Pattern and Outcome of Gynaecological Admissions at a Nigerian Tertiary Care Centre

Context: Hospital based data, when monitored over a period of time may help in evaluating changes in disease pattern and mortality, thus assisting health planners and policy makers to re-order their priority. Objective: The main objective of this study is to review the gynaecological admissions and deaths over a fiveyear period. Subjects and Methods: The case notes of all admissions and deaths on the gynaecological ward between January, 1996 and December 2000 were reviewed. Analysis were made of the various diagnoses and outcome, length of hospitalization, turn around period, number of patients per bed per year and bed occupancy. Results: There were 803 admissions over the study period, out of which 429 (53.4%) were emergencies while 374 (46.6%) were electively admitted for surgery. Two hundred and seventy five (34.2%) patients had purely medical treatment while 528 (65.8%) had surgical management. There were 9 patients per bed per year with a turn around (turnover) of 11.5 days and bed occupancy of 64.3%. .Twenty five (3.1%) patients discharged themselves against medical advice and there were 23 (2.9%) deaths. The interval between admission and death ranged from 1 to 37 days with a mean of 9.5 ± 3.2 days. All the deaths occurred in the emergency group. Abortion accounted for 15.6% of total gynaecological admissions and was the commonest disease entity responsible for gynaecological admission. Mortality was highest for (malignant) neoplasms accounting for 56.5% of deaths. This was followed by infections, 43.5% with post abortal sepsis contributing as much as 30.4% of fatality. Conclusion: The study recommends improvement of preventive strategies towards complications of early pregnancy especially abortion in the community and encourages better admission policy, provision of appropriate facilities and manpower to improve the hospital services. Key Words: Pattern, outcome, gynaecological admissions, fatality. [Trop J Obstet Gynaecol, 2004;21:52-55

Should Ultrasonography be Done Routinely for all Pregnant Women?

Context: Although the importance of routine ultrasound screening of the fetus during pregnancy to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders and placental abnormalities, and to assess fetal age is not in doubt, but whether or not routine ultrasound screening is desirable is still a contentious issue. Objective: The objective of this study is to determine whether ultrasonography should be done routinely for all pregnant women or not. Materials and Methods: This is a retrospective study that reviewed 1,000 obstetric ultrasound scans performed at the Olabisi Onabanjo University Teaching Hospital, Sagamu between June 1998 and May 1999. The case notes and ultrasound scan records of all the patients were analyzed Results: The age range and the mean age of the 1,000 pregnant women who had the obstetric scans were 17-42 years and 27.3 ± 2.1 years respectively. Six hundred and eight (60.8%) had routine ultrasonography (control group) while 392 (39.2%) were scanned for specific obstetric indications. In all, positive findings were seen in 328 cases (32.8%). Seventy five percent of those with specific indications for scanning had positive findings of clinical significance while only 5.6% of the control group had incidental findings of clinical significance. Positive findings on ultrasound were significantly greater in the group with specific indications for scanning, P< 0.001. Conclusion: Our suggestion is that ultrasound examination in pregnant women should be performed only when there are clear obstetric reasons, established clinically. Key Words: obstetric ultrasound scan, positive findings, pregnancy. [ Trop J Obstet Gynaecol, 2004;21:11-14

Maternal Deaths from Induced Abortions

Context: Unsafe abortion has grave implications for the life of a woman and her future reproductive career. Efforts to find the reasons underlying how a woman gets to the point of having an unsafe abortion, and means of preventing and minimising complications arising thereby are highly desirable. Objective: To find the extent to which unsafe abortion contributes to maternal mortality in our environment. Study Design, Setting and Subjects: A descriptive study of patients who were admitted for complications arising from induced abortions between January 1988 and December 2000 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with the data being obtained from case records. Results: A total of 103 patients presented with complications arising from induced abortions. Twenty-one (20.4%) of these patients died as a result of complications arising thereby. During the same period, there were 71 deaths in the gynaecological ward. Thus, deaths from induced abortion accounted for 29.6% of all gynaecological deaths. There were 105 maternal deaths in the hospital during the period. Hence, induced abortions were responsible for 20% of all maternal deaths. The patients had various complications including 15 (71.4%) with septicaemia, 10 (47.6%) with anaemia, 7 (33.3%) each with jaundice and peritonitis. Conclusion: Abortion-related maternal death is still a major contributor to maternal mortality in this environment. Women empowerment, easy access to good quality and cheap family planning methods and post abortion care and rationalisation of abortion law may help to halt this stream of deaths from unsafe abortions. Key Words: Pregnancy, Unsafe Abortion, Maternal Mortality [Trop J Obstet Gynaecol, 2003, 20: 101-104