Female genital tract cancers in Sagamu, southwest, Nigeria

Objective: To describe pattern of female genital tract cancers seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria.Design: This is a retrospective review of all cases of female genital tract cancers managed at the Gynaecology department of OOUTH, Sagamu, Nigeria.Setting: OOUTH is a tertiary health institution of the State’s university and it takes referrals from within and outside the State.Subjects: Case records of all female genital tract cancers managed between January 2004 and December 2013 were retrieved and analysed using SPSS version 16.0.Results: There were 2059 women treated for various gynaecologic conditions, 179 (8.7%) were cases of female genital tract cancers and 161 records were available for analysis. Cervical cancer constituted the commonest (51.6%), followed by ovarian (35.4%), endometrial (9.9%), and choriocarcinoma (1.9%). There were no cases of vaginal and fallopian tube cancers. The lowest mean age was found in choriocarcinoma (36.60 ±4.50 years) and highest in vulvar cancer (70.00 ±2.82 years). The mean ages for cervical, endometrial and ovarian cancers were (51.98±12.39), (65.38±7.24), and (54.42±10.51) years respectively. Similarly the least mean parity was found in choriocarcinoma (2.33±1.52), and the highest in vulvar cancer (6.00±1.44). The mean parity for cervical, endometrial, and ovarian were (4.10±1.49), (3.06±1.48), and (3.72±1.68) respectively. These differences are statistically significant, age; F= 7.61, p<0.0001, and parity; F= 3.27, p= 0.013.Conclusion: Incidence of cervical, endometrial, and ovarian cancers remain high and presentations are at late stages. There is a need to improve on cervical cancer screening, and for the attending physicians to improve on their indices of suspicions as regards endometrial and ovarian cancers

Rheumatoid Arthritis Associated with Pulmonary Fibrosis in Nigerians: Two Case Reports

Rheumatoid arthritis may sometimes present with extra-articular involvement, pulmonary involvement is not common. Rheumatoid arthritis has been reported among Nigerians and extra-articular manifestations are rarely seen. One of the patients was misdiagnosed and mismanaged as a patient with pulmonary tuberculosis. The study is to demonstrate that rheumatoid arthritis is not as rare as previously reported in Nigeria and its pulmonary involvement can mimic tuberculosis or other granulomatous lung disorder. Clinical and serological acumen are necessary to distinguish between the two. Two diagnosed patients with rheumatoid arthritis and pulmonary involvement seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), are hereby presented

Effect of pre-operative sub-lingual misoprostol versus intravenous oxytocin on Caesarean operation blood loss

Background: Caesarean operation remains the most common abdominal surgery in women and has immense benefits to both mother and baby when employed. Haemorrhage, however, remains the greatest challenge associated with its outcome.Objective: To compare the effectiveness of pre-operative sub-lingual misoprostol with intravenous oxytocin administered after delivery of the neonate in minimising blood loss at Caesarean operationDesign: A prospective study.Results: The mean blood loss was significantly lower in misoprostol group compared to oxytocin group (517.32mls versus 621.22mls; p = 0.005). The drop in haematocrit was significantly lower in misoprostol group than the oxytocin group, (400μg-misoprostol versus oxytocin: 1.88 versus 3.04; p=0.0001). Side effects of chills, shivering and pyrexia were noted more with the use of misoprostol.Conclusion: Pre-operative sub-lingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss at Caesarean section operation. However, occurrence of transient side effects of chills, shivering and pyrexia were noted more with use of misoprostol

QT Intervals and Outcome of Pregnancy in Patients with Eclampsia

Background: Eclampsia is associated with considerable mortality and morbidity for the mother and the foetus. QT intervals and dispersions elongations are associated with dangerous arrhythmias and sudden death. Hypocalcaemia is related to both conditions.Aim: To investigate the pattern of QT intervals and dispersions among eclamptic patients and determine outcomes in mother and foetus and also to find out if there is a relationship between the two conditions.Method: Electrocardiograms of 32 patients with intra-partum eclampsia were compared with 30 normal matched for gestational age. Biochemical indices were also compared. Outcome in mother and foetus in the 2 groups were studied.Results: The mean QT intervals and dispersions were comparable in subjects and controls. It was only in QTcmax that there was a significant prolongation in eclamptics (437.87+35.24 vs 420.36+ 32.07 msecs p< 0.05), though the mean QTcmax of the subjects was not absolutelyprolonged. 59.4% of the patients had QTcmax prolonged compared to 13.3% of controls. The QTd and QTcd were prolonged in 18.8% and 15.6% of the patients respectively. No control had a prolongation of these intervals. There were 9(28.1%) foetal deaths in patients compared tonone in controls. None of the QT intervals were related to either maternal or foetal outcome. There was significant difference in serum calcium between patient and control (9.03 +0.41 vs 10.4 + 0.47mg/dl, p < 0.05). The higher the serum calcium, the tendency to better foetal outcome (r=0.83).Conclusion: Many eclamptics had prolonged QT intervals and dispersions but were not associated with dangerous arrhythmias and sudden death

Risk factors and Perinatal Outcome of Umbilical Cord Prolapse in Sagamu, Nigeria

Background: Umbilical cord prolapse is an obstetric emergency that threatens the life and well-being of the fetus and also increases maternal morbidity. Fetal survival in umbilical cord prolapse can be enhanced by prevention where risk factors are identified and prompt diagnosis and decisive intervention. Objective: The aim of this study was to determine the incidence, identify the risk factors associated with umbilical cord prolapse and document the perinatal outcome of cases of cord prolapse. Methods: This was a 13-year retrospective case-control study of cases of umbilical cord prolapse seen at the OOUTH, Sagamu, Southwestern Nigeria between January 1, 2000 and December 31, 2012. Result: During the study period, the incidence of umbilical cord prolapse was 1 in 122 deliveries (0.82%). The umbilical cord prolapse occurred in association with breech presentation five times (33.3%) and transverse lie eleven times (18.5%). The occurrence of breech presentation among the control cases was 8.6% (p<0.001) and that of transverse lie was 1.9% (p<0.001). There were also significant statistical differences between the cases of cord prolapse and controls in terms of prematurity, low birth weight, unbooked status and multiparity. The perinatal rate was 222/1000 (22.2%) compared to the perinatal mortality of 68/1000 (6.8%) for the control group. Conclusion: It is suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care as this will enhance early identification of the risk factors and appropriate management instituted to reduce perinatal mortality

Primigravida at Advanced Maternal Age

Evolving socioeconomic development and its challenges, and advances in medical science have led to increasing proportion of women delaying childbearing beyond the age of 35years in the past three to four decades. A woman who is carrying her first pregnancy at age 35years or more is referred to as elderly primigravida. Similar consideration is given to a woman who delivers her first child at age 35years or more. Pregnancy in this group of women is associated with several adverse pregnancy outcomes including hypertensive disorders of pregnancy, diabetes and its complications, uteroplacental bleeding, preterm birth, low birth weight, still birth, chromosomal defects, labour complications, and caesarean section. They, therefore, constitute one of the obstetric high risk categories requiring special attention and vigilant care. Early booking, close supervision in the antenatal and intrapartum periods, appropriately timed obstetric intervention and advocation of active management of labour would engender good fetal and maternal outcomes. A definitive increase in the number of women in this group is expected to occur both in developed and developing countries thus necessitating an in-depth review and updating of knowledge in the management of this category of women.Keywords: Primigravida, Advanced Maternal Age, Obstetric OutcomeNigerian Medical Practitioner Vol. 63, No. 5-6,201

Deep Pressure Sores Complicating Labour; A Case Report

In the late 1960s and the mid 1970s the reproductive health indices from the developing countries, particularly the sub-Saharan Africa, were alarming and worrisome. The maternal and prenatal mortality rates were unacceptably high. Over 80% of all deliveries in these countries are attended to by untrained birth attendants. The United Nation, through its organ World Health Organization [W.H.O.] then conceived the programme of training Traditional birth attendants to care for delivery services of women at the grassroot. The strategy was to reduce maternal and neonatal mortality in communities with shortages of midwives and where pre-natal care and delivery services were lacking. To date, evidence in support of TBAs remains limited and conflicting. The maternal and prenatal indices continue to worsen and majority of these morbidities and mortalities are traceable to errors of judgments by TBAs during conducts of deliveries. Miss AA is here by presented to demonstrate an example of errors of judgments by TBAs during conducts of labour and deliveries resulting in deep pressure sores in the gluteal and sacral areas and obstetric fistula.Keywords: Deep Pressure Sores, Labour, Traditional Birth Attendants [Tbas