Abdominal Fascial Closure in Obstetrics: Comparison of Outcome Between Layer and Mass Closure *

Background: Midline laparotomies are in common use in obstetrics for caesarean section and other obstetric laparotomies. Current challenges in this surgical approach include the best approach to the repair of the abdominal wall incision, the optimal suture material for its fascial repair and poor cosmetic outcome of the scar.Objective: The study was to compare the outcome of layer and mass closure for midline abdominal incisions following caesarean section.Methodology: A randomized prospective study was carried out at the Colliery Hospital Enugu between 2001 and 2006. One hundred and six consenting parturients were randomized into layer (52) and massclosure (54) groups. Outcome measures were defined and the patients followed up at six weeks, 6 months and in the next pregnancy. Statistical analysis utilized Chi-square test and p-value of less than 0.05 was regarded as significant.Results: The mean age of the parturients was 30.0 ± 5.1 years and the majority of parturients were multiparous (65%). The average duration of surgery was significantly shorter in mass closure than layer closure (43.1 vs 53.4 minutes; p <0.001). There was no statistically significant difference in the duration of hospitalization between the two groups. The incidence of wound sepsis was higher in the mass closure than layer group (5.5% vs 1.9%) but intra-abdominal and peritoneal adhesions were commonerin the layer group. The only case of incisional hernia (1.5cm) was in the mass closure group.Conclusion: Mass closure reduces operative time, exposure to anaesthesia and is cost effective. It is recommended as a relatively safe method of abdominal fascial closure in caesarean section. Key Words: Abdominal Fascia, Suturing, Layered Closure, Mass Closur

Caesarean Hysterectomy

BACKGROUND: Caesarean hysterectomy is an obstetric emergency procedure performed to save maternal life in uncontrollable haemorrhage and few elective indications. It could be a planned procedure but more often it is an emergency operation.OBJECTIVE: To ensure adequate exposure and mastery of this emergency procedure by residents in training in Obstetrics and Gynaecology in Nigeria.METHODS: Review of the pertinent literature, selected references, and internet services through Medline search on caesarean hysterectomy.RESULTS: The incidence for emergency caesarean hysterectomy is 0.01-0.05%. The maternal death rate associated with caesarean hysterectomy from all causes is 0.7% compared to 0.05% for all caesarean sections.     Porro's operation was a subtotal amputation but opinion now favours a total hysterectomy where practicable. Inexperienced surgeons may encounter identification of the lower margin of the cervix as limiting factor, for fully effaced and dilated cervix. Subtotal hysterectomy may therefore be the more prudent, safest and fastest option, but the potential problems of a residual cervical stump must always be borne in mind.CONCLUSION: Caesarean hysterectomy though a rare procedure is a life saving obstetric emergency. There is need for adequate exposure and mastery by the residents and a must for all obstetricians in their practice

Prevalence of Dysmenorrhea and its Contribution to School Absenteeism Among Nigerian Undergraduate Students

Background: Dysmenorrhea remains one of the common gynaecological conditions among women of reproductive age. With varying severity, it can be associated with morbidities that affect the quality of life. Among students, dysmenorrhea leads to school absenteeism which may ultimately affect school performance. Objectives: To determine the prevalence of dysmenorrhea among undergraduates as well as the incidence of school absenteeism in women with dysmenorrhea. Methods: A questionnaire-based cross-sectional study of 583 female university students was done using the multistage sampling method. Results: Four hundred and twenty-four respondents out of 516 had experienced dysmenorrhea giving a prevalence of 82.2%. On a visual analogue scale, 8.5% reported mild pain, 59.7% moderate and 31.8% severe. Two hundred and thirty-six (55.7%) could not carry out their routine chores because of the pain while 181 (42.7%) had been absent from school because of painful menses. School absenteeism was significantly associated with severe pain. Conclusion: This study has identified that dysmenorrhea is common among undergraduates. It is also associated with school absenteeism, especially in those that reported severe pain. Therefore, it has the potential to affect the academic performance of the affected students. It is recommended that university managements should provide basic care for dysmenorrheic students to improve their school attendance and ultimate performance

Trends of Myomectomy at the University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria

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Desire for prenatal gender disclosure among primigravidae in Enugu, Nigeria

Tochukwu C Okeke,1 Jamike O Enwereji,1 Onyemaechi S Okoro,1 Eric S Iferikigwe,1 Lawrence C Ikeako,2 Cyril C Ezenyeaku,2 Charles O Adiri1 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Anambra State University Teaching Hospital, Awka, Nigeria Background: Prenatal gender disclosure is a nonmedical fetal ultrasonography view, which is considered ethically unjustified but has continued to grow in demand due to pregnant women’s requests.Objective: The aim of this study was to determine the proportion of primigravidae who want prenatal gender disclosure and the reasons for it.Methods: This was a descriptive cross-sectional study of randomly selected primigravidae seen at Enugu Scan Centre. The women were randomly selected using a table of random numbers.Results: Ninety percent (225/250) of 250 primigravidae who fulfilled the criteria for inclusion in this study wanted to know the gender of their unborn baby, while 10% (25/250) declined gender disclosure. Furthermore, 62% (155/250) of primigravidae had preference for male children. There was statistically significant desire for male gender (P=0.0001). Statistically significant number of primigravidae who wanted gender disclosure did so to plan for the new baby (P=0.0001), and those that declined gender disclosure “leave it to the will of GOD” (P=0.014).Conclusion: Ninety percent of primigravidae wanted gender disclosure because of plans for the new baby, personal curiosity, partner and in-laws’ curiosity; moreover, some women wanted to test the accuracy of the findings at delivery and 62% of primigravidae had preference for male children. In view of these results, gender disclosure could be beneficial in this environment. Keywords: gender disclosure, prenatal ultrasonography, pregnant women, Enugu, Nigeri