Management outcome of ruptured ectopic pregnancy at a secondary level of health care delivery in south-west, Nigeria

Background:  Ectopic pregnancy is a condition of high morbidity and mortality with an enormous threat to life. Therefore it is of immensegynaecological importance, particularly in the developing world, where the majority of patients present late with rupture and haemodynamic instability.Objectives: The objectives of this study were to determine the incidence and analyze the clinical presentations, risk factors, sites of ectopic pregnancy and associated morbidity and mortality.Methods: This was a retrospective review of records of patients managed as cases of ruptured ectopic pregnancy at Our Lady of Apostle (O.L.A)Catholic Hospital, Ibadan over a six-year period between January 1st 2010 and December 31st 2015.Results: The incidence of ectopic pregnancy was 1.03% (65/6,342) of total deliveries, 2.9% (65/2280) of all gynaecological admissions and 13.5% (65/480) of gynaecological emergencies. Fifty-four case folders were analyzed. The leading symptom was pain 87.3% (47/54), followed by  amenorrhea 60.0% (32/54), while syncope attack and vaginal bleeding had 50.0% (27/54) and 36.4% (19/54) respectively. Pelvic infection was the leading risk factor of57.4% (31/54) of the study population, followed by induced abortion 36.4% (19/54). Two patients had previous ectopic pregnancy; hence the recurrent rate was 3.7%. Tubal pregnancy accounted for 85% (46/54) while the abdominaland cornual gestation accounted for 2% (1/54) and 13% (7/54) respectively. All patients with tubal pregnancy had salpingectomy while those with cornual pregnancy had wedged resection. The diagnosis was missed in 18.2% (10/54) of patients. There was no record of maternal death.Conclusion: The fact that all cases were ruptured and that pelvic infection and induced abortion were the major risk factors, efforts should be made to improve on early detection of ectopic pregnancy before rupture and prevent pelvic infection and induced abortion among the women of  reproductive age. Keywords: Ruptured ectopic pregnancy, secondary healthcare delivery, management outcome

Effects of a 12-week endurance exercise program on adiposity and flexibility of Nigerian perimenopausal and postmenopausal women

Summary: Menopause is a sign of aging in the woman. Loss of ovarian function induces a reduction in resting metabolic rate, physical energy expenditure, fat-free mass and abdominal adipose tissue accumulation. Location of adipose tissue deposit in abdominal region plays an important role in occurrence of hyperlipidemia, diabetes, hypertension and atherosclerosis. Although regular participation in physical exercise have been suggested to improve adiposity and body flexibility which are important health related components of physical fitness, few published studies are available on the effect of exercise on Nigerian menopausal women. This study investigated effects of a twelve-week endurance exercise program (EEP) on central and abdominal obesity as well as flexibility of perimenopausal and postmenopausal Nigerian women. The study employed a pretest- posttest control group design comprising a sample of 175 apparently healthy, literate, sedentary women within age range 40-59 years. They were workers in state and federal establishments in Ibadan North Local Government Area of Oyo State, Nigeria. Based on history of their last menstrual period, women with regular or irregular menstrual cycle status were allocated into perimenopausal group and those who no longer menstruated into postmenopausal group. A table of random numbers was used for further allocation into perimenopausal exercise group (PEMEG, 45), postmenopausal exercise group (POMEG, 45) perimenopausal control group (PEMCG, 42) and postmenopausal control group (POMCG, 43). Waist Hip Ratio (WHR), Body Mass Index (BMI) as well as Hip and Trunk Flexibility (HTF) were evaluated at baseline and 4weekly intervals until end of 12th week. EEP consisted of a 10-station circuit of cardiovascular endurance, flexibility, coordination, abdominal and pelvic floor muscle exercises. Data were analyzed using descriptive and inferential statistics. Mean age of participants was 52.3± 4.1 years, 95% C.I (51.64-52.88) years. Significant reduction occurred between baseline and end of 12th week mean values of WHR in PEMEG (0.86 ± 0.08 vs 0.71 ± 0.07)and POMEG groups (0.88± 0.06 vs0.77 ± 0.07)p<0.05 while significant increases were observed between baseline values and end of 12th week mean values of HTF in PEMEG (18.84 ± 4.23vs28.27± 3.82) and POMEG (19.51 ± 4.02vs25.97± 2.36) (p<0.05). Significant changes did not occur in BMI in both groups even though mean differences were observed in baseline values compared with end of 12th week mean values of these variables. In PEMCG and POMCG groups, there were no observable changes in mean values of WHR, BMI and HTF from baseline to end of study. Participation in endurance exercise program is essential for perimenopausal and postmenopausal Nigerian women for improved central and abdominal adiposity as well as flexibility

Hearing loss following spinal anaesthesia among obstetric patients at the University College Hospital Ibadan

Background: Sensorineural hearing loss (SNHL) is a rarely reported complication of subarachnoid block and may go unnoticed unless audiometric test is performed.Objective: The aim of this study was to determine the prevalence of sensorineural hearing loss following spinal anaesthesia in obstetric patients.Patients and Methods: Seventy patients of ASAphysical status classes I and II scheduled for elective Caesarean section were randomized into two groups (A&amp; B). Lumbar puncture was performed using 25 gaugepencil point spinal needle type in group Aand 25 gauge Quincke cutting tip type in group B. Spinal anaesthesia was achieved in both groups with 12.5mg (2.5ml) of 0.5% hyperbaric bupivacaine subarachnoid injection in the sitting position. Each patient had a preoperative pure tone audiometry (PTA) test done before spinal anaesthesia as a baseline; this was repeated on the first and third days after the surgery for each patient.Results: Twelve (34.3%) patients in group Aand 24 (68.6%) in group B had more than one attempt at lumbar puncture; and 5[1 (2.9%) from group Aand 4 from group B (11.4%)] developed Post Dural Puncture Headache(PDPH), p= 0.36. Of the 4 patients in group B who developed PDPH, 2 had associated transient sensorineural hearing loss.Conclusion: This study shows that spinal anaesthesia may lead to transient hearing loss among few obstetric patients without long term sequelae. Use of Quincke spinal needle type was more likely to cause PDPH and transient hearing loss.Keywords: Caesarean section, Spinal anaesthesia, Hearing loss, Spinal needle

Non-enzymatic antioxidant status of women using four different methods of contraception.

ArticleObjective: To investigate antioxidant status of women on four different methods of contraception. Methodology: Sixty non-pregnant women aged 16-45 years on oral contraceptive pills, injectables, Norplant and intra-uterine contraceptive devices (IUD) attending the Family Planning Clinics of the University College Hospital (UCH) and Adeoyo Maternity Hospital, Ibadan were recruited for the study. Fifty-eight apparently healthy women aged 16-45 years who were not on any contraceptive served as a control group. The body mass index (BMI) of all participants (subjects and controls) was determined following standard protocol. Serum levels of ascorbic acid, tocopherol, malondialdehyde, bilirubin, creatinine, uric acid, total protein and albumin were determined using standard spectrophotometric methods. Progesterone was estimated by the chemilumiscence method while selenium was determined by atomic absorption spectrophotometry (AAS). Results: The BMI was significant in women on oral contraceptive pills (OCP) when compared to the control group (P<0.05) but insignificant (P>0.05) in intra-uterine device (IUD), injectables and Norplant users. The mean serum ascorbic acid (P<0.01), tocopherol (P<0.05), total protein (P<0.01), albumin (P<0.05), uric acid (P<0.05), selenium (P<0.01) of women on OCP were significantly lower when compared to the control group but insignificant (P>0.05) in users of other contraceptive methods. Serum levels of malondialdehyde was significantly elevated in women on OCP (P<0.01) than in control group and insignificant P>0.05) in users of other contraceptive methods. There was no significant association between progesterone and antioxidants in women on OCP, IUD, injectables and Norplant. Conclusion: Oral contraceptive pills showed a significant decreasing effect on the antioxidant status of its users while IUD, injectables and Norplant did not indicate any significant effect. Routine monitoring of the antioxidant status of women on different methods of contraceptive particularly those on OCP is recommended