Giant vulva fibroma presenting as a genital mass: a case report

Introduction: Even though vulva fibroma is rare, it is among the solid tumors of the vulva. Its cause is unknown although it has been associated with physiological hormonal changes. We report a patient with a unique vulva fibroma which has grown to the extent of interfering with her gait and urination. Case presentation: A 22-year-old woman presented with a genital mass which had been present for the duration of 2 years and felt embarrassed to report to the hospital early as the growth was in the genital area, with the perception of it being a sexually related illness, despite having not yet started engaging in sexual activity. On physical examination, a palpable pendulous mass of about [30 x 22] cm was seen originating from the right labia and extending to the right perineum. The mass was firm, nodulated, non-tender and had limited mobility. Surgical excision was performed under spinal anesthesia. Histologically, features suggestive of mixoid fibroma were reached after the mass was excised.  No recurrence has been observed. Conclusion: Clinicians should be aware of this rare disease which can be associated with recurrence if there is incomplete excision. Again, the unusual finding of the genital mass can be very embarrassing to the patient affecting her psychosocial well-being. It needs to be treated immediately upon diagnosis. &nbsp

Maternal vaginorectal colonization by Group B Streptococcus and Listeria monocytogenes and its risk factors among pregnant women attending tertiary hospital in Mwanza, Tanzania

Background: Group B streptococcus (GBS) and Listeria monocytogenes are members of the normal microbes of the female genital tract. During labour GBS and Listeria monocytogenes may infect the new-borns, leading to neonatal sepsis and meningitis. So far, there is no report on prevalence of GBS and Listeria monocytogenes among pregnant women in Mwanza. The objective of the study was to determine the magnitude of Group B Streptococcus and Listeria monocytogenes and its associated factors at Bugando Medical Centre, Mwanza, Tanzania.Methods: The study was a cross section conducted from 1st November 2011 to 31st May 2012 at Bugando Medical Centre in Mwanza, Tanzania.  Vaginal and rectal swabs were obtained and cultured on 5% sheep blood agar and susceptibility testing done using disk diffusion technique.Results: A total of 295 pregnant women participated in the study. GBS strains were isolated from 28 (9.49%) and only two (0.68%) had isolates of Listeria spp. All GBS and Listeria spp. isolates were sensitive to penicillin and ampicillin. Eight GBS isolates were resistant to erythromycin (28.6%), seven GBS isolates were resistant to clindamycin (25%) and 15 of GBS isolates were resistant to tetracycline (53.6%). One Listeria spp isolate was resistant to cotrimoxazole. Pregnant women with no formal education and those dwelling in rural areas were more frequently colonized by GBS.Conclusion: There is a significant prevalence rate of GBS culture positive at Bugando Medical Centre with demonstrable resistant to some common antibiotics (tetracycline, erythromycin and Clindamycin). Screening for GBS should be instituted in Tanzania between 35 and 37 weeks of gestation coupled with regular check up for antimicrobial susceptibility pattern due to emerging resistance toward existing antibiotics

Maternal and Perinatal Outcomes among Eclamptic Patients Admitted to Bugando Medical Centre, Mwanza, Tanzania

Eclampsia continues to be a major problem, particularly in developing countries such as Tanzania, contributing significantly to high maternal and perinatal morbidity and mortality. We conducted a study to establish the incidence of eclampsia and the associated maternal and perinatal outcomes among eclamptic patients admitted to our center. A descriptive cross-sectional study of all women presenting with eclampsia was performed from June 2009 to February 2010. Seventy-six patients presented with eclampsia out of a total 5562 deliveries during the study period (incidence of 1.37%). Antenatal attendance was 96% among patients with eclampsia; however, only 45.21% and 24.66% were screened for blood pressure and proteinuria respectively. Maternal and perinatal case fatality rates were 7.89% and 20.73% respectively. The main factors contributing to maternal deaths were acute renal failure (10.5%), pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated Intravascular Coagulopathy (3.5%). Perinatal deaths were caused by prematurity (42.9%) and birth asphyxia (57.1%). Forty-eight babies had low-birth weight (58.54%). The high incidence of eclampsia and its complications during this study period may indicate the need for earlier and more meticulous intervention at both the clinic and hospital levels Keywords: Eclampsia, maternal, perinatal, morbidity, mortality, TanzaniaAfr J Reprod Health 2012; 16[1]:35-4

Rater training for standardised assessment of objective structured clinical examinations in rural Tanzania

In this study, six healthcare providers assessed and scored 42 training scenarios. Raters identified average test proficiency 50% of the time. Experts in the field of clinician-based training for frontline staff recommend that all examiners undergo rater training prior to becoming an Objective Structured Clinical Examination (OSCE) assessor. Helping Babies Breathe, Essential Care for Every Baby and Bleeding after Birth are standardised training programmes in maternal and child health care. Studies examining the reliability of assessments are rare. This study shows that rater training is critical to ensure that the potential of training programmes translates to improved outcomes for mothers and babies.Innovating for Maternal and Child Health in Africa (IMCHA) initiativeGlobal Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Conséquences maternelles et périnatales chez les patientes atteintes de l’éclampsie qui sont admisses à Bugando Medical Centre, Mwanza, Tanzanie

Eclampsia continues to be a major problem, particularly in developing countries such as Tanzania, contributing significantly to high maternal and perinatal morbidity and mortality. We conducted a study to establish the incidence of eclampsia and the associated maternal and perinatal outcomes among eclamptic patients admitted to our center. A descriptive cross-sectional study of all women presenting with eclampsia was performed from June 2009 to February 2010. Seventy-six patients presented with eclampsia out of a total 5562 deliveries during the study period (incidence of 1.37%). Antenatal attendance was 96% among patients with eclampsia; however, only 45.21% and 24.66% were screened for blood pressure and proteinuria respectively. Maternal and perinatal case fatality rates were 7.89% and 20.73% respectively. The main factors contributing to maternal deaths were acute renal failure (10.5%), pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated Intravascular Coagulopathy (3.5%). Perinatal deaths were caused by prematurity (42.9%) and birth asphyxia (57.1%). Forty-eight babies had low-birth weight (58.54%). The high incidence of eclampsia and its complications during this study period may indicate the need for earlier and more meticulous intervention at both the clinic and hospital levels (Afr J Reprod Health 2012; 16[1]:35-41).L’éclampsie ne cesse d’être un problème majeur, surtout dans les pays en développement tel que la Tanzanie, ce qui contribue significativement à la morbidité et à la mortalité maternelle et périnatale élevées. Nous avons mené une étude pour établir l’incidence de l’éclampsie et les conséquences maternelles et périnatales qui y sont associées chez les patientes atteintes de l’éclampsie admises dans notre Centre. Nous avons fait une étude transversale descriptive de toutes les femmes qui souffraient de l’éclampsie et qui venaient nous consulter dans notre Centre du mois du juin 2009 au mois du février 2010. Sur un total de 5562 accouchements au cours de l’étude, soixante-seize patientes souffraient de l’éclampsie (Incidence de 1,37%). La fréquentation au service de l’anténatal était de 96% chez les femmes souffrant de l’éclampsie ; toutefois, seulement 42,21% et 24,66% ont subi le test de dépistage pour détecter la pression artérielle et la protéinurie respectivement. Les taux de fatalité des cas maternels et périnatals étaient de 7,89% et 20,73% respectivement. Les principaux facteurs qui contribuent au décès maternel étaient l’insuffisance rénale (10,5%), l’œdème pulmonaire (10,5%), l’apoplexie cérébrale maternelle (8,8%), le syndrome de HELLP (50, 9%), et la coagulopathie intra vasculaire disséminée (3,5%). Les décès périnatals ont été causés par la prématurité (42,9%) et l’asphyxie de la naissance (57,1%). Quarante huit bébés avaient des poids de naissance bas (58,54%). La haute incidence de l’éclampsie et ses complications au cours de cette étude peuvent indiquer la nécessité des interventions plus tôt et plus méticuleuses aux niveaux de la clinique et de l’hôpital (Afr J Reprod Health 2012; 16[1]:35-41)

Rudimentary horn pregnancy, a differential diagnosis of an intraabdominal pregnancy: a case report

Abstract Background Rudimentary horn pregnancy is a rare life-threatening obstetric condition with clinical and sonographic presentation resembling that of an abdominal pregnancy. Preoperative diagnosis of advanced rudimentary horn pregnancy is difficult and cases are often identified incidentally during laparotomy for a presumed abdominal pregnancy. Case presentation We report a case of a 29-year-old African woman, gravida 2 para 1 at 28 weeks of gestation complaining of epigastric pain for 7 days with no other associated gastrointestinal or genitourinary symptoms. On examination, she had normal vital signs and an enlarged abdomen sized at 33 cm with unremarkable fetal lie and presentation. She had normal laboratory blood results with an ultrasound revealing an abdominal pregnancy of 28 weeks. The informed decision for conservative management was planned after informing of the benefit and risks of early termination versus conservative management, however, with worsening symptoms an emergency laparotomy had to be performed in which a left unruptured rudimentary horn pregnancy with a viable fetus was identified incidentally and delivery of the fetus followed by surgical excision of the horn was done. The postoperative period was uneventful, and the patient was discharged home with her newborn. Conclusion Rudimentary horn pregnancy is very rare and often indistinguishable from an abdominal pregnancy in advanced gestation age. First trimester ultrasound is by far the only noninvasive sensitive diagnostic modality for rudimentary horn pregnancy. Laparotomy with horn excision remains the standard of care for advanced rudimentary horn pregnancy

Bizarre presentation of bilateral ovarian leiomyoma: a case report

Primary leiomyoma of the ovary is rarely described in literature. It accounts for 0.5–1% of all benign ovarian tumours. Bilateral ovarian leiomyoma are rare and only few cases have been described. In this report, we describe a case of 29-year-old nulliparous, Tanzanian lady presented with one-year history of abdominal swelling and secondary amenorrhea. Examination revealed a palpable, suprapubic mass, and a pelvic ultrasound showed features of ovarian tumour. An explorative laparotomy was performed to confirm the diagnosis. A bilateral salpingo–oophrectomy and hysterectomy was performed for huge bilateral ovarian tumours. Histopathological examination confirmed ovarian leiomyoma. Challenges remain in the management of bilateral primary ovarian tumours, especially for young and nulliparous women. Pre-laparotomy diagnostic measures are important so as to know the type of the tumour you are dealing with and plan the appropriate management

Simulation-based training and peer-to-peer learning

The Mama na Mtoto initiative aims to improve maternal, newborn, and child health (MNCH) in Misungwi and Kwimba Districts (Tanzania) through a variety of activities, including development of clinical capacity at health facilities. Using simulation, teams can practice managing emergency cases in a safe and controlled environment with supportive coaching. Simulation events were used to refresh MNCH clinical care skills through 5-day workshops for 200 health workers.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR