Huge Benign Granulosa Cell Tumour In A 61 Year Old Nigerian Grandmultipara With Late Presentation

Objective: To re-appraise clinicians that huge ovarian lesions with features of malignancies may still be benign and that late presentation is a problem in genital cancer management that should be addressed. Subject, material and method: A case report of a huge benign granulosa cell tumour in a postmenopausal woman is presented. Results: She presented as a case of a huge right ovarian tumour with weight loss, respiratory and abdominal discomfort one year after initial diagnosis was made because of fear of surgery. She had laparotomy, total abdominal hysterectomy and bilateral salpingoophorectomy. Histology revealed granulosa cell tumour of the benign type. Conclusion: Huge ovarian tumours in the elderly could be benign. In the absence of proper screening technique for ovarian cancers, laparotomy for histological purposes is required. Health education and proper counselling is imperative to reduce delays of patients to hospitals. Key Words: Huge, benign, granulosa cell tumour, 61 year old, Late presentation

Bilateral tubal ligation in a rural hospital in the Niger Delta, Nigeria

Background and Objective: To document bilateral tubal ligation (BTL) rate  and highlight the need to improve on the rates.Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group.Results: There were a total of 103 BTLs, 58 were Caesarean BTLs, six were cases of BTL with repair of uterine rupture and 39 had BTL from mini-laparotomy. There were 937 Caesarean sections and 2,356 deliveries during the study period. BTL therefore constituted 0.044% of the total deliveries. The majority (51.7%) were above 35 years of age and grandmultiparity constituted 60.4% of BTL cases. The majority was in the low social Class 4 and 5 (41.3%). Grandmultiparity was the most common indication (60.4%). Previous Caesarean sections were more in the highest social class with a mean of 2.9 ± 1.21 while ruptured uterus had the lowest. Unbooked cases of BTL constituted 62.1% of BTL.Conclusions: Bilateral tubal ligation rate was low in this study with grandmultiparity being the commonest indication, the majority of patients were elderly parturient and largely unbooked. Social class was highest among those with previous Caesarean section

Strengthening the emergency healthcare system for mothers and children in The Gambia

A system to improve the management of emergencies during pregnancy, childbirth, infancy and childhood in a region of The Gambia (Brikama) with a population of approximately 250,000 has been developed

Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania

\ud Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.\u

Female reproductive tract infections: understandings and care seeking behaviour among women of reproductive age in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Reproductive tract infections (RTI's) are endemic in developing countries and entail a heavy toll on women. If untreated, RTI's can lead to adverse health outcomes such as infertility, ectopic pregnancy and increased vulnerability to transmission of the human immunodeficiency virus. It is also associated with adverse pregnancy outcomes. While RTI's and its sequelae abound in Nigeria, there is paucity of publications on the subject in the country. This study assessed the understandings and care seeking behavior with regards to RTI's among women of reproductive age in Lagos, Nigeria with the aim of improving awareness on the subject.</p> <p>Methods</p> <p>A descriptive cross sectional survey of women attending the gynaecological outpatient and family planning clinics of the Lagos State University Teaching Hospital was carried out between 1^stJune 2008 and 31^stAugust 2008 using a pre-tested questionnaire. Data was analysed using the Epi-Info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U.S.A.</p> <p>Results</p> <p>Most of the respondents (77.2%) had heard of RTI's. Toilet was the most perceived mode of contracting RTI's (44.6%), followed by sexual intercourse and poor hygiene. Vaginal discharge was the commonest symptom of RTI's named while inability to get pregnant was the commonest named complication. Majority of the respondent's demonstrated poor overall knowledge of symptoms and complications of RTI"s. 37.4% of the respondents had experienced symptoms of RTI's in the preceding six months. Vaginal discharge was the commonest symptom reported (21.8%) and the majority of those who reported symptoms sought medical treatment. Government health centres were the most visited health facilities for treatment.</p> <p>Conclusion</p> <p>Even though most of the respondents have heard of RTI's and sought treatment when symptomatic, they demonstrated poor overall understanding of the subject. There is need to educate women on preventive strategies, as RTI's are often assymptomatic.</p

Twinning across the Developing World

Contains fulltext : 95481.pdf (publisher's version ) (Open Access)5 p

Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states

<p>Abstract</p> <p>Background</p> <p>Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy.</p> <p>Method</p> <p>In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering.</p> <p>Findings</p> <p>The most consistent and prominent of 28 candidate risk factors and underlying determinants for non-fatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5).</p> <p>Interpretation</p> <p>Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives – genital mutilation, domestic violence, and steep power gradients – is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.</p

The impact of tubal ectopic pregnancy in Papua New Guinea - a retrospective case review

BACKGROUND: Ectopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region. METHODS: We undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described. RESULTS: A total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/−5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed. CONCLUSIONS: Tubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers’ awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion

Knowledge and perception of obstetric complications among women in a semi urban community in the Niger delta of Nigeria

Background: Ogunu is an oil producing community located in Warri South Local Government Area of Delta State. It is a semi urban area with no hospital but a Primary health center. Majority of the women patronize traditional birth attendants for delivery and obstetric complications are high. In the absence of any orthodox health facilities apart from the primary health center here, traditional birth attendants manage majority of the deliveries.Objective: The study was aimed at assessing the knowledge and perception of obstetric complications among women in the reproductive age group at Ogunu community in Warri South Local Government Area of Delta State.Methodology: This was a community based cross sectional survey of randomly selected reproductive aged women who consented, using an interviewer-administered semi structured questionnaire. Data was analyzed with the SPSS 16 statistical software package. Consent of the women was sought and once obtained, they were assisted in filling a semi-structured questionnaire containing questions on knowledge and perception of obstetric complications. Information generated was recorded on a data collection sheet designed for the study. The coded data were fed into the computer using the SPSS 16 programme to determine the mean values and frequencies.Results: A total of 400 questionnaires were distributed with 349 completely filled and analyzed. Majority of the subjects were in the age range 25-34 [154 (44.1%)] and the mean age was 31.6&plusmn;7.7 years. 191 (54.7%) of subjects were married and 307 (88.0%) had one form of education or the other. Over 307 (88%) subjects had knowledge of the major obstetric complications of excessive bleeding, hypertension, and obstructed labour. 162(46.4) and 141(40.4%) of subjects believed that vaginal bleeding in pregnancy and excessive bleeding after delivery were due to evil forces and infidelity respectively. 162 (46.4%) and 123(35.2%) of participants&nbsp; respectively believed that vaginal bleeding in pregnancy and excessive bleeding after delivery will stop, therefore hospital visit is not necessary and that local herbs are best treatment. Majority, 251 (71.9%) did not know the definition of prolonged labour. Very few believed that difficult labour should be treated by local herbs, 24 (6.9%), massaging the abdomen 23 (6.5%) and visiting of&nbsp; TBA's 25 (7.2%).Conclusion: This study shows that a large proportion of subjects have a good knowledge and perception of obstetric complications. However the few that have negative perception may contribute to the already alarming high rate of obstetric complications in Nigeria. Despite the high level of awareness of obstetric complications, there still exists some erroneous perception with regards to the aetiology &amp; management of such complications among the women. Widespread public health enlightment campaigns are urgently needed to correct these negative perceptions of obstetric complications by the populace

Spontaneous heterotropic pregnancy: A case report

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