Ikechukwu Innocent Mbachu

Uterine leiomyoma associated non-puerperal uterine inversion misdiagnosed as advanced cervical cancer: A case report

INTRODUCTION Uterine inversion is an un-common complication of parturition which often occurs in the immediate postpartum period. The chronic (non-puerperal) uterine inversion is rarer and most times tumour associated. PRESENTATION OF CASE A 51-year old grand multiparous lady presented with a month history of abnormal vaginal bleeding associated with offensive vaginal discharge, lower abdominal pain and dizziness. The initial evaluation suggested severe anaemia secondary to advanced cervical cancer. Examination under anaesthesia (EUA), staging and biopsy was attempted but this was however inconclusive due to profuse haemorrhage. A repeat EUA revealed chronic uterine inversion secondary to fundal submucous uterine leiomyoma. Myomectomy was done with tissue histology confirming benign uterine leiomyoma. Two weeks later, a modified Haultains procedure was done followed by simple hysterectomy and posterior colpoperineorrhaphy. She had satisfactory recovery. DISCUSSION This is the first reported case of chronic non-puerperal uterine inversion in our hospital. When it occurs, it is usually tumour associated with the commonest tumour being prolapsed myoma and leiomyosarcoma. The diagnosis is based on high index of suspicion. CONCLUSION Chronic uterine inversion is a rare gynaecological condition and can be misdiagnosed as advanced cervical cancer or other causes of severe genital haemorrhage in women. A high index of suspicion is needed for its proper diagnosis. Sometimes, an EUA and biopsy was required to determine the cause here and conveniently it could be described as a “gynaecolological near miss”.

Use of Condoms among Human Immunodeficiency Virus Positive Women Attending Antenatal Clinic in Nnewi, South East Nigeria

Background: Consistent use of condom provides protection from transmission of human immunodeficiency virus (HIV) infection in couples with sero-discordant HIV status. It also protects against acquiring other strains in HIV positive concordant couples. Aim: This study evaluated the use of barrier method of contraception among HIV patients. Subjects and Methods: This was a descriptive cross-sectional study conducted among pregnant women in Nnamdi Azikiwe University Teaching Hospital Nnewi. An interviewer administered questionnaire was used to obtain relevant information from the subjects. Data was analyzed using SPSS software version 20.0 (Chicago, IL, USA, August 2011). Result: A total of 126 HIV positive pregnant women participated in this study. The mean age of the women was 30.4 (5) years while the mean parity was 2.6 (1). All the patients had at least primary education with 63.5% (80/126) having secondary education as the highest educational attainment while 87.3% (110/126) were in monogamous marriage. The partner′s HIV status showed that 41.3% (52/126) tested negative to HIV antibodies while 42.8% (54/126) tested positive to HIV antibodies and 15.9% (20/126) do not know partner′s HIV status. Only 61.9% (78/126) of the couples use condom during sexual intercourse. Further analysis showed that 26.2% (33/126) use condom consistently except during timed intercourse for conception. There was significant association between type of relationship and use of barrier method of contraception. There was no significant association between sero-discordant couples and highest educational status with use of barrier method of conception. Conclusion: Condom use among HIV positive couples is low and raises great concern on transmission of the virus to partners and babies born to positive mothers.

The prevalence of HIV sero-positivity in late pregnancy among antenatal attendees with seronegative status in first half of pregnancy in Nnewi, South East Nigeria

Background: In sub-Saharan Africa, women and children are vulnerable to HIV/AIDS with about 61% of the infections occurring in women and about 90% of the pediatrics infection through Mother-to-child transmission (MTCT). Antenatal attendees in Nigeria are offered routine HIV testing and counselling on the first visit with opt-out option irrespective of the gestational age at contact. This appears commendable but, considering the national HIV prevalence of 4.6%, our large population of >140 million, the long period of seroconversion of the virus and the fact that pregnant women continue to indulge in activities like: unprotected sexual intercourse with single or multiple partners or men with multiple sexual partners or legal polygamy, cross generational sex, intercourse with sero-discordant partners that put them at risk of new infections; a single screening test on contact may not be sufficient to detect all maternal infections. Aim and Objectives: This is to perform a second HIV testing in antenatal women late in pregnancy and determined the sero-prevalence of HIV amongst those who tested negative in the first half of pregnancy. Materials and Methods: This is a prospective cross sectional study conducted among previously HIV negative pregnant women in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi between November 2010 and February 2011. The rapid test kits: Determine, Stat Pak and Unigold were used for detection/diagnosis of HIV antibody. Semi structured questionnaire was used to collect socio-demographic data of the subjects. Descriptive analysis of the result was done using the SPSS version 16. Results: The HIV prevalence following repeat testing in late pregnancy was 3.91% (9/230). The mean HIV prevalence at antenatal booking during the study period was 20.64% (116/562). Conclusion: The study highlights the high prevalence of HIV among previously negative attendees in late pregnancy. It brings to the fore the enormity of missed opportunity associated with a single routine antibody rapid test for pregnant women on contact/early pregnancy. Therefore, routine repeat antenatal HIV testing and counselling in late pregnancy is strongly advocated.

Post-Date Extrauterine Abdominal Pregnancy in aRhesus Negative Nullipara with Successful Outcome: A Case Report

Post-Date Extrauterine Abdominal Pregnancy in a Rhesus Negative Nullipara with Successful Outcome: A Case Report Abdominal pregnancy is becoming a nightmare to many obstetricians and it represents just about 1% of ectopic pregnancies. Since its first report in 1708, copious cases have been published subsequently. The diagnosis is usually intricate except if there are complications such as abdominal pain and haemorrhage. Maternal mortality and morbidity are also very high principally if the condition is not diagnosed and managed appropriately. By and large, abdominal pregnancies do not attain to or go beyond 37 weeks of gestation.

Effect of on‐site training on the accuracy of blood loss estimation in a simulated obstetrics environment

To determine the effect of on‐site training on the accuracy of blood loss estimation in a simulated obstetrics environment.