Ibrahim Adamu Yakasai

Maternal and fetal outcome in patients with eclampsia at Murtala Muhammad specialist Hospital Kano, Nigeria

BACKGROUND/OBJECTIVES Eclampsia is a major contributor to maternal and perinatal mortality worldwide. It is much more common in developing countries like Nigeria where presentation is usually late and resources are scarce. The staggering figures of maternal death (46%) reported by the Society of Obstetricians and Gynaecologists of Nigeria (SOGON) in 2004 moved the Kano State government to initiate programs that will reduce maternal mortality in the state. The objectives of this report were; 1) to determine the prevalence of eclampsia at Murtala Muhammad Specialist hospital (MMSH) Kano between April 2008 and May 2009; 2) to determine maternal and fetal outcome in eclamptic patients admitted to MMSH Kano between April 2008 and May 2009. METHODS Case records of all patients admitted to MMSH between April 2008 and May 2009 were retrieved and analyzed using Epi-info version 3.2.2 April 2004 (CDC Atlanta, USA). Information extracted includes demographic data, maternal and fetal outcome. A P value of less than 0.05 was considered significant. RESULTS There were 688 eclamptic patients admitted and 13 943 women delivered during the study period giving a prevalence of 5% of total deliveries. One hundred and twenty six women died giving a maternal mortality ratio (MMR) of 904/100 000, among them 36 were eclamptics. The perinatal mortality rate for the eclamptics was 132/1 000. 81.4% of the women were primigravidas and majority (82.2%) were at term. Almost 83.3% presented within 12 hours of the onset of the fits and nearly half (44.9%) had their convulsion before the onset of labor. CONCLUSION The incidence of eclampsia is 5% of total deliveries. Delay in presentation is associated with poor outcome.

Preeclampsia: A review of the evidence

Preeclampsia is a common complication of pregnancy associated with high maternal and perinatal morbidity and mortality especially in developing countries. There is considerable progress in the understanding of the pathophysiology and the management of the diseases, although the aetiology and primary pathology remained elusive. Integration of current evidence in the clinical management of the condition has witnessed improved maternal and fetal outcomes in many societies. In developing countries variations in management often not based on current evidence accounts for comparatively higher morbidity and mortality. This article aims to provide an overview of our present understanding of preeclampsia help care providers and our managers focus practice and policy to reflect existing evidence.

Review of intrauterine adhesiolysis at the Aminu Kano Teaching Hospital, Kano, Nigeria

BACKGROUND Hysteroscopic adhesiolysis is shown to significantly improve the outcome of intrauterine adhesions (IUA). The Minimally Invasive Surgical Unit (MISU) of our Department recently acquired a hysteroscope which is being used for hysteroscopic adhesiolysis among others. MATERIALS AND METHODS There were 57 patients diagnosed to have IUA of which 54 case notes were available for analysis, giving a retrieval rate of 95%. The information extracted includes age, parity, and menstrual pattern, predisposing factors, treatment option, outcome, complications and the year of the procedure. The data extracted were analyzed using Epi info Version 3.4.1. Chi squared test (Fishers exact test) was used to test for statistical difference in the outcome of the modalities of treatment. P value of less than 0.05 was considered significant. RESULTS There were 57 cases of IUA out of 4160 gynecological patients seen, giving a prevalence of 14/1000. The mean age was 28.9 years (SD 4.5) and mean parity was 1.4 (SD 1.4). Etiologic factors include Dilatation and curettage (D and C) (33.3%), Caesarean section (C/S) (31.5%), manual removal of placenta and Pelvic Inflammatory Disease (PID) (7.4% each), and unexplained (3.7%). Mode of presentation was secondary amenorrhoea (50%), oligomenorrhoea (22.2%), and hypomenorrhoea (10%). As for the management, 68% had blind procedure while 25.9% had hysteroscopic procedure. Lippes loop was used in all except three patients who had pediatric Foleys catheter instead. Upon follow-up 59.3% resumed normal menses, 11.1% had oligomenorrhoea, hypomenorrhoea 13% and amenorrhoea 5.6%. There was no statistical difference in the outcome of treatment between hysteroscopic adhesiolysis and the blind procedure when return to normal menses is considered as the end point, OR=2.27, CI 0.45-12.65, Fisher exact test (one-tailed) P=0.2184818. CONCLUSION There was no significant difference between the blind and hysteroscopic procedures. Dilatation and curettage was found to be the commonest cause of IUA.

Late presentation of advanced abdominal pregnancy with live baby: A case report and literature review

Abdominal pregnancy is a rare form of ectopic pregnancy. It is associated with an increase in maternal morbidity and mortality, as well as perinatal mortality rate of up to 85%-95%. A case of abdominal pregnancy in an unbooked primigravida who presented in the third trimester and was successfully managed is hereby described. She came with weight loss and jaundice. The fetus was alive and she was managed conservatively till a laparotomy was eventually performed. The outcome was good for mother and baby.

Outcome of repeat surgery for genital prolapse using prolift-mesh

IntroductionUrogenital prolapse can have a significant impact on quality of life. The life time risk of requiring surgery for urogenital prolapse is 11%. Prolift mesh has recently been introduced to reduce repeat operation rate and for long-term benefit.ObjectiveTo evaluate the outcome of the treatment of urogenital prolapse with synthetic mesh.MethodsA retrospective review of case notes of all women who underwent prolift mesh insertion for prolapse between July 2004 and June 2005, at Royal Alexandra Hospital Paisley UK. We looked at the presenting complaints, previous operation, intraoperative complications and complications at six weeks and six months follow-up.ResultsTwenty-two procedures were carried out in the twelve months period. Age of the patients ranged from 55 to 82 years (median 64 yrs). Eleven had anterior Prolift (50%), Seven had posterior Prolift 31.8% and four total Prolift 18%. There were no intraoperative complications. All the patients had previous surgery for prolapse. Eight patients had anterior repair, six patients had posterior repair, and three patients had abdominal hysterectomy. Vaginal hysterectomy was carried out with mesh insertion as a concomitant procedure in seven cases (31.25%). All patients were seen at six weeks and six months after the surgery. Complications rate included mesh erosion one patient and suture material protruding in the vagina one patient, one patient had failed prolift operation. All the twenty-one patients were cured giving 95.4% success rate.ConclusionThe use of prolene mesh in pelvic reconstructive surgery was associated with good outcome and minimal complications in this study.

Cancer of the Cervix in Unscreened West African Women

Background: Cancer of the cervix remains an important health problem amongst women worldwide. Widespread comprehensive cervical cancer control programs have resulted in a marked reduction in the incidence and mortality in most developed countries. Developing countries bear over 80% of the global burden, with only 5% of the global resources for the control of cancer. Majority of the cases in these countries present late and are incurable at the time of diagnosis. Aim: To review the presentation and histopathological types of cervical cancer cases seen in Aminu Kano Teaching Hospital Kano, over a sixteen-year period (1995– 2010). Materials and Methods: Case records of histopathologically diagnosed cases of cancer of the cervix were retrieved. Demographic data, stage of the tumor at presentation, and histopathologic type were extracted. The results were analyzed using descriptive statistics. Results: Six hundred and sixty gynecological cancers were seen during the study period, with cancer of the cervix accounting for 58.5% (386/660) cases. Among these cases with cancer of the cervix 71.1% (275/386) were grand multiparous and majority 89.7 % 346/386 presented with advanced disease. Squamous cell carcinoma (SCC) accounted for 86.3% (333/386) of the cancers, adenocarcinoma contributed 12.4%,(48/386) and others contributed 1.3% (5/386). Conclusion: Cancer of the cervix is the commonest gynecological cancer at Aminu Kano Teaching Hospital, Kano, Nigeria. SCC is the commonest histological type.

Unusual presentation of giant condylomata acuminata of the vulva: A case report and review of literature

The lesion of Condylomata Acuminata popularly known as venereal warts are lesions which are generally diagnosed based on their warty appearance. The mode of treatment range from application of podophyllin to surgical excision by cauterization. A case of unusual presentation of giant Condylomata in a 26 year old, single, nulliparous, retroviral disease positive woman is presented and the literature reviewed. She presented with 18 months history of rapidly progressive vulval swelling and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin without success. The growth measured 40×30 cm and was successfully excised with no evidence of malignancy.

Umbilical artery Doppler velocimetry study on prediction of adverse pregnancy outcomes among pregnant women with hypertensive disorders in Kano, Nigeria

Background: Doppler velocimetry studies have been widely used to predict adverse pregnancy outcomes in hypertensive disorders of pregnancies. Objective: To identify the pregnant women with hypertensive disorders for umbilical artery Doppler velocimetry to predict adverse pregnancy outcomes. Methods: This was a prospective study among 264 pregnant women with hypertensive disorders. The umbilical artery Doppler velocimetry study was conducted using 3.5 m Hz convex of the Mindry Digital Ultrasound Imaging System (Model DP-8800Plus; Shenzen Mindray Biomed Electronics, China). Results: A total of 264 pregnant women within the age of 18–40 years with a mean ± standard deviation of 31.33 ± 5.92 were studied. One hundred and twenty-four (29.90%) presented with pregnancy-induced hypertension (PIH), 72 (58.06%) had abnormal resistive indices (RIs) of at least 0.58 of which 4 had diastolic notches. The remaining 52 (41.94%) had normal RIs with no diastolic notch. Twenty (4.80%) presented with preeclampsia, 12 (60.00%) had abnormal RI of which four had diastolic notches. One hundred and twenty (28.90%) women presented with chronic hypertension, 72 (60.00%) had abnormal RI of which 16 had diastolic notches. Abnormal RI was associated with low Apgar scores and early neonatal death among the patients with PIH, low Apgar scores among patients with preeclampsia and low birth weight among chronic hypertensive pregnant women. Conclusion: We found abnormal umbilical artery Doppler velocimetry RI to be associated with adverse pregnancy outcomes. However, diverse nature of the hypertensive disorders and adverse pregnancy outcomes revealed different optimum cut-off points for various hypertensive disorders following ROC analysis.

An Audit of Gynaecological Procedures Performed at Aminu Kano Teaching Hospital, Kano

Background: Audit of all gynecological procedures as one of the commonest operations performed in medical practice is not routinely done in developing countries, including Nigeria. Aim: The study was aimed at determining the rate of all gynecological procedures performed; the common gynecological procedures and their indications, and the cadre of surgeons that performed different gynecological procedures within the period under review. Materials and Methods: A 1-year retrospective chart analysis of all gynecological procedures performed at Aminu Kano Teaching Hospital (AKTH) between 01/10/2012 and 30/09/2013 was conducted. Patients with complete relevant information in the registers were included in the audit and those with incomplete data were excluded. Data was further cleaned and analyzed using Microsoft Excel for Mac 2011, for frequencies and percentages. Results were presented by simple statistical tables. Results: A total of 6,604 patients were gynecological attendees, out of which 646 patients had gynecological procedures performed, giving an institutional gynecological procedure rate of 9.8% (646/6,604), within the period under review. Emergency gynecological procedures accounted for 5.9% (38/646), while the elective cases accounted 4.0% (26/646). Majority of the gynecological procedures was among the 20-40 years age group. About 20 different types of gynecological procedures were done and manual vacuum aspiration (MVA), for incomplete miscarriage accounted for 58.8% (380/646), while excision of transverse vaginal septum was the least at 0.3% (2/646) of all the gynecological procedures. Interns, registrars, senior registrars, and consultants were involved in performing the different gynecological procedures. Between 69 and 100% (446/646-646/646) of some of the major gynecological procedures were carried out by consultants, 14-27% (90/646-174/646) by senior residents (SRs), while the junior residents and interns performed only MVAs among the gynecological procedures at 53.1% (343/646) and 7.3% (47/646), respectively. Conclusion: The common gynecological procedure performed in AKTH is MVA by all cadres of surgeons, and consultants performed the highest number of all the gynecological procedures except MVA. A more regular audit of services rendered by the department is advocated. This may help to identify the gaps in training and services.

Surgical procedures in obstetrics and gynecology department of a teaching hospital in northern Nigeria: A 5 year review

Background: Surgical procedures in obstetrics and gynecology have witnessed significant improvements in terms of morbidity and mortality. This is not unrelated to advancement in asepsis and anesthesia over the years. This study aimed at describing the pattern of surgical procedures in obstetrics and gynecology at a tertiary health center in Northern Nigeria. Patients and Methods: This is a retrospective study of patients who had surgical procedures in Obstetrics and Gynecology at Aminu Kano Teaching Hospital, Nigeria from 1 st January, 2005 to 31 st December 2009. The data retrieved from their case notes were analyzed using Mini Tab Electronic Statistical Software. Information extracted were age, type of surgery and anesthesia used. The data analyzed were presented using simple tables. X 2 and P value were used to test for significant statistical associations where appropriate. Results: A total of 2741 operations were done within the period under review. The mean age of the patients was 29.95 ± 8.26 years. Emergency surgeries were performed in1643 (59.9%) patients while the remaining 1098 (40.1%) were elective. General anesthesia was used for the majority 2093 (76.4%) of the cases. Cesarean section accounted for the majority (62.6%) of the procedures performed. Other surgeries include myomectomy (4.2%), total abdominal hysterectomy (4.7%), and andlaparotomy (9.3%) among others. Obstetric cases accounted for 1510 (55.1%) of the surgeries conducted while 1231 (44.9%) were gynecological cases. Conclusion: Most of the procedures were emergency obstetric surgeries performed under general anesthetic. Caesarean section rate was highest among all surgical procedures. There was statistically significant association between the type of surgery and the administered form of anesthesia.