Gynecology & Reproductive Medicine


Ethno-Regional Variations in the Proportions and Frequencies of Dilatation And Curettage, Open Myomectomy and Caesarean Section

Abayomi Ajayi, Bamgboye M. Afolabi, Victor Ajayi, Ifeoluwa Oyetunji, Oluwafunmilola Biobaku, Happiness Aikhuele, Arati Sohoni and Oluseun O. Saanu

Background: Intrauterine adhesion (IUA) occurs when trauma to the endometrial lining triggers the normal wound-healing process, which causes the damaged areas to fuse together. Termination of pregnancies, miscarriages and other gynecological operations are likely risk factors for IUA.

Materials and Methods: This was a retrospective study of 902 Nigerian women who patronized Nordica Fertility Center for fertility evaluation. Hysteroscopy was used to assess uterine abnormalities. The information extracted from the patients’ medical records included age, body mass index, ethnic group, parity, performance, type and number of uterine surgeries. Ethnic grouping was cross-tabulated against other variables using STATA-13. Chisquare and t-test, were used to determine statistical differences in means and proportions and Linear regression analysis was used to ascertain correlations between variables. A P-value of <0.05 was considered significant. 

Results: The mean (±sd) age (years) of the 902 surveyed was 38.7 (6.1) with no significant difference among women from Southwest and south-south (38.8 ± 6.2 respectively), Southeast (38.4 ± 5.9) and the North (37.4 ± 5.1). Majority (478, 52.8%) of the women were from the Southwest, the region that also produced the highest proportion of professional occupation (217, 45.4%). Overall mean (±sd) Body Mass Index was 27.8 (4.9) with women from the North slightly heavier (28.5 ± 4.4) than others. The highest proportion (85.2%) of nulliparous women were from the North. Majority (51.0%) of the women with IUA were from Southwest and only 3.0% were from the North of the country. Among women with IUA, those from the North had the highest mean number of Dilatation and Curettage (3.29 ± 1.60), those from the Southeast had the highest mean number of Open myomectomy (1.19 ± 0.47) and those from the Southwest the highest mean number of Caesarean section (1.50 ± 0.53) performed. Also, among women with IUA, the ratio of D&C per woman was highest in the North (2.9:1), while that of Open myomectomy per woman was highest in both Southeast (0.66:1) and South-south (0.66:1). The ratio of Caesarean section per woman was highest in South-south (0.34:1). The strongest positively significant correlation between performance of uterine surgery and ethnicity was found with Caesarean section (r=0.58, Std. Err.=0.014, t=39.74, P-value<0.00001, 95% CI: 0.56, 0.61). The strongest positively significant correlation between quantity of uterine surgery performed and ethnicity was found with Dilatation and Curettage (r=0.43, Std. Err.=0.022, t=19.65, P-value<0.00001, 95% CI: 0.39, 0.47). 

Conclusion: Data from this study shows some significant ethno-regional differences in the performance and quantity of uterine surgeries/procedures in different regions of Nigeria. Frequent training of medical doctors and other health workers in correct diagnosis, application of modern gynecological instrumentation and proper management of patients could reduce unnecessary uterine interventions and the attendant morbidity of intrauterine adhesions.