Rectal prolapse in pregnancy: a case report

Rectal prolapse occurs when a mucosal or full thickness layer of rectal tissue slides through the anal orifice. It is relatively infrequent and occurs commonly in elderly women. This report is to bring to focus the possibility of a rectal prolapse being misdiagnosed as haemorrhoids in pregnancy. A case of a 35-year-old woman, gravida 4, para 3+0, found to have a large rectal prolapse but misdiagnosed as prolapsed haemorrhoids at 34 weeks gestation is reported. Although rectal prolapse is not a common condition during childbearing years, it is instructive for obstetricians and midwives to be vigilant in all cases of pregnant women presenting with rectal protrusion or bleeding

Implementing The NewWHO Antenatal Care Model: Voices From End Users In A Rural Nigerian Community.

Context: The recommended WHO antenatal focused visits with reduced number of visits and tests is yet to be implemented in many communities in rural Nigeria. Aim: This paper evaluated the attitude of antenatal clients in a rural mission hospital to the new antenatal model. Study Design: Focus group discussions were carried out bi-weekly for 12weeeks with consenting booked antenatal clients. The topic guide was developed following interactions with prenatal clients at a referral tertiary center. Results: One hundred and forty-four clients were interviewed. Prior to discussion, none had heard of the new antenatal care model. More than half of them will prefer the traditional policy with multiple visits to the new model. The traditional visit was said to be more reassuring and provides the clients time away from their routine chores/occupations and afford them the opportunity to interact with other expectant mothers and get acquainted with the health care providers. Conclusion: To realize the goals of the new WHO recommended antenatal model in rural Nigeria, mass enlightenment and education must precede its gradual and cautious introduction. Keywords: Antenatal Care, Clients, Rural, WHO. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 260-26

An Unusual Cause of Uterine Rupture - A Case Report

OBJECTIVE: To revel the effect of trauma during pregnancy CASE REPORT: Mrs. L.P. was a booked 28-year old para1+0, trader who in her last confinement in 2001 had a lower uterine segment caesarean section for prolonged labour. Her post-operative period was said to have been complicated by wound sepsis necessitating a prolonged hospital stay. The outcome of that pregnancy was a live male baby. She presented at the Accident and Emergency department of the University of Port Harcourt Teaching Hospital on the 2nd of May 2003 at a gestational age of 31 weeks with the complaints of severe abdominal pains and dizziness of 4 hours duration. She claimed to have been hit on her abdomen inadvertently while separating a fight amongst her neighbours. RESULT: On examination, she was in painful distress, restless and pale. Her pulse rate was 120 beats per minute and thready while her blood pressure was 80/50mmHg. The abdomen was gravidly enlarged and distended with a subumblical midline scar that appeared to have healed by secondary intention. The abdomen was very tender and the liver, spleen and kidneys could not be palpated. The fetal heart sound was present with a rate of 160 beats per minute. There was evidence of intra peritoneal fluid collection. Vaginal examination revealed a normal vulva and vagina. There was no vaginal bleeding. The cervix was uneffaced and the OS was closed. The vaginal fornices were tender. An impression of ruptured viscus with hypovolenic shock The baby was still alive at the time of delivery due to cushion-effect of the amniotic fluid but had early neonate death because of severe asphyxia and complications of prematurity. Other workers have found that fetal demise is more common when maternal injuries include trauma to the uterus 8-10. CONCLUSION: Pregnant women especially those in the third trimester with a previous caesarean section should avoid separating physical fight involving neighbours and others so as to avoid the tragedy of trauma to the uterus and its consequences. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 127-12

Marjolin's ulcer: report of 4 cases

No Abstract. Nigerian Journal of Medicine Vol. 14(1) 2005: 88-9

HELLP syndrome: A report of two cases

No Abstract. Nigerian Journal of Medicine Vol. 14(3) 2005: 322-32

Oral Clindamycin and Metronidazole in the treatment of bacterial vaginosis in pregnant black women: Comparison of efficacy and pregnancy outcome

Bacterial vaginosis (BV) is associated with adverse pregnancy outcomes with various treatment options. Objective: To compare the efficacy and effect on pregnancy outcome of Metronidazole and Clindamycin in women with bacterial vaginosis in Port Harcourt, Nigeria. Methodology: Randomized controlled study of 136 pregnant women diagnosed with BV at the University of Port Harcourt Teaching Hospital. A structured proforma was used to obtain socio-demographic characteristics and other relevant data. Treatment was with either oral Metronidazole or oral Clindamycin for seven days. A secondary test and evaluation of the effect on adverse pregnancy outcomes were determined. Data analysis was done using the SPSS statistical package version 22.0 Results: BV prevalence was 23%, with similar cure rates with both medications. The failure rates of clindamycin and metronidazole were 10.4% and 13% respectively (p = 0.639). The mean gestational age at delivery in the metronidazole treated group was 38.67 weeks ± 1.69 compared to 38.68 weeks ± 1.64 in the oral clindamycin group (p = 0.96). Pre-labour rupture of membranes and preterm delivery rates with both medications were similar (p = 0.73; OR 1.3; 95% CI 0.3-4.9) and (p = 0.73; OR 1.3; 95% CI 0.3-4.9) respectively. Conclusion: Both medications have comparable efficacy and similar pregnancy outcomes in the treatment of bacterial vaginosis in low-risk asymptomatic pregnant Nigerian women and thus can be used interchangeably

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study

Lorretta F Ntoimo,1,2 Friday E Okonofua,1,3,4 Rosemary N Ogu,1,3,5 Hadiza S Galadanci,6 Mohammed Gana,7 Ola N Okike,8 Kingsley N Agholor,9 Rukiyat A Abdus-Salam,10 Adetoye Durodola,11 Eghe Abe,12 Abdullahi J Randawa13 On behalf of the WHARC WHO FMOH MNCH Implementation Research Study Team 1WHO Implementation Research Group, The Women’s Health and Action Research Centre, Benin City, Edo State, 2Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, 3Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, 4Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State, 5Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, 6Aminu Kano Teaching Hospital, Kano, Kano State, 7General Hospital, Minna, Niger State, 8Karshi General Hospital, Federal Capital Territory, Abuja, 9Central Hospital, Warri, Delta State, 10Adeoyo Maternity Hospital, Ibadan, Oyo State, 11General Hospital, Ijaye, Abeokuta, Ogun State, 12Central Hospital, Benin City, Edo State, 13Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Kaduna State, Nigeria Introduction: While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.Methods: A pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.Results: The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.Conclusion: MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system. Keywords: maternal death, maternal mortality ratio, emergency obstetric care, pregnancy care, tertiary hospita