Knowledge attitude and practice of cervical cancer screening among sexually active women in Onitsha, Southeast Nigeria

No Abstract

An analysis of uterine rupture at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast Nigeria

Objective: Uterine rupture is a preventable condition which has persistently remained in our environment. The aim of this study therefore is to ascertain the incidence of uterine rupture, examine the predisposing factors and maternal and fetal outcome of patients managed of uterine rupture in a tertiary hospital.Materials and Methods: This descriptive case series was conducted at the department of Obstetrics and Gynaecology, Nnamdi Azikiwe, University Teaching Hospital Nnewi from March 2004 to February 2009.Results: The incidence of uterine rupture was 6.2 per 1000 deliveries. The commonest age range of occurrence was 30-34 years. Uterine rupture occurred predominantly among women of low parity. Previous caesarean section with concurrent use of oxytocics was the commonest risk factor documented.The maternal and perinatal mortality ratio was 94 per 100,000 deliveries and 6 per 1000 births respectively. Surgery was the main stay of treatment and the commonest procedure carried out was uterine repair only.Conclusion: Rupture of the gravid uterus is still a significant cause of maternal mortality and morbidity in our environment. The causes are commonly preventable. The provision of maternal care by skilled personnel, proper antenatal care, update training programmes for health care providers and appropriate legislation on maternal care will significantlyreduce the incidence of uterine rupture and improve its prognosis

The use of torniquet to reduce blood loss at Myomectomy

No Abstract

Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-year review

Background: Emergency peripartum hysterectomy has remained a challenging and very life saving surgical procedure in obstetrics. Its indications are emerging.Aims: This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south–east Nigeria.Materials and Methods: A retrospective study of the case files of patients requiring an emergency peripartum hysterectomy between January 2000 and December 2009 was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment within 24 hours of delivery. The findings were analyzed using Epi info version 3.5.1.Results: During the 10-year period, there were 6,137 deliveries and 38 cases of emergency peripartum hysterectomies, giving an incidence of 6.2 per 1000 deliveries. Of the 38 hysterectomies, only 29 (76.3%) case files were available for analysis. The mean age of the patients was 28.1 ± 5.4 years and 22 (75.9%) patients were unbooked. There were four primigravidae (13.8%) while 25 (86.2%) were parous. The main indications for hysterectomy were placenta praevia 14 (48.3%) and uterine rupture 10 (34.5%). Subtotal hysterectomy was performed in majority (72.4%) of cases. The commonest postoperative morbidities were postoperative fever (37.9%), postoperative anemia (24.1%), and wound infection (20.7%). The maternal case fatality rate was 31.0%, while the perinatal mortality was 44.8%. The mean duration of hospital stay was 9.8 ± 2.4 days.Conclusion: The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention by a skilled surgeon are crucial

Maternal Mortality At St. Charles Borromeo Hospital, Onitsha: A Six Year Review

Objective: To determine the causes and rate of maternal mortality at St. Charles Borromeo Hospital Onitsha and compare these with other parts of the country. Methods: A retrospective analysis of maternal deaths over a six year period at St. Charles Borromeo Hospital, Onitsha was done. Results: Between period January 1995 and December 2000, 6179 births were recorded, the maternal deaths were 49, giving a maternal mortality rate of 793/100,000 births. The ages of the dead mothers ranged from 16 - 46 years, with a mean of 28.43 years, standard deviation of 8.68. Causes of maternal deaths include haemorrhage (37%), septic abortion (17.4%), anaemia (13%), pre-eclampsia/eclampsia (8.7%), genital sepsis (6.5%), while the least were anaesthetic death (2.2%) and cerebral malaria (2.2%). Booked patients constituted (41.3%) while unbooked patients accounted for (58.7%) of the maternal death. Conclusion: Major causes of maternal death identified in this study are preventable. Measures to reduce maternal deaths include education of the women to use obstetric facilities, early referral of patients to specialist centres, and provision of blood transfusion services. Key Words: Maternal death, Prevention of maternal death, Causes of mortality Orient Journal of Medicine Vol.15(3&4) 2003: 26-3

Seroprevalence of hiv infection among antenatal women at a private specialist hospital in Onitsha, Anambra state, southeast, Nigeria.

Objective: The objective of this study was to determine the seroprevalence of HIV I &II infection among women who booked at an Onitshaprivate specialist hospital using rapid ELISA kits that detect HIV I & II antibodies.Patients and methods: All the women who were on a booking visit at Grace Specialist Hospital Nkpor Onitsha Southeast Nigeria werecounselled and offered HIV screening by ELISA method and confirmation by algorithm method using Determine and Statpak parallel tests.Result: Of the 2996 women who came for a booking visit during the study period, 2993 of them partook in this study thereby giving an uptakerate of 99.9%. The age range of the women was 15 – 41 years with a mean of 28.3±4.5 years. One hundred and nine of the women testedpositive to HIV I & II giving prevalence rate of 3.6%. HIV seropositivity occurred most among women at the third decade of life andnulliparous women. There was a significant association between the age distribution and HIV seropositivity (X2 = 37.67; df = 5; p = 0.000044),and parity distribution and HIV seropositivity (X2 = 17.42; df = 5; p = 0.007763)Conclusion: The seroprevalence of HIV among the anatenatal women was high. The test is highly acceptable to the women. Therefore it is veryfeasible to establish routine antenatal HIV screening in private hospitals which will also serve as a channel of recruiting women into PMTCT ofHIV/AIDS

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

Obstetrics indices at Nnamdi Azikiwe University Teaching Hospital, Nnewi,Anambra State, Nigeria

Background: Obstetrics indices vary from population to population. Some are natural occurring indices while other corresponds to the level ofobstetric practice in an area.Objective of the study: This study sought to find the obstetrics indices like mean birth weight, twinning rate, the sex ratio, caesarean section rate,instrumental vaginal delivery rate, maternal mortality rate and fetal death rate.Study design, setting and subjects: This was a retrospective study of all deliveries at Nnamdi Azikiwe University Teaching Hospital, Nnewi fromJanuary 1998 to December 2007, a ten year period. Data was extracted from the labor ward birth register and analyzed.Results: There were five thousand, six hundred and fifty eight (5658) deliveries within the period of the study. The mean birth weight was 3.3kg.The mean weight for female babies was 3.26kg and 3.34kg for the male babies. The twinning rate was 34/1000 deliveries. There was no triplet within the period of the study. The sex ratio was 93 males: 100 females. The caesarean section rate was 9.4% .Instrumental vaginal delivery rate was 3%. The maternal mortality rate was 324/ 100,000 births, while the fetal death rate was 21/1000 births.Conclusion: The obstetric indices were found to be within the range as those in other studies in the region

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