Tubal Ectopic Gestation Associated with Genital Schistosomiasis: A Case Report

Schistosoma are trematode blood flukes of the family Schistosomidae affecting the urinary and gastro-intestinal tracts. Riverine areas of the world such as in Africa, Eastern Mediterranean, Central American and East Asia are endemic for the disease, with S. haematobium accounting for most of the symptomatic genital infection. A case of a 25-year-old woman with 8 weeks amenorrhoea, lower abdominal pain and per vaginal bleeding was managed for ruptured ectopic pregnancy and discovered to have tubal infection by Schistosoma on histological examination is presented. Afr J Reprod Health 2014; 18[2]: 144-146).Keywords: Ectopic Gestation, Genital Schistosomiasis Les schistosomes sont des douves sanguines de la famille Schistosomiase affectent les voies urinaires et gastro-intestinaux. Les zones riveraines du monde comme l'Afrique, la Méditerranée Orientale, l'Amérique Centrale et l’Asie de l'Est sont endémiques de la maladie, la S. hématobie étant responsable de la plupart des infections génitales symptomatiques. Un cas d'une femme de 25 ans qui présentaient des 8 semaines d'aménorrhée, des douleurs abdominales basses et par des saignements vaginaux a été géré pour la grossesse extra-utérine rompue et l’examen histologique a découvert une infection des trompes par le schistosome. Afr J Reprod Health 2014; 18[2]: 144-146).Mots clés: gestation extra-utérine, schistosomiase génital

Uterine rupture an obstetrics catastrophy; incidence, risk factors, management and outcome at Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria

Context: Ruptured uterus is still an important obstetrics complication because it contributes significantly to both maternal and foetal morbidity and mortality in our setting. Therefore there is a need to further evaluate its causes and the outcome of its management.Objective: To determine the incidence, risk factors, management and outcome of ruptured uterus in our centre and thus provide a baseline data on the subject for comparison in the future as the hospital is now upgraded to a Teaching Hospital.Materials and Methods: A two year retrospective review carried out on 67 patients that were managed for uterine rupture during the study period. Data was obtained from patients' case files, labour ward registry, theatre registry, admission /discharge registry and entered into a proforma. Descriptive analysis was done with SPSS software (version16.0).Results: There were a total of 19,412 deliveries in the review period out of which there were 67 ruptured uteri. The incidence of ruptured uterus is 0.35% and the common risk factors include high parity, exposure to oxytocin in labour, scar on the uterus, prolonged labour and unbooked status. Foetal mortality was 100% and maternal mortality 13.4%.Wound sepsis/dehiscence, vesicovaginal fistula and anaemia were the common complications in this study.Conclusion: Ruptured uterus remains an important obstetrics problem in our centre. It is associated with high maternal mortality and foetal mortality. More effort is needed to reduce this obstetrics problem.  Key Words: Uterine rupture, Risk factors, Management, outcome, Bauch

Ectopic Pregnancy in Bauchi, North-East Nigeria

Background: Ectopic pregnancy is an important life-threatening emergency and a cause of reproductive morbidity and mortality especially in developing countries. The significance of ectopic pregnancy in our environment lies in its late presentations with its attendant consequences compounded by structurally weak health systems. This is at variance with the global trend of early diagnosis and conservative approach to thiscondition.Objective: To assess the incidence, presentation and management of ectopic pregnancy (EP), in Bauchi north-east Nigeria over a two-year period.Methods: This was a retrospective study of cases of EP managed at gynaecological unit of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi between 1st of January 2009 and 31st December 2010.Results: During the period under review, a total of 19,412 deliveries were recorded in the hospital and 119 ectopic pregnancies were managed. This gives an incidence of 0.61%. Majority of the patients were 30 yearsand below with mean age of 26.8 years. The common clinical features at presentation were abdominal pain (95%), amenorrhea (87%), vaginal bleeding (51.5%). More than half of the patients were in shock (51.4%)before intervention. Seventy patients (69%) had the EP on the right tube, 10(9.9%) on the left tube while the side was not stated in 20 patients (20.8%). The mode of surgical treatment in majority of the patients wasunilateral salpingectomy 83(82.2%); one patient (1%) had bilateral salpingectomy while the type of surgical operation was not stated in 13 cases (12.9%). None of the patients had minimal access surgery, medical or conservative management. Anaemia (65.3%) was the commonest post-operative complication. Case fatality was 4%.Conclusion: Late presentation of EP was the commonest way of  presentation in our centre. Laparotomy with salpingectomy was the main modality of management. This has adverse effect in a society which placeshigh premium on child bearing. Reproductive health education and strengthening support services like blood transfusion services are needed. Provision of minimal access approach facilities and other forms of conservative management for those that present early should be considered.Keywords: Ectopic pregnancy, incidence, presentation and management at a newly established teaching hospital, Nigeri

Ruptured uterus in Azare, north eastern Nigeria

Background:-Ruptured uterus is an obstetric emergency and results in significant maternal and perinatal morbidity and mortality in Nigeria. The objective of the review is to determine the incidence, predisposing factors, maternal and foetal outcome in cases of ruptured uterus. Methods:- A 4-year retrospective review of patients that had uterine rupture between July 2003 and June 2007 in Federal Medical Centre, Azare was carried out. Analysis of available records of the cases of ruptured uterus from the labour room, and theatre during the period under review was done. Results:-A total of 75 cases of ruptured uterus and 9015 deliveries were recorded in the period under review. The incidence of uterine rupture is 1 in 120 deliveries. The highest incidence of ruptured uterus was found in the grand multiparous women, 46 (63%). Injudicious use of oxytocin was found in more than half of the cases 41(56.2%). Majority of the rupture (56.3%) occurred in the lower segment. Thirty-two (45.1%) had repair and tubal ligation done. Maternal case fatality was 10.7% while foetal wastage was 86.3%.The commonest complication was anaemia, which occurred in 44% of the patients. Conclusion:-The incidence of uterine rupture is very high in Azare. There should be a multi-sectoral collaboration aimed at improving the utilization of medical services by the populace and the organization of health institutions offering obstetric emergency care.Key Words:-Uterine rupture, Predisposing factors, Management, Outcome, Azar

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol:

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness, low cost, stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect, uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use. Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100μg of misoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously, then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC. Keywords: Misoprostol, Induction of Labour, Disseminated intravascular CoagulationNigerian Journal of Medicine Vol. 17 (2) 2008: pp. 156-15