A recurrent gestational choriocarcinoma case complicated by a silent postpartum ruptured uterus: a unique presentation

Gestational trophoblastic diseases comprise of potentially malignant conditions arising from defective proliferation of trophoblastic tissue. Among the different types, gestational choriocarcinoma constitutes a malignant form with significant cure rate and minimal sequel if treated adequately and followed up consistently. In this case report, we describe a patient who previously had history of choriocarcinoma and was treated with six courses of combination chemotherapy and was not followed up consistently and 14 months later conceived and delivered a live 1.3 kg female baby at 31 weeks of gestation. Two weeks post-delivery she was diagnosed with ruptured uterus. Long term complication following choriocarcinoma is a rare event. Moreover, coexistence of choriocarcinoma with normal pregnancy and a subsequent ruptured uterus two week after delivery constitutes an atypical presentation. Complications and challenges described in this report highlight some of the difficulties encountered in managing gestational trophoblastic neoplasia in limited resource setting of Tanzania

Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: A population based study in Tanzanian rural community.

The prevalence and risk-factors of pelvic organ prolapse (POP) in Tanzania are unknown. To help elucidate the problem, we assessed POP and associated risk-factors among Tanzanian women by deploying the POP-Q classification system.A cross sectional community based study conducted in Hai, Rombo and Same Districts, Kilimanjaro Region, Tanzania. Women aged 18-90 were recruited through multi-stage random sampling from January to May 2015. Home-based questionnaire interviews were performed and the women were subsequently invited to the nearest health clinic for pelvic examination. Trained physicians used the POP-Q classification system to assess the POP stage.A total of 1195 women were interviewed and invited for pelvic examination; 1063(89%) women presented at the clinic of whom 1047(88%) accepted a clinical examination. Of 1047 examined women, 64.6% had an anatomical POP stage II-IV and 6.7% had a severe POP that descended 1 cm or more below the hymen. POP stage II-IV was associated with being aged 35+ years, being a farmer, doing petty trading and having delivered 3 times or more. Severe POP was associated with carrying heavy objects for ≥ 5 hours (OR 4.70;1.67-13.2), having delivered 5 times or more (OR 10.2;2.22-48.6) and having delivered at home (OR 2.40;1.36-4.22).POP is a common condition among rural Tanzanian women where 64.6% are having POP grade II-IV and 6.7% are having a severe POP descending 1 cm or more below the hymen. Risk-factors are increasing age, heavy lifting, high parity and home-delivery

Urinary incontinence and its relation to delivery circumstances: A population-based study from rural Kilimanjaro, Tanzania.

ObjectivesTo investigate the prevalence and risk factors of urinary incontinence (UI), the different UI subtypes and the association between UI and delivery circumstances.DesignCross-sectional population-based study conducted in Kilimanjaro Region, Tanzania.Participants and settings1048 women aged 18-90 women living in rural Kilimanjaro. Simple random sampling was done to select villages, households and participants. Community health workers helped in identifying eligible women and trained nurses/midwives conducted face-to-face interviews. Data were analysed using descriptive statistics and Univariate and Multivariate logistic regression modelling.ResultsThe overall prevalence rate of UI was 42%. When focusing on the different types of UI, 17% of the women had stress UI, 9% had urge UI and 16% had mixed UI. Only one woman (0.1%) with vesico-vaginal fistula was identified. UI was found to be significantly associated with increasing parity (OR = 2.41 (1.55-3.74). In addition, women who in relation to their first delivery had delivered at home or had been in labour for more than 24 hours, had increased adjusted ORs of 1.70(1.08-2.68) and 2.10(1.08-4.10), respectively, for having UI.ConclusionUI is common in rural Tanzania and of the subtypes of UI, Stress Urinary Incontinence (SUI) is the commonest followed by Mixed Urinary Incontinence (MUI). Home delivery, prolonged labour and increasing parity especially having 5 or more deliveries are associated with increased risk for developing UI

Socio-demographic and reproductive characteristics of participants.

<p>Socio-demographic and reproductive characteristics of participants.</p

Frequency of POP stage II-IV and severe POP (Ba/C/Bp≥ 1cm) by age groups.

<p>Frequency of POP stage II-IV and severe POP (Ba/C/Bp≥ 1cm) by age groups.</p

Prevalence of POP by anatomical site.

<p>Prevalence of POP by anatomical site.</p

The association between socioeconomic characteristics, obstetric history and severe POP.

<p>The association between socioeconomic characteristics, obstetric history and severe POP.</p

Study flowchart.

<p>Study flowchart.</p