Outcome of Subsequent Labour After Primary Caesarean Section For Arrest Disorders in Teenage Pregnancies

Context: Teenage mothers are at risk of numerous problems among which is cephalopeelvic disproportion or obstructed labour because of small and immature pelvis. This leads to a tendency to allowing trial of scar in subsequent pregnancies because the teenage pelvis might not have reached full capacity as at the time of the previous caesarean section. Despite the fact that some of the patients had a height of more than 152cm. Complications of scar dehiscence, haemorrhage, sepsis etc., and perinatal morbidity / therefore imperative to examine the outcome of labour in teenage mothers with one lower uterine segment caesarean section scar in which the section was done because of obstructed labour or CPD. Objective: To determine the outcome of trial of labour after one previous lower uterine segment transverse caesarean section. The main focus is possibility of vaginal delivery and associated morbidity mortality and mortality. Design: A longitudinal study (1993-1999). Participants And Methods: Teenage mothers with one previous lower transverse uterine segment caesarean section scar which was performed 2-3 Years earlier were allowed to labour. All these caesarean sections were primarily done because of cephalopelvic disproportion with or without obstructed labour.(excluded were those with more than 3 Years- as these were already over 19 Years). Setting: University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Main Outcome Measures: The possibility of vaginal delivery, the fetal outcome and associated morbidity and mortality. Results: 66 women were eligible for the study. 67% successfully achieved vaginal delivery. There was no maternal mortality even though there were 2 cases of ruptured uterus. Conclusion: Mothers aged 19 years and under with one previous transvere lower uterine segment caesarean section scar performed for cephalopelvic disproportion or obstructed labour should be allowed to labour with the aim of achieving vaginal delivery. This was found to be very possible and of benefit in this study. [Trop J Obstet Gynaecol, 2004;21:36-39

The benefit of myomectomy in women aged 40 years and above: Experience in an urban teaching hospital in Nigeria

Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1-6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6΁2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6΁8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered