Oropharyngeal fetus-in fetu in Ilero Nigeria: A case report

Fetus-in-fetu is a rare congenital condition in which a malformed parasitic twin is found within the body of its partner. Although a few had been documented worldwide, none has been reported in Nigeria. In this report, we document the history of a concoction of drugs of an indeterminate nature taken in pregnancy, the wrong diagnosis by the rural based sonographer and the presence of polyhydraminos. Our finding of a previously misdiagnosed oropharyngeal fetus-in fetu with dichorionic and cardiac features calls for a revision of the current definition of fetus-in fetu. It also raises an important hypothesis of the likely associations between drugs, infections, pregnancy induced hypertension and fetus-in-fetu.Key words: Fetal abnormality; oropharyngeal fetus-in fetu; pregnancy

Vesicouterine fistula: A case report of successful repair

The increasing rate of cesarean deliveries especially in previous scars is a major cause of vesicouterine fistula (VUF). The incidence of VUF is on the rise because of the increasing incidence of cesarean deliveries. VUF is a pathological communication between the uterus and the bladder. VUF presents in various ways, the main symptoms are urinary incontinence with or without hematuria. There could be depression or psychological distress, which may culminate in reduction in quality of life. The precise and early diagnosis of vesicouterine fistula may be difficult; thus necessitating myriad of investigations such as retrograde cystography, cystoscopy, contrast‑enhanced CT scan, MR urogram, and transvaginal ultrasound with or without Doppler. Examination under anaesthesia (EUA) is crucial to the diagnosis of VUF and this includes methylene blue test. We report a case of VUF.Key words: Urinary bladder; urogenital fistula; uterus; vesicouterine fistula

Quality of Sleep and Psychological Distress in Glaucoma

Background: People living with glaucoma are psychologically burdened because of the threat of visual loss. Therefore, understanding the psychosocial issues and quality of sleep holds important implications for the recognition, prevention, and treatment of emotional problems among people with glaucoma. This study investigated the quality of sleep and psychological distress among people with glaucoma. Methods: This was a cross-sectional study of adults recruited over a period of 12 weeks from a glaucoma clinic of a Teaching Hospital in south-west Nigeria. The quality of sleep and psychological distress were evaluated using the Pittsburgh Sleep Quality Index and General Health Questionnaire respectively. Results: Ninety-three adults with glaucoma participated in the study. The mean age was 62.33 ± 15.25 years. Fifty-seven (61.3%) of the subjects were poor sleepers while 27 (29.0%) were psychologically distressed. Psychological distress correlated with global sleep score (r = 0.399, p = 0.000), subjective sleep quality (r = 0.341, p = 0.001), sleep latency (r = 0.245, p = 0.018) and sleep disturbance (r = 0.279, p = 0.007). Conclusion: Psychological distress and sleep disturbances were common among patients with glaucoma. Concerns about these issues should be incorporated into routine clinical evaluations of patients with glaucoma

The impact of decision – delivery interval on maternal and fetal outcome: a three- year experience in a tertiary hospital.

Background: Human resources development has been identified as a very important tool in improving maternal and child health. An enhanced human resource capability helps in the reduction of the decision delivery interval (DDI), which has been identified as a key factor in improving the feto-maternal outcome in emergency caesarean delivery (ECD) for fetal and maternal reason.Aim: This study aims to find out the feasibility of 30-minute decision-delivery interval (DDI) and the average decision-delivery interval in our setting, the effect of delayed decision-delivery interval on maternal and fetal outcome; to identity the prevailing factors and to proffer solutions.Materials and Methods: This was a retrospective study carried out over a 3-year period between 1st January 2011 and 31st December 2013. The case notes of 577 patients who had emergency caesarean delivery during this period were reviewed and information relating to socio-demographic characteristics, indications for the caesarean delivery, decision-delivery interval, reasons for delay and feto-maternal outcome were obtained. All cases of preterm deliveries, intra-uterine fetal demise and multiple pregnancies were excluded.Results: The prevalence of caesarean delivery during this period of study was 36.4% with 83.3% done as emergency. Seventy One percent of the parturients were multiparous women who were mostly unbooked (54.8%). The indication for surgery was fetal distress in majority of cases (40.4%). None of the parturient was delivered within 30 minutes of decision and the mean DDI was 120.35±40.26 minutes overall but lower for cases of fetal distress (96.38±34.72 minutes, P<0.001). The major reasons for delay in delivery were laboratory challenges and financial constraint (63.6% and 53.4% respectively). There was a statistically significant reduced mean time interval for instituting general anaesthesia compared with spinal anaesthesia. Severe fetal morbidity and mortality occurred with increase in DDI but was not shown to be statistically significant. Perinatal mortality rate among study group was 7.3%. Maternal mortality and near misses increased with increase in DDI and was shown to be significant (P=0.014). The maternal mortality rate from this study was 2.6%.Conclusion: The decision-delivery interval of 30- minutes is difficult to achieve in low resource settings; even in the face of emergency, due to prevailing factors which include poor human capital development, poor standard of living, bad attitude of health workers and infrastructural challenges

Abdominal pregnancy: A cause of failed induction of labour

No Abstract. Nigerian Journal of Medicine Vol. 14(2) 2005: 213-21

A Six-Year Review of Ruptured Ectopic Pregnancies at the Olabisi Onabanjo University Teaching Hospital, Sagamu

Background: Ectopic pregnancy is a major complication of early pregnancy and is a common reason for gynaecological emergency admissions. The ruptured variety accompanied by profuse intra-abdominal haemorrhage is one of the leading causes of maternal mortality in the developing countries. Objective: To describe the local epidemiology of ruptured ectopic pregnancy at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu. Methods: This was a retrospective study of ruptured ectopic pregnancies managed at OOUTH between January 2009 and December 2014. The case records were retrieved from the medical records department. Other relevant information were obtained from the operating theatre registers and pathology department records for statistical analysis. Results: Sixty-two cases of ruptured ectopic pregnancies were identified out of 2,875 gynaecological admissions and 2,360 deliveries over the specified period. The incidence of ruptured ectopic pregnancies was 1 in 38 deliveries and prevalence of 2.2% of all gynaecological admissions. About 90.7% of the patients studied belonged to the active reproductive age group (21 – 35 years) while 58.0% were of low parity (Para 0 – 1). The leading symptoms included abdominal pain (95.2%) and amenorrhoea (83.9%). The fallopian tubes were the sites of implantation in 96.8% of the cases. There were no cases of heterotopic or cervical pregnancy. All the patients had laparotomy and salpingectomy (partial/total) was the commonest procedure undertaken (79.0%). Anaemia was the most frequent postoperative complication (69.4%), and only one death was recorded (case fatality rate of 1.6%). Conclusion: Ruptured ectopic pregnancy contributed to maternal morbidity and mortality at the study centre. Most of the common predisposing factors in this setting are preventable