Management Outcomes of Abruptio Placentae at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

BACKGROUND: The objective of this study is to determine incidence, risk factors and management outcomes of abruptio placentae (AP) and comparing them with cases without AP who delivered within the same period.METHODS: A 10 year retrospective study of AP managed at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, between January 2001 andDecember 2010 was undertaken. Proforma was initially used for data collection before transfer to Epi-info 2008 software. Test of associations were evaluated and P<0.05 was considered significant.RESULTS: Sixty nine cases out of a total delivery of 8,811 were seen, giving an incidence of 0.8%. The mean age and parity of women with AP were 30.8 ± 0.9 years and 4.1±0.6 respectively and majority (78.3%) of cases were unbooked (p=0.0019). Grand multiparity and age =35 years were significant risk factors (p<0.05). Fifty two (75.4%) cases weredelivered by caesarean section (c/s) (P=0.0000). The sex ratio was 160 (p=0.0134). The overall maternal mortality ratio during the studyperiod was 987 per 100,000 live births with AP contributing 3.8% of the maternal deaths while perinatal mortality rate was 52.2%.CONCLUSION: A significant number of cases have high perinatal mortality. Unbooked, high parity, advanced maternal age and previous c/s scar weresignificant aetiological risk factors.KEYWORDS: Abruptio placentae, risk factors, Nnewi,Nigeri

Prevalence of asymptomatic bacteriuria among pregnant women in Nnewi, southeast Nigeria

Asymptomatic bacteriuria (ASB) in pregnancy is associated with obstetric complications including preeclampsia, pyelonephritis, preterm labour, low birth weight and prematurity. Determining the prevalence of asymptomatic bacteriuria among pregnant women locally is needed to justify routine screening for ASB in pregnancy. This cross sectional, case controlled study examined 440 women comprising equal numbers of pregnant and non pregnant women attending various clinics at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Nigeria with the aim of determining the prevalence of ASB among them and the antibiotic sensitivity of the isolated organisms. Urine culture using MacConkay and blood agar were used to isolate bacteria organisms. Significant bacteriuria was defined as the finding of single pure isolate of ≥105 in two consecutive, freshly voided, midstream urine. The prevalence of asymptomatic bacteriuria among the pregnant women was 19.5% (n=43) and 6.4% ( n=14) for the non pregnant women. (x2=16.9,0R=3.6, P=0.00). There was no significant influence of age (x2=1.89,P=0.39), parity (x2=3.92,P=0.14) or social class (x2=5.7, p=0.22) on the prevalence of asymptomatic bacteriuria in pregnancy. Escherichia coli (E. coli) was the commonest isolated organism, 30(52.6%) followed by Staphylococcus aureus, 10 (17.5%) and Klebsiella sp, 9 (15.8%). The isolated E. coli was 100% sensitive to ofloxacin, nitrofurantoin and nalidixic acid and 83.3%, 73.3% and 66.7% sensitive to augmentin, gentamicin and cefuroxime, respectively. Sensitivity to ampicillin and cotrimoxazole were 43.3% and 30.0%, respectively. The prevalence of asymptomatic bacteriuria among pregnant women attending antenatal clinic in NAUTH is high and the isolated organisms were mainly susceptible to ofloxacin, nitrofurantoin and nalidixic acid. Routine screening for ASB in pregnancy in the hospital is recommended for all pregnant women.Keywords: Prevalence, Asymptomatic bacteriuria, Nnewi, Nigeri

Inevitable Caesarean Myomectomy

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequentpregnancies had been prescribed in its place.We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgeryensured minimal intra operative and post operative blood loss.Keywords: caesarean myomectomy, inevitable, fibroid

Use of absolute lymphocyte count or neutrophil ingestion rate of nitroblue tetrazolium (NBT) as alternative index to CD4+T-cell count to initiate ART in the management of HIV/AIDS disease

The present study was designed to evaluate absolute lymphocyte count or neutrophil ingestion rate of NBT as alternative indices to CD4+ T cell count in the management of HIV/AIDS subjects. 158 adult participants (male = 70, female = 88) were recruited for the study and grouped as: (i) Symptomatic HIV subjects with or without malaria (ii) Asymptomatic HIV subjects (iii) HIV seronegative subjects with or without malaria. Blood samples taken from these participants were analyzed using standard procedures for absolute lymphocyte count, neutrophil ingestion rate of NBT and CD4+ T cell count. The result showed that the mean absolute lymphocyte and neutrophil ingestion rate of NBT were significantly reduced in both symptomatic and asymptomatic HIV subjects with or without malaria infection when compared to the control group. The CD4+ T cell count was significantly reduced in the two groups and positively correlated with the absolute lymphocyte count (r = 0.301, P<0.05, r = 0.403, P<0.05) and neutrophil ingestion rate of NBT (r = 0.116, P = 0.01, r = 0.359, P<0.01) with or without malaria infection respectively. This finding suggests that in resource limited settings, absolute lymphocyte count or neutrophil ingestion rate of NBT could be used as alternative to CD4 count to monitor or initiate ART where the later is not easily accessible especially in a malaria endemic area.Keywords: Absolute lymphocyte count, NBT, ART, CD4+ T-cell count, HI

Reduced serum tetanus antibody titre in HIV infected subjects with malaria co-infection in a malaria endemic area of Nigeria

Tetanus infection is widespread and difficult to completely eradicate. Thus the present study was designed to assess the tetanus antibody titre in HIV infected subjects in relation to the presence or absence of malaria parasitaemia. 107 subjects consisting of asymptomatic group (asymptomatic HIV, n=17 and asymptomatic HIV-Malaria co-infection, n=17), symptomatic group (symptomatic HIV, n=18 and symptomatic HIV-Malaria co-infection, n=17), and control group (control without malaria, n=19 and control with malaria, n=19) participated in the study. Blood sample collected from the participants were used for the determination of packed cell volume, CD4+ T cell count, malaria parasite, HIV seropositivity and tetanus antibody titre using standard laboratory methods. The tetanus antibody titre was significantly reduced in symptomatic HIV infected subjects with malaria co-infection compared with symptomatic HIV infected subjects without malaria (

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Pattern of degeneration of leiomyoma uteri

The aim of this study is to determine the prevalence and pattern of degenerations in leiomyomas. We sought to relate these degenerations with clinical features. It is a retrospective study of histological features of specimens of leiomyomas obtained at the myomectomy, hysterectomy and polypectomy. Results showed that 88.89% had degenerations. Hyaline degeneration was the commonest accounting for 89.71% of all degenerations followed by cystic degeneration (15.44%), calcification (8.82%) and red degeneration which was the least common (5.15%). The clinical features seen in our series cannot be reliably matched with any particular pattern of degeneration. However, lower abdominal pain seems to be a constant feature in red degeneration of fibroids. There is a high prevalence of degenerative changes in leiomyomas of Nigerian Igbo women. Key words: Leiomyoma, degeneration, patter

Uterocutaneous fistula following caesarean section (A Case Report

Background: Uterocutaneous fistula is a rare complication of uterine surgery. Surgical treatment with hysterectomy and or excision of the fistuloustract has been successful. A successful medical treatment with gonadotropin releasing hormone agonist (leuprolide acetate) has been reported.A case of uterocutaneous fistula that was successfully treated with excision is reportedCase: A 35 years old para 2 lady, presented with bloody discharge during her menstrual period from a pfannenstiel incision scar, following a repeatcaesarean section. She admitted to post operative wound sepsis. A fistulous tract leading from uterus to the abdominal incision scar wasdemonstrated through a hysterosalpingogram. The patient has been symptoms free following excision and repair.Conclusion: The case highlights this rare complication of caesarean section. It also emphasizes the need for competence at caesarean section andmeasures to prevent post operative sepsis

Clinicopathological Analysis of Primary Ovarian Cancers in A Tertiary Health Facility In Nnewi, South Eastern, Nigeria

Next to cervical cancer, ovarian cancer is responsible for most gynaecological cancer death and ill health in Nigeria. However, its management still poses tremendous challenge to the gynaecologist due to late presentation. Over a period of ten years (January 1999 to December 2008) 76 patients presented with carcinoma of the ovary at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The case files of 70 patients were available and were analysed retrospectively. Ovarian cancer accounted for 76 of the 317 gynaecological malignancies treated in the hospital giving an incidence of 24.0% of all gynaecological cancers. The mean age of the patients was 51.2±1.2 while the modal age group was 50 - 59 years (28.6%). Most of the patients were grandmultiparous (54.3%) and belonged to social classes I (28.6%) and II (20.0%). Abdominal swelling (85.7%), abdominal mass (74.3%), abdominal pain (71.4%) and weight loss (60.0%) were the common presenting features. Majority of the patients (57.1%) presented in stage iv. Serous adenocarcinoma (46.9%) was the commonest histological type found and was followed by mucinous adenocarcinoma (28.1%). Sixty eight (97.1%) of the patients had surgery(cytoreduction) with chemotherapy while 2 patients received chemotherapy only. Sepsis/ wound breakdown (17.2%) and haemorrhage (14.1%) were the main postoperative complications encountered. Following treatment, thirty three (47.1%) of the patients were lost to follow up while Eighteen (25.7%) patients died during the follow up period. We advocate public sensitization and awareness among medical practitioners for early detection, and improved treatment outcome.Key words: ovarian cancer, clinicopathological analysis, Southeast Nigeri

Lactating Vulva Mammary Tissue in a Nigerian

Forty one cases of ectopic mammary gland in the vulva have been reported since 1872. Ectopic mammary tissue is subject to the physiologic and pathologic changes that occur in the orthotopic breast. We report on a case of a 33 year old woman with a cystic mass in the right labium majus that developed rapidly in the early puerperium following her 5th confinement. Histology of the completely excised cyst revealed a secretory mammary tissue. There was no recurrence ten months after surgery while breastfeeding. Key Words: lactation, vulva, Mammary tissue, Nigerian Nig. Medical Practitioner Vol. 44(3) 2003: 50-5