Obstetric performance following previous uterine rupture: A report of three cases

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Recurrent breech presentation due to congenital uterine malformation

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Correlates of Abortion Related Maternal Mortality at the Lagos State University Teaching Hospital, Ikeja

This study was carried out to highlight the probable correlates of mortality among patients managed for abortion related complications at the Lagos State University Teaching Hospital, Ikeja. All patients managed for abortion related complications between 1st January 2000 and 31st December 2003 were studied. Certain relevant socio demographic and clinical factors were compared among the survivors and fatalities. There were a total of 338 patients with abortion related complications. 299 survived while 39 died. Being single, nulliparous, of low educational status, presenting late and having major complications were significantly associated with mortality in this series. Encouragement of safe sex practices, increasing adolescents’ access to contraception, additional training of physicians and other appropriate heath workers in abortion care as well as the liberalisation of the restrictive abortion laws in Nigeria will go a long way in reducing abortion related mortality (Afr J Reprod Health 2009; 13[2]:139-146)

Wound Complications Following Laparoscopic Surgery in a Nigerian Hospital

Background: Different complications may occur at laparoscopic port sites. The incidence of these varies with the size of the ports and the types of procedure performed through them. Objectives: The aim was to observe the rate and types of complications attending laparoscopic port wounds and to identify risk factors for their occurrence. Patients and Methods: This is a prospective descriptive study of all patients who had laparoscopic operations in one general surgery unit of a University Teaching Hospital in Nigeria between January 2009 and December 2012. Results: A total of 236 (155 female and 81 male) patients were included. The laparoscopic procedures include 63 cholecystectomies, 49 appendectomies, 62 diagnostic, biopsy and staging procedures, 22 adhesiolyses, six colonic surgeries, eight hernia repairs and 22 others. Port site complications occurred in 18 (2.8%) ports on 16 (6.8%) patients including port site infections in 12 (5.1%) and hypertrophic scars in 4 (1.7%) patients, while one patient each had port site bleeding and port site metastasis. Nine of 11 infections were superficial, while eight involved the umbilical port wound. Conclusion: Port site complications are few following laparoscopic surgeries in our setting. We advocate increased adoption of laparoscopic surgeries in Nigeria to reduce wound complications that commonly follow conventional open surgeries.Keywords: Laparoscopy, Nigeria, wound complication

Emergency non–obstetric abdominal surgery in pregnancy

Background: Despite recent advances in anaesthetic, perinatal and preoperative care, surgical intervention during pregnancy may still result in fetal loss from either spontaneous abortion (especially in the first trimester) or premature labor (especially in the third trimester). This study was aimed at determining the factors that affect fetal and maternal outcome following emergency non-obstetric abdominal surgery in pregnancy.Methods: We reviewed all cases of emergency non-obstetric abdominal surgery performed on pregnant women at Obafemi Awolowo University Teaching Hospital complex from January 1991 and December 2006. The socio-demographic characteristics, obstetric history, diagnosis and outcome of management were documented and analyzed.Results: A total of 46 pregnant patients presented with various conditions necessitating emergency non-obstetric abdominal surgery during the study period. Their ages ranged from 23 to 39 years with a mean age of 29.33 +/-4.904. Six (13%) of the patients presented during the first trimester, 32 (69.6%) patients during the second trimester and 8 (17.4%) were seen in the third trimester. Thirty-two (69.6%) patients presented with features of acute appendicitis out of 12 had ruptured appendicitis and 8 had appendicular abscess. Eight (17.4%) had intestinal obstruction, 5 (10.8%) had haemoperitonueum from abdominal injury and 1 (6.7%) had an ectopic foetus in bladder. Four (8.8%) mothers and 20(43.5%) babies died. Factors affecting maternal outcome included parity (P=0.010), duration of symptoms (P<0.0001) and delay in surgery (P<0.0001) while the factors affecting fetal outcome include maternal age (P<0.0001), booking status (P<0.0001), educational status (P<0.010), parity (P<0.040), gestational age (P=0.048) and delay in surgery (P=0.016).Conclusion: Complicated appendicitis is the most common indication for abdominal surgery in pregnancy in our center. High foetal loss seen in this study can be reduced by early presentation of the patients, early booking and high index of suspicion and prompt treatment by the attending surgeon

Ultrasound scan finding in 72 consecutive patients suspected to ha ectopic pregnancies, at the Lagos State University Teaching Hospital, Ikeja, Nigeria

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Contraception Failure Due to Uterine Didelphys: A Case Report

We present the case of an unsuspected uterine didelphys in a 28-year old woman who has had three previous caesarian sections after which an intrauterine contraceptive device was inserted. She, however, got pregnant again, was evacuated and the IUCD was removed. Persistence of the pregnancy symptoms informed a pelvic scan which confirmed a viable early intrauterine pregnancy with a suggested coexisting fibroid in the pouch of Douglas. A caesarian section was performed at term and a live female infant was delivered. Detailed scrutiny during caesarian section confirmed another uterus with its appendages on the right within the pouch of Douglas, separate from the gravid uterus on the left. This makes uterine didelphys as the probable cause of the contraceptive failure. Key words: uterine didelphys pregnancy, caesarian section, ultrasound, contraceptive failur

Prenatal ultrasonic diagnosis of conjoint twins

Background: A primipara with multiple pregnancy who booked for antenatal care at 21 weeks presented with vaginal bleeding and pedal oedema at the 27th week. She had had five previous ultrasound scans that gave conflicting results.Materials and Methods: The patient was therefore sent for a confirmatory scan, which was performed using a linear 3.5 MHz transducer of a dynamic imaging dedicated, concept MC ultrasound scan machine.Results: A diagnosis of conjoint twins was made. The twin was joined from the mandible to the abdomen. Although they cried at birth, they died afew minutes after. The pregnancy was terminated by caesarian section at the patient’s request. The patient did well postpartum and was discharged on the 5th postoperative day. Records confirm that this is the firstcase seen in this hospital, which has been in existence for 18 years. Conclusion: To diagnose conjoint twins by ultrasound, one needs the expertise and careful scanning techniques, as the diagnosis may be easily missed, especially if the union is extensive

Maternal Tetanus in Pregnancy: Medical Management and Spontaneous Vaginal Delivery at Term: A Case Report.

A 30-year old pregnant woman presented at 30 weeks gestation with inability to open the mouth, eat or swallow and abdominal pain of two weeks duration having sustained abrasive injuries and laceration to the face 10 days earlier. Provocative spasms and risus sardonicus were found on examination. She was managed with intravenous infusions, metronidazole and diazepam. She resumed oral feeds two weeks later and was discharged home after 4 weeks of admission. She later had vaginal delivery at term with both mother and fetus being in good condition