The occurrence of uterine prolapse during pregnancy is rare. The aim of this report is to highlig... more The occurrence of uterine prolapse during pregnancy is rare. The aim of this report is to highlight uterine prolapse as a rare cause of obstructed labor and discuss its associated complications and management challenges. A 29-year-old gravida 5 parity 4 woman was presented with uterine prolapse, obstructed labor due to cervical dystocia and intrauterine fetal death. She was underwent emergency classical caesarean section and bilateral tubal ligation. The prolapse was managed conservatively with saline dressing. The patient was uneventful in postpartum period.
Journal of Algorithms & Computational Technology
The differential equations of pharmacokinetic models, obtained from the formulation based on the ... more The differential equations of pharmacokinetic models, obtained from the formulation based on the Fick's perfusion principle and law of conservation of mass action, deals with absorption, distribution, and elimination of drugs by the body systems. In the formulation, the ordinary differential equations obtained may result into highly stiff systems whereby suitable implicit methods have to be employed to solve accurately drug concentration in the body systems, owing to the complex nature of the exact solutions, if they exist. Further, because of the large and increasing interest in the problems of drug kinetics, it is necessary to apply considerably accurate implicit numerical methods in evaluating and in applying them to specific cases. These solutions are to help determine the distribution of drug concentration in different compartments (parts) of the human body network systems as a fundamental step to help in understanding and improving treatments. This is necessary since drug ...
Background: The emergence of long-term reversible contraceptives (LARC) has helped in reaffirming... more Background: The emergence of long-term reversible contraceptives (LARC) has helped in reaffirming the concept of Family Planning (FP) 2020. LARC is one of the safest and most effective methods covering both hormonal implants and intrauterine devices (IUDs). However, despite their acceptability and wide usage, they are associated with undesired effects limiting their use ranging from personal to device-related or both. Aim: This study is aimed at determining the reasons for the discontinuation of LARCs among women accessing FP services in Bauchi. Methods: The study was for 1-year period. It was a retrospective survey of 335 clients that presented to the FP unit of a tertiary institution in Northeastern Nigeria for removal of implants. Data were inputted into and analysed using SPSS version 21 and results presented in tables and charts. Results: A total of 1069 clients had one method of contraception or the other over the study periods. About 335 (31.3%) clients had removal of LARCs (...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
Background: IUCD remains a popular, effective and a long-term reversible method of contraception ... more Background: IUCD remains a popular, effective and a long-term reversible method of contraception that enjoys wide acceptability globally. One of the most serious complications of its insertion is uterine perforation and its migration into the pelvic/peritoneal cavity including the broad ligament. This rare complication can happen where the insertion was done by an inexperienced health personnel. Case Presentation: A case of a 41 year old multiparous woman who had Mirena intrauterine device insertion in the hands of an inexperienced health personnel, who later developed lower abdominal pain and migration of the Mirena IUD into the pelvic cavity (left broad ligament). The thread of the migrated IUD could not be visualized or felt at pelvic examination. An Abdominopelvic ultrasound scan showed a normal sized uterus with a rounded opacity in the lower uterine portion and also a faint posterior acoustic shadow outside the uterus above the uterine fundus. The myometrial echotexture was no...
Background The WHO in collaboration with the Nigeria Federal Ministry of Health, established a na... more Background The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Methods Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme. Findings Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58¢3%) had at least one pregnancy complication, out of which 6,618 women (8¢6%) met our criteria for potentially life-threatening complications, and 940 women (1¢2%) died. Leading causes of maternal death were eclampsia (n = 187,20¢6%), postpartum haemorrhage (PPH) (n = 103,11¢4%), and sepsis (n = 99,10¢8%). Antepartum hypoxia (n = 1455,31¢1%) and acute intrapartum events (n = 913,19¢6%) were the leading causes of perinatal
Summary Background Risk of mortality following surgery in patients across Africa is twice as high... more Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov, NCT03853824. Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.
Laparoscopy uses fiber optic endoscope passed through the abdominal wall to visualize the periton... more Laparoscopy uses fiber optic endoscope passed through the abdominal wall to visualize the peritoneal cavity for both diagnosis and therapy; it is also referred to as Minimal Access Surgery. It is an important tool in the evaluation of infertility. The objective of this study is to determine the value of laparoscopy for evaluation and treatment of infertility patients in Bauchi. North east, Nigeria. This is a retrospective cross-sectional study of women who had evaluation using laparoscopy. The case files and theatre records of all the women who had laparoscopy over a 5-year period between the 21st February, 2012 and 20th January, 2017 were retrieved and analyzed. Data on age, parity, type of infertility, intra operative findings and type of procedures done were extracted using a proforma. Analysis was done using statistical package for social sciences (SPSS version 21, IBM). One hundred and thirty-seven women had laparoscopy and or hysteroscopy during the review period, retrieval ra...
The surgical treatment of this benign tumor in women aged 40 years or more remains a challenge. 4... more The surgical treatment of this benign tumor in women aged 40 years or more remains a challenge. 4 In African countries where the prevalence of fibroids is higher, this is furthermore complicated by the fact that many patients also suffer from infertility and wish to preserve their uterus for further childbirth. 3,5 New advances in assisted reproductive techniques now permit women in the later reproductive years to bear a child if the uterus is still intact. This has brightened their fertility prospects, thereby giving them more reasons to choose myomectomy as an alternative to hysterectomy. Abdominal myomectomy for large uterine fibroids can be technically challenging, and it may be associated with the risks of hemorrhage, anemia, wound sepsis, pelvic adhesions and uterine rupture in subsequent pregnancies. 1,2 However, recent studies have shown that the morbidity of myomectomy and hysterectomy is comparable. 6 Newer
Background: Hysterosalpingography is a commonly performed examination due to recent advances and ... more Background: Hysterosalpingography is a commonly performed examination due to recent advances and improvement in reproductive medicine.It involves the radiographic delineation of female reproductive organs. The major role of Hysterosalpingography is to investigate the uterus and the fallopian tubes which is achieved following the introduction of contrast agent into the female reproductive system.
Background: Hysterosalpingography is a commonly performed examination due to recent advances and ... more Background: Hysterosalpingography is a commonly performed examination due to recent advances and improvement in reproductive medicine.It involves the radiographic delineation of female reproductive organs. The major role of Hysterosalpingography is to investigate the uterus and the fallopian tubes which is achieved following the introduction of contrast agent into the female reproductive system.
Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our envir... more Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1-6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. The mean age of the patients was 42.6±2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6±8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.
The occurrence of uterine prolapse during pregnancy is rare. The aim of this report is to highlig... more The occurrence of uterine prolapse during pregnancy is rare. The aim of this report is to highlight uterine prolapse as a rare cause of obstructed labor and discuss its associated complications and management challenges. A 29-year-old gravida 5 parity 4 woman was presented with uterine prolapse, obstructed labor due to cervical dystocia and intrauterine fetal death. She was underwent emergency classical caesarean section and bilateral tubal ligation. The prolapse was managed conservatively with saline dressing. The patient was uneventful in postpartum period.
Journal of Algorithms & Computational Technology
The differential equations of pharmacokinetic models, obtained from the formulation based on the ... more The differential equations of pharmacokinetic models, obtained from the formulation based on the Fick's perfusion principle and law of conservation of mass action, deals with absorption, distribution, and elimination of drugs by the body systems. In the formulation, the ordinary differential equations obtained may result into highly stiff systems whereby suitable implicit methods have to be employed to solve accurately drug concentration in the body systems, owing to the complex nature of the exact solutions, if they exist. Further, because of the large and increasing interest in the problems of drug kinetics, it is necessary to apply considerably accurate implicit numerical methods in evaluating and in applying them to specific cases. These solutions are to help determine the distribution of drug concentration in different compartments (parts) of the human body network systems as a fundamental step to help in understanding and improving treatments. This is necessary since drug ...
Background: The emergence of long-term reversible contraceptives (LARC) has helped in reaffirming... more Background: The emergence of long-term reversible contraceptives (LARC) has helped in reaffirming the concept of Family Planning (FP) 2020. LARC is one of the safest and most effective methods covering both hormonal implants and intrauterine devices (IUDs). However, despite their acceptability and wide usage, they are associated with undesired effects limiting their use ranging from personal to device-related or both. Aim: This study is aimed at determining the reasons for the discontinuation of LARCs among women accessing FP services in Bauchi. Methods: The study was for 1-year period. It was a retrospective survey of 335 clients that presented to the FP unit of a tertiary institution in Northeastern Nigeria for removal of implants. Data were inputted into and analysed using SPSS version 21 and results presented in tables and charts. Results: A total of 1069 clients had one method of contraception or the other over the study periods. About 335 (31.3%) clients had removal of LARCs (...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
Background: IUCD remains a popular, effective and a long-term reversible method of contraception ... more Background: IUCD remains a popular, effective and a long-term reversible method of contraception that enjoys wide acceptability globally. One of the most serious complications of its insertion is uterine perforation and its migration into the pelvic/peritoneal cavity including the broad ligament. This rare complication can happen where the insertion was done by an inexperienced health personnel. Case Presentation: A case of a 41 year old multiparous woman who had Mirena intrauterine device insertion in the hands of an inexperienced health personnel, who later developed lower abdominal pain and migration of the Mirena IUD into the pelvic cavity (left broad ligament). The thread of the migrated IUD could not be visualized or felt at pelvic examination. An Abdominopelvic ultrasound scan showed a normal sized uterus with a rounded opacity in the lower uterine portion and also a faint posterior acoustic shadow outside the uterus above the uterine fundus. The myometrial echotexture was no...
Background The WHO in collaboration with the Nigeria Federal Ministry of Health, established a na... more Background The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Methods Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme. Findings Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58¢3%) had at least one pregnancy complication, out of which 6,618 women (8¢6%) met our criteria for potentially life-threatening complications, and 940 women (1¢2%) died. Leading causes of maternal death were eclampsia (n = 187,20¢6%), postpartum haemorrhage (PPH) (n = 103,11¢4%), and sepsis (n = 99,10¢8%). Antepartum hypoxia (n = 1455,31¢1%) and acute intrapartum events (n = 913,19¢6%) were the leading causes of perinatal
Summary Background Risk of mortality following surgery in patients across Africa is twice as high... more Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov, NCT03853824. Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.
Laparoscopy uses fiber optic endoscope passed through the abdominal wall to visualize the periton... more Laparoscopy uses fiber optic endoscope passed through the abdominal wall to visualize the peritoneal cavity for both diagnosis and therapy; it is also referred to as Minimal Access Surgery. It is an important tool in the evaluation of infertility. The objective of this study is to determine the value of laparoscopy for evaluation and treatment of infertility patients in Bauchi. North east, Nigeria. This is a retrospective cross-sectional study of women who had evaluation using laparoscopy. The case files and theatre records of all the women who had laparoscopy over a 5-year period between the 21st February, 2012 and 20th January, 2017 were retrieved and analyzed. Data on age, parity, type of infertility, intra operative findings and type of procedures done were extracted using a proforma. Analysis was done using statistical package for social sciences (SPSS version 21, IBM). One hundred and thirty-seven women had laparoscopy and or hysteroscopy during the review period, retrieval ra...
The surgical treatment of this benign tumor in women aged 40 years or more remains a challenge. 4... more The surgical treatment of this benign tumor in women aged 40 years or more remains a challenge. 4 In African countries where the prevalence of fibroids is higher, this is furthermore complicated by the fact that many patients also suffer from infertility and wish to preserve their uterus for further childbirth. 3,5 New advances in assisted reproductive techniques now permit women in the later reproductive years to bear a child if the uterus is still intact. This has brightened their fertility prospects, thereby giving them more reasons to choose myomectomy as an alternative to hysterectomy. Abdominal myomectomy for large uterine fibroids can be technically challenging, and it may be associated with the risks of hemorrhage, anemia, wound sepsis, pelvic adhesions and uterine rupture in subsequent pregnancies. 1,2 However, recent studies have shown that the morbidity of myomectomy and hysterectomy is comparable. 6 Newer
Background: Hysterosalpingography is a commonly performed examination due to recent advances and ... more Background: Hysterosalpingography is a commonly performed examination due to recent advances and improvement in reproductive medicine.It involves the radiographic delineation of female reproductive organs. The major role of Hysterosalpingography is to investigate the uterus and the fallopian tubes which is achieved following the introduction of contrast agent into the female reproductive system.
Background: Hysterosalpingography is a commonly performed examination due to recent advances and ... more Background: Hysterosalpingography is a commonly performed examination due to recent advances and improvement in reproductive medicine.It involves the radiographic delineation of female reproductive organs. The major role of Hysterosalpingography is to investigate the uterus and the fallopian tubes which is achieved following the introduction of contrast agent into the female reproductive system.
Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our envir... more Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1-6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. The mean age of the patients was 42.6±2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6±8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.
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