Abimbola O. D. Kolawole

Epidemiology of ovarian cancers in Zaria, Northern Nigeria: a 10-year study

Background Globally, the absence of a premalignant stage of ovarian cancer and a reliable screening tool make early diagnosis difficult. Locally, poverty, ignorance, and lack of organized cancer services make prognosis poor. We describe the epidemiological features of ovarian cancer seen at Ahmadu Bello University Teaching Hospital Zaria, Northern Nigeria, a tertiary referral center, over a 10-year period in this challenging setting. Methods All cases of histologically diagnosed ovarian cancer between January 1, 2004 and December 31, 2013 were included in the study. Case notes were retrieved to collect clinical data including age, parity, clinical stage of disease at presentation, and known associated factors. Results were analyzed using Epi info™. Results A total of 78 patients were included in the study. About 4–13 cases were seen every year with a tendency to increasing incidence. The patients were aged 8–80 years with mean of 37 years. Sixty-two (79.5%) patients were premenopausal while postmenopausal women accounted for only seven cases or 9.0%. There were 17 cases (22.3%) of aggressive cancers in patients aged ≤20 years. A majority of the patients, 65 (83.3%), were parous with only nine (11.5%) patients being nulliparous. Serous cyst adenocarcinoma accounted for 32 (41%) cases. Granulosa cell tumor was the second commonest with 18 cases (23.1%). The mean age of occurrence of serous cyst adenocarcinoma was 31 years and for epithelial ovarian cancers in general it was 33.5 years. Endometrioid adenocarcinoma was rare with only one case in 10 years. Factors like age, parity, and premenopausal status did not appear to be protective to the occurrence of malignant ovarian tumor in this group. Conclusion Increasing numbers of patients with ovarian cancer were seen over the 10-year period. Young, premenopausal, parous women made up the majority of cases. Serous cystadenocarcinoma was the most common histological variant.

Partial hydatidiform molar gestation following assisted conception

Molar gestation, with its attendant risk to progress to frank choriocarcinoma, has been reported in the literature. It can follow both spontaneous and assisted conceptions. With the growing popularity of assisted conception techniques for the management of infertility in our setting, it is important to bring to the fore that similar complications could occur and hence should inform the counseling of patients before and during such procedures. We present a 39-year-old nullipara who had in vitro fertilization and frozen embryo transfer. Eight weeks later, she was diagnosed with missed abortion and had manual vacuum aspiration at a private hospital in Zaria. Histopathological examination revealed partial hydatidiform mole, and she was subsequently managed at a tertiary health center in Zaria with six cycles of methotrexate chemotherapy because she was low risk based on the International Federation of Gynecologists and Obstetricians criteria. She was monitored with monthly serum beta-human chorionic gonadotropin (β-HCG) and was placed on combined oral contraceptive pills. The serum β-HCG levels fell to almost undetectable levels and remained so after four cycles of the chemotherapy regimen. Molar pregnancy can follow assisted conception in our environment. This underscores the importance of pretransfer cytogenetic and histopathological assessment of any specimens aspirated following every incomplete/missed abortion. This case also brings to the fore the importance of referral of similar cases to higher levels of care for expert/multidisciplinary management.

Gestational trophoblastic disease in Abuth Zaria, Nigeria: A 5-year review

Gestational trophoblastic diseases (GTD) includes a spectrum of diseases (tumor or tumor-like conditions) characterised by aberrant growth and development of the trophoblasts that may continue even beyond the end of pregnancy. It encompasses the benign trophoblastic disease (complete and partial moles), and the malignant trophoblastic diseases including the invasive mole (chorioadenoma destruens), choriocarcinoma, and Placental Site Trophoblastic Tumor (PSTT). This study was to determine the prevalence, risk factors, clinical presentation, diagnosis, treatment options and outcomes of GTD in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. A five-year retrospective study of patients with GTD managed at ABUTH, North-west Nigeria, from 1 st January 2008 to 31 st December, 2012 was undertaken. Data of all cases of GTD in the hospital over the 5 year period were obtained. The gynaecology ward and labour ward registers also provided information on the total number of gynaecological admissions and deliveries respectively. The data processing and analysis were carried out using the SPSS software version 16. The data obtained were expressed in percentages, means, and standard deviations. During the period of study there were 8,138 deliveries and 2,453 gynaecological admissions. There were 59 cases of GTD with 41 having choriocarcinoma, 18 molar pregnancies and no case of invasive mole or PSTT. Out of the 41 case folders retrieved, 23 were choriocarcinoma and 18 of molar pregnancies. The prevalence of GTD was 7.2 per 1000 deliveries (0.72% or 1 in 138 deliveries) and constituted 2.4% of gynaecological admissions. Hydatidiform mole (HM) occurred in 1 in 452 deliveries and choriocarcinoma occurred in 1 in 198 deliveries. Ages ranged from 19-49 years with mean of 32.5+ 5.0 years. Most (66.7%) cases of HM were 19-29years while 60.9% of choriocarcinoma cases were 30-39years. Majority of cases were multiparous. The antecedent events predating choriocarcinoma were Hydatidiform mole (31.7%), abortions (29.3%) and 2.4% followed term pregnancy. History of amenorrhea was present in all cases while vaginal bleeding occurred in 97.6%, pallor (87.8%), hyperemesis gravidarum (48.8%) and 4.9% came in shock. Consequently, common complications reported were haemorrhage (90.2%), anemia (87.8%) and shock (12.2%). Pregnancy test was positive in 90.2% of cases and serum beta hCG was done in 24.4% with more than half having a level >12,000miu/ml. All patients had pelvic ultrasound scan and snowstorm appearance occurred in 41% of benign GTD cases. Histology was used to confirm 56.1% cases of choriocarcinoma and 43.9% of molar gestation. Most (94.4%) of HM had suction evacuation while 95.6% of choriocarcinoma cases had chemotherapy, one case (2.4%) had Total Abdominal Hysterectomy. Contraception was used in 78% and common methods were male condom (41.5%) and 36.6% used combined oral contraceptive pills. Less than half (43.9%) had follow up for 6 months and 9.8% were seen for more than a year. Eight patients had subsequent pregnancies and there was one death in the series giving a case fatality of 2.4%. Gestational trophoblastic disease is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.

The effect of frequency of antenatal visits on pregnancy outcome in Kaduna, Northern Nigeria

Context: The benefit of antenatal care is no longer in doubt, but the ideal number of encounters to achieve those benefits has been the subject of discussion among maternity care stakeholders. Objective: To study the effect of frequency of antenatal visits on pregnancy outcome. Materials and Methods: This is a prospective study of 228 pregnant women attending the antenatal clinic of the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 3-month period. Maternal and fetal outcome were compared against the frequency of antenatal visits. Results: The mean frequency of visits was 6.77. Majority of the women 124 (54.4%) attended less than seven times. Compliance with antenatal drugs and mean hemoglobin level at delivery increased with increasing frequency of visits reaching 93.7% and 11.44 g/dl, respectively, in the moderate attendees (4–6 visits). Prevalence of anemia was high (56.7%) among the unbooked but lowest (9.5%) with moderate attendees. Thereafter, there was no significant improvement. Delivery mode, malaria parasitemia, and gestational age at delivery were fairly uniform in all the groups. The prevalence of low birth weight was 20% in the unregistered and decreased from 22% in the low frequency (1–3 visits) group, to 4.8% in the moderate attendees, and to 0% in the very high-frequency (ten and above visits) group. Mean Apgar scores at 1 and 5 min were also best (7.1/8.1) in the moderate attendees and worst in the unregistered. Conclusion: More than six visits conferred no significant advantage on fetomaternal outcome. Therefore, the new WHO recommendation on reduced antenatal visits can be satisfactorily implemented in Kaduna.

The burden of gynecological cancer management in Northern Nigeria

Background: Carcinoma of the Cervix is one of the gynecologic cancers. Gynecological cancer is a scourge in the developing nations because of the burden of cervical cancer. Carcinoma of the cervix is the leading cause of cancer death in women. The costs of treatment of cancers generally are very high and this has made care very difficult in the developing nations. The question therefore is who bears the cost and whose responsibilities? Aims and Objective: To study the economic burden of cancers on the patient, and how they source for these funds. To determine how the lack of funds or otherwise has affected their care. To assess their perception of who should bear the cost of this care. Methodology: It is a prospective study of all consecutive patients that attended the Gynecologic clinic of our unit between 2nd January 2010 and 30th June 2010. Data were analyzed using Excel statistical package. Result: A total of 93 patients were interviewed. A majority of 70 (76%) of the patients had Carcinoma of the cervix. The mean age of there husbands was 58 years. Most of them were either farmers (21%) or retired civil/public servants (15%) and earn between 700 - 1700 dollars per year. A large group of the patients were full time House wives (48%), while Petty trading and farming account for 13.3% each. The women earn less than 500 dollars per year. Only 50% received assistance, from family members (35.8%) or relatives (29.6%). More than 50% of them have spent between 1000 - 3000 dollars for their health bills. It was sad to note that 40% of them have no hope of help/assistance from anywhere. A majority of 83.3% believe that the government should come to their aids. Conclusion: In the developing nations, poverty still remains major problem, where people still earn less than a dollar per day. In essence prevention is paramount; otherwise most of our women who escaped maternal mortality may end up being a victim of cancer death.