Iron Store of Pregnant Women with Hemoglobin SS and SC in Benin City

Background: Anemia in pregnancy is common and morbidity is increased in the presence of sickle cell disease. There has been conflicting argument concerning routine iron replacement. However few, studies in Nigeria have comprehensively evaluated the iron status of these women. Objective: The study was carried out to determine the iron stores status of pregnant women with hemoglobin (Hb) Sickle cell S or Sickle cell C using the serum assay. C-reactive protein (CRP) was also assayed to rule out the effect of inflammation / infection on the serum level of ferritin.Materials and Methods: This was a prospective longitudinal study conducted at the University of Benin Teaching Hospital (UBTH), Benin City, over a period of eight months (from April 2011 to December 2011). The patients for the study were identified using the booking investigation results in the antenatal clinic records. Only those clinically stable pregnant women, in a healthy state, participated in this study.The hematological indices, serum ferritin assay, and the CRP were determined in both test (Hb SS / SC) and control (Hb AA) pregnant women. The data obtained were fed into a personal computer (PC) and analyzed using the Statistical Package for Social Sciences (SPSS) software version 16 for Windows. Categorical data were expressed as percentages and compared using the Chi-squared test, whereas, numerical data were expressed as mean (SD) and compared using the Student’s t-test. The level of significance was set at P≤0.05.Results: A total of 23 Hb SS / SC pregnant women formed the test group. They were recruited for the study from the Sickle-Cell Center (attached to the Central Hospital, Benin City, the UBTH). The mean age, educational status, and the social class of both the test group and the control group were comparable. There was a significant difference in the mean hemoglobin concentration between the test group and control group, both at 16–20 weeks and 28 – 32 weeks of gestation (P<0.001), and the mean corpuscular volume (MCV) values at both gestational ages (GAs) (P=0.097 and 0.231, respectively). The values of the serum ferritin in the test group were also statistically and significantly higher than those of the control group (P<0.001 and P=0.009, respectively), at both GAs.Conclusion: This study demonstrated higher serum iron levels in Hb SS / SC pregnant women than in the controls (even after excluding those levels raised by the increased levels of CRP). In situations that may require iron supplementation, it may be reasonable to determine the iron status to ascertain the quantity that should be given.Keywords: Benin City, iron status, pregnancy, sickle-cell hemoglobi

Management challenges of pelvic abscess in a tertiary health institution in Nigeria

Background: This study was carried out to review the incidence, demographic variables and challenges in managing pelvic abscess in a tertiary health institution, the University of Benin Teaching Hospital, Benin City, Nigeria.Methods: This was a retrospective study. Gynaecological patients known to have had pelvic abscess over a 14 year period at the Obstetrics and Gynaecology department of the University of Benin Teaching Hospital Nigeria formed the subjects. The retrieved case files were scrutinized for the necessary variables which were then analysed.Result: Pelvic abscess was surgically confirmed in one in every fifty four major gynaecological operations. The age ranged from 15 - 44 with a mean of 27± 6.0 years. Four out of every five of the patients were in their third and fourth decades of life. The parities ranged between 0 - 6 with a modal parity of 2. About half of the patients were nulliparous. Pregnancy related conditions were associated factors in 57.7% of cases. Sepsis following abortion and pelvic inflammatory disease each accounted for 30.8% of cases. Ultrasound scan as a diagnostic tool gave a sensitivity of86% and specificity of 70%. Clinical assessment/ impression had a sensitivity of 88.5% and specificity of 70%. All patients had conservative surgery involving laparotomy with drainage of abscess and adhesiolysis of the abscess cavity. There were 2 deaths and both were related to abortion complications.Conclusion: Conservative surgery with drainage of abscess and adhesiolysis was the treatment of choice after adequate preoperative resuscitation.Key words: pelvic abscess; management, challenges, laparotomy, complications

Volunteerism in a Health Care Delivery System in Nigeria: A Cottage Hospital Experience

Introduction: The need for volunteerism in the implementation of National Programmes is becoming more obvious now than before, especially in resource poor countries. The activities of volunteers are required in all aspects of life, especially in the developed countries, and they cut across age groups, gender, occupation and geographical barriers. Unfortunately there is paucity of information on the activities and constraints of volunteers in developing countries.Aim: To evaluate the contribution of volunteer staff involved in implementing the Community Health Insurance Scheme of a cottage hospital in Southern Nigeria.Method: The study design involved a descriptive analysis of all volunteering activities at Obio Cottage Hospital in Port Harcourt, Rivers State South-south Nigeria, from January 1, 2011 till December 31, 2011. Primary and secondary sources of data were used.Results: The total number of applicants who wished to volunteer during the period was 131, thirty-four of these were selected as 'Participants' in the programme. Women were more likely to volunteer than men, and highly educated Nigerians, including medical doctors and degree holders participated. Obio Cottage Hospital benefitted from the scheme in financial terms to the tune of more than 4 million Naira. (about 27 thousand US Dollars) within the one year of study while the participants all agreed that the scheme assisted them in actualizing their career and positioned them to getting paid jobs. The clinical output of the hospital more than doubled during the period.Conclusion: Organized volunteerism is of great benefit to the participants, institution, community and country and should be encouraged.Keywords: Volunteer, Obio Cottage Hospital, Participants, Nigeri

How Unsafe is Myomectomy at Caesarean Section?

Objective: To provide evidence on the safety or otherwise of the practice of myomectomy during Caesarean section.Methods: This was a prospective, randomized, case controlled study conducted at the Obio Cottage Hospital, Port Harcourt, Nigeria, between November 2011 and October 2012. 42 Caesarean section patients, who also had myomectomy, were compared with those who had Caesarean section alone. The Caesarean myomectomy cases also had the number, location and size of the fibroids removed analyzed.Results: 446 women were delivered by Caesarean section and 42 of these had Caesarean myomectomy. The mean ages were similar. Between 1 and 23, uterine fibroids were removed. The mean blood loss from the  Caesarean myomectomy and Caesarean section was 584.72 and  695.71mls respectively. There was no statistical difference in the blood loss, Hematocrit deficit and length of hospital stay (p values of 0.053, 0.299 and 0.334 respectively) while the duration of surgery and number of sutures used were statistically different between the two groups (p value < 0.001 in both). The post-operative complications were similar.Conclusions: This study found that Caesarean myomectomy is a safe procedure in experienced hands and has obvious advantages to the patient.Keywords: Caesarean section, Myomectomy, Blood loss, Port Harcourt

Successful myomectomy during pregnancy : A case report

BACKGROUND: The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy. CASE PRESENTATION: A 30 year old woman presented with a one year history of abdominal swelling, amenorrhea and severe epigastric discomfort of 19 weeks duration. The abdomen was grossly distended and tense. A sonographic diagnosis of ovarian tumor in pregnancy was made. Laparotomy revealed a 32 cm degenerating subserosal uterine fibroid co-existing with an intrauterine pregnancy. Myomectomy was successfully performed. The subsequent antenatal period was uneventful with a spontaneous vaginal delivery of a female baby at 38 weeks. CONCLUSION: This report supports other studies and case series that have demonstrated the safety of myomectomy during pregnancy in selected circumstances

Socio-demographic characteristics, maternal and fetal outcome of parturients presenting in second stage labour

Purpose: To document the socio-demographic characteristics, maternal and foetal outcome of booked patients presenting in second stage labour and compare them with those who presented in spontaneous active phase, first stage labour, delivering normally and without oxytocin augmentation. Method: Retrospective case - control study. Result: Women who presented in second stage labour were more likely to book late in pregnancy (23.01±7.55 weeks versus 20.80±7.98, p value 0.014) and attended fewer antenatal care visits (7.22±3.09 versus 8.67±2.98 p value 0.000). Higher parity (p value 0.002), lower female education (p value 0.000) and HIV positive status (10.52% versus 0.66% p value 0.000) were other factors found with late presentation in labour. The commonest reason for presentation in the second stage of labour was transportation problems (31.9%). Perineal tear was the only significant maternal outcome between the cases and control (26.3% versus 13.8%, p value 0.001). There was no significant difference in the foetal outcome between the two groups. Conclusion: Socio-demographic characteristics of patients affect their utilization of available obstetric care. Maternal and foetal outcomes were comparable in the two groups except for increased perineal tear among the cases. A multicentre prospective study is necessary to further evaluate the foetal and maternal outcome in this group of patients.Keywords: Second stage labour, first stage of labour, failed antenatal care, socio-demographic characteristics

Obstetric and neonatal outcome among pregnant women and urinary tract infection (asymptomatic and symptomatic)

No Abstract. Nigerian Medical Practitioner Vol. 48(5-6) 2005: 120-12

A Comparative Study of Endocervical and Pelvic Peritoneal Bacterial Flora in Infertile Women in Benin City, Nigeria

The relationship between the bacterial flora of the endocervix and the pelvic peritoneum in fifty infertile patients undergoing diagnostic laparoscopy and dye test was investigated at the University of Benin Teaching Hospital. The study design was prospective and cross-sectional. The setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria. The study population was made up of fifty infertile subjects undergoing laparoscopic investigations. The results showed that there was no relationship between the bacterial colonies of the two studied anatomic sites in the subjects. However, a significant finding worthy of note to all clinicians were the two cases of Mycobacterium tuberculosis, which were isolated from both the endocervix and peritoneal cavities in the same patients. The other organisms isolated were of less clinical significance and were either only isolated from endocervix (82%), or the pelvic peritoneum [pouch of Douglas, (16%)]. It is concluded that there is no convincing scientific basis for the routine use of bacteriological investigation of the endocervix in the management of pelvic inflammatory disease (PID), and that pelvic tuberculosis may be more common than many clinicians presently believe. Sahel Medical Journal Vol.7(4) 2004: 107-10

Caesarean Myomectomy: New Frontier in Surgical Practice

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