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

Letter to the Editor: Reflecting on the Challenges of Prevention of Mother to Child Transmission of HIV/AIDS in Africa

Letter to the Editor: No Abstract Availabl

Pattern of seminal fluid abnormalities in male partners of infertile couples in southeastern Nigeria

No Abstrac

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

Salpingocutaneous fistula in an adolescent resulting from septic induced abortion. A case report

Unwanted pregnancy and the attendant unsafe abortion is a major health challenge for the adolescent because of the various reproductive and social consequences. A case of an unmarried 15year old secondary school student who developed pelvic abscess with salpingo cutaneous fistula from septic induced abortion is presented. She had exploratory laparotomy, Adhesiolysis, abscess drainage, right salpingo-oophorectomy and excision of the fistulous tract. The issue of unsafe abortion within the context of the unmet sexual and reproductive needs of the adolescent is discussed. Keywords: Fistula, adolescent, unsafe abortion, abscessTropical Journal of Medical Research Vol. 12 (1) 2008: pp. 50-5

Ectopic pregnancies seen at Nnamdi Azikiwe University Teaching Hospital, Nnewi: (a 5-year review).

Background: Ectopic pregnancy is a recognized cause of both maternal mortality and morbidity in early pregnancy and has remained a reproductive health challenge to our women. Highlighting the patients’ characteristics and risk factors as well the management options will aid in improving treatment outcome.Objective: This is a retrospective study to analyze the clinical profile of patients presenting with ectopic pregnancy at Nnamdi Azikiwe UniversityTeaching Hospital (NAUTH), Nnewi over a 5- year period. The incidence, risk factors and management options were also reviewed.Materials and Methods: The case files of all ectopic pregnancies managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi between 1stJune, 2002 and 31st May, 2007 were analyzed.Results: A total no of 24 cases of ectopic pregnancies were managed, giving an incidence of 0.9% of total births and 4.3 % of all gynaecologicaladmissions. Majority of the patients (58.3%) were nulliparous while the peak age of incidence was 25-29years. Induced abortions (50.0%) and previous abdominal surgeries (41.7%) were the commonest identified risk factors. Amenorrhea (91.7%), abdominal pain (91.7%) and vaginal bleeding (76.0%) were the most frequent modes of presentation. All patients had ruptured ectopic on presentation and 66.7% of them were in shock at presentation. All patients had laparatomy with salpingectomy and 91.7% of them were transfused. Adhesions were noted in majority (58.3%) of cases. Twelve of the patients (83.3%) suffered post operative morbidities of which anaemia (60.0%) and fever (30.0%) were the commonest. All the surgeries were done by senior registrars and no case mortality was recorded.Conclusion: The incidence of ectopic pregnancy in the hospital over the period of review was low. Majority of the patients were nulliparous and intheir mid twenties, with a history of induced abortion and previous abdominal surgeries. Post operative morbidity was high, but no mortality was recorded. Pelvic adhesions were noted in majority of cases during surgery and laparatomy with partial salpingectomy was the means of management employed in all cases. Health education addressing healthy sexual behaviours and contraceptive utilization is urgently needed. Efforts should be made to reduce, as much as possible, the risk of adhesions, during pelvic surgeries

The pattern of gynaecological outpatient diagnosis in a tertiary health institution in southeast Nigeria

Background: Pattern of clinical presentations and diagnosis varies worldwide. Determining the pattern of clinical cases seen in low resourceareas is necessary to ensure an efficient distribution of the available human and material resources, and planning.Objective: To determine the pattern of gynaecological cases seen at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria.Study design/settingA retrospective study of all the cases seen in the gynaecological outpatient clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi overa 5-year period.Materials and methods: The case files of all the gynaecological patients seen within the study period were analyzed for biosocial data and theclinical diagnosis. Data analysis was done with epi info version 2006.Result: 1108 cases were seen during the study period but only 1066 folders were available for analysis. Majority (53.0%) of the patients wereaged 20-29 years, and most of them were nulliparous (47.7%). 77.8 % of the patients had acquired secondary education and above, while mostof them (36.6%) were civil servants. 59.3 percent of the patients were married. Infertility was the commonest case seen (36.6%) followed by uterine fibroids (17.3%), gynaecological cancers (13.2%) and gynaecological infections (10.2%). Only 0.6 %( n=6) of the patients presented on account of contraceptive needs. Of the gynaecological cancers, carcinoma of the cervix was the commonest gynaecological malignancy (53.2%), followed by cancer of the ovary (22.7%) and cancer of the endometrium (13.5%)Conclusion: Infertility, uterine fibroids and gynaecological cancers were the commonest gynaecological cases seen among the patients. There isthe need to build capacity towards an effective and up to date management of these case

Massive Haematometra Arising From Herbal Treatment Of Menorrhagia Associated With Uterine Fibroids: A Case Report

Uterine fibroids are common among our women. Several local alternative treatments with varying adverse health implications have been reported. We present a case of a nullipara who developed massive haematometra from herbal treatment for symptomatic uterine fibroids. She had earlier declined surgery in our clinic. She eventually had uterine exploration, evacuation and myomectomy. The need for a wide scale public education on the nature and treatment of uterine fibroids and the necessity of utilizing the newer and less invasive treatment modalities to reduce the health risks associated with aversion for major surgeries are highlighted. Keywords: Herbal, menorrhagia, fibroids, myomectom Tropical Journal of Medical Research Vol. 12 (1) 2008: pp. 53-5