Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-year review

Background: Emergency peripartum hysterectomy has remained a challenging and very life saving surgical procedure in obstetrics. Its indications are emerging.Aims: This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south–east Nigeria.Materials and Methods: A retrospective study of the case files of patients requiring an emergency peripartum hysterectomy between January 2000 and December 2009 was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment within 24 hours of delivery. The findings were analyzed using Epi info version 3.5.1.Results: During the 10-year period, there were 6,137 deliveries and 38 cases of emergency peripartum hysterectomies, giving an incidence of 6.2 per 1000 deliveries. Of the 38 hysterectomies, only 29 (76.3%) case files were available for analysis. The mean age of the patients was 28.1 ± 5.4 years and 22 (75.9%) patients were unbooked. There were four primigravidae (13.8%) while 25 (86.2%) were parous. The main indications for hysterectomy were placenta praevia 14 (48.3%) and uterine rupture 10 (34.5%). Subtotal hysterectomy was performed in majority (72.4%) of cases. The commonest postoperative morbidities were postoperative fever (37.9%), postoperative anemia (24.1%), and wound infection (20.7%). The maternal case fatality rate was 31.0%, while the perinatal mortality was 44.8%. The mean duration of hospital stay was 9.8 ± 2.4 days.Conclusion: The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention by a skilled surgeon are crucial

Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?

INTRODUCTION: We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. MATERIALS AND METHODS: We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant. RESULTS: Most women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066–2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066–6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959–6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004–1.006). The area under the curve was 0.789 (p < 0.001). CONCLUSIONS: Double-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section

Knowledge, attitude and practice of family planning among pregnant women at Grace Specialist Hospital

Background: Unwanted pregnancy is a common event in our environment and many of them will end in an unsafe abortion. Unsafe abortion isa significant cause of maternal mortality. Correct use of effective family planning methods will reduce the incidence of unwanted pregnancy andimprove the health of women.Objective: To determine the knowledge, attitude and practice of family planning among ante natal clients.Method: A cross sectional study of 346 consecutive antenatal clients using a self administered structured questionnaire. Analysis was with SPSSfor windows, version 15 and level of significance was set at P = 0.5 ( 95% confidential interval).Results: The mean age in the study was 28.06 + 4.9 and the mean parity was 1.51 + 1.5. 96.3% were married and all of them had at leastprimary education. Ninety-six percent of the respondents (n = 309) were aware of at least one family method. The most common methods knownby the respondents were Condom and Billings’ methods (48.6%). The commonest source of information on family planning was the mediarepresenting 35.1%. Only 47.5% of the respondents had used one form of family planning method. The most commonly used method wasBillings / Calendar (50.3%). Child spacing was the commonest reason for using family planning. Most of those who did not use (30.2%) feltthey had no need for it. Education and religion did not significantly affect the use of a family planning method. However, members of religiousgroups other than Roman Catholic were more likely to use a modern method (

Inter-Pregnancy Interval (IPI): What Is The Ideal?

No Abstract Available Afrimedic Journal 2011;2(1):36-3

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

Background:&nbsp;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:&nbsp;To determine the prevalence of dysmenorrhea among undergraduates as well as the incidence of school absenteeism in women with dysmenorrhea. Methods:&nbsp;A questionnaire-based cross-sectional study of 583 female university students was done using the multistage sampling method. Results:&nbsp;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:&nbsp;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

Pattern of Presentation of Cervical Cancer at Nnamdi Az ikiwe University Teaching Hospital, Nnewi

Background: Cervical cancer is the second commonest cancer among women worldwide. It remains the commonest cancer cause of death among women in developing countries. Objectives: This is to assess the pattern of presentation of cervical cancer in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi and to make relevant recommendation concerning screening. Methods: This is a retrospective review of the case records of st patients managed for cancer of the cervix between January 1 st 1999 and December 31 , 2008. Results: Thirty seven patients were included in the study. The mean age of the patients was 59.7 + 13.3 years while the mean parity was 6.4 + 3.2. Only 23.1% of the women had at least a secondary education while 46.2% had no formal education. The commonest presenting symptom was post menopausal vaginal bleeding (67.6%) followed by irregular vaginal bleeding (59.5%), watery vaginal discharge (35.1%) and post coital bleeding (16.2%). Weight loss was present in 29.7% while 10.8% had evidence of distant metastasis. The mean duration of symptom was 4.5 + 3.6 months, and the commonest cause of delayed presentation was inability to appreciate the problem (77.8%). Only 7.1% had stage 1 disease while 46.4% had stage 3b. Complication was present in 75.7% of patients. Squamous cell carcinoma accounted for 84.2% of the cancers. Treatment was mainly palliative for these women. Conclusion: Late presentation is common in our environment. Women empowerment and increased provision of cervical cancer screening are expected to reduce the burden of this disease. In resource-deprived settings, expanded training on visual inspection techniques cannot be overemphasized. Key words: Cervical cancer, presentation, vaginal bleeding. Afrimedic Journal 2010; 1(1): 20-2

Advanced Abdominal Pregnancy in a Diabetic Multipara- is Delivery of the Placenta Always a Problem? A Case Report

Introduction: Abdominal pregnancy is a comparatively rare type of ectopic gestation with a high fetal and maternal morbidity and mortality. Although this entity had been well documented, it still remains a serious dilemma for most obstetricians in practice because of the difficulties in early diagnosis and proper management. The occurrence in a diabetic woman could make management even more complex. Objective: This is to report a case of advanced abdominal pregnancy occurring in a diabetic multipara. Method: A case report of abdominal pregnancy in a diabetic multipara who was referred to the Nnamdi Azikiwe University Teaching Hospital, Nnewi and relevant review of literature. Result: Following a laparotomy, the baby was delivered, and placenta completely removed. Conclusion: The delivery of the placenta following an abdominal pregnancy may not pose a problem in some patients. Appropriate pre-operative diagnosis and timed intervention is recommended

Pre-Labour Rupture of Membranes at Term: A Review of Management in a Health Care Institution

Background: Pre-labour rupture of membranes (PROM) at term is often encountered in current obstetric practice. Its management is sometimes controversial. Objectives: This was to determine the incidence, management modalities and pregnancy outcomes of cases of pre-labour rupture of membranes at term in Nnewi, Southeast Nigeria. Methods: This was a retrospective review of cases of PROM at term in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria over a 5-year period (January 2005 - December 2009). Their demographic and obstetrics records were extracted and the findings were analysed using SPSS version 15.0. Results: During the study period, there were 3,513 deliveries and 86 cases of PROM at term, giving an incidence of 2.4%. Of the 86 cases, only 74 (86.0%) case files were available for analysis. The mean age and gestational age of the patients were 26.9±3.9 years and 38.8±1.7 weeks respectively. Vaginal delivery was aimed at 60 (81.1%) patients, of which 18 (30.0%) and 7 (11.7%) patients had immediate stimulation of labour with oxytocin and intravaginal misoprostol respectively. Ten (16.7%) and 6 (10.0%) patients had delayed stimulation of labour with oxytocin and intravaginal misoprostol respectively. Nineteen (31.7%) patients had spontaneous labour within 12 hours of rupture of membrane. Only 3(5.0%) patients had failed stimulation of labour. Vaginal delivery success rate was 95.0% while 17 (23.0%) patients were delivered by caesarean section (CS). There was no significant difference in the 1 and 5-minutes APGAR scores 0.05). The mean duration of hospital stay was 6.1± 1.3 days and 10.9 ± 1.7 days for patients that had vaginal delivery and CS respectively. There was no recorded maternal death but the perinatal mortality rate was 0.26 per 1000 deliveries. Conclusion: The incidence of PROM at term was high in Nnewi. While stimulation of labour was safe and effective, the pregnancy outcomes did not significantly depend on the time and methods of stimulation of labour or route of delivery. Further study may be necessary to substantiate these findings. Key Words: PROM, stimulation of labour, oxytocin, misoprostol. Afrimedic Journal 2010; 1(2): 10-1

Third Degree Perineal Tear Following Sexual assault in a minor: a case report and review of literature

Background: Child sexual assault presents a major challenge to the society that is supposed to be protective. This has both short and long-term health implications for the child. Objectives: This is to highlight the presence of child sexual assault in our society, its associated complications and to proffer ways of preventing its occurrence in our society. Methods: A case report of third degree perineal tear following sexual assault in a minor that presented with vaginal bleeding. Results: The third degree perineal tear was repaired after resuscitation. There was no incontinence of flatus and faeces post repair. Conclusion: Child sexual abuse is present in our society and may be associated with severe injury. Prompt management of injuries is very important in preventing long term effects. Keywords: Perineal tear, sexual assault, minor. Afrimedic Journal 2010; 1(1): 37-3

Knowledge of Cervical Cancer and its Screening Amongst Female Workers In Nnewi, Nigeria

Background: Cervical cancer is an important women's reproductive health problem, especially in developing countries. Efforts towards its prevention worldwide have focused on screening women at risk of disease using Pap smears and treating pre-cancerous lesions. A good knowledge and understanding of the level of awareness of cervical cancer and its screening among female workers in Nnewi will help in creating population-specific health programs. Objectives: This is to determine the awareness of cervical cancer screening among female workers in Nnewi as well as ascertain the influence of age, educational status and marital status on the awareness of cervical cancer screening among this group. Methods: A cross-sectional descriptive study carried out among female workers in Nnewi who were selected using multi-stage approach between December, 2007 and January, 2008. Results: A total of 172 females responded. The mean age was 29.7 ± 8.8 years and the ages ranged from 15 to 65 years. A total of 146 respondents (84.9%) were aware of cervical cancer. One hundred and twenty-three respondents (71.5%) knew about the Pap smear screening test. Educational level was found to significantly affect the awareness of cervical cancer and Pap smear screening test. Age and marital status were found not to affect awareness of cervical cancer and Pap smear screening test. Conclusion: There is relatively high level of awareness of cervical cancer and Pap smear test among this group. Educational status was found to significantly influence the level of awareness of cervical cancer and its screening. Key words: cervical cancer, knowledge, screening. Afrimedic Journal 2010; 1(1): 31-3