Spectrum of birth trauma and predisposing factors; experience in two Nigerian tertiary health facilities

Objectives: To highlight the spectrum of birth trauma encountered in our practice, identify the risk factors, and the management outcome in two tertiary health facilities in Nigeria. Design: A five-year prospective case control observational study carried out between June 2013 and May 2018.Setting: The Departments of Obstetrics and Gynaecology, Paediatrics, Surgery and Family Medicine of: Federal Medical Centre, Owerri, Imo State Nigeria and University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria Subjects: Consecutive cases of birth trauma in infants seen within six weeks of life, and a control group of randomly selected similar infants without birth trauma. Factors investigated in this study were gestational age at birth, type of health facility, mode of delivery, presentation of baby during delivery, status of birth attendant, birth weight and maternal parity. Results: There were 128 cases of birth trauma seen in 107 patients (BT group) during the study period. Forty six of these BT were delivered in our institutions giving hospital incidence of 3.1/1000 live births. Breech presentation, vaginal delivery, congenital malformation, instrument-assisted delivery, and birth weight above 3.5Kg were significantly associated with birth trauma. Conclusion: A wide spectrum of birth trauma is encountered in our region and it is slightly different from those reported from other regions. Traumatized or ruptured congenital body swellings have been identified as a major predictor of mortality in patients with birth trauma in our region. Conflicts of interest: The authors have no conflicts of interest in carrying out this study. The entire study was funded by the authors themselves

A Five Year Review of the Complications of Progestogen only Injectable Contraceptive at the University of Port-Harcourt Teaching Hospital

The injectable progestogen only contraceptive is a widely accepted method of contraception in our environment and very little has been reported on its complications in our environment. The aim of the study was to highlight the complications associated with use of Injectable Medroxyprogesterone Acetate and Norethisterone Enanthate in clients at the University of Port- Harcourt Teaching Hospital, Port-Harcourt, South- South Nigeria It was a 5 year retrospective study of the clients who accepted and used progestogen only injectable contraceptives (depot medroxyprogesterone acetate and noerthistherone enantate) at the family planning units of the University of Port Harcourt Teaching Hospital between 1st January 2000 and 31st December 2004. The case files of these clients were retrieved their data extracted. The information included the clients sociodemographic characteristics, the types doses of of injectable contraceptives received and the side effects reported at the follow up visits. The data was coded and entered into a data bank and analysed using SPSS for windows11.0 version. Seven hundred and seventy seven (777) injectable contraceptive acceptors out of the 1720 contraceptive acceptors during the study period. This accounted for 45.17% of the new acceptors over the 5 years period, making the injectable contraceptives the most commonly used method of birth control in UPTH. Five hundred and five (505) clients took depot medroxyprogesterone acetate (DMPA) while 272 used norethesterone enanthate (NE-ET). The mean age of the injectable contraceptive users was 31.31±5.5 years and the mean parity was 5.5±2.5 deliveries. The users reported multiple side effects with 579 episodes. Secondary amenorrhea was the commonest side effect occurring in 350 (45.34%) clients. Others were hypertension in 17 (2.94%) and metabolic disturbances in 14 (2.41%). Conclusion: Injectable progestogen only contraceptive is associated with multiple side effects, with secondary amenorrhoea being the most common. The contraceptive failure rate of thismethod in ourwomenis low.Keywords: progestogen injectable contraceptive, medroxyprogesterone acetate, norethisterone enanthate, complicat ions, secondary amenorrhoea

Phaeochromocytoma in early pregnancy: A case report and review of the literature

Phaeochromocytomas are rare neuroendocrine tumors of the adrenal. They are a very rare cause of secondary hypertension. They are very rare in pregnancy and much more so in early pregnancy. In this narrative review, we conducted a MEDLINE search of review articles on phaeochromocytoma from 2000 to 2018 using the key words “phaeochromocytoma, early pregnancy, hypertension, catecholamines, and chromaffin tumors. We identified relevant articles and also looked up key references. We also highlight the challenges and limitations of our management experience in our practice setting. Although phaeochromocytomas are very rare in early pregnancy, a high index of suspicion is needed to make this diagnosis. Otherwise, it may be misdiagnosed as pregnancy induced or related hypertension.Keywords: Phaeochromocytoma, early pregnancy, hypertension, catecholamines, chromaffin tumor

Rupture of a primigravid uterus following a domestic accident

Background: Uterine rupture is an infrequent but life threatening obstetric emergency especially in a developing country such as Nigeria. Often encountered is the rupture of previously scarred uterus especially in multiparous women, but the traumatic rupture of an unscarred primigravid uterus as presented here is a relatively rare event. Aim: To report a case of rupture of an unscarred uterus in a primigravidae due to blunt abdominal trauma. Design: Case report. Case report: We present a primigravidae with no previous uterine surgery who had uterine rupture following trauma from a fall at 38 weeks of pregnancy. She was resuscitated with intravenous fluids and blood transfusion. The uterine rupture was repaired without tubal ligation. Conclusion: Rupture of an unscarred uterus in a primigravidae although uncommon can occur. Blunt trauma to the abdomen from a fall can be an aetiological factor.   Keywords: Domestic accident, Uterine rupture, Trauma, Primigravid

Experience with the bonanno catheter in the management of OHSS from IVF-ET cycles

Objective: To document our experience with the use of the Bonanno catheter as a closed abdominal drain for OHSSMethods: A retrospective study of all IVF embryo transfer (ET) treatment cycles carried out between May 2006 and April 2009 at a dedicated IVF centre. Case notes of patients with OHSS were retrieved and the outcome of the continuous closed abdominal drain with Bonanno catheter documented.Result: Within the period under review, 234 patients had controlled ovarian stimulation with ultrasound guided egg retrieval. Two hundred and twenty eight (228) got to the stage of embryo transfer with 72 clinical pregnancies. The clinical pregnancy rate was 31.58%. Fourteen (6%) of those who were stimulated developed OHSS and had a closed abdominal drain of the ascitic fluid using the Bonanno catheter. The average number of days of the abdominal drainage was 7.5days and the average volume of ascitic fluid drained from a patient per day was 2454.9 + 748mls. Eight (8) patients who had OHSS achieved clinical pregnancy (six intrauterine, one ectopic and one heterotopic pregnancies), giving a clinical pregnancy rate of 57.14% in patients with OHSS. Four patients had blocked Bonanno catheters and three of them had the catheter changed while the fourth had the catheter successfully flushed. Four patients had the insertion site dressing changed due to soaking with ascitic fluid. There was no incidence of injury to intra abdominal organs or broken catheter.Conclusion: Bonanno Catheter is both effective and safe in draining ascitic fluid following OHSS.Keywords: In vitro fertilization, ovarian hyperstimulation syndrome, Bonano catheter, ascitic drainag