Imperforate Hymen Presenting as Acute Urinary Retention in a 14-Year-Old Nigerian Girl

Acute urinary retention in adolescent females is rare, just like imperforate hymen. We present a case of acute urinary retention secondary to imperforate hymen in a 14–year-old Nigerian girl. Its diagnosis and treatment are discussed with a brief review of literature. We highlight the need for a thorough evaluation in the female patient presenting with acute urinary retention, and also the need to provide better health facilities in rural areas in developing countries such as ours. Key words: Acute urinary retention, imperforate hymen, haematocolpo

Management of pituitary adenoma with mass effect in pregnancy: a case report

A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transferred to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma

Anaesthetic challenges in emergency peripartum hysterectomy in West Africa: a Nigerian perspective

Background: To determine the foeto-maternal outcome and the anaesthetic challenges in emergency peripartum hysterectomy at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Method: A retrospective study was carried out on parturients that had had emergency peripartum hysterectomy at UNTH in Nigeria, from July 1998 to June 2006. Data collected included demographics, anaesthetic and obstetric records, foeto-maternal outcomes and the need for critical care management. Results: There were a total of 6 798 deliveries and 6 485 live births, with 16 emergency peripartum hysterectomies. The incidence of emergency peripartum hysterectomy was 0.23% of all deliveries (2.3/1 000 deliveries). The causes of emergency hysterectomies were ruptured uterus (11 patients or 69%), placenta accreta/morbidly adherent placenta (4 patients or 25%) and uncontrollable postpartum haemorrhage following vaginal delivery (1 patient or 6%). Eight patients had subtotal hysterectomy, while eight had total abdominal hysterectomy (TAH). All the patients received general anaesthesia and blood transfusion. There were two postoperative admissions to the intensive care unit (ICU) and two procedure-related deaths due to hypovolaemic shock. There were nine stillbirths but no documented neonatal deaths. Conclusion: Emergency peripartum hysterectomies challenge the anaesthetist and the obstetrician who have to maintain haemodynamic stability in patients who may have lost volumes of blood, in a setting where blood and colloid availability is often limited. The maternal mortality was higher than that of most of the studies reviewed.Keywords: anaesthesia; peripartum hysterectomy; West Africa; Nigeri

Obstetric outcome of teenage pregnancies at a tertiary hospital in Enugu, Nigeria

Context: Maternal age, parity, and socioeconomic class are important determinants of obstetric outcome of pregnancy. Teenage pregnancy constitutes a high risk pregnancy with complications arising from a combination of physiological, anatomical, and socioeconomic factors.Objective: The objective was to determine the current incidence of all teenage pregnancies and their obstetric outcomes at UNTH, Enugu.Materials and Methods: This was a retrospective review of all teenage pregnancies at University of Nigeria Teaching Hospital, Enugu over a 6-year period (2000--2005). A total of 74 teenage pregnancies were analyzed and compared with 105 controls (adult mothers).Results: Records of 74 teenage pregnancies were identified within the study period which constitutes 1.67% of 4422 deliveries within the period. Majority of the teenagers (78.3%) were nulliparous. There was statistically significant differences between the teenage mothers and older mothers in the rate of unemployment (75.7% vs. 24.8%, P = 0.000), booking status (41.9% vs. 100%, P = 0.000) anemia (32.4% vs. 24.8%, P = 0.001), unsure of last menstrual period (32.4% vs. 15.2%, P = 0.007), caesarean section (18.9% vs. 10.5%, P = 0.000), cephalopelvic disproportion as an indication for caesarean section (9.4% vs. 3.8%, P = 0.001), preterm delivery (18.9% vs. 11.4%, P = 0.001), low birth weight (23.0% vs. 10.5%, P = 0.005), episiotomy (61.7% vs. 28.7%, P = 0.001), instrumental delivery (6.8% vs. 2.9% P = 0.001), Apgar score at 1 minute (35.1% vs. 19.1% P = 0.005), and perinatal mortality (16.2% vs. 12.4%). There were no maternal deaths.Conclusion: Pregnant teenagers are at higher risk than their older counterparts. Female socioeducational development and proper use of contraceptive services will help reduce teenage pregnancy rate, while perinatal care will help to minimize it associated hazards

Fetal macrosomia: Obstetric outcome of 311 cases in UNTH, Enugu, Nigeria

Background: In modern obstetrics, fetal macrosomia is a major contributor to obstetric morbidity. It is an important cause of perinatal morbidity and mortality.Aim: This study aims to determine the maternal characteristics, fetal and neonatal complications associated with fetal macrosomia, and its contribution to obstetric morbidity in Enugu, Nigeria.Materials and Methods: This was a 3-year retrospective study carried out from 1st January 2005 to 31st December 2007.Results: There were a total of 434 cases of fetal macrosomia out of 5,365 deliveries. The incidence of fetal macrosomia was 8.1%. Only 311 case notes (71.6%) were available for analysis. Statistical analysis showed that mothers of macrosomic newborns were older (30.6 ± 5.6 vs. 27.4 ± 4.74; P = 0.001), higher parity (4.1 ± 2.7 vs. 2.5 ± 1.07; P = 0.001), and weighed more at term (89.13 ± 6.17 kg vs. 71.43 ± 5.27 kg; P = 0.002). The study group had more mothers with previous history of macrosomic babies (39.5% vs. 12.5%), diabetes (3.2% vs. 1%), significant higher cesarian section rate (27.3% vs. 11.9%, P = 0.001), and operative vaginal delivery (3.6% vs. 1%; P = 0.001) compared with the control. There was male dominance in the study group compared with the control (63% vs. 56.3%; P = 0.001), higher risk of fetal asphyxia (P = 0.001), and greater mean birth weight (3.6 ± 1.2 kg vs. 3.2 ± 0.6 kg; P = 0.002). There were 7 (2.3%) cases of shoulder dystocia in the macrosomic group and none in the non-macrosomic group. The stillbirth rate (3.2/1000) was the same in both study group and control. This was not statistically significant (P = 0.124).Conclusion: The precise determination of fetal weight is only done at delivery. Clinical and ultrasound determination of fetal weight are highly imprecise especially at the third trimester. The route of delivery should therefore be individualized

Sterilization by Minilaparotomy in South-Eastern Nigeria

The study aimed to assess the trend in acceptance and characteristics of acceptors of female sterilization between January 1999 and December 2006 at the University of Nigeria Teaching Hospital, Enugu,South-Eastern Nigeria. There were a total of 20,485 new clients, with 212 (1.0%) accepting sterilization between January 1999 and December 2006. There was an initial rise in acceptance from 0.4% in 1999 to 3.0% in 2004, then a decline. 108 (50.9%) were between 35-39 years. 169(79.7%) had more than five living children. 69 (32.5%) and 76 (35.9%) had secondary and higher education respectively. Health workers were the main source of information. Completed family size was the reason for choosing sterilization in 185 clients (87.3%). 120 (56.6%) were in occupational social class 3. 106 (50.0%) did not practice any form of family planning prior to the procedure. 184 (86.8%) had interval sterilization and the rest (13.2%) postpartum. Acceptance of tubal sterilization is still low in our community (Afr J Reprod Health 2009; 13[4]:105-111)

Trend in the use of Intra-uterine Contraceptive Device (IUCD ,TCU 380A) ,in Enugu, Nigeria

OBJECTIVE: To estimate the acceptance rate and trend of Intrauterine Contraceptive Device (IUCD) use in Enugu,NigeriaPATIENTS AND METHODS: A review of all new acceptors of intrauterine contraceptive device (IUCD) over a nine year period(1999-2007) .RESULTS: A total of 133,375 clients were seen at the UNTH family planning clinic between 1999 and 2007. Out of 6,947 users of IUCD, during the period, 1,659 were new acceptors. The IUCD acceptance rate was 5.21%. Majority of the clients (29.7%) were aged 40 years and above. Eight hundred and forty seven (51.4%) had attained post secondary education . Majority of the clients (99.4%) were married . Twenty-six percent(26.0%) had completed their desired family size. Majority 1,359 (82.4%) did not use any method of contraception prior to IUCD insertion. The commonest complication was menorrhagia (5.8%) and this was responsible for removal in 3.0% of cases. Eight (0.5%) and nine(0.6%) requested for removal forfear of causing cancer and migration to the brain or heart respectively. Two (0.1%) became pregnant while having the IUCD in-situ. Majority of the clients (50.5%) had the knowledge of IUCD through friends.Conclusion: This study has shown that IUCD (TCU 380A) is both safe and effective in Enugu, Nigeria. Its use is for both child spacing and limiting family size.KEYWORDS: Intrauterine contraceptive device, acceptance rate,complications

Patients’ satisfaction with eye care services in a Nigerian Teaching Hospital

Background: Understanding the patientsf perception of services received is essential as the parameters important to the patient may be quite  different from that to the eye health provider.Aim: This study aims to evaluate patientsf satisfaction with the care received from the pioneer teaching hospital in south.eastern Nigeria and use it to audit services.Materials and Methods: This was a descriptive cross.sectional study. An interviewer.administered questionnaire was administered to 307 consecutive consenting patients seen at the eye clinic of the University of Nigeria Teaching Hospital Enugu in April 2013. The questionnaire asked questions regarding satisfaction with the time spent in the clinic, attitudeof various categories of staff, physical facilities, cleanliness of the clinic and willingness to come again to the clinic or recommend it to others.Results: The respondents were more satisfied with the attitude of the doctors and nurses than that of revenue and medical records clerks (P = 0.001). Most patients, 288 (93.8%) expressed satisfaction with the overall cleanliness of the eye clinic; 220 (71.7%) and 288 (93.8%) were not satisfied with the toilet facilities and cost of services, respectively. Only 140 (45.6%) participants will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly.Conclusion: Majority of the patients were satisfied with the services  received. The major dissatisfaction points were cost of services and inadequate toilet facilities.Key words: Developing country, eye care services, patient satisfactio

Mermaid Syndrome in Enugu, Nigeria

Mermaid syndrome is a type of gross fetal anomaly, characterized by the fusion of lower extremities, absent external genitalia, and apparentlywell‑formed abdomen, chest, upper extremities, and head. The neonatal mortality rate due to this anomaly is high, but the disorder is relatively rare.Hence, few cases have been reported in the medical literature, and none in University of Nigeria Teaching Hospital, Ituku‑Ozalla, Enugu State. Keywords: Congenital anomaly, mermaid syndrome, sirenomeli

Seroprevalence of Human Immunodeficiency Virus, Hepatitis B, Hepatitis C, syphilis, and co infections among antenatal women in a tertiary institution in south east, Nigeria

Background: Sexually transmitted infections and human immunodeficiency virus (HIV)/AIDS are a major public health concern owing to both their prevalence and propensity to affect offspring through vertical transmission. Aim: The aim was to determine the seroprevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and co‑infections among antenatal women in Enugu, South‑East Nigeria. Materials and Methods: A retrospective study of antenatal women at the University of Nigeria Teaching Hospital, Enugu, South‑East Nigeria from 1st May 2006 to 30th April 2008. A pretested data extraction form was used to obtain data on sociodemographic variables and screening test results from the antenatal records. The analysis was done with SPSS version 17 (Chicago, IL, USA). Results: A total of 1239 antenatal records was used for the study. The seroprevalence of HIV, HBV, HCV, and syphilis among the antenatal women were 12.4% (154/1239), 3.4% (42/1239) 2.6 (32/1239) 0.08% (1/1239), respectively. The HIV/HBV and HIV/HCV co‑infection prevalence rates were 0.24% (3/1239), 0.16% (2/1239), respectively. There was no HBC and HCV co‑infection among both HIV positive and negative antenatal women. There was no statistically significant difference in HBV and HCV infection between the HIV positive and negative antenatal women. The only woman that was seropositive for syphilis was also positive to HIV. Conclusion: The seroprevalence of HIV, HBV, HCV, and syphilis is still a challenge in Enugu. Community health education is necessary to reduce the prevalence of this infection among the most productive and economically viable age bracket.Keywords: Antenatal women, Co‑infection, Human immunodeficiency virus, Hepatitis C virus, Hepatitis B virus, Seroprevalence, Syphili