Non-puerperal uterine inversion due to huge submucosal uterine myoma: a case report

Uterine inversion is a rare clinical entity with challenging diagnosis and management. Reports of successfully managed cases contribute to knowledge and aid future management of cases among practitioners. We report a case of a 46 year old para-3 with protrusion of a mass from her vagina and vaginal bleeding of 7 days duration. She was managed as a case of chronic uterine inversion. She was resuscitated and had vaginal myomectomy, Haultin’s procedure and subsequently total abdominal hysterectomy due to ischaemic necrosis of parts of the uterus.

Serum uric acid as a prognostic marker for preeclampsia at a tertiary hospital in Port Harcourt, Nigeria

Background: Preeclampsia is a recognized cause of maternal and perinatal morbidity and mortality. Some biomarkers such as uric acid are increased in the presence of the disease. This could serve as a marker of severity and provide a basis for making management decisions. This study sought to determine the association between elevated serum uric acid and adverse pregnancy outcomes in preeclampsia.Methods: A prospective case-control study was carried out on consenting preeclamptic (95) and normotensive (95) pregnant women in their third trimester of pregnancy. Blood samples were taken for serum uric acid estimation at recruitment and delivery. Their Socio-demographic information was collected through a structured proforma. Data were analyzed using Statistical package for social sciences (SPSS) version 23. A p<0.05 was considered statistically significant.Results: The mean serum uric acid level was higher in the preeclamptic than in the normotensive controls (400.0±105.27 versus 256.31±67.18; p=0.001). High serum uric acid levels were associated with a higher incidence of AKI (p=0.005), birth asphyxia (p=0.002), and low birth weight (p=0.006) compared to preeclamptics with normal uric acid levels. The sensitivity of high uric acid in predicting the outcomes was 78-81% while the specificity was 48%. Serum uric acid ≥334 µmol/l was the threshold for predicting adverse outcomes.Conclusions: Women with preeclampsia had significantly higher serum uric acid levels. Hyperuricaemia in preeclampsia was associated with a high incidence of acute kidney injury, Birth asphyxia, and low birth weight. Serum uric acid ≥334 µmol/l was the threshold for the prediction of adverse outcomes.

Prevalence, associated factors, and outcomes of singleton preterm births at a Tertiary Hospital in Port-Harcourt, Nigeria

Background: Preterm birth poses an important management challenge and is a major public health problem associated with a higher perinatal morbidity and mortality. Although the rates of preterm birth are reportedly high in sub-Saharan Africa, there are little available data on factors associated with preterm birth in this sub-region. Aim: To determine the prevalence, associated factors, and outcomes of preterm births in a tertiary care centre in Nigeria. Materials and Methods: A retrospective case–control study of preterm births, in a two-year period between January 2020 and December 2021, was conducted at the Rivers State university teaching hospital. An unmatched control group of term births was used for comparison. Data were retrieved from the hospital records of all the participants using a structured pro forma. Data were analysed using IBM SPSS version 23 and the significance was set at P < 0.05. Results: Of 3476 singleton birth, 258 (7.4%) were preterm births. Six patients had incomplete data and were excluded from further analysis. Majority, 167 (66.3%), were moderate preterm, gestational age (GA) 32–35. The mean GA at birth was 32.02 ± 2.26 weeks. Majority were aged 31–40 years and parity of 2–4. Stillbirths were 71/252 (28.2%) and 19/101 (18.8%) admitted to the neonatal intensive care unit (NICU) suffered early neonatal death. Preterm birth was more likely in unbooked women, those who developed pregnancy-induced hypertension/eclampsia and following prelabour rupture of membranes (PROM). Babies <32 weeks were more likely delivered by spontaneous vaginal delivery and suffered birth asphyxia. Conclusion: The preterm birth prevalence among singleton gestation was 7.4% and remains a significant factor for perinatal death. Hypertensive disorders of pregnancy, PROM, and lack of antenatal care were identified as risk factors

Evaluation of blood transfusion practice in obstetrics and gynaecology at a tertiary hospital in Port Harcourt, Nigeria

Background: Blood transfusion is an important part of patient management in obstetrics and gynaecology. There is a need to periodically assess blood transfusion practices in order to identify areas for improvement. Objectives: This study aimed to determine the rate of blood transfusion, indications, local use pattern, and variability of blood type transfused. Patients, Materials and Methods: A prospective observational study over six months was conducted at the Rivers State University Teaching Hospital. Obstetric patients in the peripartum period and gynaecological admissions who underwent blood transfusion were included. The patients' characteristics, blood type, pretransfusion packed cell volume (PCV), indication for transfusion, blood product used, number of pints, and donor group were recorded. Analysis was performed using SPSS version 23, and statistical significance was set at P < 0.05. Results: Overall, 84 out of 1000 patients were transfused, giving a rate of 8.4%, 7.4% in obstetric patients, and 13% in gynaecological patients. Haemorrhage was the main reason for transfusions in obstetrics 40 (65.6%), made up of postpartum haemorrhage 27 (44.3%) and antepartum haemorrhage 13 (21.3%), while antepartum anaemia was 17 (27.9%). In gynaecology, chronic anaemia was the main reason for transfusions 10 (43.5%), while acute haemorrhage was 7 (30.4%). Blood components used were whole blood 66.7% (56/84) and sedimented blood 33.3% (28/84) only. About a quarter of the patients who received blood transfusion, had a pretransfusion PCV of 25% or more (20/84) and received only one pint of blood (21/84). Conclusion: The rate of blood transfusion was relatively high, with gynaecology rates higher than obstetric. The indication for blood transfusion in obstetrics was mainly haemorrhage, while in gynaecology, it was chronic anaemia