Abdominal Pregnancy in Usmanu Dan-Fodiyo University Teaching Hospital, Sokoto: A 10-year Review

Background: Abdominal pregnancy, a rare condition with high maternal mortality (up to 50%), and even higher perinatal mortality (40 – 95%), is often associated with diagnostic difficulties.Objectives: To determine the mode of presentation and management of abdominal pregnancy, from cases in the Usmanu Dan-Fodiyo University Teaching Hospital (UDUTH), Sokoto.Materials and Methods: A retrospective review of the case records of all abdominal pregnancies managed in UDUTH, Sokoto, between January 2000 and December 2010. Results: During the 10-year study period, there were eight cases of abdominal pregnancies, 285 extrauterine pregnancies, and 25,506 total deliveries. All the patients were not booked for antenatal care and their ages ranged between 20 and 39 years (mean=28.1±3.4 years). The majority (88%) were grand multipara. The main presenting symptoms were persistent abdominal pain, vaginal bleeding, and prolonged pregnancy. Seven cases (87.5%) were diagnosed accurately by an ultrasound scan. There were seven perinatal deaths (87.5%) and one live birth. There was one maternal death (12.5%), which occurred in the patient whose placenta was left in-situ.Conclusion: Presence of persistent lower abdominal pain, vaginal bleeding, and prolonged pregnancy should raise the suspicion of abdominal pregnancy. Removal of the placenta, where feasible, improves the outcome of maternal health.Keywords: Ectopic pregnancy, Africa, diagnostic difficulties, maternal mortalit

Vesicovaginal fistula: Do the patients know the cause?

Background : So much has been written on vesicovaginal fistula (VVF) but there is little on the patients\u2032 perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fistula and their attitude toward measures that would prevent future occurrence. Methods : The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling. Results : One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-five (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confirmed that pre and post-operative counseling were inadequate. Conclusion : Even though majority (70%) of the patients knew the cause of their fistula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fistula in order to prevent a recurrence

Abdominal Pregnancy With a Full Term Live Fetus: Case Report

This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.Ce cas clinique se rapporte \ue0 une grosses abdominale qui s'est d\ue9roul\ue9e jusqu'\ue0 terme avec un f\ue9tus vivant. L'ignorance, la pauvret\ue9 et l'absence de consultation pr\ue9natale ont abouti \ue0 une consultation tardive. Un saignement par voie vaginale, une douleur abdominale persistante, une perte de poids et une p\ue2leur \ue9taient les \ue9l\ue9ments caract\ue9ristiques au plan clinique. Elle a b\ue9n\ue9fici\ue9 d'une laparotomie avec accouchement d'un f\u153tus vivant

Predictors of extra care among magnesium sulphate treated eclamptic patients at Muhimbili National Hospital, Tanzania

\ud The inclusion of Magnesium Sulphate (MgSO4) as a gold standard in the treatment of eclampsia has substantially reduced incidences of repeated fits, eclamptic morbidity and deaths. However, despite treatment with MgSO4, a proportion of patients need extra medical/nursing attention and prolonged stay in the intensive care unit (ICU). The literature on the underlying factors for the need of extra care in the MgSO4 era is lacking. This study sought to establish predictors of extra care in ICU among eclamptic patients after treatment with MgSO4 at Muhimbili National Hospital (MNH). Data were obtained from hospital records of eclamptic patients who were admitted at MNH and treated with MgSO4 from January 1st to December 31st, 2008. Based on set criteria, patients who needed extra care were identified. Analysis was performed using PASW statistics 18 whereby frequencies, cross-tabulations, bivariate and multiple logistic regressions were performed. A total of 366 eclamptic patients were admitted and treated with MgSO4 at MNH during a 12 month study period in 2008. Most of these (76%) were referred from district hospitals and 132 (36%) met the criteria for extra care in ICU. After adjusting for other variables, the risk of extra care in ICU for patients who were admitted with altered consciousness was double (OR = 2.3; 95% CI: 1.3-4.0) that of the ones admitted in alert state. The risk or need of extra care increased by increasing time to delivery and was doubled (OR = 2.0; 95% CI:1.1-3.7) if it was between 12 and 24 hours and tenfold elevated (OR = 10.0; 95% CI:4.3-23.6) if beyond 24 hours as compared to when time to delivery was less than 12 hours.Abdominal delivery was also independently associated with increased risk compared to vaginal delivery (OR = 2.5; 95%CI: 1.4-4.5). The type of referral and number of fits were associated with extra care in ICU but this association was wholly explained by the clinical status of the patient on admission to MNH and prolonged time lag to delivery. We concluded that even with MgSO4 used as the gold standard in the treatment of eclampsia, effective pre-referral care and expedited delivery were crucial in minimizing the need for extra care in ICU.\u

Age at menarche and the menstrual pattern of secondary school adolescents in northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Population studies on normal and dysfunctional characteristics of menstrual cycles are scarce in Ethiopia. In addition variability in menarcheal age and menstrual characteristics are common. Knowledge on this variability is necessary for patient education and to guide clinical evaluation.</p> <p>Methods</p> <p>A cross sectional study was conducted in two small towns called Dabat and Kola Diba, northwest Ethiopia between April and May 2007. Systematic sampling method was used to select 622 school girls from two secondary schools. A pretested questionnaire prepared in Amharic was used to gather data. Selected girls cooperated in answering the questionnaire in their classrooms under the supervision of the research team. Only 612 of the adolescent females were included in the final analysis, of which 305 were from Koladiba High School and 307 from Dabat.</p> <p>Results</p> <p>The age of the study subjects ranges between 14 and 19 with a mean (standard deviation) of 16.9 ± 1 years. About 92.2% had attained menarche by the time the survey was conducted. The probit analysis of the <it>status quo </it>data yielded a median (CI) age at menarche of 14.8 (13.9-15.3) years. The average age at menarche by recall method was 15.8 ± 1 years. The mean age at menarche was 0.3 years younger for urban females compared with rural ones (p < 0.001). A cycle length between 21 and 35 days was observed in 70.3% of the girls. The mean duration of flow was 4 ± 1.3 days with a range of 2-7 days. The menstrual cycles were irregular in 42.8% of the subjects. The overall prevalence of dysmenorrhoea was 72% among these subjects. Premenstrual symptoms were present in 435 of the females (75.4%). The leading sources of menarcheal information to the adolescents were mothers (39.7%), followed by their friends (26.6%) and teachers (21.8%).</p> <p>Conclusion</p> <p>In this study age of menarche was found to be delayed which is even higher than the findings indicated similar studies conducted in Ethiopia and other African countries. A significant number of students complain of abnormal menstrual cycle, dysmenorrhoea and premenstrual symptoms which call for appropriate counselling and management.</p

Prevalence and Outcome of Increased Nuchal Translucency in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria: A Cohort Study

Background: An important component of the first‑trimester scan is nuchal translucency thickness at 11 weeks to 13 weeks 6 days of gestation. A nuchal translucency ≥3.3 mm is a significant early pregnancy scan finding associated with Trisomies 13, 18, and 21 and congenital heart diseases. Aims: To determine the prevalence and outcome of increased fetal nuchal translucency among pregnant women. Subjects and Methods: A prospective cohort study at the Obstetrics and Gynaecology Department of Usmanu Danfodiyo University Teaching Hospital Sokoto. This was a prospective study of 265 consecutively recruited women in the first trimester of pregnancy who presented to antenatal clinics over a 20‑week period. An NT scan was conducted at 11 weeks to 13 weeks 6 days followed by an anomaly scan at 18–22 weeks. Patients were followed up to delivery and 6‑week post‑partum. The neonates were examined at delivery and at 6‑week postnatal life. Data entry and analysis was done with IBM SPSS version 20. The level of significance was set at less than 0.05. Frequency distribution; student t‑test and Chi‑squared test. Results: The 95th percentile NT was 3.3 mm and the prevalence of increased&nbsp; NT above 3.3 mm was 3%. The mean maternal age of the participants was28.1 ± 5.1 years and the modal parity was Para 0. The most common anomalies associated with increased NT were ventricular septal defect and spina bifida. A congenital anomaly was significantly associated with increased NT (P &lt;0.001). Conclusions: The prevalence of increased fetal nuchal translucency is relatively high in our environment and is associated with congenital fetal defects. Routine screening with first‑trimester ultrasound will help detect congenital anomalies early

Vesicovaginal fistula: Do the patients know the cause?

Background : So much has been written on vesicovaginal fistula (VVF) but there is little on the patients′ perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fistula and their attitude toward measures that would prevent future occurrence. Methods : The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling. Results : One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-five (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confirmed that pre and post-operative counseling were inadequate. Conclusion : Even though majority (70%) of the patients knew the cause of their fistula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fistula in order to prevent a recurrence

Pregnancy outcome in women involved in road traffic accidents in Sokoto

Background: Road traffic accidents (RTA) are common in Nigeria. Pregnant mothers could be involved in such accidents and this might affect pregnancy outcome. Method: A retrospective analysis of pregnant mothers admitted at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria because of road traffic accidents between January 1998 and December, 2002, was undertaken to determine the incidence, type of injury and pregnancy outcome. Results: One hundred and forty nine women admitted because of major injuries sustained after road traffic accidents. Twelve (8%) of these women were pregnant at the time of the accident. Gestational age ranged from 16 to 38 weeks. Fall from commercial motorcycles was the most common accident with deep lacerations and long bone fractures. Obstetric complication included abruptio placentae and premature uterine contractions. There was normal delivery in 9 patients, 2 stillbirths and one moth with head injury died undelivered. Conclusion: Early consult with appropriate obstetric intervention was associated with good foetal and maternal outcome. The emergency duty doctor should always think of the possibility of a co-existing pregnancy whenever managing any woman within the reproductive age group involved in RTAs