Rabiu Ayyuba

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.

Surgical management of uterine fibroids at Aminu Kano Teaching Hospital

Background: Uterine fibroid is one of the most common pelvic tumours of the female genital tract. Surgery offers long-term relief of symptoms but is associated with complications, hence, the aversion for it in our environment. Therefore, understanding the factors associated with the complications will help to reduce morbidity and mortality. Objective: To determine the surgical options, socio-demographic characteristics, clinical presentations and post-operative complications associated with uterine fibroids at Aminu Kano Teaching Hospital, Kano. Methods: A retrospective review of case notes of 132 surgically managed cases of uterine fibroids at Aminu Kano Teaching Hospital over the study period. Results: Surgical operations for uterine fibroids constituted 21.4% of all gynaecological operations. Most of the cases were seen in 30–39 age group (41.5%) and 51.2% of them were nulliparous. Menorrhagia (53.7%), infertility (26.3%) and abdominal swelling (40.4%) were the common presenting symptoms. Myomectomy was performed in 75.6% of the cases while abdominal hysterectomy accounted for 24.6% of cases. Anaemia was the most common post-operative complication seen in this study (31.7%). Conclusion: Uterine fibroid is common in our environment. The main-stay of management of uterine fibroid is surgery which is associated with post-operative complications. The surgical options used in the management of uterine fibroids in this study were hysterectomy and myomectomy due to lack of requisite skills for the more technical procedures. Improvements in surgical skill will help reduce the frequency and severity of the complications.

Otorhinolaryngological health of women attending antenatal care clinic in a tertiary hospital: The Aminu Kano Teaching Hospital experience

Background: Physiological changes of pregnancy have a profound effect on the head and neck region; pregnant women often present with otorhinolaryngological health challenges to the obstetricians. Objective: The objective of this study is to find out the otorhinolaryngological health complaints of pregnant women at Aminu Kano Teaching Hospital (AKTH). Materials and Methods: It was a cross-sectional study conducted among consenting pregnant women at AKTH. Ethical approval was obtained from the hospital ethical committee. The questionnaire was administered among consenting pregnant women. Data obtained were analysed using the Statistical Packages for Social Sciences version 18. Qualitative data were summarised using frequencies and percentages. Fischers exact test was used for categorical data, and the P ≤ 0.05 was considered statistically significant. Results: A total of 146 pregnant women were recruited during the study. The mean age ± standard deviation was 28.57 years ± 5.796. Only 4 (2.7%) of the pregnant women were in the first trimester, while the rest were in second 47 (32.2%) and third trimester 95 (65.1%) respectively. Furthermore, few pregnant women 10 (6.8%) presented with mild hypertension, while in 136 (93.2%) of the pregnant women, the blood pressure measurements were normal. Ear itching 35 (24.0%), headache 42 (28.8%) and heartburn 55 (37.7%) were the most frequent complaints. High blood pressure was found to be statistically associated with tinnitus (P = 0.035), and high parity was also found to be associated with aural fullness (P = 0.028). Conclusion: The common otorhinolaryngological manifestations among pregnant women in this study were otomycosis, rhinitis and gastroesophageal reflux disease.

Obstetric outcome of teenage pregnancy at Aminu Kano Teaching Hospital: A 3-year review

Background: Teenage pregnancy is generally considered to be a high-risk event. Teenage mothers are physically and psychologically ill-prepared for reproduction. Low socioeconomic status and lack of prenatal care are among the factors influencing pregnancy outcome in these patients. Objective: To assess the obstetric outcome of teenage pregnancy, its current trends, sociodemographic determinants, and incidence in Aminu Kano Teaching Hospital. Materials and Methods: A retrospective study of 540 teenage primigravidae who delivered in Aminu Kano Teaching Hospital between 1st of January 2009 and 31st of December 2011. Results: The incidence of teenage pregnancy over the study period was 5.8% (58/1000 deliveries). Majority of the patients (78.9%) belonged to low socioeconomic class. Pregnancy complications prevalent in these patients included anemia (33.5%), low birth weight (17.8%), preeclampsia/eclampsia (12.4%), preterm labor (11.5%), and stillbirth (2.5%). Cesarean section rate among them was 18.9%. Conclusion: Teenage pregnancy is a high-risk pregnancy because of the associated pregnancy complications which are more prevalent in the unbooked patients. Access to health care services, girl-child education, and improvement of the socioeconomic status of the patients will reduce its incidence.

Age at first pregnancy among primigravidae attending antenatal clinic at a Tertiary Hospital in Kano

Background: The first pregnancy marks a transition into motherhood and influences the number of children a woman bears throughout her reproductive period, and consequently the size, composition, and future growth of the population in a community. The aim of this survey was to determine the average age at first pregnancy among primigravidae attending antenatal clinic in Aminu Kano Teaching Hospital, Kano. Patients and Methods: This was a retrospective study among women who booked for antenatal care at Aminu Kano Teaching Hospital over a 1 year period. Data were retrieved from case files and analyzed using the Statistical Package for the Social Sciences, version 17 (SPSS Inc., Chicago, IL, USA). Result: The mean age at first pregnancy was 23.9 ± 4.27 years. Teenage women accounted for 10.2% of the total population. Majority of the women were Hausas (71.8%), Muslims (86.1%), unemployed (80.9%), and had formal education (92.4%). Ethnicity (Hausas versus other tribes), religion (Islam versus Christianity) and occupation (employed versus unemployed) were not statistically associated with the age at first pregnancy above teenage age group (X2= 2.578, P = 0.108; X2 = 1.788, P = 0.181; X2 = 3.350, P = 0.067, respectively). However, formal education was statistically associated with average age at first pregnancy (X2= 13.486, P = 0.001). Conclusion: The age at first pregnancy was found to be 23.9 ± 4.27 years. This was within the recommended age of 20–35 years. Women with formal education were more likely to delay the age at first pregnancy until after teenage years. Formal education will certainly contribute to reducing maternal mortality and morbidity associated with teenage pregnancies.

Episiotomy at Aminu Kano Teaching Hospital, Kano, Nigeria: A 3-Year Review

Background: Episiotomy continues to be increasingly performed in our labor wards despite current scientific evidence restricting its use. The objective of this study was to determine the incidence, indications, and establish reference point for future studies on episiotomy in Aminu Kano Teaching Hospital. Patients and Methods: This was a 3-year retrospective study of vaginal deliveries in Aminu Kano Teaching Hospital, Kano, from January, 1, 2010 to December 31, 2012. The parturients who had episiotomy were identified from the labor ward register and the following information was extracted: Parity, type of vaginal delivery, gestational age at delivery, birth weight, Apgar scores, and estimated blood loss. The information obtained were analyzed and presented. Results: The episiotomy rate was 41.4%. Episiotomy was commonly performed in primigravidae (79.4%) than multigravidae (X2 = 3017, P < 0.001), fetal macrosomia in 86.9% of the cases (X2 = 669.7, P < 0.001) and assisted vaginal delivery seen in 75% of the cases (X2 = 172.4, P < 0.001). Episiotomy was also associated with more postpartum blood loss when compared with parturients without episiotomy and was statistically significant (t = 95.82, P < 0.001). Conclusion: Episiotomy rate is high in Aminu Kano Teaching Hospital. Midwives and doctors conducting deliveries should be educated on the indications for episiotomy and early repair to reduce associated postpartum blood loss.

Induction to delivery interval using transcervical Foley catheter plus oxytocin and vaginal misoprostol: A comparative study at Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Induction of labor (IOL) is an artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Many factors are associated with its success in postdatism. Objective: To compare the induction delivery intervals using transcervical Foley catheter plus oxytocin and vaginal misoprostol, and to identify the factors associated with successful induction among postdate singleton multiparae. Materials and Methods: The study was a prospective randomized controlled trial of singleton multiparous pregnant women. They were randomized into two groups, one group for intravaginal misoprostol and the other group for transcervical Foley catheter insertion as a method of cervical ripening and IOL. The data were analyzed using SPSS version 17 computer software (SPSS Inc., IL, Chicago, USA). Comparisons of categorical variables were done using Chi-squared test, with P < 0.05 considered as significant. Students t-test was used for continuous variables. Results: The incidence of postdatism was found to be 136 (13.1%). The mean induction delivery time interval was shorter in the misoprostol group 70 (5.54 ± 1.8 h) than in the Foley catheter oxytocin infusion group 66 (6.65 ± 1.7 h) (P = 0.035). There was, however, no statistically significant difference in the maternal and neonatal outcomes when these two agents were used for cervical ripening and IOL. Higher parity and higher Bishops score were the factors found to be associated with high success rate of IOL (P < 0.001). Conclusion: Vaginal misoprostol resulted in shorter induction delivery time interval as compared to transcervical Foley catheter. High parity and high Bishops scores were the factors found to be associated with the success of IOL.

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.

Knowledge, attitude and perception of patients towards informed consent in obstetric surgical procedures at Aminu Kano Teaching Hospital

Background/Aim: The practice of informed consent prior to any surgical procedure should form the fundamental element that serves to protect both patient and surgeon from prosecution. The aim of this study was to assess knowledge, attitude and perception of women towards informed consent prior to Surgery in Obstetrics and Gynaecology department of Aminu Kano Teaching Hospital. Materials and Methods: This was a cross-sectional study conducted among 398 women who had undergone surgery at the Obstetrics and Gynecology department of the Aminu Kano Teaching Hospital, Kano State, Nigeria. Data was obtained following surgery but prior to discharge and was analyzed using SPSS version 17. Results: Three hundred and ninety eight women were recruited. The mean age was 30.3 years ± 5.2. All respondents believed signing a consent prior to surgery was important and believed it was a legal document involved in decision making process. Ninety seven percent of the respondents were satisfied with the explanation given to them prior to the surgery however, 15.8% had some reservations to the explanations while 3% were not completely satisfied with the explanations. Conclusion: Awareness and knowledge of consent was high in this study and the respondents had positive attitude towards signing consent.

Awareness of fertility period among women attending immunization clinic at Aminu Kano Teaching Hospital, Northern Nigeria

Background: There is a global concern about poor awareness of fertility. Knowledge of fertility period even among fertile women will reduce the burden of infertility. The objective of this study was to determine the awareness of fertility period among fertile women at Aminu Kano Teaching Hospital (AKTH). Patients and Methods: It was a descriptive study among 220 consenting women at AKTH over a period of 3 months, following approval by the hospital management. Structured pretested questionnaires were administered. Data were analyzed with a computer using Statistical Package for Social Sciences (SPSS) version 17 computer software. Results: Two hundred and twenty women were recruited. The mean age ± standard deviation (SD) were 28.47 ± 5.91. One hundred and eighty-four (83.64%) of the respondents knew the duration of their menstrual interval, while 36 (16.36%) were unaware. Menstrual intervals of 30 days was the model (24.50%) followed by 28 days (20.50%). One hundred and seventy-one (77.70%) respondents were aware that pregnancy is related to menstrual cycle, while 49 (22.30%) were not aware. Also, 129 (58.60%) knew their last menstrual periods, while the remaining 91 (41.40%) did not. One hundred and seventeen (53.20%) respondents knew what fertility period meant, while 103 (46.80%) were ignorant of it. Only 85 (38.60%) of the respondents were aware of their fertility periods, while 135 (61.40%) were not. Similarly, only 13 (5.90%) knew any method to determine fertility periods, while 207 (94.10%) did not. Conclusion: The study revealed good knowledge of fertility awareness among fertile women, but awareness of fertility period was lacking.