Case Report: Massive Ascites Complicating Uterine Fibroids:

A rare case of massive ascites complicating uterine fibroid is presented. At presentation, she was emaciated with grossly distended abdomen and a mass, which corresponded to 36 weeks gestation. At operation a large soft mass attached to the uterus by fibrous strands and to the omentum by large dilated new vessels was seen. It weighed 4.5kg and histology confirmed a degenerated leiomyoma. Key Words: Leiomyoma, Ascites, Nulliparity, Hysterectomy [Trop J Obstet Gynaecol, 2003, 20: 74-75

Caesarean Section in the Delivery of Nigerian Eclamptics

Context: The place of caesarean section in the delivery of eclamptics has remained controversial, thereby creating the need for further studies. Objective: To evaluate the place of caesarean section in the delivery of eclamptics using the experience at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria. Study Design, Setting and Subjects: Retrospective descriptive analysis of 44 ante- and intra-partum eclamptics treated at the University of Nigeria Teaching Hospital over a 4-year period. Main Outcome Measures: Caesarean section rate, maternal mortality ratio, maternal morbidity rates, perinatal mortality rate and perinatal morbidity rates. Results: A caesarean section rate of 91% was recorded due to superimposed ante- and intra-partum factors. The maternal and fetal outcomes were better in those who had caesarean section than in those who delivered vaginally. Conclusion: The results suggest the need for a more liberal and early use of caesarean section in Nigerian eclamptics. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 34-37

Outcome of pregnancy in the Grandmultipara in Enugu, Nigeria

Context: Grandmultiparity is considered high-risk because of the associated maternal and fetal complications. Grandmultiparae constitute a significant proportion of the obstetric population in Nigeria hence the problems of grandmultiparity still abound. Objective: To describe the outcome of pregnancy in grandmultiparae. Design, Setting and Subjects: A retrospective study of the grandmultiparous patients delivered at the University of Nigeria Teaching Hospital, UNTH, Enugu, Nigeria, from 1 January 1998 to 31 December 2002. Main Outcome Measures: Data on the age, parity, booking status, literacy level, complications during pregnancy and labour, method of delivery, maternal and foetal outcome, were collected and analysed. Results: Of 3767 deliveries, 618 or 16.41% were grandmultiparous. Their mean age was 34.63 years and mean parity 5.77. 61.6% were illiterate and 83.82% were booked. Anaemia, hypertension and multiple pregnancies occurred in 18.29% in pregnancy. 17.95% had complications in labour. 74.3% achieved vaginal delivery. There was no maternal death. The perinatal mortality rate was 73.4/1000 deliveries. Conclusion: Grandmultiparae make up a significant proportion of our obstetric population. Illiteracy, desire for large families, high perinatal mortality and non-use of contraception are predisposing factors. Non-use of antenatal services and delay in referral worsen pregnancy outcome. Formal education, campaign against large families, reduction in childhood mortalities and improvement in use of family planning will reduce its incidence while use of hospital services will improve pregnancy outcome. Early referral, team work between health professionals and the roles of government, hospital management and non-governmental organizations are discussed. Keywords: grandmultiparity, pregnancy outcome, Enugu, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 8-1

Are Destructive Operations Still Relevant to Obstetric Practice in Developing Countries?

Context: From our clinical observation, we often see caesarean section being performed in situations where destructive operations would have been more appropriate. Objective: To determine the proportion of cases of obstructed labour that meet defined criteria for destructive vaginal operation vis-à-vis the proportion that actually undergo the operation. Study Design, Setting and Subjects: A retrospective audit of all cases of obstructed labour seen at a university teaching hospital in South-Eastern Nigeria, over a fifteen- year period. Results: Out of 2947 patients presenting with obstructed labour during the study period, 67 (2.3%) met the set criteria for destructive vaginal delivery. Only 11 (16.4%) of these had destructive vaginal operations while the remaining 56 (83.6%) had caesarean section. Consultants were more likely than junior residents to perform craniotomy instead of caesarean section for the same indications (p < 0.02). Senior residents occupied an intermediate position. No maternal death occurred in the craniotomy group while three maternal deaths were recorded in the caesarean section group. Rates of infection, blood transfusion, vesico-vaginal fistula and Asherman's syndrome were also higher in the caesarean than in the craniotomy group. Conclusion: Only one-sixth of women who are suitable candidates for destructive vaginal operations are offered the procedure at the UNTH, Enugu, the rest being delivered by caesarean section, despite the higher complication rate of caesarean delivery in such cases. The reasons for this situation and the ways to either reverse it or else eliminate the need for destructive operations are discussed. Key Words: Destructive Operations, Obstructed Labour, Fetal Death [Trop J Obstet Gynaecol, 2002, 19: 90- 92