Cervical Cancer, a Sequela of a Sexually Transmitted Infection: The Human Papillomavirus Infection

Cervical cancer has contributed to a large number of gynecologically related oncologic deaths in most developing countries. Almost all cases of cervical cancer are related to the presence of persistent strains of sexually transmitted oncogenic strains of human papillomavirus infection (HPV). Steps taken to decrease infection rate will reduce the long-term sequelae of cervical cancer globally

A 10-year review of instrumental vaginal delivery at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Instrumental vaginal deliveries are conducted for either maternal or fetal indications to shorten the second stage of labour. Global trends show a diminished instrumental delivery rates. Objectives: To determine the prevalence, indications, complications, and the trend of instrumental vaginal deliveries at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a retrospective study of 164 women who had an instrumental vaginal delivery over a 10-year period at the University of Port Harcourt Teaching Hospital from January 1, 2008, to December 31, 2017. Data obtained from the labour ward registers and case notes of patients were entered into a proforma and analyzed using EPI-info ver. 7. P value of 0.05 was set as significant at 95% confidence interval. Results: The incidence of instrumental vaginal delivery was 0.67% of all deliveries. Vacuum delivery accounted for 0.63% whereas forceps delivery was 0.04%. Delayed second stage of labour (56; 34.15%) and severe pre-eclampsia/eclampsia (42; 25.61%) were the most common indications. Senior resident trainees conducted majority (121; 73.78%) of the deliveries. The most common maternal complications were perineal tears (13; 50%) and primary postpartum haemorrhage (11; 42.31%). These maternal complications significantly occurred more with vacuum delivery (P value = 0.001). About half of the babies (80; 47.62) had birth asphyxia. Conclusion: The instrumental vaginal delivery rate in this study is very low despite being an alternative to caesarean section. Therefore, efforts should be made toward training and retraining of doctors on this skill to reduce maternal and fetal morbidity associated with the procedure, and also reduce the caesarean section rate

Review of episiotomy and the effect of its risk factors on post episiotomy complications at the University of Port Harcourt Teaching Hospital

Aim: This study aimed to determine the prevalence of episiotomy and postepisiotomy complications and to assess the relationship between the risk factors and postepisiotomy complications in the University of Port Harcourt Teaching Hospital. Methodology: This was a descriptive longitudinal study, in which 403 consecutive women who had episiotomy in the labor ward were recruited for the study. They were followed up and reviewed at the postnatal clinic on the 1st and 6th weeks postdelivery. Data regarding age, marital status, occupation, educational status, address, parity, booking status, postepisiotomy complications, and the associated risk factors were entered adequately into a prestructured pro forma, and statistical analysis was done using statistical software (SPSS for Windows® version 19.0). t‑test was used to explore the association of risk factors to postepisiotomy complications. Results: The episiotomy rate was 22.1%. The prevalence of postepisiotomy complications was 52.1%. The mean age of the women was 23.8 (standard deviation ± 3.2) years. Seventy‑two (34.3%) patients had perineal pain, which lasted for 72 h or more; 61 (29.1%) had difficulty in walking, while 37 (17.6%) had perineal discomfort. Four (1.9%) had wound infection and only one (0.4%) had wound dehiscence. The development of postepisiotomy complications was not statistically significantly associated with risk factors such as gestational age (T = 1.4, P = 0.1), packed cell volume on admission (T = 1.0, P = 0.2), duration of first stage of labor (T = 0.5, P = 0.1), duration of second stage of labor (T = 0.7, P = 0.3), duration of rupture of fetal membranes (T = 0.8, P = 0.4), delivery repair interval (T = 0.6, P = 0.2), estimated blood loss (T = 0.9, P = 0.2), duration of Sitz bath (T = 1.0, P = 0.2), duration of analgesic (T = 1.2, P = 0.1), duration of antibiotics (T = 1.3, P = 0.1), or the operator who performed or repaired the episiotomy (P = 0.2). Conclusion: The prevalence of episiotomy and postepisiotomy complications in this study was high. Necessary attention should be given to ensure adequate pain relief for all parturients who had episiotomy, and the policy of restrictive use of episiotomy should be fully implemented in the department in line with the best practices and evidence‑based recommendations. This will further reduce the incidence of episiotomy rate as well complications that may arise from it and ensure a positive pregnancy experience for pregnant women