARAMETERS. PT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNSELED THAT HYSTERECTOMY WITH BILATERAL SALPINGO-OPHORECTOMY WILL BE PROCEDURE OF CHOICE .

SPECIMEN FROM SURGERY



-Date: 07/10/08

UTERUS (PRE-SURGERY) AND FIBROIDS
UTERUS (POST-SURGERY),TUBES AND OVARIES



35 Y.OLD MARRIED FEMALE G3. P0 WHO FIRST PRESENTED TO OUR FERTILITY CLINIC ON 05/04/07 WITH HX OF INFERTILITY FOLLOWING 7 YEARS OF MARRIAGE. INVESTIGATIONS OF THE COUPLE REVEALED MULTIPLE UTERINE FIBROIDS EXTENDING ABOVE THE UMBILICUS. THE CERVIX WAS ENGULFED BY FIBROID MASSES AND WAS INACCESSIBLE FOR HSG AND SALINE INFUSION SONOGRAPHY. LABORATORY INVESTIGATIONS REVEALED SEVERE ANEMIA WITH HB 25%. GENOTYPE AA, BLOOD GROUP/ RH A+ , HIV NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS STABILIZED WITH HEMATINICS, NUTRITIONAL DIETS AND RECEIVED TWO UNITS OF COMPATIBLE BLOOD PRIOR TO MYOMECTOMY SURGERY. 42 FIBROIDS OF VARIOUS SIZES WERE EXTRACTED. FOLLOWING SURGERY, SHE RESUMED NORMAL MENSTRUAL PERIODS AND GOT PREGNANT WITH EDD OF OCTOBER 2008. SHE NOW PRESENTED WITH REQUEST FOR CESAREAN DELIVERY AT TERM.

FIBROIDS REMOVED IN 2007

BABY BOY BIRTH WT 2.9KG DOB 07/10/08



-Date: 07/10/08



40 YR.OLD FEMALE G0. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 10/09/08 WITH HX OF PROGRESSIVE ABDOMINAL SWELLING AND INFERTILITY FOLLOWING 13 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF SEVERE MENOMETRARRHAGIA, PELVIC PAIN AND MULTIPLE UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS UP TO THE UMBILICUS. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH LARGE SUBMUCOUS LESION. LABORATORY INVESTIGATIONS REVEALED SEVERE ANEMIA WITH HB 38%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

UTERINE FIBROIDS AT SURGERY



40 YR.OLD FEMALE G2. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 04/10/08 WITH HX OF INFERTILITY FOLLOWING 3 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF MULTIPLE UTERINE FIBROIDS AND HERBAL USE. SHE EXPERIENCES IRREGULAR CYCLES NOW WITH MENSTRUAL CYCLES OF 30 TO 90 DAYS. SHE UNDERWENT LAPAROSCOPY AT NNEWI UNIVERSITY TEACHING HOSPITAL IN 2007. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS REVEALED NARROW AND DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS LESIONS ON SIS AND BILATERAL TUBAL BLOCKADE ON HSG. LABORATORY INVESTIGATIONS REVEALED HB 64%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 18/10/08

UTERINE FIBROIDS AT SURGERY



45 YR.OLD FEMALE G2. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 284/04/08 WITH HX OF INFERTILITY FOLLOWING 15 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF MULTIPLE UTERINE FIBROIDS. SHE HAD PAST HX OF BILATERAL BREAST LUMPECTOMIES (1986 AND 1988), AND APPENDECTOMY IN 1997. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED OBESE FEMALE WITH MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS REVEALED NARROW AND DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS LESION ON SIS AND BILATERAL TUBAL BLOCKADE ON HSG. LABORATORY INVESTIGATIONS REVEALED HB 65%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OPERATIVELY AND ASSESSED BY THE ANESTHETIST.

SPECIMEN FROM SURGERY



-Date: 26/10/08

UTERINE FIBROIDS AT SURGERY



37 YR.OLD FEMALE G2. P1 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 30/06/08 WITH HX OF INFERTILITY FOLLOWING HER ONLY DELIVERY OF A FEMALE BABY IN 1993. PATIENT GIVES A HISTORY OF MULTIPLE UTERINE FIBROIDS AND HERBAL USE. SHE HAS MENSTRUAL CYCLES OF 30-31 DAYS AND HEAVY FLOW. SHE UNDERWENT LAPAROSCOPY AT OGIDI. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS REVEALED NARROW AND DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE ON HSG. LABORATORY INVESTIGATIONS REVEALED HB 62%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY

UTERINE FIBROIDS AT SURGERY



26 YR.OLD SINGLE FEMALE NULLIGRAVIDA WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 24/10/08 WITH HX OF MULTIPLE UTERINE FIBROIDS. SHE HAS MENSTRUAL CYCLES OF 27-28 DAYS AND HEAVY FLOW. SHE UNDERWENT APPENDECTOMY AT MERCY HOSPITAL, ABAKILIKI AT AGE 15. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED UTERINE FIBROIDS EXTENDING TO THE UMBILICUS. INVESTIGATIONS REVEALED ENLARGED ENDOMETRIAL CAVITY WITH UNIILATERAL LT TUBAL PATENCY ON HSG. LABORATORY INVESTIGATIONS REVEALED HB 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and B+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



: 21/11/08



38 YR.OLD MARRIED FEMALE G0. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 7/10/08 WITH HX OF INFERTLITY FOLLOWING 11 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF MENSTRUAL CYCLES OF 26-28, WITH 5 TO 7 DAYS OF FLOW AND RECURRENCE OF MULTIPLE UTERINE FIBROIDS. SHE HAD USED LOCAL HERBS. SHE UNDERWENT MYOMECTOMY IN 2000 AT A HOSPITAL IN DELTA STATE. INVESTIGATIONS REVEALED MALE FACTOR WITH OLIGOZOOSPERMIA. HSG SHOWED RIGHT TUBAL CORNUAL BLOCKADE AND LT TUBE THAT WAS OPACIFIED WITH POSSIBLE DISTAL LOCULATED. THE ENDOMETRIAL CAVITY WAS DISTORTED. TVS SHOWED RECURRENT MULTIPLE UTERINE FIBROIDS. SALINE INFUSION SONOGRAPHY SHOWED DISTORTED ENDOMETRIAL CAVITY WITH INTRA-CAVITARY LESIONS SUSPICIOUS FOR SUBMUCOUS FIBROIDS AND POLYPS. COUPLE PRESENTED WITH REQUEST FOR REPEAT MYOMECTOMY. LABORATORY INVESTIGATIONS REVEALED HB 55%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE COUPLE WERE COUNSELED

SPECIMEN FROM SURGERY



--Date: 28/11/08



51 YEAR OLD FEMALE G2. P2 WHO PRESENTED ON 24/11/08 TO OUR FERTILITY CENTRE WITH HX OF MENOMETRORRHAGIA , ABNORMAL ENDOMETRIAL BIOPSY RESULT AND RECURRENT UTERINE FIBROIDS. SHE UNDERWENT MYOMECTOMY PROCEDURE AT ABA (BERMA HOSPITAL) ABOUT 12 YEARS AGO. REVIEW OF THE ENDOMETRIAL PATHOLOGICAL REPORT SHOWED COMPLEX PAPILLARY PATTERN WITH HIGH DEGREE OF CYTOLOGIC ATYPIA. PAST MEDICAL AND SURGICAL HISTORY REVEALED PEPTIC ULCER DISEASE MANAGED WITH ANTACIDS. PT HAS CORNEAL DYSTROPHY AND HAS UNDERGONE CORNEAL TRANSPLANTS THREE TIMES IN THE USA ( 1991, 1995 AND 2005). PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING MID WAY TO THE UMBILICUS AND RELATIVELY IMMOBILE WITH DENSE PELVIC ADHESIONS. LABORATORY INVESTIGATIONS SHOWED HB 40%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV –SCREENING WAS NEGATIVE. FASTING BLOOD SUGAR WAS 114MG/DL. CXR WAS NORMAL. ECG SHOWED NORMAL PATTERN. KIDNEY FUNCTIONS WERE NORMAL VALUES. LIVER FUNCTIONS SHOWED NORMAL PARAMETERS. PT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNSELED THAT HYSTERECTOMY WITH BILATERAL SALPINGO-OPHORECTOMY WILL BE PROCEDURE OF CHOICE .

INTRA-OPERATIVE

POST-OPERATIVE

SPECIMEN FROM SURGERY


-Date: 03/12/08

UTERINE FIBROIDS AT SURGERY



43 YEAR OLD FEMALE NULLIGRAVIDA WHO PRESENTED TO OUR FERTILITY HOSPITAL ON 01/07/08 WITH HX OF MENOMETRORRHAGIA , RECURRENT UTERINE FIBROIDS AND DESIRING EVALUATION FOR POSSIBLE PREGNANCY. SHE UNDERWENT MYOMECTOMY PROCEDURE AT PORT HARCOURT IN 1997. OTHER SURGICAL HX INCLUDED APPENDECTOMY AND STRANGULATED HERNIA IN 1995. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING PAST THE UMBILICUS AND RELATIVELY IMMOBILE WITH DENSE PELVIC ADHESIONS. LABORATORY INVESTIGATIONS SHOWED HB 60%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV –SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT. CXR SHOWED NO CARDIOMEGALY. ECG WAS READ AS NORMAL. KIDNEY FUNCTIONS WERE NORMAL VALUES. LIVER FUNCTIONS SHOWED NORMAL PARAMETERS. PT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNSELED THAT HYSTERECTOMY WILL BE PROCEDURE OF CHOICE .

SPECIMEN FROM SURGERY




-Date: 02/12/08

UTERINE FIBROIDS AT SURGERY



40 YR.OLD FEMALE G3. P2 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 17/11/08 WITH HX OF INFERTILITY FOLLOWING HER LAST DELIVERY IN 1998. SHE HAD TWO TERM PREGNANCIES 1995 (BOY) AND 1998 (GIRL). PATIENT GIVES A HISTORY OF MULTIPLE UTERINE FIBROIDS. SHE UNDERWENT MYOMECTOMY IN 2003 AT ENUGU. SHE NOW PRESENTS WITH RECURRENT FIBROIDS AND DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED A FEMALE WITH MULTIPLE UTERINE FIBROIDS WITH PELVIC DHESIONS. INVESTIGATIONS REVEALED NARROW AND DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS LESION ON SIS AND BILATERAL TUBAL PATHOLOGY ON HSG. LABORATORY INVESTIGATIONS REVEALED SEVERE ANEMIA WITH HB 45%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OPERATIVELY AND ASSESSED BY THE ANESTHETIST.

SPECIMEN FROM SURGERY



Date: 2/12/08

UTERINE FIBROIDS AT SURGERY



30 YR.OLD MARRIED FEMALE NULLIGRAVIDA WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 01/12/08 WITH HX OF MULTIPLE UTERINE FIBROIDS, MENOMETRARRHAGIA AND ANEMIA. SHE HAS MENSTRUAL CYCLES OF 24-28 DAYS AND HEAVY FLOW LASTING 7-10 DAYS IN DURATION. SHE HAS BEEN MARRIED FOR 4 YEARS WITHOUT PREGNANCY. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED UTERINE FIBROIDS. INVESTIGATIONS REVEALED ENLARGED ENDOMETRIAL CAVITY WITH SUB-MUCOUS FIBROID. LABORATORY INVESTIGATIONS REVEALED HB 56%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and B NEGATIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 3/12/08

UTERINE FIBROIDS AT SURGERY



35 YR.OLD MARRIED FEMALE G2 G2 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 07/12/04 WITH HX OF MULTIPLE UTERINE FIBROIDS, MENOMETRARRHAGIA AND ANEMIA. SHE HAS MENSTRUAL CYCLES OF 26-28 DAYS AND HEAVY FLOW LASTING 7-8 DAYS IN DURATION. SHE HAS BEEN MARRIED FOR 11 YEARS AND HAD HER FIRST PREGNANCY IN 1993 – MALE AND A SECOND PREGNANCY IN 1996 OF A FEMALE. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. SHE WAS LOST TO FOLLOW –UP AND REPRESENTED TO THE HOSPITAL ON 02/08/08 WITH REQUEST FOR SURGERY BECAUSE OF CONTINUED FIBROID GROWTH AND SEVERE ANEMIA. PHYSICAL EXAMINATION REVEALED UTERINE FIBROIDS. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS. LABORATORY INVESTIGATIONS REVEALED SEVERE ANEMIA WITH HB OF 37%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 09/12/08

LEFT OVARIAN COMPLEX CYST AT SURGERY



30 YR.OLD MARRIED FEMALE G3 P1 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 06/12/08 WITH HX OF INABILITY TO GET PREGNANT AGAIN FOLLOWING THE DELIVERY OF HER ONLY SON IN 2003 BY CESAREAN SECTION. SHE HAS MENSTRUAL CYCLES OF 28-29 DAYS AND HEAVY FLOW LASTING 5 DAYS IN DURATION. SHE HAS BEEN MARRIED FOR 8 YEARS. EXAMINATION REVEALED LARGE LEFT ADNEXAL MASS THAT WAS FAIRLY FIXED. INVESTIGATIONS REVEALED LEFT ADNEXAL COMPLEX CYST . LABORATORY INVESTIGATIONS REVEALED HB 64%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 09/12/08

UTERINE FIBROIDS AT SURGERY



42 YR.OLD MARRIED FEMALE G6 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 18/04/08 WITH HX OF MULTIPLE UTERINE FIBROIDS AND THREE MISCARRIAGES DURING THE FIRST TRIMESTER IN 2001, 2002 AND 2003. SHE HAS IRREGULAR MENSTRUAL CYCLES AND FLOW LASTING 3-5 DAYS IN DURATION. SHE HAS BEEN MARRIED FOR 5 YEARS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED UTERINE FIBROIDS. INVESTIGATIONS REVEALED ENLARGED ENDOMETRIAL CAVITY WITH SUB-MUCOUS FIBROID. LABORATORY INVESTIGATIONS REVEALED HB 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 09/12/08

        42 YEAR OLD FEMALE G?2. P1 WHO PRESENTED ON 10/11/08 TO OUR FERTILITY CENTRE WITH HX OF MENOMETRORRHAGIA , WEAKNESS AND ANEMIA. SHE HAS BEEN MARRIED FOR 21 YEARS AND DELIVERED HER ONLY DAUGHTER IN 1989. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED ADENOMYOSIS WITH A LARGE GLOBULAR UTERUS WITH DENSE PELVIC ADHESIONS. LABORATORY INVESTIGATIONS SHOWED HB 40%, GENOTYPE AS, BLOOD GROUP/RH B-POSITIVE, HIV –SCREENING WAS NEGATIVE. CXR WAS NORMAL. ECG SHOWED NORMAL PATTERN. KIDNEY FUNCTIONS WERE NORMAL VALUES. LIVER FUNCTIONS SHOWED NORMAL PARAMETERS. PT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNSELED THAT HYSTERECTOMY WILL BE PROCEDURE OF CHOICE .

SPECIMEN FROM SURGERY



-Date: 22/12/08

HSG WITH BILATERAL TUBAL BLOCKADE UTERINE FIBROID

31 YR.OLD MARRIED FEMALE G4. P2 WAS FIRST SEEN HERE ON JUNE 10, 2006 WITH HX OF BREECH STILBIRTH FOLLOWING ONE YEAR OF MARRIAGE. PATIENT GAVE A HISTORY OF EXCESSIVE IRREGULAR MENSTRUAL BLEEDING AND PELVIC PAIN. INVESTIGATIONS AT THAT PRESENTATION REVEALED DISTORTED ENDOMETRIAL CAVITY WITH LARGE SUBMUCOUS AND INTRAMURAL FIBROID AND BILATERAL TUBAL BLOCKADE. ON 20/06/2006, SHE UNDERWENT EXPLORATORY LAPAROTOMY WITH EXTRACTION OF ONE LARGE INTRA-MURAL FIBROID OBSTRUCTING BOTH TUBES AND DISTORTING THE ENDOMETRIAL CAVITY. FOLLOWING SURGERY, SHE BECAME PREGNANT WITHIN 6 WEEKS. SHE PRESENTED HERE AT 37 COMPLETED WEEKS OF GESTATION WITH REQUEST FOR ELECTIVE CESAREAN SECTION FOR A FEMALE INFANT (5.1KG) DELIVERED ON 01/05/2007. SHE AGAIN GOT PREGNANT AND PRESENTED WITH REQUEST FOR REPEAT CESAREAN SECTION. SHE HAD HER ANTE-NATAL CARE AT UMUAHIA. INVESTIGATIONS REVEALED ANEMIA (HB 61%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and B+ BLOOD GROUP AND RHESUS FACTOR.

BABY BOY D.O.B 22/12/2008 WT 4.9 KG



-Date: 05/01/09

UTERINE FIBROIDS AT SURGERY



44 YR.OLD MARRIED FEMALE G2 P1 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 09/09/08 WITH HX OF MULTIPLE UTERINE FIBROIDS FOLLOWING THE DELIVERY (1993) OF HER ONLY DAUGHTER FROM HER PREVIOUS MARRIAGE . SHE HAS MENSTRUAL CYCLES OF 26 DAYS AND FLOW LASTING 5-7 DAYS IN DURATION. SHE REMARRIED IN 2000 AND HAD A MISCARRIAGE IN 1992. SINCE THEN SHE HAS BEEN UNABLE TO CONCEIVE. SHE HAS HISTORY OF LOCAL HERBS USE. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED ENLARGED ENDOMETRIAL CAVITY WITH SUB-MUCOUS FIBROIDS. LABORATORY INVESTIGATIONS REVEALED HB 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 10/01/09

UTERINE FIBRIODS AT SURGERY



38YR OLD MARRIED FEMALE, NULLIGRAVIDA, WHO PRESENTED TO OUR FERTILITY CENTER FOR THE FIRST TIME ON 08/12/08 WITH HX OF INFERTILITY FOLLOWING NINE YEARS OF MARRIAGE . SHE HAD MYOMECTOMY AT DR ALUKA’S FACILITY IN 2003. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS EXTENDING ABOVE THE UMBILICUS AND RELATIVELY IMMOBILE WITH DENSE ADHESION . HSG SHOWED LARGE ENDOMETRIAL CAVITY WITH SUBMUCUS LESIONS. IT ALSO SHOWED BILATERAL TUBAL BLOCKADE AT THEIR CORNUA. SALINE INFUSION SONOGRAPHY (SIS) REVEALED LARGE CAVITY WITH LESIONS SUSPICIOUS FOR SUBMUCOUS FIBROIDS. LABORATORY INVESTIGATIONS REVEALED SEVERE ANEMIA WITH INITIAL HB OF 30%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR B-POSITIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNELED THAT AN ATTEMPT OF MYOMECTOMY WILL BE MADE BUT IF IT FAILED SHE WILL UNDERGO HYSTERECTOMY. THE COUPLE CONSENTED.

SPECIMEN FROM SURGERY



Date: 07/02/09

UTERINE FIBROIDS


37 YR.OLD FEMALE G3. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 08/11/08 WITH HX OF SEVERE DYSMENORRHEA AND UTERINE FIBROIDS . PATIENT GIVES A HISTORY OF IRREGULAR MENSTRUAL CYCLES AND MULTIPLE UTERINE FIBROIDS. SHE HAD USED DIFFERENT LOCAL REMEDIES THAT FAILED. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS UP TO MID WAY BETWEEN THE UMBILICUS AND THE XIPHOID. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. LABORATORY INVESTIGATIONS REVEALED ANEMIA (HB 60%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY



Date: 07/02/09

29 YR.OLD MARRIED FEMALE G1. P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 02/02/09 FOR INVESTIGATION AND MANAGEMENT OF INFERTLITY FOLLOWING 6 YEARS OF MARRIAGE. PATIENT GIVES A HISTORY OF USE OF LOCAL HERBS BY ORAL AND INSERTION ROUTES. INVESTIGATIONS REVEALED DISTORTED ENDOMETRIAL CAVITY WITH SUBMUCOUS MASS. HSG DONE AT HANSA CLINIC ENUGU REPORTED BILATERAL TUBAL BLOCKADE WITH HYDROSALPINGES. LABORATORY INVESTIGATIONS REVEALED ANEMIA (HB 55%), HIV SCREENG WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY



-Date: 20/02/09

UTERINE FIBROIDS AT SURGERY



34 YR.OLD MARRIED FEMALE G3 P3 (one male and 2 females) WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 17/01/09 WITH HX OF SYMTOMATIC MULTIPLE UTERINE FIBROIDS. SHE HAS MENSTRUAL CYCLES OF 24-26 DAYS AND HEAVY FLOW LASTING 3-5 DAYS IN DURATION. SHE HAS USED ORAL CONTRACEPTIVE TO CONTROL EXCESSIVE BLOOD LOSS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED ENDOMETRIAL CAVITY WITH NO LESIONS. LABORATORY INVESTIGATIONS REVEALED HB 70%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 20/02/09

FIBROID AT SURGERY



     45 YEAR OLD FEMALE G4. P2 (BOYS) WHO PRESENTED ON 04/02/09 TO OUR FERTILITY CENTRE WITH HX OF MENOMETRORRHAGIA AND MULTIPLE SYMTOMATIC UTERINE FIBROIDS OF 10 YEARS DURATION. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE LEIOMYOMATA UTERINE REACHING CLOSE TO THE XIPHOID PROCESS. LABORATORY INVESTIGATIONS SHOWED HB 60%, GENOTYPE AA, BLOOD GROUP/RH O-NEGTIVE, HIV –SCREENING WAS NEGATIVE. CXR WAS NORMAL. ECG SHOWED NORMAL PATTERN. KIDNEY FUNCTIONS WERE NORMAL VALUES. LIVER FUNCTIONS SHOWED NORMAL PARAMETERS. PT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNSELED THAT HYSTERECTOMY WILL BE PROCEDURE OF CHOICE.

SPECIMEN FROM SURGERY



-Date: 20/02/09

UTERINE FIBRIODS AT SURGERY


34YR OLD MARRIED FEMALE, NULLIGRAVIDA, WHO PRESENTED TO OUR FERTILITY CENTER FOR THE FIRST TIME ON 27/09/08 WITH HX OF RECURRENT FIBROIDS AND HEAVY MENSES . SHE HAD MYOMECTOMY AT FMC OWERRI IN 2003. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS EXTENDING ABOVE THE UMBILICUS AND RELATIVELY IMMOBILE WITH DENSE ADHESIONS . HSG WAS DIFFICULT AND ATTEMPTS ABANDONED. SALINE INFUSION SONOGRAPHY (SIS) REVEALED RESTRICTED CAVITY AND LACK OF EXPANSION. LABORATORY INVESTIGATIONS REVEALED SEVERE ANEMIA WITH INITIAL HB OF 46%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR A-POSITIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. SHE WAS COUNELED THAT AN ATTEMPT OF MYOMECTOMY WILL BE MADE BUT IF IT FAILED SHE WILL UNDERGO HYSTERECTOMY. THE PATIENT CONSENTED. EIGHT UNITS OF BLOOD WAS PROVIDED BY THE PATIENT FOR HER SURGERY.

SPECIMEN FROM SURGERY



-Date: 28/02/09



36 Y.OLD FEMALE G3. P(11-twin) PRESENTED AT TERM FOR DELIVERYOF SINGLETON GESTATION WITH EDD OF 15/03/09. PAST HISTORY WAS SIGNIFICANT WITH HX OF SYMPTOMATIC UTERINE FIBROIDS AND 11 YEARS OF INFERTILITY. FOLLOWING ADEQUATE COUNSELING AND INFORMED CONSENT, SHE UNDERWENT EXPLORATORY LAPAROTOMY WITH EXTRACTION OF MULTIPLE FIBROIDS ON 8/4/05. FOUR MONTHS LATER, SHE BECAME PREGNANT WITH TWIN GESTATION AND WAS DELIVERED BY CESAREAN SECTION OF TWIN BOYS ON 27/05/06. THE PATIENT BECAME PREGNANT AGAIN WITH LMP OF 08/06/08 AND REQUESTED FOR A REPEAT CESAREAN SECTION AT TERM. HER ANTENATAL COURSE WAS UNEVENTFUL.

TWIN BOYS DOB 27/05/2006

BABY BOY DOB 28/02/09 WEIGHT 3.0 KG

BABY BOY DOB 01/04/09. WEIGHT 4.0 KG



-Date: 06/04/09

UTERINE FIBROIDS AT SURGERY



37 YR.OLD MARRIED FEMALE G3 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 19/03/09 WITH HX OF SYMTOMATIC MULTIPLE UTERINE FIBROIDS. SHE HAS MENSTRUAL CYCLES OF 21-35 DAYS AND MODERATE FLOW LASTING 3-5 DAYS IN DURATION. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED ENDOMETRIAL CAVITY WITH POLYPOID LESIONS. LABORATORY INVESTIGATIONS REVEALED HB 62%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 07/04/09

UTERINE FIBROIDS AT SURGERY



36 YR.OLD MARRIED FEMALE G9 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 12/03/09 WITH HX OF SYMTOMATIC MULTIPLE UTERINE FIBROIDS. SHE HAS MENSTRUAL CYCLES OF 28 DAYS AND MODERATE TO HEAVY FLOW LASTING 5-6 DAYS IN DURATION. PAST HISTORY IS SIGNIFICANT FOR MISCARRIAGES AND UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED ENDOMETRIAL CAVITY WITH LARGE SUBMUCOUS LESIONS LESIONS. LABORATORY INVESTIGATIONS REVEALED HB 53%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 07/04/09

UTERINE FIBROIDS AT SURGERY
46 YR.OLD MARRIED FEMALE G5 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 19/03/09 WITH HX OF PELVIC PAIN. SHE HAS MENSTRUAL CYCLES OF 26-30 DAYS AND MODERATE FLOW LASTING 4-5 DAYS IN DURATION. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY AND UTERINE VOLUMETRIC (SONOCUBIC) STUDIES REVEALED ENDOMETRIAL CAVITY WITH POLYPOID LESIONS. LABORATORY INVESTIGATIONS REVEALED HB 61%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and A POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



Date: 10/04/09

UTERINE FIBROIDS AT SURGERY


28 YEARS OLD SINGLE FEMALE GRAVIDA 2, WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 21/03/09 WITH HX OF SYMTOMATIC UTERINE FIBROID. SHE HAS MENSTRUAL CYCLES OF 28 DAYS AND MODERATE TO HEAVY FLOW LASTING 4 DAYS IN DURATION. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED UTERINE FIBROID MASS EXTENDING BEYOND THE UMBILICUS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED FLATTENED ENDOMETRIAL CAVITY WITH LARGE POSTERIOR –FUNDAL INTRAMURAL FIBROID. LABORATORY INVESTIGATIONS REVEALED HB 59%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



Date: 26/04/09

    41 Y.OLD FEMALE G5. P1 PRESENTED AT TERM FOR DELIVERYOF SINGLETON GESTATION WITH EDD OF 20/04/09. PAST HISTORY WAS SIGNIFICANT FOR MULTIPLE MYOMECTOMY IN 2003.SHE BECAME PREGNANT AND WAS DELIVERED BY CESAREAN SECTION OF A BOY ON 14/08/04.
    THE PATIENT BECAME PREGNANT AGAIN WITH LMP OF 3/08/08 AND REQUESTED FOR A REPEAT CESAREAN SECTION AT TERM. HER ANTENATAL COURSE WAS UNEVENTFUL.
    BLOOD WORK REVEALED HB OF 60%, HIV SCREENING WAS NEGATIVE, BLOOD GROUP AND RH B+ PATIENT PRESENTED FOR SURGERY AT 38 COMPLETED WEEKS OF GESTATION.

BABY BOY DOB 27/04/09. WEIGHT 4.0 KG



-Date: 23/05/09

UTERINE FIBROIDS AT SURGERY



34 YEARS OLD MARRIED FEMALE GRAVIDA 2, P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 24/05/08 WITH HX OF RECURRENT SYMTOMATIC UTERINE FIBROID AND NO CONCEPTION SINCE 2001. SHE HAS MENSTRUAL CYCLES OF 26-28 DAYS AND MODERATE TO HEAVY FLOW LASTING 4 DAYS IN DURATION. PAST HISTORY IS SIGNIFICANT FOR MYOMECTOMY IN LAGOS IN 2003. SHE DESIRES RE-EXPLORATION AND MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED FLATTENED ENDOMETRIAL CAVITY WITH LARGE POSTERIOR –FUNDAL INTRAMURAL FIBROID. LABORATORY INVESTIGATIONS REVEALED PRE-OP HB 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 02/06/09

28 YEARS OLD MARRIED FEMALE NULLIPARA, WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 26/05/09 WITH HX OF RECURRENT SYMTOMATIC PELVIC MASS. SHE COMPLAINED OF PELVIC PAIN SINCE HER HSG PROCEDURE PERFORMED AT YOLA SINCE MARCH 2009. THE REVIEW REVEALED BILATERAL SWOLLEN TUBES WITH BLOCKADE. SHE HAS BEEN EXPERIENCING UTERINE BLEEDING SINCE THIS PROCEDURE. SHE MARRIED IN 2006 WITH NO CONCEPTION SINCE THEN. SHE HAS MENSTRUAL CYCLES OF 28-30 DAYS AND MODERATE FLOW LASTING 6-7 DAYS IN DURATION. PAST HISTORY IS SIGNIFICANT FOR OVARIAN CYSTECTOMY PERFORMED IN 2006 AT FEDERAL MEDICAL CENTRE, YOLA. SHE DESIRES RE-EXPLORATION AND UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED LARGE PELVIC MASS FILLING THE PELVIC CAVITY AND TENDER TO PALPATION. LABORATORY INVESTIGATIONS REVEALED ANEMIA WITH HB 35%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 06/06/09

33 YEARS OLD MARRIED FEMALE GRAVIDA 2 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 27/05/09 WITH HX OF INFERTILITY. SHE HAS MENSTRUAL CYCLES OF25- 27 DAYS AND MODERATE TO HEAVY FLOW LASTING 3-5 DAYS IN DURATION. SHE PRESENTED WITH HISTORY OF BILATERAL TUBAL BLOCKADE. PHYSICAL EXAMINATION AND TVS REVEALED UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED ENDOMETRIAL CAVITY WITH NO ENDOMETRIAL LESIONS. LABORATORY INVESTIGATIONS REVEALED HB 58%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.



Date: 06/06/09

UTERINE FIBROIDS AT SURGERY



40 YEARS OLD MARRIED FEMALE GRAVIDA 1 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 04/05/09 WITH HX OF INFERTILITY SINCE 11 YEARS OF MARRIAGE. SHE HAS MENSTRUAL CYCLES OF26- 28 DAYS AND MODERATE TO HEAVY FLOW LASTING 4-7 DAYS IN DURATION. SHE PRESENTED WITH HISTORY OF BILATERAL TUBAL BLOCKADE. MEDICAL HISTORY OF OBESITY AND HYPERTENSION. PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY AND SONOCUBIC VOLUMETRIC MPR REVEALED ENDOMETRIAL CAVITY WITH SUBMUCOUS ENDOMETRIAL LESIONS. LABORATORY INVESTIGATIONS REVEALED ANEMIA WITH HB OF 40%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP. RECOVERY ROOM IN STABLE CONDITION.

SPECIMEN FROM SURGERY


12/06/09

SALINE INFUSION SON WITH MYOMETRIAL CYST SUBMUCOUS POLYP

MYOMETRIAL CYST AT SURGERY


40 Y.OLD MARRIED FEMALE G3 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING SIX YEARS OF MARRIAGE. COUPLE FIRST PRESENTED FOR EVALUATION ON 06 /03/09. SHE GAVE A HISTORY OF PERSISTENT PELVIC PAINS SINCE 2005 AND MENSTRUAL IRREGULARITY WITH CYCLES OF 27-45 DAYS , SEVERE DYSMENORRHEA AND FLOW OF 3-4 DAYS DURATION. MEDICAL HISTORY IS SIGNIFICANT FOR HYPERTENSION. SURGICAL HX INCLUDED LAPAROSCOPY AND EXPLORATORY LAPORATOMY FOR A SUSPECTED FIBROID WHICH WAS NEVER FOUND AT SURGERY IN 2005. MEDICATIONS INCLUDED THE USE OF ANTIHYPERTENSIVE, CLOMID AND LOCAL HERBS. INITIAL TRANS-VAGINAL SONOGRAM REVEALED MULTIPLE MYOMETRIAL CYSTS CLUSTERED ON THE ANTERIOR-FUNDAL UTERINE SEGMENT. HSG PERFORMED ON REVEALED ILL DEFINED SUBMUCOUS LESION AND RT TUBAL OBSTRUCTION AT THE CORNUUM. SALINE INFUSION SONOGRAPHY REVEALED PERSISTENT MULTIPLE MYOMETRIAL CYSTS AND MODERATE ENDOMETRIAL EXPANSION WITH SUBMUCOUS INTRACAVITARY LESION. BLOOD WORK REVEALED HB OF 66%, GENOTYPE AA, BLOOD GROUP/RH A-POSITIVE AND HIV SCREENING WAS NEGATIVE. THE PATIENT PRESENTED WITH REQUEST FOR SURGERY.

MYOMETRIAL CYST AND UTERINE FIBROIDS SPECIMEN AT SURGERY

-Date: 20/06/09

UTERINE FIBRIODS AT SURGERY



38YR OLD MARRIED FEMALE, GRAVIDA 2, P0 WHO PRESENTED TO OUR FERTILITY CENTER FOR THE FIRST TIME ON 28/05/09 WITH HX OF INFERTILITY FOLLOWING 6 YRS OF MARRIAGE. SHE HAD AN ECTOPIC PREGNANCY IN 2003 AND SHE UNDERWENT SALPINGECTOMY. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS AND RELATIVELY IMMOBILE WITH PELVIC ADHESIONS . HSG REVEALED BILATERAL TUBAL PATHOLOGY. SALINE INFUSION SONOGRAPHY (SIS) REVEALED RESTRICTED CAVITY AND ILL-DEFINED INTRA-CAVITARY LESION. LABORATORY INVESTIGATIONS REVEALED HB OF 72%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR AB-POSITIVE. HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY



-Date: 09/07/09

UTERUS



28 YR.OLD SINGLE FEMALE WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 21/01/08 WITH HX OF UTERINE FIBROIDS AND DESIRING MYOMECTOMY. PATIENT GIVES A HISTORY OF HEAVINESS OF THE LOWER ABDOMEN. INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS EXTENDING BEYOND THE UMBILICUS, NARROW ENDOMETRIAL CAVITY WITH BILATERAL TUBAL BLOCKADE. SIS REVEALED LACK OF ENDOMETRIAL EXPANSION DUE TO THE LARGE FIBROIDS. LABORATORY INVESTIGATIONS REVEALED HB 62%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. FOLLOWING COUNSELING AND OBTAINING AN INFORMED SURGICAL CONSENT, THE PATIENT THEN UNDERWENT MYOMECTOMY ON 2/5/08. SHE SUBSEQUENTLY BECAME PREGNANT WITH A DUE DATE OF 29/7/09. SHE HAD AN UNEVENTFUL ANTENATAL COURSE. SHE IS CURRENTLY 37WEEKS GESTATION AND PRESENTS WITH REQUEST FOR CESAREAN SECTION FOLLOWING COUNSELLING.

-Date: 25/07/09

31YR OLD MARRIED FEMALE, GRAVIDA 1, P0 WHO PRESENTED TO OUR FERTILITY CENTER FOR THE FIRST TIME ON 23/02/09 WITH HX OF INFERTILITY FOLLOWING 2 YRS OF MARRIAGE. SHE HAD MYOMECTOMY IN 2005 COMPLICATED BY INTESTINAL OBSTRUCTION WHICH REQUIRED LAPAROTOMY FOR CORRECTION. SHE PRESENTED WITH REQUEST FOR IVF. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS IN A UTERUS THAT WAS RELATIVELY IMMOBILE WITH PELVIC ADHESIONS . HSG REVEALED BILATERAL TUBAL PATHOLOGY. SALINE INFUSION SONOGRAPHY (SIS) REVEALED RESTRICTED CAVITY AND ILL-DEFINED INTRA-CAVITARY LESION. LABORATORY INVESTIGATIONS REVEALED HB OF 70%. GENOTYPE AS, BLOOD GROUP AND RHESUS FACTOR A-POSITIVE. HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY FOLLOWING COUNSELLING.

SPECIMEN FROM SURGERY



-Date: 25/07/09

FIBROTIC UTERINE MASS WITH ADHESIONS



36YR OLD FEMALE, GRAVIDA 2, P1 WHO IS A WORKER AT OUR FERTILITY CENTER FOR THE PAST 6 MONTHS. SHE PRESENTED ON 23/06/09 WITH HX OF MENOMETRORRHAGIA AND SEVERE WEAKNESSS. SHE HAD ATTEMPTED MYOMECTOMY IN 1993 WITH NO TUMORS REMOVED. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED MULTIPLE UTERINE FIBROIDS IN A UTERUS THAT WAS RELATIVELY IMMOBILE WITH PELVIC ADHESIONS AND EXTENDING ABOVE THE UMBILICUS . SALINE INFUSION SONOGRAPHY (SIS) REVEALED RESTRICTED CAVITY AND ILL-DEFINED INTRA-CAVITARY LESION. LABORATORY INVESTIGATIONS REVEALED HB OF 30%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR A-POSITIVE. HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY FOLLOWING COUNSELLING. SHE WAS COUNSELLED THAT THE COMPLEXITY OF THE CASE WILL REQUIRE HYSTERECTOMY BUT EVERY ATTEMPT WILL BE MADE TO CONSERVE THE UTERUS IF POSSIBLE. PT RECEIVED 2 UNITS OF BLOOD PRE-SURGERY.

SPECIMEN FROM SURGERY



-Date: 29/11/09



45 YR.OLD MARRIED FEMALE G4 P0 PRESENTED WITH HX OF INFERTILITY FOLLOWING TEN YEARS OF MARRIAGE. SHE PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 23-06-2009. HER PAST SURGICAL HX INCLUDED A MYOMECTOMY IN 2002. OUR INVESTIGATIONS REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS EXTENDING UP TO THE UMBILICUS. SALINE INFUSION SONOGRAPHY REVEALED LITTLE ENDOMETRIAL EXPANSION WITH LARGE SUBMUCUS FIBROID. BLOOD WORK REVEALED SEVERE ANEMIA WITH HB OF 30%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE. AFTER COUNSELING AND DISCUSSION ON HER PROGNOSIS AND TREATMENT OPTIONS WHICH INCLUDED REPEAT MYOMECTOMY, BLOOD TRANSFUSION AND POSSIBLE HYSTERECTOMY, THE PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT RECEIVED ONE UNIT OF COMPATIBLE BLOOD THE NITE BEFORE SURGERY.

FIBROID SPECIMEN AT SURGERY



-Date: 24/12/09

UTERINE FIBROIDS AT SURGERY



45 YEARS OLD MARRIED FEMALE GRAVIDA 4 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 19/12/09 WITH HX OF INFERTILITY, FIBROIDS AND DESIRE FOR SURGERY. SHE HAS NOT SEEN HER MENSES SINCE 2007. FIBROIDS WERE DIAGNOSED SINCE 2001. MEDICAL HISTORY OF OBESITY AND HYPERTENSION. PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS. INVESTIGATIONS REVEALED OBLITERATED EXTERNAL OS. LABORATORY INVESTIGATIONS REVEALED HB OF 70%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. LIVER FUNCTIONS AND KIDNEY FUNCTIONS AND ELECTROLYTES WERE WITHIN NORMAL LIMITS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 06/03/2010

HSG SHOWING BILATERAL TUBAL BLOCKADE

33 YEARS OLD MARRIED FEMALE GRAVIDA 4 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 24/02/2010 WITH HX OF INFERTILITY, FIBROIDS AND DESIRE FOR CONCEPTION. PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED BILATERAL FUBAL BLOCKADE AND SIS SHOWED DISTORTED UTERINE CAVITY WITH SUBMUCOUS FIBROID. MEDICAL HX REVEALED A KNOWN HYPERTENSIVE FOR TWO YEARS AND HER MEDICATIONS INCLUDE VASOPRIN AND HYDROCLOROTHIAZIDE. LABORATORY INVESTIGATIONS REVEALED HB OF 64%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT. PATIENT THEN PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS AGAIN COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



-Date: 01/05/2010

UTERINE FIBROIDS AT SURGERY



35 YEARS OLD MARRIED FEMALE NULLIGRAVIDA WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 31/03/2010 WITH HX OF INFERTILITY, PROGRESSIVELY ENLARGING FIBROIDS AND DESIRE FOR SURGERY. FIBROIDS WERE DIAGNOSED SINCE 2001. SHE HAS BEEN TAKING HERBAL TREATMENTS AND COMPLAINED OF PROGRESSIVE INABILITY TO SLEEP COMFORTABLY, COUGH, MENORRHAGIA AND WATERY DISCHARGE PER VAGINUM. MEDICAL HISTORY OF BLOOD TRANSFUSION DUE TO EXCESSIVE UTERINE BLEEDING AND ANEMIA. PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS EXTENDING TO THE XYPHOID PROCESS. INVESTIGATIONS INCLUDED HSG THAT REVEALED LARGE UTERINE CAVITY WITH BILATERL TUBAL BLOCADE AT TUBAL OSTIA. VOLUMETRIC STUDIES REVEALED WATERY DISHARGE FROM ENDOMETRIAL CAVITY THAT LOOKED LIKE URINE. FISTULA (UVF) WAS RULED OUT WHEN METHYLENE BLUE DYE WAS INSTILLED INTO THE BLADDER WITH NO DYE COMING FROM THE ENDOMETRIAL CAVITY. VOLUMETRIC STUDIES REVEALED LARGE ENDOMETRIAL CAVITY WITH MULTIPLE SUBMUCOUS FIBROIDS/POLYPS. THERE WAS A POLYP PROTRUDING THROUGH THE EXTERNAL OS. LABORATORY INVESTIGATIONS REVEALED HB OF 50%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and B-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. LIVER FUNCTIONS AND KIDNEY FUNCTIONS WITH ELECTROLYTES WERE WITHIN NORMAL LIMITS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP THAT IF MYOMECTOMY ATTEMPT FAILS, THEN HYSTERECTOMY WILL BE PERFORMED. SHE PROVIDED 8 UNITS OF COMPATIBLE BLOOD FROM NATIONAL HOSPITAL AND RECEIVED 2 UNITS PRE-OP WITHOUT COMPLICATIONS.

SPECIMEN FROM SURGERY


DATE: 10/05/2010

UTERINE FIBROIDS AT SURGERY


40 YEARS OLD MARRIED FEMALE GRAVIDA 4, P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 01/05/2010 WITH HX OF RECURRENT UTERINE FIBROIDS AND THREE MISCARRIAGES SINCE 13 YEARS OF MARRIAGE. SHE HAS MENSTRUAL CYCLES OF 28-29 DAYS AND MODERATE FLOW LASTING 5 DAYS IN DURATION. PAST HISTORY IS SIGNIFICANT FOR MYOMECTOMY AT THE NATIONAL HOSPITAL IN 2003. SHE DESIRES RE-EXPLORATION AND MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS WITH RESTRICTIVE MOBILITY INDICATIVE OF PELVIC ADHESIONS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED NARROWED AND RESTRICTIVE ENDOMETRIAL CAVITY WITH SURROUNDING INTRAMURAL FIBROIDS. LABORATORY INVESTIGATIONS REVEALED PRE-OP HB 70%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A POSITIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



date: 12/06/2010


36 YR. OLD FEMALE G5. P2 PRESENTED TO OUR FERTILITY CENTRE WITH HX OF TERM PREGNANCY AND WITH REQUEST FOR REPEAT CESAREAN SECTION. HER PREVIOUS HISTORY INCLUDED MYOMECTOMY X 2, BILATERAL TUBAL RECONSTRUCTION FOR BILATERAL TUBAL BLOCKADE AND HYDROSALGINGES. SHE UNDERWENT THESE PROCEDURES ON 05/09/05. HER FIRST PREGNANCY OCCURRED TWO MONTHS AFTER HER SURGERY AND SHE GAVE BIRTH TO A BABY GIRL BY CESAREAN SECTION ON 14/07/06. SHE BECAME PREGNANT AGAIN AND WAS DELIVERED OF A BABY BOY BY REPEAT CESAREAN SECTION ON OCTOBER 23, 2007. HER CURRENT ANTENATAL COURSE WAS UNEVENTFUL. PT NOW AT TERM RETURNED HERE AT A NEW LOCATION (ABUJA) WITH REQUEST FOR A REPEAT CESAREAN SECTION DELIVERY. BLOOD WORK REVEALED HB OF 60%, HIV SCREENIG WAS NEGATIVE, GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE. THE PATIENT FURTHER REQUESTED THE REPAIR OF SYMPTOMATIC UMBILICAL HERNIA AT TIME OF SURGERY.

24 HRS AFTER BIRTH


BABY BOY -DOB: WEIGHT 3.4 KG

42 YEARS OLD MARRIED FEMALE GRAVIDA 3 P3 , ALIVE 1 FEMALE, WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 11/10/2009 AT ABA WITH HX OF INFERTILITY, FIBROIDS AND DESIRE FOR CONCEPTION. SHE HAS BEEN MARRIED FOR 17 YEARS. SHE HAD 3 FEMALE CHILDREN. FIRST CHILD WAS BORN IN 1993 AND SHE IS ALIVE AND WELL. SECOND CHILD WAS BORN ALIVE BUT DIED LATER IN 1995. HER LAST PREGNANCY END IN STILBIRTH AND WAS INDUCED IN 2000. PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED BILATERAL FUBAL BLOCKADE AND SIS/VOLUMETRIC UTERINE STUDY SHOWED DISTORTED UTERINE CAVITY WITH NO SUBMUCOUS FIBROID. MEDICAL HX REVEALED A KNOWN HYPERTENSIVE . CXR AND EEG AT ECHO SCAN WERE WITHIN NORMAL LIMITS. LABORATORY INVESTIGATIONS REVEALED HB OF 55%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and B-NEGATIVE - BLOOD GROUP AND RHESUS FACTOR. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT. PATIENT THEN PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS AGAIN COUNSELED PRE-OP.



41 YEARS OLD MARRIED FEMALE GRAVIDA 3 P0 , WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 15/06/20110 AT ABUJA WITH HX OF INFERTILITY, FIBROIDS AND DESIRE FOR CONCEPTION. SHE HAS BEEN MARRIED FOR 8 YEARS. PATIENT GAVE A HISTORY OF HERBAL INTAKE (2004-2008). PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED BILATERAL TUBAL BLOCKADE AND SIS/VOLUMETRIC UTERINE STUDY SHOWED SIGNIFICANTLY DISTORTED UTERINE CAVITY WITH SUBMUCOUS FIBROID. CXR AND EEG AT ECHO SCAN WERE WITHIN NORMAL LIMITS. LABORATORY INVESTIGATIONS REVEALED HB OF 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and AB-NEGATIVE - BLOOD GROUP AND RHESUS FACTOR. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT. PATIENT THEN PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS AGAIN COUNSELED PRE-OP.

ABDOMEN BEFORE SURGERY ADHESIONS & FIBROIDS DURING SURGERY



48 YEAR OLD FEMALE G0. P0 WHO PRESENTED TO OUR FERTILITY CENTRE ON 05/06/2010 WITH HX OF MENOMETRORRHAGIA , RECURRENT UTERINE FIBROIDS AND DESIRE FOR SURGERY WITH CONSERVATION OF THE UTERUS FOR CONCEPTION . SHE HAS BEEN MARRIED FOR 16 YEARS. SHE UNDERWENT MYOMECTOMY PROCEDURE LONDON UK IN 1996. SHE THEN DEVELOPED A RECURRENCE OF FIBROIDS. AN ATTEMPT TO DEBULK THE FIBROIDS IN LONDON IN 2005 FAILED DUE TO DENSE PELVIC ADHESIONS INVOLVING THE UTERUS, BOWELS, BLADDER AND OMENTUM. THE BLADDER WAS ENTERED AND REPAIRED. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE LEIOMYOMATA UTERINE REACHING PAST THE UMBILICUS AND RELATIVELY IMMOBILE WITH DENSE PELVIC ADHESIONS. LABORATORY INVESTIGATIONS SHOWED HB 60%, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV –SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT. CXR WAS READ AS NORMAL. KIDNEY FUNCTIONS WERE REPORTED WITH NORMAL VALUES. INTRAVENOUS UROGRAPHY REVEALED HUGE ABDOMINO-PELVIC MASS CAUSING MILD HYDROCALYSES AND WITH LATERAL DISPLACEMENT OF THE RIGHT URETERS BY THE TUMOR. ON 23/07/2010, THE PT WAS ADMITTED WITH REQUEST FOR SURGERY. SHE WAS COUNSELED THAT HYSTERECTOMY WILL BE THE PROCEDURE OF CHOICE. MYOMECTOMY WILL BE ATTEMPTED ONLY IF IT IS POSSIBLE. PT WAS ALSO ADVISED TO PROVIDE 8 UNITS OF COMPATIBLE BLOOD FOR THE PROCEDURE.

FIBROIDS

FIBROIDS



34 YEARS OLD MARRIED FEMALE GRAVIDA 4, PARA 0 , WHO PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 08/06/2010 AT ABUJA WITH HX OF INFERTILITY, FIBROIDS AND DESIRE FOR CONCEPTION. SHE HAS BEEN MARRIED FOR THREE YEARS AND HAS CHALLENGES WITH CONCEPTION. THERE IS ALSO MALE FACTOR INFERTILITY. PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED BILATERAL TUBAL BLOCKADE AND SIS/VOLUMETRIC UTERINE STUDY SHOWED A SMALL UTERINE CAVITY WITH A SEPTATE BAND ARISING FROM THE FUNDUS TO THE CERVIX. LABORATORY INVESTIGATIONS REVEALED HB OF 70%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and HER HUSBAND IS ALSO GENOTYPICALLY AS (AS/AS). SHE IS B-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT INCLUDING HER CHANCE OF HAVING A CHILD THAT MAY BE GENOTYPICALLY SS. PATIENT THEN PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS AGAIN COUNSELED PRE-OP.

SPECIMEN FROM SURGERY
SPECIMEN FROM SURGERY



Date: 11/09/2010

RIGHT OVARIAN CYST

ADHESIONS DURING SURGERY



38 YEAR OLD FEMALE G2. P0 WHO PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 07/05/2010 WITH HISTORY OF RECURRENT UTERINE FIBROIDS AND DESIRE FOR SURGERY WITH CONSERVATION OF THE UTERUS FOR CONCEPTION . SHE HAS BEEN MARRIED FOR THREE YEARS. SHE UNDERWENT MYOMECTOMY PROCEDURE AT NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL NNEWI IN 2008 AND HAD AN APPENDECTOMY IN 1982. SHE ALSO GAVE A HISTORY OF HERBAL USE IN ATTEMPT TO TREAT HER FIBROID CONDITION. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT LEIOMYOMATA UTERINE WHICH WAS RELATIVELY IMMOBILE WITH DENSE PELVIC ADHESIONS. HER CERVICAL CANAL WAS COMPLETELY STENOSED. LABORATORY INVESTIGATIONS SHOWED HB 55%, GENOTYPE AA, BLOOD GROUP/RH B-POSITIVE, HIV –SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND A DESIRE TO GET PREGNANT. SHE WAS COUNSELED THAT HYSTERECTOMY WILL BE PERFORMED IF MYOMECTOMY ATTEMPT FAILS. PT WAS ALSO ADVISED TO PROVIDE 6 UNITS OF COMPATIBLE BLOOD FOR THE PROCEDURE.

SPECIMEN FROM SURGERY



Date: 23/09/2010

HSG

VOLUMETRICS



37 YEARS OLD MARRIED FEMALE GRAVIDA 2, PARA 0 , WHO PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 13/09/2010 AT ABUJA WITH HX OF INFERTILITY, FIBROIDS AND DESIRE FOR CONCEPTION. SHE HAS BEEN MARRIED FOR SEVEN YEARS AND HAS CHALLENGES WITH CONCEPTION. THERE IS ALSO MALE FACTOR INFERTILITY. PHYSICAL EXAMINATION AND TVS REVEALED UTERINE FIBROIDS. HSG REVEALED BILATERAL TUBAL BLOCKADE AND SIS/VOLUMETRIC UTERINE STUDY SHOWED A DISTORTED UTERINE CAVITY CAUSED BY A POSTERIOR-FUNDAL FIBROID . LABORATORY INVESTIGATIONS REVEALED HB OF 57%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA. SHE IS A-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT INCLUDING SURGERY. SHE THEN PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS AGAIN COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



Date: 30/09/2010

HSG

SIS

FIOIDSBR



40 YEARS OLD MARRIED FEMALE PARA 0 , WHO PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 06/12/2008 AT ABA WITH HX OF INFERTILITY AND DESIRE FOR CONCEPTION FOLLOWING EIGHT YEARS OF MARRIAGE. PHYSICAL EXAMINATION AND TVS REVEALED UTERINE FIBROIDS. HSG REVEALED ENLARGED ENDOMETRIAL CAVITY WITH DISTORTION CAUSED BY THE FIBROIDS. BOTH TUBES WERE FAINTLY OPACIFIED WITH CONTRAST DYE. AT THAT TIME, SHE WAS OFFERED SURGICAL REMOVAL BUT SHE WAS NOT READY. SHE NOW RETURNED WITH REQUEST FOR SURGERY. CURRENT INVESTIGATION INCLUDED VOLUMETRIC STUDY WHICH REVEALED A DISTORTED UTERINE CAVITY CAUSED BY A LARGE POSTERIOR-FUNDAL FIBROID . LABORATORY INVESTIGATIONS REVEALED HB OF 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA. SHE IS A-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. ECG WAS NORMAL. CXR WAS ALSO NORMAL. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT INCLUDING SURGERY. SHE THEN PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS AGAIN COUNSELED PRE-OP.

SPECIMEN FROM SURGERY



Date: 13/11/2010

VOLUMTRIC STUDY SHOWING ENDOMETRIAL LESION



38YR OLD MARRIED FEMALE, GRAVIDA 2, P0 WHO PRESENTED TO OUR FERTILITY CENTER FOR THE FIRST TIME ON 01/11/2010 WITH HX OF INFERTILITY FOLLOWING 11 YRS OF MARRIAGE. SHE HAD BEEN EVALUATED IN THE PAST WITH LAPAROSCOPY IN 2002 AND FOUND TO HAVE TUBAL BLOCKADE. SHE UNDERWENT TUBOPLASTY AND MYOMECTOMY. SHE HAD ATTEMPTED TWO PREVIOUS IVF PROCEDURES AT THE NATIONAL HOSPITAL, ABUJA BUT WAS UNSUCCESSFUL. SHE PRESENTED WITH REQUEST FOR ANOTHER IVF PROCEDURE. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS IN A UTERUS THAT WAS RELATIVELY IMMOBILE WITH PELVIC ADHESIONS . HSG REVEALED BILATERAL TUBAL PATHOLOGY. VOLUMETRIC STUDIES REVEALED RESTRICTED CAVITY AND ILL-DEFINED INTRA-CAVITARY LESION SUSPICIOUS FOR POLYP . LABORATORY INVESTIGATIONS REVEALED HB OF 70%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR B-POSITIVE. HIV SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY FOLLOWING COUNSELLING.

SPECIMEN FROM SURGERY



Date: 11/02/2011

TVS

CALCIFIED FIBROIDS

FIBROIDS AT SURGERY

30 YEARS OLD MARRIED FEMALE GRAVIDA 2, PARA 1 , WHO PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 22/01/2011 AT ABUJA WITH HX OF UTERINE FIBROIDS AND DESIRE FOR CONCEPTION. SHE HAS BEEN MARRIED SINCE 2008 AND HAD FULL TERM PREGNANCY AND VAGINAL DELIVERY OF A MALE CHILD IN 2009 WITHOUT COMPLICATIONS IN CANADA , NORTH AMERICA. SHE WAS TOLD SHE HAD FIBROIDS DURING HER DELIVERY. SHE BREASTFED HER CHILD FOR ONE YEAR AND NOW HAVING CHALLENGES WITH CONCEPTION. THERE IS NO MALE FACTOR INFERTILITY. PHYSICAL EXAMINATION AND TVS REVEALED UTERINE FIBROIDS THAT SHOWED CALCIFICATION AND FATTY DEGERATION. HSG REVEALED BILATERAL TUBAL PATENCY WITH POSSIBLE SPILLAGE. SIS/VOLUMETRIC UTERINE STUDY SHOWED A DISTORTED UTERINE CAVITY CAUSED BY AN ANTERIOR-FUNDAL FIBROID . LABORATORY INVESTIGATIONS REVEALED HB OF 60%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA. SHE IS A-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT INCLUDING SURGERY. SHE THEN PRESENTED WITH REQUEST FOR SURGERY. THE PATIENT WAS AGAIN COUNSELED PRE-OP.

SPECIMEN FROM SURGERY

Date : 15/04/2011

UTERUS AT SURGERY

SPECIMEN AT SURGERY



52 YEAR OLD FEMALE G3. P3 PRESENTED FOR EVALUATION AND MANAGEMENT OF ENLARGING UTERINE FIBROIDS . SHE WAS DIAGNOSED WITH FIBROIDS FOR THE PAST 24 YEARS, BUT SHE HAS NOTED PROGRESSIVE ENLARGEMENT IN RECENT TIMES AND NOW DESIRING SURGERY AFTER DUE CONSULTATIONS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED LEIOMYOMATA UTERINE REACHING THE UMBILICUS. PATIENT HAS NO SIGNIFICANT MEDICAL HX. HER FAMILY HX IS SIGNIFICANT FOR MOTHER WITH BREAST CANCER AND SISTER WITH OVARIAN CANCER. BLOOD WORK-UP REVEALED HB 57% INDICATIVE OF SIGNIFICANT ANEMIA, GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE, HIV –SCREENING WAS NEGATIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT WAS COUNSELED THAT HYSTERECTOMY WITH OOPHORECTOMY OF BOTH OVARIES WOULD BE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION AND FAMILY HISTORY. PATIENT , HOWEVER , AFTER DUE CONSULTATIONS, OPTED FOR SUPRACERVICAL HYSTERECTOMY WITH PRESERVATION OF BOTH OVARIES.



Date: 10/05/11

LARGE OVARIAN CYST

OVARIAN CYST AND FIBROIDS



      38 YEAR OLD MARRIED FEMALE GRAVIDA 1, PARA 0, WHO PRESENTED FIRST TO OUR FACILITY ON 07/02/2011 WITH HX OF 2 YEARS OF MARRIAGE WITHOUT PREGNANCY . SHE COMPLAINED OF PELVIC MASS AND EXPERIENCES SEVERE PELVIC PAINS. SHE PRESENTED WITH A DESIRE TO ACHIEVE PREGNANCY. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED IMMOBILE AND FIXED UTERUS WITH MULTIPLE UTERINE FIBROIDS AND LARGE PELVIC CYSTS SUSPICIOUS FOR ENDOMETRIOMA. BOTH OVARIES HARBOR MULTIPLE HEMORRHAGIC CYSTS. TVS FURTHER CONFIRMED MULTIPLE UTERINE FIBROIDS. HSG SHOWED OPACIFICATION OF BOTH TUBES WITH DISTAL PATHOLOGY. BLOOD WORK REVEALED HB 61%, GENOTYPE AA, BLOOD GROUP/RH 0-POSITIVE AND HIV SCREENING WAS–NEGATIVE. PATIENT WAS COUNSELED ON HER OPTIONS AND SHE OPTED FOR SURGERY.

SPECIMEN FROM SURGERY


Date: 15/05/2011

UTERINE FIBROIDS


40 YR.OLD FEMALE, NULLIGRAVIDA, WHO PRESENTED TO OUR FERTILITY CENTRE ON 12/05/11 WITH HX OF UTERINE FIBROIDS AND WITH REQUEST FOR SURGERY . PATIENT GIVES A HISTORY OF WEAKNESS, MODERATE PELVIC PAIN AND ENLARGING MULTIPLE UTERINE FIBROIDS. SHE DESIRES MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED ABDOMINAL MASS EXTENDING FROM THE PELVIS UP TO NEAR THE XIPHOID. VAGINAL EXAM REVEALED VIRGIN’S INTROITUS REQUIRING PEDIATRICS SPECULUM . SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED DISPLACED EXTERNALCERVICAL OS BY THE PELVIC MASSES. LABORATORY INVESTIGATIONS REVEALED ANEMIA (HB 46%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A+ BLOOD GROUP AND RHESUS FACTOR. PATIENT WAS COUNSELED THAT SHE WOULD NEED BLOOD TRANSFUSION PRIOR TO SURGERY AND DURING SURGERY.

SPECIMEN FROM SURGERY



Date: 09/06/2011

UTERINE FIBROIDS



36 YR. OLD MARRIED FEMALE, GRAVIDA 7, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 27/05/11 WITH HX OF UTERINE FIBROIDS AND WITH REQUEST FOR SURGERY . PATIENT GIVES A HISTORY OF 11YEARS OF MARRIAGE WITH SEVEN MISCARRIAGES AND NO VIABLE BABY. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS. SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED CERVICAL STENOSIS AND MINIMAL ENDOMETRIAL EXPANSION WITH IRREGULAR ENDOMETRIAL LINNING. LABORATORY INVESTIGATIONS REVEALED (HB 69%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT WAS COUNSELED OF HER OPTIONS OF MANAGEMENT THAT INCLUDED SURGERY . SHE REQUESTED MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY



Date: 07/08/2011

UTERINE FIBROIDS


45 YR. OLD FEMALE, GRAVIDA 3, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 05/08/2011 WITH HX OF UTERINE FIBROIDS AND REQUEST FOR SURGERY . PATIENT GIVES A HISTORY OF PELVIC PRESSURE AND URINARY SYMPTOMS OF THREE YEARS DURATION. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS. SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED CERVICAL STENOSIS AND MINIMAL ENDOMETRIAL EXPANSION WITH IRREGULAR ENDOMETRIAL LINNING. REVIEW OF HSG BROUGHT BY PATIENT REVEALED BILATERAL TUBAL BLOCKADE AND DISTORTED ENDOMETRIAL CAVITY. LABORATORY INVESTIGATIONS REVEALED (HB 70%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT WAS COUNSELED OF HER OPTIONS OF MANAGEMENT THAT INCLUDED SURGERY . SHE REQUESTED MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY



Date: 27/10/2011

RUPTURED LEFT ECTOPIC



A CROWD OF FULANI HERDSMEN AND WOMEN BROUGHT INTO THE HOSPITAL A MIDDLE AGED MARRIED FEMALE MULTIGRAVIDA WHO PRESENTED WITH HX OF SEVERE ABDOMINAL PAIN AND FAINTING SPELLS. SHE WAS UNSURE OF HER LAST MENSES. LANGUAGE WAS A BARRIER TO EFFECTIVE COMMUNICATION BUT SHE REQUIRED URGENT EVALUATION AND TREATMENT. SHE PRESENTED HERE WITH SEVERE LT ADNEXAL PAIN AND TVS REVEALED LT ADNEXAL MASS SUSPICIOUS FOR ECTOPIC PREGNANCY. LAB SHOWED PREGNANCY TEST POSITIVE, ANEMIA HB OF 40%. GENOTYPE AA, HIV NEGATIVE, O- POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT WAS COUNSELED THAT EXPLORATION WAS NECESSARY AND SHE CONSENTED FOR SURGERY.

SPECIMEN AT SURGERY
DR PROSPER WITH FULANI TRIBES MEN AT KARSHI

TWO FEMALE COWS GIVEN TO DR PROSPER IN GRATITUDE


Date: 23/11/2011

UTERINE FIBROIDS

42 YR. OLD FEMALE, GRAVIDA 1, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 16/11/2011 WITH HX OF INFERTILITY SINCE HER MARRIAGE IN 2005 . SHE GAVE A MEDICAL HX OF PEPTIC ULCER DISEASE MANAGED WITH TAGAMET AND GELUSIL MEDICATIONS. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS. FURTHER INVESTIGATIONS INCLUDED VOLUMETRIC STUDIES THAT REVEALED LARGE SUBMUCOUS FIBROID. HSG WAS ORDERED BUT WAS NOT DONE BY THE PATIENT. LABORATORY INVESTIGATIONS REVEALED (HB 74%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT THAT INCLUDED SURGERY . SHE REQUESTED FOR MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY


Date: 17/12/2011

UTERINE FIBROIDS WITH OMENTUM AND BOWEL ADHESIONS



45 YEARS OLD MARRIED FEMALE GRAVIDA 2, P1 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 19/12/2009 WITH HX OF RECURRENT UTERINE FIBROIDS. SHE HAS MENSTRUAL CYCLES OF 28-31 DAYS AND MODERATE FLOW. PAST HISTORY IS SIGNIFICANT FOR MYOMECTOMY AT SACRED HEART HOSPITAL, ABEOKUTA, OGUN STATE IN 1996. SHE HAD HER FIRST DELIVERY OF A FEMALE INFANT IN 2001 BY CESAREAN SECTION. SHE GAVE A HISTORY OF DIABETES SINCE 2007 AND MANAGED WITH GLUCOPHAGE AND DIANYL. SHE ALSO GAVE A HX OF HYPERTENSION. SHE DESIRED RE-EXPLORATION AND MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. SHE WAS LOST TO FOLLOW-UP UNTIL 29/11/2011 WHEN SHE PRESENTED AGAIN TO THE HOSPITAL WITH THE SAME REQUEST. ADDITIONAL HISTORY OBTAINED AS UPDATE INCLUDED A TRIP BY PATIENT TO INDIA WHERE SHE UNDERWENT A UTERINE ARTERY EMBOLIZATION PROCEDURE IN 2010 BUT THE FIBROIDS CONTINUED TO PERSIST. PHYSICAL EXAMINATION REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS WITH RESTRICTIVE MOBILITY INDICATIVE OF DENSE PELVIC ADHESIONS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED NARROWED AND RESTRICTIVE ENDOMETRIAL CAVITY AND A SUBMUCOUS FIBRIOD. LABORATORY INVESTIGATIONS REVEALED PRE-OP HB 59%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-NEGATIVE - BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND WAS THOROUGHLY COUNSELED PRE-OP ON HER OPTIONS INCLUDING HYSTERECTOMY WHICH SHE DID NOT CONSENT TO.

SPECIMEN FROM SURGERY



Date: 02/16/2012

UTERINE FIBROIDS


31 YR. OLD FEMALE, GRAVIDA 1, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 06/02/2012 AS A REFERAL FROM PRINCESS MARY SPECIALIST HOSPITAL, GWARIMPA, ABUJA. SHE CAME WITH HX OF UTERINE FIBROIDS AND BILATERAL TUBAL BLOCKADE AND REQUESTED FOR EVALUATION AND POSSIBLE IVF. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS. SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED CERVICAL STENOSIS AND MINIMAL ENDOMETRIAL EXPANSION WITH IRREGULAR ENDOMETRIAL LINNING. REVIEW OF HSG BROUGHT BY PATIENT REVEALED BILATERAL TUBAL BLOCKADE AND DISTORTED ENDOMETRIAL CAVITY. LABORATORY INVESTIGATIONS REVEALED (HB 62%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT WAS COUNSELED OF HER OPTIONS OF MANAGEMENT THAT INCLUDED SURGERY . SHE CONSNTED TO MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY



Date: 22/02/2012

UTERINE FIBROIDS WITH OMENTUM AND BOWEL ADHESIONS



42 YEARS OLD MARRIED FEMALE GRAVIDA 1, P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 25/02/2012 WITH HX OF RECURRENT UTERINE FIBROIDS AND DESIRE FOR CONCEPTION. SHE HAS MENSTRUAL CYCLES OF 24-26 DAYS AND MODERATE FLOW. PAST HISTORY IS SIGNIFICANT FOR MYOMECTOMY AT LAGOS IN 2009. SHE DESIRED RE-EXPLORATION AND MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY. PHYSICAL EXAMINATION REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS WITH RESTRICTIVE MOBILITY INDICATIVE OF DENSE PELVIC ADHESIONS. INVESTIGATIONS WITH SALINE INFUSION SONOGRAPHY REVEALED NARROWED AND RESTRICTIVE ENDOMETRIAL CAVITY. HSG REVEALED BILATERAL TUBAL BLOCKADE. LABORATORY INVESTIGATIONS REVEALED PRE-OP HB 70%, HIV SCREENING WAS NEGATIVE, HBSAG WAS NEGATIVE. SHE IS GENOTYPICALLY AS and O-POSITIVE- BLOOD GROUP AND RHESUS FACTOR. PATIENT PRESENTED WITH REQUEST FOR SURGERY AND WAS THOROUGHLY COUNSELED PRE-OP ON HER OPTIONS INCLUDING AUTO-TRANSFUSION. SHE DONATED ONE UNIT OF BLOOD FOR HER OWN SURGERY.

SPECIMEN FROM SURGERY



Date: 16/04/2012

UTERINE FIBROIDS



40 YR. OLD FEMALE, GRAVIDA 1, P1, WHO PRESENTED TO OUR FERTILITY CENTRE ON 13/04/2012 FROM PORT HARCOURT. SHE CAME WITH HX OF UTERINE FIBROIDS AND AND REQUESTED FOR EVALUATION AND POSSIBLE SURGERY. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS. SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED CERVICAL STENOSIS AND GOOD ENDOMETRIAL EXPANSION WITH IRREGULAR ENDOMETRIAL LINNING. LABORATORY INVESTIGATIONS REVEALED (HB 60%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. PATIENT WAS COUNSELED OF HER OPTIONS OF MANAGEMENT THAT INCLUDED SURGERY . SHE CONSENTED TO MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY



Date: 05/05/2012

UTERINE FIBROIDS



40 YR. OLD FEMALE, GRAVIDA 2, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 10/12/2011 WITH HX OF 15 YEARS OF MARRIAGE AND INABILITY TO HAVE A VIABLE PREGNANCY. SHE REQUESTED FOR EVALUATION AND MANAGEMENT. PAST HISTORY IS SIGNIFICANT FOR FAILED IVF TWO TIMES AND HISTORY OF AMENORRHEA OF THREE YEARS DURATION. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED UTERINE FIBROIDS, DECREASED OVARIAN VOLUME WITH FEW FOLLICLES AND BILATERAL BREAST NIPPLE DISCHARGE (GALLACTORRHEA). SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED CERVICAL STENOSIS AND GOOD ENDOMETRIAL EXPANSION WITH THE ANTERIOR FIBROID VERY CLOSE TO THE ENDOMETRIAL CAVITY. HORMONAL ASSAY REVEALED MILDLY ELEVATED FSH OF 10.6 AND HIGHLY ELEVATED OF 119. COUPLE WAS COUNSELED AND THEY REQUESTED FOR A TRIAL OF IVF. TWO ATTEMPTS OF IVF WERE CARRIED OUT AT OUR FACILITY WITH NO SUCCESS. SURGICAL REMOVAL OF THE UTERINE FIBROIDS WAS RECOMMENDED AND ACCEPTED BY THE COUPLE. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 64%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY WITH UTERINE CONSERVATION FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY



Date: 05/05/2012

LT OVARIAN ENDOMETRIOMA

SUBMUCOUS LESION



29 Y.OLD MARRIED FEMALE G0 P0 WHO FIRST PRESENTED TO OUR FERTILITY CENTRE ON 30/06/2011 WITH HX OF INFERTILITY .PATIENT HAS BEEN LIVING WITH HER HUSBAND SINCE THREE YEARS WITHOUT CONCEPTION . INVESTIGATIONS REVEALED LARGE RT OVARIAN CYST BY TVS AND SMALL UTERINE FIBROIDS WITH THE ENDOMETRIAL CAVITY SHOWING A LESION INSIDE IT. BIMANUAL PELVIC EXAM REVEALED A RESTRICTIVE UTERINE MOTION INDICATIVE OF PELVIC ADHESIONS. A LEFT ADNEXAL MASS WAS PALPATED. HSG REVEALED BILATERAL TUBAL BLOCKADE WITH HYDROSAPINGES. VOLUMETRIC STUDIES REVEALED SUBMUCOUS LESIONS WITH MODERATE ENDOMETRIAL EXPANSION. COUPLE WAS COUNSELED AND SURGICAL EXPLORATION WAS RECOMMENDED. THEY RETURNED ON 6/4/2012 WITH REQUEST FOR SURGERY. BLOOD WORK SHOWED HB OF 58%. GENOTYPE AA, BLOOD GROUP/RH O-POSITIVE AND HIV SCREENING WAS NEGATIVE.

SWOLLEN TUBES

SPECIMEN AT SURGERY



Date: 19/07/2012

FIBROIDS



36 YEARS OLD MARRIED FEMALE GRAVIDA 6, PARA 0 , WHO PRESENTED TO OUR FERTILITY CENTRE FOR THE FIRST TIME ON 08/06/2010 WITH HX OF INFERTILITY, FIBROIDS AND DESIRE FOR CONCEPTION. THERE IS ALSO MALE FACTOR INFERTILITY. PAST MEDICAL HISTORY REVEALED POORLY CONTROLLED HYPERTENSION. PHYSICAL EXAMINATION AND TVS REVEALED MULTIPLE UTERINE FIBROIDS. HSG REVEALED BILATERAL TUBAL BLOCKADE AND SIS/VOLUMETRIC UTERINE STUDY SHOWED A SMALL UTERINE CAVITY WITH A SEPTATE BAND ARISING FROM THE FUNDUS TO THE CERVIX. LABORATORY INVESTIGATIONS REVEALED HB OF 70%, HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and HER HUSBAND IS ALSO GENOTYPICALLY AS (AS/AS). SHE IS B-POSITIVE - BLOOD GROUP AND RHESUS FACTOR. THE PATIENT WAS COUNSELED ON HER OPTIONS OF MANAGEMENT INCLUDING SURGERY FOLLOWED WITH IVF. ON 9/8/2010, SHE UNDERWENT MYOMECTOMY AND EXCISION OF INTRA-UTERINE SEPTUM. FOLLOWING SURGERY, SHE ATTEMPTED IVF AND GOT PREGNANT BUT SHE HAD FIRST TRIMESTER MISCARRIAGE. A REPEAT TRIAL YIELDED THE CURRENT PREGNANCY. PRE-NATAL COURSE WAS COMPLICATED BY PERSISTENT HYPERTENSION, GENERALIZED EDEMA, ONSET OF COUGH AND DYSPNEA . FETUS WAS IN BREECH PRESENTATION. PATIENT WAS COUNSELED AT 37WEEKS GESTATION TO CONSIDER C/SECTION WHICH SHE CONSENTED TO.

BABY BOY - WEIGHT 3.8 KG



Date: 26/07/2012

42 YR. OLD FEMALE, GRAVIDA 1, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 24/07/2012 WITH HX OF FERTILITY CHALLENGES FOLLOWING FIVE YEARS OF MARRIAGE . SHE REQUESTED FOR EVALUATION AND MANAGEMENT. MEDICAL HISTORY IS SIGNIFICANT FOR HYPERTENSION. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS AND BILATERAL BREAST NIPPLE DISCHARGE (GALLACTORRHEA). SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED ABNORMAL BRIDGING OF THE ENDOMETRIAL CAVITY AND WITH THE ANTERIOR FIBROID VERY CLOSE TO THE ENDOMETRIAL CAVITY. COUPLE WAS COUNSELED AND SURGICAL REMOVAL OF THE UTERINE FIBROIDS WAS RECOMMENDED AND ACCEPTED BY THE COUPLE. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 62%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and B-NEGATIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY.

SPECIMEN FROM SURGERY



Date: 27/07/2012

UTERINE FIBROIDS



39 YR. OLD FEMALE, GRAVIDA 2, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 27/06/2012 WITH HX OF FERTILITY CHALLENGES FOLLOWING TWELVE YEARS OF MARRIAGE . SHE REQUESTED FOR EVALUATION AND MANAGEMENT. MEDICAL HISTORY IS SIGNIFICANT FOR FAILED IVF ATTEMPTS IN 2010 AND 2011 AT LAGOS. SHE ALSO GAVE A HISTORY OF LOCAL HERBAL PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS AND BILATERAL BREAST NIPPLE DISCHARGE (GALLACTORRHEA). SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED SEVERE SCARRING OF THE ECTOCERVIX AND POSTERIOR VAGINAL POUCH FROM INTRA-VAGINAL APPLICATION OF LOCAL HERBS. PATIENT WAS COUNSELED AND SURGICAL REMOVAL OF THE UTERINE FIBROIDS WAS RECOMMENDED AND ACCEPTED BY THE PATIENT. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 62%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and B-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY.

SPECIMEN FROM SURGERY



Date : 15/08/2012

UTERUS AT SURGERY

SPECIMEN AT SURGERY



43 YEAR OLD FEMALE G1. P0 PRESENTED TO OUR CENTRE ON 19/07/2012 FOR EVALUATION AND MANAGEMENT OF ENLARGING UTERINE FIBROIDS . SHE WAS DIAGNOSED WITH FIBROIDS FOR THE PAST THREE YEARS. SHE HAS NOTED PROGRESSIVE ENLARGEMENT IN RECENT TIMES AND HEAVY MENSTRUAL FLOW. SHE IS NOW DESIRING SURGERY AFTER DUE CONSULTATIONS. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED LARGE LEIOMYOMATA UTERINE REACHING ALMOST TO THE XIPHOID. PATIENT HAS NO SIGNIFICANT MEDICAL HX EXCEPT OBESITY. HER FAMILY HX IS SIGNIFICANT FOR FATHER WITH HYPERTENSION . BLOOD WORK-UP REVEALED HB 70%. GENOTYPE AS, BLOOD GROUP/RH B-POSITIVE. PATIENT PRESENTED WITH REQUEST FOR SURGERY. PT WAS COUNSELED THAT HYSTERECTOMY WITH PRESERVATION OF BOTH OVARIES WOULD BE THE PROCEDURE OF CHOICE FOR OPTIMAL OUTCOME OF HER CONDITION.



Date: 21/08/2012

SIS SHOWING SUBMUCOUS FIBROID

UTERINE FIBROIDS



45 YR. OLD FEMALE, GRAVIDA 2, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 09/07/2012 WITH HX OF FERTILITY CHALLENGES FOLLOWING THIRTEEN YEARS OF MARRIAGE . SHE REQUESTED FOR EVALUATION AND MANAGEMENT. MEDICAL HISTORY IS SIGNIFICANT FOR HYPERTENSION AND INCREASED BODY MASS INDEX. SHE FAILED IVF ATTEMPT IN 2008. SHE DID NOT COMPLETE HER CYCLE OF TREATMENT DUE TO POOR STIMULATION RESPONSE. HER SURGICAL HISTORY WAS ALSO SIGNIFICANT FOR LAPAROSCOPIC MYOMECTOMY AT SINGAPORE. SHE ALSO GAVE A HISTORY OF LOCAL HERBAL USE. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS THAT WERE RELATIVELY FIXED DUE TO PELVIC ADHESIONS. SPECULUM EXAM REVEALED SEVERE SCARRING OF THE ECTOCERVIX AND POSTERIOR VAGINAL POUCH. SALINE INFUSION SONOGRAPHY (SIS) REVEALED ENDOMETRIAL CAVITY WITH LESIONS SUSPICIOUS FOR SUBMUCOUS FIBROIDS. PATIENT WAS COUNSELED AND SURGICAL REMOVAL OF THE UTERINE FIBROIDS WAS RECOMMENDED AND ACCEPTED BY THE PATIENT. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 56%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY.

SPECIMEN FROM SURGERY



Date: 12/09/2012

UTERINE FIBROIDS

ENDOMETRRIUM WITH DYE



39 YR. OLD FEMALE, GRAVIDA 1, P1, WHO PRESENTED TO OUR FERTILITY CENTRE ON 23/08/2012 WITH HX OF FERTILITY CHALLENGES AND RECURRENT UTERINE FIBROIDS. SHE REQUESTED FOR EVALUATION AND MANAGEMENT. SURGICAL HISTORY IS SIGNIFICANT FOR MYOMECTOMY AT KADUNA IN 2008. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS THAT WERE RELATIVELY FIXED DUE TO PELVIC ADHESIONS. SALINE INFUSION SONOGRAPHY (SIS) WAS NOT DONE. PATIENT WAS COUNSELED AND SHE REQUESTED SURGICAL REMOVAL OF THE UTERINE FIBROIDS WITH UTERINE CONSERVATION FOR FUTURE PREGNANCY. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 65%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY.

SPECIMEN FROM SURGERY



Date: 13/09/2012

UTERINE FIBROIDS



37 YR. OLD FEMALE, GRAVIDA 4, P1, WHO PRESENTED TO OUR FERTILITY CENTRE ON 12/09/2012 WITH HX OF FERTILITY CHALLENGES AND SYMPTOMATIC UTERINE FIBROIDS. SHE REQUESTED FOR EVALUATION AND SURGICAL REMOVAL OF THE FIBROIDS. SHE HAS HISTORY OF HERBAL USE WITH NO RELIEF. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS THAT EXTENDED ALMOST TO THE XIPHOID PROCESS. SOME OF THE FIBROIDS WERE FELT ON THE POSTERIOR VAGINAL WALL. THE CERVIX WAS COMPLETELY EFFACED INTO THE FIBROID. SALINE INFUSION SONOGRAPHY (SIS) WAS NOT DONE. PATIENT WAS COUNSELED AND SHE REQUESTED SURGICAL REMOVAL OF THE UTERINE FIBROIDS WITH UTERINE CONSERVATION FOR FUTURE PREGNANCY. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED ANEMIA (HB 52%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A-NEGATIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY.

SPECIMEN FROM SURGERY



Date: 13/09/2012

UTERINE FIBROIDS



43 YR. OLD FEMALE, GRAVIDA 6, P1, WHO PRESENTED TO OUR FERTILITY CENTRE BY REFERRAL FROM DR. IGBANUGO ON 12/09/2012 WITH HX OF FERTILITY CHALLENGES AND UTERINE FIBROIDS. SHE REQUESTED FOR EVALUATION AND MANAGEMENT. PAST HISTORY IS SIGNIFICANT FOR SERIES OF MISCARIAGES FOLLOWING HER ONLY TERM AND DELIVERED PREGNANCY IN 2004 (GIRL). SHE HAS BEEN RECEIVING MEDICAL EVALUATION AND TREATMENT IN ZAMFARA STATE. PHYSICAL EXAMINATION AND INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS THAT WERE LOCATED AT FUNDAL POSTERIOR UTERUS. SALINE INFUSION SONOGRAPHY (SIS) REVEALED COMPRESSION OF THE ENDOMETRIAL CAVITY BY FIBROIDS. PATIENT WAS COUNSELED AND SHE REQUESTED SURGICAL REMOVAL OF THE UTERINE FIBROIDS WITH UTERINE CONSERVATION FOR FUTURE PREGNANCY. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 70%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AS and A-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY.

SPECIMEN FROM SURGERY



Date: 12/02/2013

43 YR. OLD FEMALE, GRAVIDA 3, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 14/01/2013 WITH HX OF FERTILITY CHALLENGES FOLLOWING 18 YEARS OF MARRIAGE . SHE REQUESTED FOR EVALUATION AND MANAGEMENT. PAST SURGICAL HISTORY IS SIGNIFICANT FOR MYOMECTOMY IN 2011 AT JOS. SHE HAS BEEN IN A STATE OF AMENORRHEA FOR ABOUT A YEAR NOW. SHE GAVE A HISTORY OF RECURRENT UTERINE FIBROIDS.
PHYSICAL EXAMINATION REVEALED MODERATELY OBESE WOMEN WITH SEVERE RESTRICTION AND MOBILITY OF HER BULKY UTERUS WITH MULTIPLE FIBROIDS. CLINICAL BREAST EXAMINATION REVEALED BILATERAL BREAST NIPPLE DISCHARGE (GALLACTORRHEA). INITIAL ULTRASOUND EVALUATION REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS.. SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED SEVERE SCARRING OF THE ECTOCERVIX AND SUBMUCOUS LESIONS SUGGESTIVE OF ENDOMETRIAL POLYPS.
PATIENT WAS COUNSELED AND SURGICAL REMOVAL OF THE UTERINE FIBROIDS WAS RECOMMENDED AND ACCEPTED BY THE PATIENT. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 67%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY.

SPECIMEN FROM SURGERY



Date: 15/02/2013

SUBMUCOUS FIBROID AT SIS



38 YR. OLD FEMALE, GRAVIDA 0, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 27/01/2013 WITH HX OF FERTILITY CHALLENGES FOLLOWING 5 YEARS OF MARRIAGE. SHE REQUESTED FOR EVALUATION AND MANAGEMENT. OVER THESE YEARS, SHE HAD NOT SEEN A SPECIALIST FOR HER EVALUATION AND CARE BUT RELIED ON PRAYERS AND SUBMITTED HERSELF TO THE WILL OF GOD.
PHYSICAL EXAMINATION REVEALED MODERATELY OBESE WOMAN WITH BULKY UTERUS WITH MULTIPLE FIBROIDS. CLINICAL BREAST EXAMINATION REVEALED NO BREAST NIPPLE DISCHARGE OR BREAST MASSES. INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS. SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED VERY LARGE SUBMUCOUS MASS SUGGESTIVE OF SUBMUCOUS FIBROID. HSG REVEALED BILATERAL TUBAL BLOCKADE WITH MULTIPLE UTERINE FIBROIDS.
PATIENT WAS COUNSELED AND SURGICAL REMOVAL OF THE UTERINE FIBROIDS WAS RECOMMENDED AND ACCEPTED BY THE PATIENT AFTER SEEKING SECOND OPINION FROM OTHER SPECIALISTS IN THE FIELD OF INFERTILITY. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 57%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and O-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY WITH PRESERVATION OF HER UTERUS FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY



Date: 02/03/2013

FIBROIDS AT SURGERY


46 YR. OLD FEMALE, GRAVIDA 0, P0, WHO PRESENTED TO OUR FERTILITY CENTRE ON 26/02/2013 THROUGH REFERAL FROM PHARMACIST AGBAI, WITH HX OF SYMPTOMATIC FIBROIDS WITH PELVIC PAIN, MENORRHAGIA AND SEVERE ANEMIA REQUIRING BLOOD TRANSFUSIONS. SHE REQUESTED FOR EVALUATION AND MANAGEMENT. SHE WAS DIAGNOSED WITH FIBROID CONDITION AT LAGOS IN 2008. PHYSICAL EXAMINATION REVEALED TALL LEAN WOMAN WITH BULKY UTERUS WITH MULTIPLE FIBROIDS. CLINICAL BREAST EXAMINATION REVEALED MINIMAL BREAST NIPPLE DISCHARGE BILATERALLY AND NO BREAST MASSES. INITIAL ULTRASOUND EVALUATION REVEALED MULTIPLE UTERINE FIBROIDS. SALINE INFUSION SONOGRAPHY INVESTIGATIONS REVEALED NO SUBMUCOUS MASS HSG WAS NOT PERFORMED BECAUSE OF PATIENT’S AGE. PATIENT WAS COUNSELED AND SURGICAL REMOVAL OF THE UTERINE FIBROIDS WAS RECOMMENDED AND ACCEPTED BY THE PATIENT. PRE-OPERATIVE LABORATORY INVESTIGATIONS REVEALED (HB 56%), HIV SCREENING WAS NEGATIVE. SHE IS GENOTYPICALLY AA and A-POSITIVE BLOOD GROUP AND RHESUS FACTOR. SHE CONSENTED TO MYOMECTOMY WITH PRESERVATION OF HER UTERUS FOR POSSIBLE FUTURE PREGNANCY.

SPECIMEN FROM SURGERY



Date:18/03/2013

UTERINE FIBRIODS and PERITONEAL MESH



39YR OLD MARRIED FEMALE, GRAVIDA 3, P0 WHO PRESENTED TO OUR FERTILITY CENTER FOR THE FIRST TIME ON 13/02/2013 WITH HX OF INFERTILITY FOLLOWING 2 YRS OF MARRIAGE. SHE HAD MYOMECTOMY WITH COMPLICATIONS IN 2006 AT ABA AND SHE UNDERWENT FACIAL RE-ENFORCEMENT WITH ANTERIOR ABDOMINAL MESH FOR WOUND DEHISCENCE AND INCISIONAL HERNIA. SHE GAVE A HISTORY OF TWO PREVIOUS MISCARRIAGES. PHYSICAL EXAMINATION AND INVESTIGATIONS REVEALED RECURRENT MULTIPLE UTERINE FIBROIDS AND RELATIVELY IMMOBILE WITH PELVIC ADHESIONS . HSG REVEALED BILATERAL TUBAL PATHOLOGY. SALINE INFUSION SONOGRAPHY (SIS) REVEALED RESTRICTED CAVITY AND ILL-DEFINED ENDOMETRIAL CAVITY WITH NO LESION. LABORATORY INVESTIGATIONS REVEALED HB OF 71%. GENOTYPE AA, BLOOD GROUP AND RHESUS FACTOR O-POSITIVE. HIV SCREENING WAS NEGATIVE. THE PATIENT AND HER HUSBAND WERE COUNSELED ON THEIR OPTIONS INCLUDING RE-EXPLORATION. PATIENT PRESENTED NOW WITH REQUEST FOR SURGERY.

SPECIMEN FROM SURGERY