Fibroma of the Vulva: Report of a Case

A rare case of vulva fibroma in a 35 year-old woman is presented. She had a non-tender, firm mass arising from the superior aspect of the left vulva. It was about 24cm long, with fleshy pedicle that had a club-like ending with a crater-like area of ulceration. She also had uterine fibroids. Histological examination of the tissue following excision confirmed its benign nature. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 93-94

Ectopic Pregnancies at the Ahmadu Bello University Teaching Hospital, Kaduna, Northern Nigeria

Background: Ectopic pregnancy continues to be a major surgical emergency in gynaecology. Objective: To determine the incidence, clinical pattern, surgical management, morbidity and mortality from ectopic pregnancy in a Nigerian tertiary health care center. Study Design, Setting and Subjects: The case files of 149 patients who had ectopic pregnancy between 1990 and 1997 at a University Teaching Hospital, were reviewed for biological, social and clinical data. Results: The frequency of ectopic pregnancy was 1 in 71 deliveries (1.4%). Being married, in the age group 25-29 years, nulliparous and never practiced contraception were found to be risk factors. Abdominal pain (87.2%) and abnormal vaginal bleeding (57.4%) were the commonest symptoms, while circulatory collapse occurred in 10.7% of patients. Diagnostic differentials ranged from acute pelvic inflammatory disease (PID) and threatened abortion to ruptured uterus. Nearly all (96%) of the gestational sacs were ruptured before presentation. In 97 (67%) of the patients, there was macroscopic evidence of PID. More than 90% of the pregnancies were tubal, with 88% of these being located in the ampulla. Abdominal pregnancy occurred in 4 patients. Unilateral partial salpingectomy was done in 104(69.79%) patients, and 2 live mature fetuses were delivered at laparotomy. One maternal death occurred among the patients. Conclusion: The frequency of ectopic pregnancy is still high in this environment. Early presentation, high index of suspicion and use of modern diagnostic techniques will improve overall clinical outcome in patients. Promotion of family planning, early treatment of PID and good quality obstetric care could be important preventive intervention measures. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 82-86

Socio-Demographic and Some Anamnestic Characteristics of Antenatal Patients in Nigeria and Germany

Objective: To examine the socio-demographic characteristics of the two populations, with a view to identifying areas where intervention could lead to better reproductive performance. Study Design: Prospective study of consecutive deliveries . Setting: A university teaching hospital in Nigeria and the perinatal data pool of the state of Hesse, Germany. Results: There were more teenage mothers in Nigeria(2.7%) than in Germany(0.6%). Reproduction starts earlier in Nigeria (22.2, SD 3.9 years) than in Germany (26.7, SD 4.5 years). There is a remarkable decrease in the number of pregnant women as parity increases in the two populations. Germans are generally taller than the Nigerians, 3.1% of Nigerians and 0.4% of Germans being below the critical obstetric height. In Nigeria, 60.2% of women continued wage-earning jobs during pregnancy compared to 43.3% in Germany. In Nigeria, 0.4% of the women are single mothers compared to 6.9% in Germany. Only 0.1% of Nigerian pregnant women smoke during pregnancy compared to 15% of the Germans. Drug abuse is not reported among Nigerian pregnant women compared to the 5.8% prevalence in German women. First induced abortion is more common in Germans than in Nigerians but the Nigerian is more likely to have had multiple induced abortions. Conclusion: The Germans appear to have a clear socio-biological advantage over the Nigerians with regard to reproduction. Key Words: Antenatal, Socio-Demographic, Anamnestic, Outcome. [Trop J Obstet Gynaecol, 2002, 19: 93- 96

Pregnancy in Rhesus Negative Women in Kaduna, Northern Nigeria

Objective: To determine the incidence, review some anamnestic and bio-demographic characteristics of the women and pregnancy outcome. Study design: An eight year retrospective review of pregnancies in Rhesus- negative women in a University teaching hospital. Results: There were a total of 10572 deliveries and 76 rhesus negative pregnancies during the period, giving an incidence of 0.7%. The Yoruba ethnic group was the highest contributor of patients (44.73%), while the Southern minority ethnic groups the lowest contributors (3.9%). About 51% of the patients were of ABO Blood group O. Sixty four (84.2%) of the patients have had previous pregnancies and only 8(12.5%) of these received Anti- D(Rhogam) prophylaxis. Seventy two (94.7%) of the pregnancies were booked and 70.8% of them booked after 20 weeks of gestation. Antibody screening was done in 56.6% of the pregnancies. The incidence of izoimmunisation was 9.1%. Neonatal jaundice occurred in 9.2% of the babies. There was one perinatal death. Only in 19(25%) of the pregnancies was Rhogam administered after delivery. Conclusion: Rhesus negative pregnancies constitute a small number of our clinical load and the incidence of izoimmunisation appear to be very low. Setting up of dedicated Care centers to enhance good quality care and also enable a didactic pool of patients for postgraduate training is advocated. Key Words:Rhesus Negative, Pregnancies, Isoimmunisation,Incidence, Antibody screening, Anti-D Prophylaxis, Kaduna, Nigeria. [Trop J Obstet Gynaecol, 2004;21:21-23

Obstetric and gynaecological admissions in an intensive care unit of a Nigerian teaching hospital: a 5-year review

Background: Management of critically ill women in intensive care units (ICU) is crucial in reducing maternal mortality. This study sought to determine the ICU obstetric and gynaecology utilization rate, indications for admissions, assess the outcome and risk factors associated with mortality.Design/ settings: A retrospective descriptive study of admissions in a multidisciplinary ICU setting in a University Teaching Hospital in Nigeria.Methods: Records of obstetric and gynaecological patients admitted to the ICU over a 5-year period were entered into a computer. Data included demographic and clinical characteristics of the patients, interventions performed and outcomes of patients' ICU care. Data was analysed using SPSS version 20 for windows.Results: The MMR was 870 per 100,000 live births. The incidence of obstetric and gynaecological admissions to the ICU was 5.2% (37/706) of all admissions. 20 (58%) were obstetric cases, mostly severe PET/eclampsia15 (40.5%), 42% of the women were admitted for complications of gynaecological procedures. Commonest complication was adult respiratory distress syndrome (ARDS). The mortality was 16 (43%) overall, 10 (62.5%) were obstetric cases mainly PET/eclmpsia (56%). The likelihood of Obstetric mortality was twice that of gynaecological mortality (OR 2.5, 95% CI 0.99 – 6.16, P<0.026). Factors related to poor outcomes were 2 or more interventions (P=0.001).Conclusion: Obstetric and gynaecology ICU utilization was low considering the high MMR. The major indication for admission was severe PET/eclampsia. The need for ventilatory support may predict poor outcome. There is need for dedicated obstetrics and gynaecology ICU to make access easier for Near Miss cases.Keywords: Obstetrics; Critical care; Gynaecology; Intensive care uni

Audit of hysterectomies in a group of private hospitals in Kaduna City, northern Nigeria

Background: Hysterectomy is a major surgical intervention that could lead to significant degradation of the woman if performed in unsafe institutions. Objective: To determine the indications for hysterectomy, associated demographic factors, surgical types and associated morbidity and mortality. We also seek to promote the culture of self- auditing in clinical work in Kaduna. Study Design, Setting and Subjects: A retrospective review of women in who record st of operation was available in some Private hospitals ,in Kaduna, from January 31 , 1996 to June30, 2000. Result: There was generally poor data keeping in most of the hospitals. There were 47recorded hysterectomies; 42(89.39%) were elective and 5(10.63%) emergency. Forty two (89.36%) were abdominal and 5(10.63%) vaginal; Obstetric indications accounted for only 4.25% of the operations. Four (8.51%) of the operations were performed in the nulliparae. Indications for hysterectomy included, Uterine fibroids 22(46.80%), DUB 7(14.89%), Genital prolapse 4(8.51%), Complications of induced abortions 3(6.38%). Consultant grade Obstetricians performed 42(89.36%) of the operations. Midline abdominal incision was the choice of access in 24(57.14%) of the operations. Only in 23(48.93%) was histological examination of specimens performed. About 30% of the women had blood transfusion and abdominal wound sepsis, primary post operation haemorrhage and fever occurred in 2.12% each. No death was associated with the operation. Conclusion: The indications for hysterectomy are varied and the operation appears to be safe in private hospitals in Kaduna. Quality assurance could be improved by simple supply of operation registers to hospitals. Keywords: hysterectomy, indications, medical audit, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 16-2