Abayomi Ajayi1, Bamgboye M. Afolabi2, Victor Ajayi1, Ifeoluwa Oyetunji1, Oluwafunmilola Biobaku1,
Happiness Aikhuele1, Arati Sohoni1 and Oluseun O. Saanu1
ABSTRACT
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).
Research Article
Citation: Abayomi Ajayi, Bamgboye M. Afolabi, Victor Ajayi, et al. Ethno-Regional Variations in the Proportions and Frequencies of
Dilatation And Curettage, Open Myomectomy and Caesarean Section among Women With and Without Intra-Uterine Adhesion a Sub-
Saharan Setting. J Gynecol Reprod Med. 2017; 1-10.
J Gynecol Reprod Med, 2017 Volume 1 | Issue 2 | 2 of 10
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.