Abdominal myomectomy: A retrospective review of determinants and outcomes of complications at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background: The aim of this study was to describe the pattern, outcomes, and determinants of perioperative complications of abdominal myomectomy at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.Methods: This was a retrospective review of cases of abdominal myomectomy between January 2010 and December 2013. Data were obtained from ward and operating theatre case records and analysed using SPSS version 20. The continuous variables were analysed with Student’s t-test. The categorical variables were analysed with the chi-square test. P-values of 0.05 or less was taken to be significant.Results: Total sampling yielded 204 cases, of which 170 records (80%) were adequate for analysis. Using criteria developed by Garry et al., major and minor complications occurred in 43.6% and 32.9% of procedures, respectively, while 23.5% of the patients had no complications. The commonest complication was intraoperative haemorrhage requiring blood transfusion. Mean estimated blood loss was 630.88 ± 392.42 mL. There were no cases converted to hysterectomy, and no deaths were recorded. Uterine size equivalent to 16 weeks’ gestation or more was significantly associated with heavier blood loss, blood transfusion, and fever (P = 0.034). Other significant determinants of major intraoperative haemorrhage with or without blood transfusion were menstrual flow of 6 days or more, preoperative anaemia, previous surgery, posterior incision, and surgery duration longer than 4 hours (P < 0.05).Conclusions: Outcome of abdominal myomectomy is generally favourable even if uterine size is greater than 16 weeks by palpation. Nevertheless, patients should be counselled preoperatively on the risk of blood loss and the possibility of blood transfusion

Caesarean section in a primigravida with spina bifida occulta and a spinal cord stimulator: Preconception counselling, antenatal care and anesthetic considerations

Recent developments in medical and surgical subspecialties have contributed to improved quality of life in patients with spina bifida (SB). Despite the challenges of chronic pain, spinal abnormality, gait abnormalities, loss of urinary, and fecal continence, female patients can become pregnant. Provision of obstetrics and/or surgical care to patients with SB may become more common as more patients survive to adulthood. Preconception counseling, antenatal care, obstetrics, and other specialized care are essential components of optimal management of these patients. We report the obstetric and anesthetic challenges encountered in a primigravida with SB occulta and a spinal cord stimulator who had caesarean delivery. Effective communication between the patient, obstetricians, and anesthetists, as well as planned and coordinated care, ensured a successful feto‑maternal outcome.Keywords: Antenatal management; caesarean delivery; preconception care; spina bifida; spinal cord stimulato

Non-fistulous urinary leakage among women attending a Nigerian family planning clinic

Urinary leakage is an important gynecological challenge, which has a substantial impact on quality of life. The aim of this study was to determine the prevalence and types of non-fistulous urinary leakage among women attending the family planning clinic of the University of Ilorin teaching hospital, Ilorin, Nigeria. The study was a cross-sectional study carried out between January 3 and April 25 2009. One hundred and two women experienced urinary leakage out of 333 women interviewed, giving a prevalence rate of 30.6%. Stress incontinence was the most common urinary leakage (prevalence rate 12.0%). This is followed by urge incontinence (10.8%), urinary incontinence (4.8%), and overflow incontinence (3.0%). None of the women afflicted sought medical help. Conclusively, this study has demonstrated that non-fistulous urinary leakage is a common problem among women of reproductive age in this environment

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Caesarean section in a primigravida with spina bifida occulta and a spinal cord stimulator: Preconception counselling, antenatal care and anesthetic considerations

Recent developments in medical and surgical subspecialties have contributed to improved quality of life in patients with spina bifida (SB). Despite the challenges of chronic pain, spinal abnormality, gait abnormalities, loss of urinary, and fecal continence, female patients can become pregnant. Provision of obstetrics and/or surgical care to patients with SB may become more common as more patients survive to adulthood. Preconception counseling, antenatal care, obstetrics, and other specialized care are essential components of optimal management of these patients. We report the obstetric and anesthetic challenges encountered in a primigravida with SB occulta and a spinal cord stimulator who had caesarean delivery. Effective communication between the patient, obstetricians, and anesthetists, as well as planned and coordinated care, ensured a successful feto-maternal outcome

Duration of labor with spontaneous onset at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background/Objective: Duration of labor varies from one pregnancy to another and a period of less than 12 hours is regarded as normal. Modern obstetric practice involves active management of labor with the aim of preventing prolonged labor and its sequelae. The main objective of this study was to determine and compare the average duration of labor of spontaneous onset between nulliparas (Po) and multiparas (P 65 1) and to determine factors affecting duration of labor. Materials and Methods: This study was a prospective study carried out between 15 May and 14 June 2004 at the Labor Ward of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Two hundred and thirty-eight women who satisfied the inclusion criteria were studied. The inclusion criteria were term pregnancy with vertex presentation, labor with spontaneous onset, live fetus at presentation and spontaneous vertex delivery. Results: The mean \ub1 SD admission-delivery interval in labor ward was shorter (3.77 \ub1 2.88 hours) among multiparas than that of nulliparas (5.00 \ub1 3.17 hours) (P = 0.235). The mean \ub1 SD duration of labor (from the onset of labor to delivery) was shorter among multiparas (8.73 \ub1 4.17 hours) than that of nulliparas (11.23 \ub1 4.29 hours) (P = 0.426). The differences were not significant (t-test, P > 0.05). Maternal age and individual parity had significant correlation with the duration of labor in this study (Pearson correlation = 120.019, 120.027, respectively, P < 0.05). Conclusion: Interestingly, duration of labor was not significantly different among multiparas and nulliparas although it was shorter. Correlation existed between duration of labor and maternal age and individual parity

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways