Fertilty outcome in women after open abdominal myomectomy at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Myomectomy is the surgical treatment of choice for uterine fibroids especially in women desirous of conception. There are controversies regarding fertility outcome following open abdominal myomectomy.Objective: To assess fertility outcome after open abdominal myomectomy in women with previous infertility.Design: A retrospective study.Setting: University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria.Subjects: Women who wished to conceive after open abdominal myomectomy and had only subserous and/or intramural fibroids at surgery.Results: Over the five-year period under review, there were 301 abdominal myomectomies performed. One hundred and twenty case notes were retrieved giving a retrieval rate of 39.9%. Of these, 50 met the inclusion criteria. The mean age was 33.3 ± 3.2 years (range 27- 42 years). Pregnancy and miscarriage rates were 88% and 9.1% respectively. Live birth rate was 84.1%. Most (95.5%) of the patients conceived spontaneously after the procedure. Caesarean section was the common (84%) mode of delivery.Conclusion: Fertility and live birth rates improved after open abdominal myomectomy

Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis

BACKGROUND: Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. METHODS: A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. RESULTS: There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31). CONCLUSION: At the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution

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

Life threatening vaginal haemorrhage from coital laceration in a post-menopausal woman

Background: Life threatening coital laceration from consensual intercourse in the postmenopausal period is unusual without any predisposing factors(s). The usual site of occurrence is the right side of the posterior fornix. Aim: To report a case of haemorrhagic shock from coital laceration. Design: Case report Case report: A 55-year-old woman who presented as an emergency with haemorrhagic shock following vaginal bleeding from consensual coitus is presented. She was resuscitated with intravenous fluids and blood transfusions. The vaginal laceration of about 5 cm on the right side of the posterior fornix was sutured following examination under anaesthesia. Conclusion: Coital laceration should be considered a differential diagnosis in any postmenopausal vaginal bleeding while prompt recognition and treatment are important to avoid morbidity and even mortality. Keywords: Life threatening, Postmenopausal, Coital, Laceration, Posterior fornixPort Harcourt Medical Journal Vol. 2 (3) 2008: pp. 275-27

Severe Pre-Ecclampsia/Ecclampsia And Maternal Deaths At Upth, Port Harcourt (A Ten-Year Review)

A total of 17,670 mothers delivered at the University Teaching of Port Harcourt teaching Hospital (UPTH) over a ten-year period 1989 to 1998. Three hundred and thirty seven (1.9%) maternal deaths were recorded amongst booked and unbooked mothers over the period, with a maternal mortality rate of 1907.2 per 100,000 deliveries. Pre-eclampsia and eclampsia accounted for 76 (0.4%) deaths constituting 22.6% of all deaths and a maternal mortality rate of 430. 1per 100,000 deliveries. Pre-eclampsia and eclampsia remain the bane of obstetric practice in the topics. Preventive and better management modalities for this pregnancy disorder are advocated. Journal of Medical Investigation and Practice Vol. 4: 2003: 26-2

Ruptured heterotopic pregnancy and subsequent vaginal delivery at term

Background: Heterotopic pregnancy is the co- existence of intrauterine and extrauterine gestation at the same time. The condition is life threatening when the ectopic pregnancy ruptures and it is unrecognized. Objective: To report the first successfully managed case of heterotopic pregnancy in a woman without obvious risk factors in our centre. Design: Case report. Setting: University of Port Harcourt Teaching Hospital, Port Harcourt. Result: A multiparous 30 - year old lady who had heterotopic pregnancy with natural conception and salpingectomy for the ruptured ectopic component delivered a live baby at term . Management of the ectopic pregnancy with viable intrauterine pregnancy delivered at term. Conclusion: Heterotopic pregnancy though rare, is possible in our women without known risk factors. Medical practitioners should have a high index of suspicion when a parous woman presents with lower abdominal pain in the first trimester of pregnancy. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 201-20

Maternal Mortality from Ruptured Ectopic Pregnancy in Rivers State of Nigeria: Analysis of 38 Autopsies performed in 12 years

In a period of twelve years (1 January 1990 to 31 December 2001), one thousand, two hundred and twenty five (1225) autopsies were performed in the Anatomical Pathology department of the University of Port Harcourt Teaching Hospital, (UPTH) Port Harcourt. Of this number, thirty eight (38) 3.1% were due to ruptured ectopic pregnancy. Most of the deaths 27(71.0%) occurred from cases brought from the rural areas of the state while 11(29.0%) were from the urban area of the Port Harcourt metropolis. Age group 20-30 years was the most vulnerable. With regards to parity, those of 1 and 2 were mostly affected and the major clinical presentations were lower abdominal pains, fainting/dizziness and amenorrhoea 31(81.6%). Police investigation and autopsy should be mandatory in all cases of ‘mysterious' deaths in women of reproductive age. In addition, health care deliveries should be extended to the rural dwellers as it is in the urban centers. (Key Words: Ectopic pregnancy, Deaths, Autopsy, Rivers State) Sahel Medical Journal Vol.6(4) 2003: 108-11

Pattern of primary female genital cancer in Port-Harcourt, Nigeria: a 12-year Review

A retrospective study of 278 gynaecological malignancies was carried out for a period of 12 years (1990-2001) by the authors in the University of Port-Harcourt Teaching Hospital, Port-Harcourt (UPTH) with respect to age, site and histological pattern of the cancers in each anatomical class. Cancers of the cervix, ovaries and the vulva were commoner in the age group 50 – 59 years while those of the uterus and the vagina were commoner in the age group 60 – 69 years. Of the given anatomical classes, cancer of the cervix formed the majority, accounting for 63% of the cases, and the least was cancer of the vulva which recorded 3.2%. Others in order of frequency were ovary 15.5%, uterus 13.3% and vagina 5%. In all the cases, except those of the uterus and ovaries-where choriocarcinoma and serous papillary cystadenocarcinomas were more frequent, squamous cell carcinoma of “well and moderately differentiated variants formed majority. The uterine cancers were made up of both epithelial and mesenchymal cancers. Severely dysplastic lesions were considered as malignant since they showed all the characteristics of malignancy except infiltration of the surrounding tissues. Key words: Gynaecological malignancies; Age, Sites and Histological types Sahel Med. J. Vol.6(2) 2003: 34-3

Complete lactational failure in four consecutive deliveries: a case report

Although the ever-breastfeeding rate in Nigeria is over 98%, there are some women who may not be able to lactate despite the desire and motivation to do so. Some of the reasons for this failure include lack of skilled support and inherent failure to lactate. We report .the case of a 29-year old graduate, who, despite adequate breast development, motivation to breastfeed and frequent suckling of the newborns, failed to lactate in four consecutive deliveries. Her last postpartum prolactin level was 260µ Units/L. She refused all methods of contraception and consequently delivered four term babies in a period from 1998¬ - 2004 [a period of 6 years] with inter-delivery intervals of 16.5, 36 and 18 months respectively and a mean of 23.5 months. Lactational failure, although uncommon in Nigeria, constitutes a medical indication for the use of breast milk from a wet nurse or breast milk substitute. In view of the high re-lactation rate by affected women when offered skilled assistance, there is need to identify and refer early affected mother-baby pairs to prevent total and consecutive failure to lactate. In event of failure to relactate, safe birth spacing methods should be offered to prevent short inter-delivery intervals with its attendant risks. Similarly, safe and affordable methods of feeding should be provided for the infant to prevent malnutrition and associated problems. Nigerian Medical Practitioner Vol. 49(1&2) 2006: 10-1