Cervical pregnancy: dilatation and curettage and successful control of severe haemorrhage with Foley catheter

Cervical pregnancy is a rare form of ectopic pregnancy in which the fertilized ovum implants in the endocervical canal. Its clinical presentation mimics threatened abortion. We report a case of cervical pregnancy in a grand-multiparous woman still desirous of more children, which was initially wrongly diagnosed, but which diagnosis was confirmed at dilatation and curettage. The torrential haemorrhage that ensued was eventually arrested with a Foley catheter, thus preserving the uterus. Haemorrhagic shock was prevented using plasma expanders, as the patient had refused to consent to blood transfusion. Other methods used in the management of cervical pregnancy are acknowledged. Sonographers are encouraged to acquaint themselves with the ultrasound features of cervical pregnancy as a way of curtailing the error in diagnosis, while physicians are advised to learn this conservative surgical skill which has been found very handy during emergency, and especially in our environment. Keywords: cervical pregnancy, dilatation and curettage, severe haemorrhage, Foley catheter Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 80-8

Trends in the Age of Primigravidae in Enugu, Nigeria

Objective: To assess the trend in the age of primigravidae at a tertiary care centre in Enugu, Eastern Nigeria. Study Design, Setting and Subjects: An analysis of the birth records of all primigravidae who delivered in the hospital over a twenty-one year period. Trends were assessed by chi-square and one-way analysis of variance (ANOVA) tests at the 95% confidence level. Results: The proportion of primigravidae significantly increased from 17.4% of all parturients in 1980 to 24.1% in 2000. The proportion of teenage primigravidae significantly decreased while that of elderly primigravidae significantly increased (p < 0.001 for each variable). The mean age of the primigravidae also significantly increased from 21.0 ± 4.1 years in 1980 to 27.6 ± 4.5 years in 2000. Conclusion: Over the last twenty-one years, there has been a significant increase in the mean age of primigravidae and the proportion of elderly primigravidae and a significant decrease in the proportion of teenage primigravidae in Enugu, Nigeria. Key Words: Trends, Temporal, Primigravida, Maternal Age. [Trop J Obstet Gynaecol, 2002, 19: 71-73

A Six-Year Study of the Clinical Presentation of Cervical Cancer and the Management Challenges Encountered at a State Teaching Hospital in Southeast Nigeria

Cervical cancer is still a major contributor to cancer-related mortality amongst women living in poor, rural communities of developing countries. The objective of this study is to establish the clinical presentation of cervical cancer and the management challenges encountered in Abakaliki, southeast Nigeria, with a view to finding intervention strategies. This study is a retrospective descriptive assessment of cases of clinically diagnosed cervical cancer managed at a state teaching hospital over six years. Of 76 cases managed, 61 (80.3%) cases notes were available for study. The mean age and parity of patients were 53.8 years and 6.8 years, respectively. The majority (75.4%) were illiterate. All had been married, but 42.6% were widowed. The main occupations were farming or petty trading. One patient (1.6%) had had a single Pap smear in her life. The major presenting complaints were abnormal vaginal bleeding (86.9%), offensive vaginal discharge (41.0%), and weight loss. Twenty patients (32.8%) were lost to follow-up prior to staging. Of the remaining 41 patients, 16 (39.0%) had stage III disease and 17.1% stage IV. Fifteen patients (24.6%) with late stage disease accepted referral, and were referred for radiotherapy. Those who declined were discharged home on request, though 4 (9.8%) died in the hospital. There was no feedback from referred patients confirming that they went and benefitted from the referral. The presentation followed known trends. Illiteracy, poverty, early marriages, high parity, widowhood, non-use of screening methods, late presentation, non-acceptance of referral, and lack of communication after referral were some of the major challenges encountered. These underscore the needs for health education and awareness creation, women educational and economic empowerment, legislation against early marriages and in protection of widows, and creation of a well-staffed and well-equipped dedicated gynecologic oncology unit to forestall further referral

The Use of the Foley Catheter in Controlling Severe Uterine Haemorrhage in Gynaecological Practice

Three patients with severe uterine bleeding were managed successfully by intracavitary insertion and distension of Foley catheter balloons. Blood transfusion was averted in the first patient and reduced to 2 units in the second, while imminent maternal death was prevented in the third case. The availability of the Foley catheter and minimal requirements for its use, coupled with lack of untoward effects in cases managed, make the procedure a useful one. Key Words: Uterus, Haemorrhage, Foley Catheter. [Trop J Obstet Gynaecol, 2002, 19: 44-46

Outcome of pregnancy in the Grandmultipara in Enugu, Nigeria

Context: Grandmultiparity is considered high-risk because of the associated maternal and fetal complications. Grandmultiparae constitute a significant proportion of the obstetric population in Nigeria hence the problems of grandmultiparity still abound. Objective: To describe the outcome of pregnancy in grandmultiparae. Design, Setting and Subjects: A retrospective study of the grandmultiparous patients delivered at the University of Nigeria Teaching Hospital, UNTH, Enugu, Nigeria, from 1 January 1998 to 31 December 2002. Main Outcome Measures: Data on the age, parity, booking status, literacy level, complications during pregnancy and labour, method of delivery, maternal and foetal outcome, were collected and analysed. Results: Of 3767 deliveries, 618 or 16.41% were grandmultiparous. Their mean age was 34.63 years and mean parity 5.77. 61.6% were illiterate and 83.82% were booked. Anaemia, hypertension and multiple pregnancies occurred in 18.29% in pregnancy. 17.95% had complications in labour. 74.3% achieved vaginal delivery. There was no maternal death. The perinatal mortality rate was 73.4/1000 deliveries. Conclusion: Grandmultiparae make up a significant proportion of our obstetric population. Illiteracy, desire for large families, high perinatal mortality and non-use of contraception are predisposing factors. Non-use of antenatal services and delay in referral worsen pregnancy outcome. Formal education, campaign against large families, reduction in childhood mortalities and improvement in use of family planning will reduce its incidence while use of hospital services will improve pregnancy outcome. Early referral, team work between health professionals and the roles of government, hospital management and non-governmental organizations are discussed. Keywords: grandmultiparity, pregnancy outcome, Enugu, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 8-1

Cervical Cancer Screening: A Survey of Current Practice Amongst Nigerian Gynaecologists

Context: Cervical malignancy is the commonest genital tract malignancy in Nigeria. In the absence of a national screening programme, any hope of minimising death from invasive cervical carcinoma in Nigeria is through increased opportunistic cervical screening by physicians. Recent evidence showed a high awareness but a low practice of cervical screening among Nigerian women, a situation that the respondents attributed to poor physician referral. Objective: To study the attitude toward and practice of cervical cancer screening amongst Nigerian gynaecologists, on whom the burden of treating cervical cancer rests. Study Design, Setting and Subjects: A self-administered, questionnaire survey of 113 Nigerian gynaecologists who attended the Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abuja in November 2000. Results: The 86 (76.1%) gynaecologists who practised in centres with cervical screening services estimated that they screened 15.0 + 18.9% of their gynaecology patients. Pap smear was available to 85 (76.1%) gynaecologists, colposcopy to 28 (32.6%), direct visual inspection (after applying 5% acetic acid solution) to 16 (18.6%), human papillomavirus (HPV) DNA testing to 2 (2.3%) and cervicography to 1 (1.2%). Thirty gynaecologists had definite cervical screening programmes, most of which were selective and based on specific indications. All the respondents favoured a national cervical screening programme. Conclusion: Despite general agreement amongst Nigerian gynaecologists on the need for a national cervical screening programme, their level of opportunistic screening of patients is currently low. A plea is made for increased opportunistic screening pending the establishment of a national screening programme. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 78-81