Unusual complications of incisional hernia

Incisional hernia represents a breakdown or loss of continuity of a fascial closure. These hernias are of particular concern not only for the high recurrence rates among them but also for the challenges that follow their repair. It is known to occur in 11‑23% of laparotomies. This paper presents two unusual complications of incisional hernia managed by the authors. One ruptured incisional hernia with evisceration of gut and a case of incarcerated gravid uterus in a woman in labour. The case records of the two patients with unusual complications of incisional hernia were pooled and presented to highlight the clinical presentation and management options of this condition. The patient with ruptured hernia and eviscerated gut presented immediately and was resuscitated and the hernia repaired with polypropylene mesh. The patient with incarcerated uterus had caesarean section and mesh repair of the hernia. Incisional hernia can present with unusual complications. The management is very challenging. Good knowledge and skills are required to deal with this condition.Keywords: Unusual complications, Eviscerated gut, Incisional hernia, Incarcerated uterus, Polypropylene mes

Primary Caeserean Section In Grandmultiparae At Mater Misericordiae Hosptial Afikpo: A 5 Year Retrospective Study

To identify the common indications and the outcome of primary caesarian section in grandmultiparae at Mater Misericordiae Hospital Afikpo. The case notes of 69 grandmultiparae who had primary caesarean section at Mater MisericordiaeHospitalAfikpo between January 1999 toDecember 2003 inclusively.The information obtained included age, parity, occupation, height, educational status, booking status, indication for caesarean section, operative and post-operative complications, types of anaesthesia, types of uterine incision, mean blood loss, associated pelvic findings and foetal outcome. Eighty nine percent (89%) of 69 primary caesarean sections were done emergency procedure. The commonest indications for a caesarean section were dystocia (76.8%), antepartum haemorrhage (17.4%), essential hypertension (10.1%) Puerperal pyrexia (24.6%), haemorrhage (7.2%)wound dehiscence (4.3%) and anaemia (2.9%), were the commonest intra- and post operative complications encountered. The perinatal mortality ratewas 153/1000.Therewere twomaternal deaths (29 per 1000). Health education of the population coupled with better utilization of comprehensive maternity care and family planning facilities are advocated. Keywords: Caesarean Section, Grand multiparae. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 368-37

Caesarean section related morbidity and mortality at the Imo State University Teaching Hospital Orlu

Background: There is a general aversion to Caesarean section among Nigerian women. However, with increasing safety of the procedure and better enlightenment, more women are beginning to accept the procedure. To maintain this increasing acceptability, Caesarean section related morbidity and mortality must be reduced to the barest minimal levels. Aim: To determine the incidence and the complications associated with Caesarean section at the Imo State University Teaching Hospital, Orlu. Methods: A four-year descriptive study from June 2004 to May 2008 from the Obstetrics Department of Imo State University Teaching Hospital, Orlu was conducted. All pregnant women that were delivered by Caesarean section were included. Results: There were 363 (33.2%) mothers who underwent Caesarean sections out of 1094 deliveries in the unit during the period under review. Postoperative complications occurred in 52 patients (14.5%). The complications cut across all reproductive age groups and parity. The commonest complications encountered were wound infection (71.9%), postpartum haemorrhage (63.2%) and anaemia (40.4%). The mortality rate was 1.2%. Conclusion: The Caesarean section complication rate of 14.5% is still high, even though it is less than the figures quoted for some environments. There is still the need to reduce this rate to the barest minimum for us to be able to sustain the gains of the recent past.   Key words: Caesarean section, Morbidity, Mortality, Orl

The choice of contraceptives among women in Orlu, Nigeria

Background: Remarkable progress has been recorded in the turn of the century towards the development of more efficient and safer contraceptives. Previous studies from some parts of the country showed an increase in the percentage of clients changing from one contraceptive method to another. With the advent of the HIV/AIDS pandemic at the turn of the new millennium there may still be further changes in the choice of contraceptives in different parts of the world, Nigeria inclusive. Aim: To study the choice of contraceptive usage and the factors predictive of such choices in Orlu, southern Nigeria. Design:  A cross sectional study Setting: Imo state University Teaching Hospital, Orlu, Nigeria. Subjects:  Clients attending the family planning clinic. Main outcome variables: contraceptive choice, reason for choice, awareness and source of awareness about contraceptives. Results: Five hundred and three clients were reviewed. Ninety one percent knew at least one method of contraception. Their ages ranged between 18 and 52 years with majority in the 33-37 years age bracket. Most of the women were housewives (46.5%). Clients who had attained post secondary school education or more constituted 29.4%, majority were married (84.7%), in monogamous marriages (81.7%) and grandmultiparous (45.9%). The commonest contraceptive choice was the injectables (44.3%) while nurses and midwives formed the commonest source of knowledge about contraception and referral. Conclusion: The most commonly used contraceptive method in Orlu, Nigeria is the injectables. The HIV/AIDS pandemic may likely change or affect this trend.   Keywords: Contraceptive choice, Source of awareness, Referral, Orl

The prevalence of gynaecological diseases at the Imo State University Teaching Hospital, Orlu, Nigeria

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Experience with manual vacuum aspiration at the Imo State University Teaching Hospital, Orlu, Nigeria

Background: Criminal or illegal abortions and it's attendant complications contribute significantly to maternal morbidity and mortality in developing countries. Manual vacuum aspiration provides a cheap, safe and effective means of reducing this morbidity and mortality.Aim: To evaluate the usefulness of manual vacuum aspiration in the management of first trimester miscarriages in Orlu.Methods: The case notes of 324 patients with first trimester miscarriages managed with manual vacuum aspiration (MVA) over a 5-year period from June 2004 to June 2009 were retrieved. Information extracted included age, parity, gestational age at presentation, indication for MVA use and complications resulting from the procedure.Results: A total of  1672 gynaecological patients were seen during the study period out of which 324 had MVA procedure, giving a prevalence rate of 19.4% with a mean age of 24+2.3 years. The highest number of procedures were carried out on patients aged 26-30 years (23.5%). Grandmultiparous patients accounted for the highest number of cases (53.1%). Most of the procedures (46.3%) were carried out in patients whose miscarriages occurred between 9-10 weeks of gestation. Incomplete miscarriage (75.6%) was the commonest indication for the use of MVA while genital tract bleeding (46.4%) was the commonest complication encountered. Majority of the procedures (86.4%) were carried out on out patient basis. There was no maternal death or blood transfusion.Conclusions: Abortion and it's attendant complications with a prevalence  rate of 22.1% appears to be fairly common in our environment. MVA is very effective in the management of first trimester miscarriages in our centre. Keywords: Manual vacuum aspiration, Miscarriage, Experience, Orl

Presentation and management fo uterine leiomyoma at Imo State University Teaching Hospital, Orlu, Nigeria

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Preliminary outcome of the management of eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia.Aim: This study aims at determining the prevalence and management outcome of  eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7% of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p<0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p<0.05). Twenty-eight (93.3%) of the eclampsia occurred antepartum. Twenty-eight (93.3%) had severe hypertension on presentation. Twenty nine (95.8%) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital.  Twenty-six (86.7%) of the patients had emergency Caesarean section was carried out, mostly for unfavourable cervix. The perinatal mortality was 6.7% while maternal mortality was 3.3%. Complications included acute renal failure, aspiration pneumonitis and abruptio placentae.Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking, antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment. Keywords: Eclampsia, Prevalence, Morbidity, Mortality, Orl

The use of cervical smear in the diagnosis of gemital tract infections at a University Teaching Hospital

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Prevalence of Anaemia Among Human Immunodeficiency Virus (HIV) Positive Pregnant Women at Booking in Orlu, South-Eastern Nigeria

Background: Anaemia is the most commonly encountered haematological abnormality in human immunodeficiency virus (HIV) positive patients with estimates climbing as high as 95% depending on clinical settings. The twin effects of HIV infection and anaemia in pregnancy is associated with adverse maternal and perinatal outcomes.Objective: To determine the prevalence of anaemia among HIV positive pregnant women at booking at Orlu, South-East Nigeria.Methods: A retrospective analysis of the case records of women who were screened for Human Immunedeficiency Virus and anaemia at the Imo State University Teaching Hospital from 1st March 2008 to 28th February 2010 was done. Data on age, parity, educational status, marital status, haemoglobin concentration and retroviral status were collected and analyzed using SPSS version 13.Results: Nine hundred and twenty one pregnant women were screened at booking within the study period. The age range of the women was  8-39years with a mean age of 28.22 ± 5.04years. One hundred and six (11.5%) of the women tested and were confirmed positive to HIV 1 & 2 antibodies. Anaemia was significantly higher among HIV positive pregnant women than in HIV negative pregnant women (75.5% vs 57.9%; P=0.001). Seventy seven point three percent (75/97) of women ≤ 20 years were anaemic. This was shown to be significant (P=0. 000). Three hundred and thirty three (69.2%) of the women that had only secondary education were significantly (P=0.000} more anaemic than those that had postsecondary education.Conclusion: There was a high prevalence of anaemia among HIV positive pregnant women at booking at the Imo State University Teaching Hospital (IMSUTH, Orlu. Anaemia was also more significant in younger age (≤20years} and lesser educated women (only secondary.school}Key Words: Anaemia, HIV, Pregnancy, Booking, Orl