Tubal ectopic pregnancy 4 years after hysterectomy : a case report

BACKGROUND : Ectopic pregnancy after hysterectomy is a rare event. To date there are 73 definitive cases of post-hysterectomy ectopic pregnancy. The first case was reported by Wendler in 1895. CASE : A 31 year old P2G4 (one miscarriage) presented with a history of severe lower abdominal pain of three days duration. She previously had a subtotal hysterectomy four years prior her current presentation for a septic miscarriage with multiple organ dysfunction. She had a background history of being HIV reactive on antiretroviral therapy initiated two days before her presentation. Her CD4 count was 54 cells/uL, negative cryptococcal latex test. She was first diagnosed with HIV in 2015, however had not been on antiretroviral therapy since then. On clinical examination she was hemodynamically stable, normal blood pressure and pulse, afebrile and no stigmata of AIDS. She had an acute abdomen and on pelvic examination a cervical stump was palpable with no blood from the cervical os. Her haemoglobin was 13.4g/dl. Urine pregnancy test was positive. Her quantitative beta-HCG of 3979 IU/L. Pelvic ultrasound showed fluid collection in the pelvis, no definite masses seen, no uterus seen and ovaries could also not be visualised. Abdominal ultrasound did not show any abnormalities in the rest of the abdomen. The patient was counselled for surgery. Preparation with multidisciplinary consultation was done. Intraoperatively, 100ml haemoperitoneum was found. There were dense pelvic adhesions. Adhesiolysis was done and a bleeding right fallopian tube ampullary pregnancy was found. The right ovary was grossly normal. The contralateral adnexa could not be identified. A right salpingectomy was done. Total blood loss was 100ml. She recovered well post operatively and was discharged three days later to continue her antiretroviral therapy. DISCUSSION : A rare case of tubal ectopic pregnancy after hysterectomy is presented. Access to the peritoneal cavity and fallopian tube through the cervical canal, we postulated as the mechanism in this case. Ectopic pregnancies after hysterectomy are classified into early and late. The former being associated with a pregnancy (or viable gametes) that was present at the time of hysterectomy. These present soon after the hysterectomy. The latter present long after the hysterectomy. Conception can occur after hysterectomy through access via a prolapsed fallopian tube, a fistula or defect in the vault. Cervical stump pregnancy is also described. Surgical intervention is the most common intervention described amongst the case reports. CONCLUSION : Pregnancy after a hysterectomy is a rare possibility with possible adverse outcomes. Clinicians must have a strong index of suspicion for a possible ectopic pregnancy in patients that present with abdominal pain after hysterectomy.https://journals.co.za/journal/medogam2022Obstetrics and Gynaecolog

An audit of patients with abruptio placentae in the Pretoria Academic Complex

BACKGROUND: Obstetric hemorrhage is the third most common cause of maternal death in South Africa. Abruptio placentae (AP) contributed to 12.9% of deaths caused by haemorrhage between 2017 and 2018. OBJECTIVE: To investigate the risk factors, management and outcomes of pregnancies affected by AP. METHODS: We conducted a prospective descriptive study in a one-year period at the Pretoria Academic Complex (PAC). All patients who presented with AP were recruited for the study. The demographics, risk factors, management, complications and outcomes were reported using descriptive statistics. RESULTS: One hundred women with AP presented during the study period, representing an incidence of 1% of pregnancies at PAC. Sixtyone percent of the women had caesarean delivery while 37% had vaginal delivery. A minority of women presented with known risk factors of AP in this setting. Two comparison groups were defined based on the degree of placental separation from the decidua, i.e. >50% and 50% AP (43% v. 57%; p=0.002). More women had postpartum haemorrhage in the >50% group (67% v. 33%; p=0.001). Fifty-eight (58%) live babies and 44 (44%) stillborn babies were delivered. CONCLUSION: The known risk factors of AP were largely absent in women with AP in this setting. The typical clinical findings of AP were late signs associated with severe placental separation. Early resuscitation and delivery of the fetus can positively influence perinatal and maternal morbidity and mortality.http://www.sajog.org.zapm2020Obstetrics and Gynaecolog

Tubal Ectopic Pregnancy 4 years after hysterectomy: A case report

Background: Ectopic pregnancy after hysterectomy is a rare event. To date there are 73 defi nitive cases of post-hysterectomy ectopic pregnancy. The fi rst case was reported by Wendler in 1895.Case: A 31 year old P2G4 (one miscarriage) presented with a history of severe lower abdominal pain of three days duration. She previously had a subtotal hysterectomy four years prior her current presentation for a septic miscarriage with multiple organ dysfunction. She had a background history of being HIV reactive on antiretroviral therapy initiated two days before her presentation. Her CD4 count was 54 cells/uL, negative cryptococcal latex test. She was fi rst diagnosed with HIV in 2015, however had not been on antiretroviral therapy since then. On clinical examination she was hemodynamically stable, normal blood pressure and pulse, afebrile and no stigmata of AIDS. She had an acute abdomen and on pelvic examination a cervical stump was palpable with no blood from the cervical os. Her haemoglobin was 13.4g/dl. Urine pregnancy test was positive. Her quantitative beta-HCG of 3979 IU/L. Pelvic ultrasound showed fl uid collection in the pelvis, no defi nite masses seen, no uterus seen and ovaries could also not be visualised. Abdominal ultrasound did not show any abnormalities in the rest of the abdomen. The patient was counselled for surgery. Preparation with multidisciplinary consultation was done. Intraoperatively, 100ml haemoperitoneum was found. There were dense pelvic adhesions. Adhesiolysis was done and a bleeding right fallopian tube ampullary pregnancy was found. The right ovary was grossly normal. The contralateral adnexa could not be identifi ed. A right salpingectomy was done. Total blood loss was 100ml. She recovered well post operatively and was discharged three days later to continue her antiretroviral therapy.Discussion: A rare case of tubal ectopic pregnancy after hysterectomy is presented. Access to the peritoneal cavity and fallopian tube  through the cervical canal, we postulated as the mechanism in this case. Ectopic pregnancies after hysterectomy are classifi ed into early and late. The former being associated with a pregnancy (or viable gametes) that was present at the time of hysterectomy. These present soon after the hysterectomy. The latter present long after the hysterectomy. Conception can occur after hysterectomy through access via a prolapsed fallopian tube, a fi stula or defect in the vault. Cervical stump pregnancy is also described. Surgical intervention is the most common intervention described amongst the case reports.Conclusion: Pregnancy after a hysterectomy is a rare possibility with possible adverse outcomes. Clinicians must have a strong index of suspicion for a possible ectopic pregnancy in patients that present with abdominal pain after hysterectomy

Popping Quality and Acceptability of Sorghum Pops in Selected Sorghum (Sorghum bicolour (L) Moench) Genotypes

Forty sorghum genotypes comprising five local and 35 introductions were evaluated for physical, popping qualities and grain yield. Twenty five of the forty genotypes were further characterized for sensory and acceptability qualities. The study revealed genotypic differences in grain yield, grain physical characteristics and popping qualities. Grain yield ranged from 751 to 2861 kg ha-1, with only 10 percent of the genotypes had grain yield of more than 2000 kg ha-1. Popping yield ranged from 61 to 95 percent and 25 percent of the genotypes yielding above 90 percent. More than 50 percent of the genotypes had popped volume of 12 to 14.3 mililitres (ml). Sorghum pops prepared from the genotype 80c 2241, MR114-90M11 and SDSH 49 were the most preferred for color, while TX2767 was most preferred for both texture and taste. These genotypes were accepted with a high hedonic rating of between like very much to like extremely. These genotypes were among the top eight in popping yield rating. The most liked sorghum pops were those that were prepared from the white colored sorghum genotypes, while the red and particularly the brown colored ones were least liked for both color and taste. Generally the sorghum introductions were superior in popping and acceptability qualities than the local cultivars. Based on these results it is recommended that farmers should be encouraged to grow the top ranking genotypes for preparation of their traditional foods as well as for popping purposes. UNISWA Research Journal of Agriculture, Science and Technology Vol 3 (1) 1999: pp 44-4

Whole-Genome Analyses Identifies Multiple Reassortant Rotavirus Strains in Rwanda Post-Vaccine Introduction

Children in low-and middle-income countries, including Rwanda, experience a greater burden of rotavirus disease relative to developed countries. Evolutionary mechanisms leading to multiple reassortant rotavirus strains have been documented over time which influence the diversity and evolutionary dynamics of novel rotaviruses. Comprehensive rotavirus whole-genome analysis was conducted on 158 rotavirus group A (RVA) samples collected pre- and post-vaccine introduction in children less than five years in Rwanda. Of these RVA positive samples, five strains with the genotype constellations G4P[4]-I1-R2-C2-M2-A2-N2-T1-E1-H2 (n = 1), G9P[4]-I1-R2-C2-M2-A1-N1-T1-E1-H1 (n = 1), G12P[8]-I1-R2-C2-M1-A1-N2-T1-E2-H3 (n = 2) and G12P[8]-I1-R1-C1-M1-A2-N2-T2-E1-H1 (n = 1), with double and triple gene reassortant rotavirus strains were identified. Phylogenetic analysis revealed a close relationship between the Rwandan strains and cognate human RVA strains as well as the RotaTeq® vaccine strains in the VP1, VP2, NSP2, NSP4 and NSP5 gene segments. Pairwise analyses revealed multiple differences in amino acid residues of the VP7 and VP4 antigenic regions of the RotaTeq® vaccine strain and representative Rwandan study strains. Although the impact of such amino acid changes on the effectiveness of rotavirus vaccines has not been fully explored, this analysis underlines the potential of rotavirus whole-genome analysis by enhancing knowledge and understanding of intergenogroup reassortant strains circulating in Rwanda post vaccine introduction

Whole-Genome Analyses Identifies Multiple Reassortant Rotavirus Strains in Rwanda Post-Vaccine Introduction

Children in low-and middle-income countries, including Rwanda, experience a greater burden of rotavirus disease relative to developed countries. Evolutionary mechanisms leading to multiple reassortant rotavirus strains have been documented over time which influence the diversity and evolutionary dynamics of novel rotaviruses. Comprehensive rotavirus whole-genome analysis was conducted on 158 rotavirus group A (RVA) samples collected pre- and post-vaccine introduction in children less than five years in Rwanda. Of these RVA positive samples, five strains with the genotype constellations G4P[4]-I1-R2-C2-M2-A2-N2-T1-E1-H2 (n = 1), G9P[4]-I1-R2-C2-M2-A1-N1-T1-E1-H1 (n = 1), G12P[8]-I1-R2-C2-M1-A1-N2-T1-E2-H3 (n = 2) and G12P[8]-I1-R1-C1-M1-A2-N2-T2-E1-H1 (n = 1), with double and triple gene reassortant rotavirus strains were identified. Phylogenetic analysis revealed a close relationship between the Rwandan strains and cognate human RVA strains as well as the RotaTeq® vaccine strains in the VP1, VP2, NSP2, NSP4 and NSP5 gene segments. Pairwise analyses revealed multiple differences in amino acid residues of the VP7 and VP4 antigenic regions of the RotaTeq® vaccine strain and representative Rwandan study strains. Although the impact of such amino acid changes on the effectiveness of rotavirus vaccines has not been fully explored, this analysis underlines the potential of rotavirus whole-genome analysis by enhancing knowledge and understanding of intergenogroup reassortant strains circulating in Rwanda post vaccine introduction