A giant hydronephrotic pelvic kidney mimicking an ovarian cyst in a 34-week pregnancy

Background: A giant hydronephrosis is defined as a dilated pelvi-calyceal system with an amount of urine exceeding one Litre in the urinary tract of an adult. It can mimic several other clinical conditions including a huge ovarian cyst. An ectopic pelvic kidney with hydronephrosis in pregnancy is a rare occurrence.Aim: This study documents a case of giant hydronephrosis that was wrongly diagnosed as an ovarian cyst. Findings: A 36-year old primiparous with a giant hydronephrosis which was initially diagnosed as an ovarian cyst. She was planned for a laparotomy with caesarean section and ovarian cystectomy at 34 weeks gestation. She was delivered of a live female neonate. Further exploration was done which revealed a left ectopic kidney. She had a left simple nephrectomy because the kidney appeared totally unhealthy.Conclusion: There is a need to be careful when dealing with cystic lesions of the abdomen. A high index of suspicion is required and further imaging other than ultrasound scan such as computerized tomography or magnetic resonance imaging may be necessary to make accurate diagnosis.Keywords: Caesarean section, ectopic gestation, hydronephrosis, urinary tract, cystectomy, ovarian cyst

Prevalence and Causes of Stillbirths at Lagos University Teaching Hospital, Lagos, Nigeria: A five year review

Objective: To determine the prevalence and pattern of stillbirths and identify the clinical causes.Study design: It was a retrospective descriptive study of all cases of stillbirth managed at Lagos University Teaching Hospital from January 1, 2012 to December 31, 2016. Only cases occurring at 28 weeks gestational age and above were included in this study. Information was retrieved from the Labour Ward register. These included the maternal age, parity, gestational age at delivery, type of stillbirth and pregnancy complications. Data collected was analyzed using SPSS version 20.Results: During the study period, total birth was 5,721 and total stillbirth reported was 377, making the prevalence of stillbirth 65.9 per 1000 births. Of the stillbirths reported, 35.9% were fresh stillbirths and 64.1% were macerated stillbirths. The commonest causes were hypertensive disorders in pregnancy (10.6%), ruptured uterus (8.5%), abruptio placentae (7.7%), obstructed labour (4.5%), maternal infection (4.0%) and congenital fetal anomaly (3.2%). Although fetal maceration was found to be commoner in the nulliparous women and in women within 26 – 35 years age group, no statistically significant association was found between type of stillbirth and parity (p = 0.3070), maternal age (p = 0.6332) and booking status (p = 0.2819).Conclusion: The commonest causes of stillbirths are to a great extent avoidable. Good antenatal care and delivery practice by skilled personnel, enforcing the use of partograph at primary and secondary health care centres, encouraging safe sex practice, and establishment of preconception care clinics will help lower prevalence of stillbirth in our environment. Key words: Stillbirths, prevalence, causes

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods: The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared. Results: Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p<0.001), more frequent signs of heart failure (pulmonary rales in 70.7% and 55.4%, p=0.002), higher baseline LVEF (32.7% and 30.7%, p=0.005) and smaller left ventricular end diastolic diameter (57.4mm [±6.7] and 59.8mm [±8.1], p<0.001). There were no differences in the frequencies of death from any cause, re-hospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF≥50%) (adjusted OR 2.08 95% CI 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted OR 2.84 95% CI 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Additional file 4 of Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018

Additional file 4: Supplemental results.1. README. 2. Prevalence range across districts. 3. Prevalence range between sexes. 4. Prevalence range between ages. 5. Age-specific district ranges