A Review of Gynaecological Hysterectomies at the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki: Indications and Outcome

Context: Hysterectomy is one of the commonly performed major gynaecological operations in the world. There is no baseline information in our hospital regarding this surgery.Objective: To determine the rate, indications and outcome of gynaecological hysterectomy at EBSUTH Abakaliki.Method: Descriptive analysis of retrospective records of all cases of gynaecological hysterectomy over a five year period (January 1, 2005-December 31, 2009).Results: The hysterectomy rate was 10.6% of gynaecological operations. The mean age of patients was th th 47.0±12.00 years (2S.D).  Hysterectomies were commonest in the 4 and 5 decades of life (58.0%) with th highest occurrence in the 5 decade (32.1%). Grandmultipara accounted for 63% of all cases. The major indications for hysterectomy were uterovaginal prolapse (45.7%), uterine fibroids (21.0%) and cervicalcarcinoma (12.3%). Total abdominal hysterectomy(TAH), was the commonest type of hysterectomy (54.3%) while vaginal hysterectomy accounted for 45.7%. Uterine fibroid was the commonest indicationfor TAH (38.6%). Vaginal hysterectomy was employed exclusively uterovaginal prolapse. Wound infection was the commonest complication (41.2%). Majority of the patients were hospitalized for more than 10 days (92.6%).Conclusion: The commonest indication for hysterectomy in this study differs from other reports. Hysterectomy is safe in our centre. There is the need to allow senior residents actively participate in hysterectomy to enable them acquire enough skill.Keywords: Hysterectomy, Indications, Benign, Management, Outcom

Trends and Factors Associated With Maternal Mortality in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki

Background: Maternal health indices are poor in Nigeria. Regular audit of maternal deaths is vital to maternal health care planning and delivery in Nigeria and other developing countries.Objectives: The aim of the study was to audit maternal deaths in EBSUTH and determine the trend and factors associated with such mortality.Method: A retrospective review and analysis of all maternal deaths between January 2004 and December 2007 at Ebonyi State University Teaching Hospital was carried out.Result: There were thirty-five deaths out of the 3471 live births during the study period giving a maternal mortality ratio (MMR) of 1,008 per 100,000 live births. This represents a 41.2% decline from the preceding immediate triennia ratio. The commonest cause of maternal death during the period were obstructed labour/ ruptured uterus which accounted for 40% of the deaths as against sepsis which was responsible for 33% of deaths in the preceding triennia. The un-booked parturients and rural dwellers accounted for 74.3% and 82.9% of the deaths respectively.Conclusion: Preventable maternal deaths remain a feature of obstetric practice in Nigeria. Concerted effort must be focused on the precipitating factors of such deaths if the Millennium Development Goal on maternal health is to be attained.  Key Words: Maternal Death, Morbidity, Pregnancy Complication

Profiling Gestational Trophoblastic Disease in a Tertiary Hospital in South-East Nigeria

Background: Gestational trophoblastic disease (GTD) comprises a spectrum of interrelated tumours including complete and partial hydatidiform mole, placental site trophoblastic tumours and choriocarcinoma.Objective: To evaluate the clinical presentation, management and treatment outcomes of gestational trophoblastic diseases in a tertiary health institution.Methodology: This was a descriptive study of all cases of gestational trophoblastic diseases managed at Ebonyi State University Teaching Hospital, Abakaliki over a five-year period.Results: The incidence of GTD was 3.58 per 1000 deliveries. The age range was 19-55 years and the mean age was 33.4±7.4 years. The mean gravidity was 6 and women who are gravida 5 and above accountedfor 63.3% of those that presented with GTD. Gestational trophoblastic disease was commonly found in women with blood group O (60%) and 46.7% of cases of gestational trophoblastic disease occured in agegroup 30-39 while 23.3% of gestational trophoblastic diseases occured in women 40 years and above. The commonest clinical presentation was recurrent vaginal bleeding 96.7%. Suction curettage (66.7%) was the commonest form of treatment offered to those with GTD in EBSUTH. Total Abdominal hysterectomy and chemotherapy was performed only in 10% of the patients. The commonest complication was haemorrhage (40%). Maternal death attributable to GTD was 10%. About 60% of the patients did not turn up for follow up.Conclusion: Early presentation and proper treatment of this condition is emphasized. There is need for adequate follow-up of these patients.Key Words: Molar Pregnancy, Trophoblastic, Mortality, Chemotherap

After the Repair, What Next? Reproductive Health Expectations of Vesico-Vaginal Fistula(VVF) Patients in Southeast Nigeria

Background: Reproduction occurs under conditions that threaten the life and well-being of women resulting in a very high level of maternal mortality and morbidity. Prominent among these morbidities is obstetric fistula which when occurs threatens the reproductive health of the . womanAim and Objective: To examine the reproductive health expectations of women who had successful Obstetric VVF repair in South East Nigeria.Methods: A qualitative study based on an in-depth interview was conducted of six successfully repaired post vvf repair women at the South East Fistula Centre.Results: Six women who had successful repair of their fistulae participated in the in depth interview. Their mean age was 28.7+ 6.4 years (2SD). Majority belonged to low social economic class. Their VVF resulted from prolonged obstructed labour and they were well aware of this. All participants had established mentrual function during the period of the condition. Five desired future pregnancy would gladly access prenatal care in their next pregnancy in a modern health facility and would also accept Caesarean delivery. None will attempt vaginal birth

The Youth Advisory Centre and Contraception: Perception of Female Medical Undergraduates in Ebonyi State, South East Nigeria

Background: Contraception prevents unwanted pregnancy. However, there remains an unmet contraceptive need and one of the contributory factors has been poor utilization resulting from lack of privacy, especially for the youths, at institutions offering family planning or contraceptive services.Youth friendly centres are established to ameliorate this. However, the extent to which the youths are aware of the existence of these centres and their services remains in doubt.Aim and Objective: This study seeks to evaluate the sources of contraceptives amongst Female medical undergraduates and their awareness of the Youth Friendly Centres.Materials and Methods: A cross sectional survey of female medical undergraduates of Ebonyi State University was done in November 2007 using self-administered questionnaires and focus group discussion was carried out. Information obtained was analyzed using Epi-info 2005 version 3.3.2. Statistical packageResult: Two hundred medical students at 100-600 levels participated in the study but 170 were analyzed. The respondents were aged 19 to 34 years, with a mean of 25.6 (+ 8) years. The modal age range was the20 to 24 year age group (42.4%). Sixty-six or 38.8% were sexually active of whom 60 or 90.9% used contraception. Thirty-six or 60.0% of the subjects who used contraception were introduced to it by their friends or peers. The condom (58 or 96.7%) and the pills (20.0%) were the commonly ever used methods. Students sourced contraceptives from pharmacy shops 83.3% (50) and private clinics 53.3%(32) among others. Only 14.1% (24) of the respondents were aware of the existence of the Youth Advisory Centre at Ebonyi State University Teaching Hospital, Abakaliki but none had ever utilized its servicesConclusion: the Youth Friendly Centre is not being utilized by the youths for contraceptive services. There is need for mass campaign amongst the youth on the existence of this centre and the services it offers.Key Words: Youth Friendly Centre, Source, Contraception, Undergraduat

Prevalence of Medical Disorders in Pregnancy in Ebonyi State University Teaching Hospital

Background: Pregnancy is a physiological state, but when associated with an underlying medical disorder, it has a large impact on the well‑being of a mother. The pattern of medical disorders has been documented to have changed over the years.Aim: This study seeks to retrospectively determine the incidence of medical disorders in pregnancy, and to determine the trend over a 5‑year period in Ebonyi State University Teaching Hospital (EBSUTH).Materials and Methods: This was a retrospective study of all medical cases in pregnancy managed in EBSUTH from 1st of January 2006 to 31st December 2010. Data were analyzed using Epi‑Info statistical package. The results were presented in simple tables. Test statistics was set at 95% confidence interval. Results: A total of 339 medical cases in pregnancy of 2117 admissions were managed during the study period (16.0%). Mean (SD) age of the women was 28.05 (5.36) years and age ranged 15‑45 years for about 314 cases that had the age documented. Of the 339 cases, a total of 149 cases of malaria occurred during the study period (149/339; 44%), out of which only 104 were malaria alone. The rest (45 in number) occurred with urinary tract infection, pregnancy‑induced hypertension, Diabetes mellitus, lobar pneumonia, and anemia in pregnancy. This was followed by hypertensive disorders which account for 29.2% of all cases of medical disorders. Urinary tract infection ranked third (20.7% of all medical disorder). The incidence of malaria was 7% (149/2117), that of hypertensive disorder was 4.7% (99/2117), and of Urinary Tract Infection was 3.1% (65/2117). Others include anemia in pregnancy 0.6% (13/2117), Diabetes mellitus 0.4% (9/2117), and Gastroenteritis 0.4% (9/2117). There is no statistical differencebetween the incidences of medical complications over the study period.Conclusion: There is relatively little change in the incidences of medical complication over the studied period. Malaria played a very important role in the prevalence of medical complications in pregnancy. Preventive strategies may have reduced the prevalence over the years. However, more effort is needed to markedly reduce the medical complications in pregnancy.  Keywords: Disorders, medical complication, pregnancy, prevalence, tren

Outcome of Teenage Pregnancy at a Tertiary Hospital in Abakaliki Southeast Nigeria

Background: Teenage pregnancy is a high risk pregnancy associated with obstetric, fetal, neonatal and psycho‑social complications. These complications are worsened by poverty, ignorance and lack of special care during pregnancy.Aim: The objective of the following study is to determine the obstetric and neonatal outcome of teenage pregnancy.Materials and Methods: A retrospective case control study was carried out over a 6 years period, 2006‑2011. All teenage pregnancies (aged 13‑19 years) at Federal Medical Center Abakaliki, Ebonyi were taken as cases. Pregnancy deliveries from mothers aged 20 to 29 that met the inclusion criteria were selected as controls. A total of 137 teenage pregnancies were analyzed and compared with 948 controls. Statistical analysis was performed using 2008 Epi‑info statistical software version 3.5.1 (Atlanta, Georgia, USA). Results: The incidence of teenage deliveries over the period of the study was (137/8020) 2.25%. Single mothers were commoner (40.9% [56/137] vs. 3.1% [29/948], P < 0.01) among the teenagers. Low educational status was more common among teenage mothers (P < 0.01). Unbooked pregnancies were significantly common among teenage mothers (23.4% [32/137] vs. 12.3% [117/948], P < 0.01). Anemia in pregnancy (18.1% [41/226] vs. 11.2% [65/579], P = 0.01), human immunodeficiency virus (HIV) in pregnancy (4.9% [11/226] vs. 1.7% [10/579], P = 0.01) and malaria in pregnancy (26.1% [59/226] vs. 12.4% [72/579], P < 0.01) were significantly common in teenage pregnancies than the control. Teenage mother had significantly increased cesarean deliveries (23% [31/137] vs. 14.8% [140/948], P < 0.02), male deliveries (64.3% [90/140] vs. 52.1% [502/963], P < 0.03) and low birth weight (19.3% [27/140] vs. 12.7% [122/963], P < 0.03). Fetal loss (22.1% [31/140] vs. 3.3% [32/963] P < 0.01) and birth asphyxia (19.3% [27/140] vs. 6.8% [65/963], P < 0.01) were significantly common among teen mothers in the 1st min American Pediatric Gross Assessment Records score. Conclusion: Teenage pregnancies were associated with a significantly higher risk of anemia in pregnancy, HIV in pregnancy, malaria in pregnancy, cesarean deliveries and poor fetal outcome. Health education, women enlightenment and empowerment will be essential in reducing the problems of teenage pregnancy.Keywords: Abakaliki, outcome, teenage pregnancy, tertiary hospita

Appraisal of indications for Ceasarean section in Abakaliki, Nigeria

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Knowledge and Attitude of Pregnant Women in Rural Nigeria to Voluntary Counseling and Testing (VCT) for Human Immunodeficiency Virus Infection/Acquired Deficiency Syndrome (HIV/AIDS)

Background: It is not immediately clear if awareness campaigns against the HIV/AIDS have filtered down the rural communities. Methods: This study ascertained awareness and attitude of pregnant women in rural Nigeria to voluntary counseling and testing (VCT), for Human immunodeficiency virus infection. Results: Six hundred expectant mothers who consented were interviewed using semi structured questionnaire in a cross sectional study that spanned six months in eight rural communities of Ebonyi State. Five hundred and two women (82.3%) have heard of HIV/AIDS. The churches were the primary source of information. Prior to the interview, only thirty-one expectant mothers have heard of VCT. However, after education, 66.3% and 57.0% respectively believed it would be of benefit to their babies and themselves and 69.8% would want to have VCT for Human immunodeficiency virus infection. Conclusion: There is need for more organized health education on HIV/AIDS among pregnant women in the rural communities to increase uptake of VCT services. Keywords: Knowledge, AIDS, prevention, counseling, testing, rural Nigeria.Nigerian Medical Journal Vol. 48 (2) 2007: pp. 27-3

Bilateral tubal ectopic pregnancies: A report of two cases

Bilateral tubal ectopic pregnancies are rare occurrences. Two recently managed cases are discussed. The first was a single, sexually active 23-year-old nullipara with family history of twinning who presented with eight weeks amenorrhea, positive pregnancy test, lower abdominal discomfort and other clinical and ultrasound findings suggestive of unruptured left tubal pregnancy. Intra-operatively, unruptured bilateral tubal pregnancies were found and bilateral salpingotomy performed with uneventful recovery. Histology of the specimens confirmed the intraoperative diagnosis. She was appropriately counseled. Case 2, a 30-year-old multiparous housewife who had been on clomid for secondary infertility, presented with signs and symptoms of ruptured tubal ectopic. Intra-operatively, ruptured left and unruptured right tubal pregnancies were found and salpingectomy and salpingotomy were done respectively, with uneventful recovery. The diagnosis was also confirmed histologically and counseling given as in case 1. Bilateral tubal ectopic pregnancies appear to be increasing with twin proneness and use of fertility drugs as risk factors. Whether spontaneous or induced, the hallmarks of good management include early presentation, high index of suspicion, meticulous ultrasound scanning, good case selection, judicious intra-operative inspection of the contralateral tube, histology of specimens and appropriate patient counseling