Tk Nyengidiki

Rupture of the gravid uterus in a tertiary health facility in the Niger delta region of Nigeria: A 5-year review

Background: Ruptured uterus is a major life-threatening condition encountered mostly in developing countries and is an index of failure of obstetric care at a point in time in a womans reproductive career. With worsening economic condition, increasing caesarean section rates, and patients’ aversion for operative delivery this condition would still remain a major obstetric matter for discussion. Objective: To identify the incidence, sociodemographic variables, clinical characteristics, causes, and outcome of ruptured uterus at the University of Port Harcourt Teaching Hospital. Materials and Methods: A 5-year retrospective study of cases of ruptured uterus at the University of Port Harcourt Teaching Hospital was carried out. The case notes of 40 patients with uterine rupture during the period 2003-2007 were analyzed. Data collected included sociodemographic characteristics, etiologic factors, clinical presentation, and outcome. Data were analyzed using Microsoft Excel version 2007 and SPSS 14.0 computer software. Results: The incidence of rupture of the gravid uterus was 1:258 deliveries. In patients with rupture of the gravid uterus, 65% (26) of patients were unbooked; 37.5% (15) were aged between 25 and 29 years. A total of 42.5% (17) of patients had secondary education and 21 (52.5%) were housewives. Rupture of a previous scar was the commonest etiologic factor accounting for 32.5% (11). The commonest presentation was abdominal pain in 92.5% of cases. Perinatal mortality and maternal mortality were 80% and 17.5% respectively. Conclusion: Rupture of the gravid uterus still remains a major cause of maternal mortality. Injudicious use of oxytocics should be discouraged in peripheral health facilities and reinforcement of the need for hospital based deliveries in patients with previous caesarean sections should also be intensified to improve outcome.

Bacterial vaginosis among women with tubal factor infertility in Nigeria

To determine the prevalence of bacterial vaginosis among women with tubal factor infertility.

Necrotizing Vaginal Leiomyoma, Huge Cystocele Mimicking a Malignancy in a Hysterectomized Nigerian Woman

BackgroundLeiomyoma are benign tumours of the mesenchymal smooth muscle that usually develop in the uterus and rarely in the vagina. The presence of such benign growth in the vagina poses a diagnostic dilemma to most practitioners because of diverse mode of presentation. We present a rare case of vaginal leiomyoma and huge cystocele in a 41-year-old, Para 8, post-hysterectomized patient presenting with offensive discharge and bleeding per vagina associated with a necrotic mass protruding from the vagina. She had examination under anaesthesia, wide excision of anterior vaginal mass, anterior colporrhaphy for huge cystocele with good post-surgical outcome. Histology of excised mass confirmed a vaginal leiomyomata.

Erratum to: Cervical Cytology or Colposcopy in the Identification of Cervical Intraepithelial Neoplastic Changes in Human Immunodeficiency Virus Positive Patients in an African Population?

Background Effective screening methods for early detection of cervical premalignant lesions among women with human immunodeficiency virus are needful since cervical cancer is one of the AIDS-defining malignancies.

A five - year review of gestational trophoblastic diseases in Port Harcourt, Nigeria

Background: Gestational Trophoblastic Diseases (GTD) are a spectrum of inter-related but histologically distinct tumours originating from the placenta with good prognosis when diagnosed early. Aim: To determine the prevalence, clinical presentations, management of gestational trophoblastic disease at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Methods: A retrospective analysis of women treated for gestational trophoblastic disease from 1st January 2008 to 31 st December 2012. The information from patients records: age, occupation, educational level, husband′s occupation, parity, presenting symptoms, uterine size, mode of treatment and management options were collated and analysed. The Chi-square test was used to compare categorical variables with a p value of ≤ 0.05 as significant. Results: A total of 38 cases of GTD were treated with a prevalence of 2.3 per 1,000 deliveries. The mean age and parity were 31 ± 6.3 years and 2 ± 1.6 respectively. Maternal age less than 35 years and low socioeconomic status were significantly associated with GTD (p=0.0000). The mean gestational age at presentation was 16.24 ± 5.4 weeks. The commonest clinical presentation was amenorrhoea in 100% of patients. Twenty-five(65.8%) cases of hydatidiform mole and 13(34.2%) cases of choriocarcinoma were observed. Twenty-two (57.9%) patients had suction evacuation only for hydatidiform mole, 3(7.9.%) had suction evacuation and cytotoxic therapy for hydatidiform mole and subsequent persistent trophoblastic disease while 8(21.1%) had chemotherapy for choriocarcinoma. Five patients with advanced choriocarcinoma did not receive definitive treatment before demise. Twenty (52.6%)defaulted in their follow up schedule. Conclusion: There is high prevalence of GTD in Port Harcourt with high mortality among patients with malignancy. Most of the patients defaulted in their follow up; thus there is a need for education and sensitization of the populace on GTD, as well as proper counseling of patients treated on the benefits of follow up visits.

Human Papilloma Virus Awareness and Uptake of HPV Vaccination among Human Immunodeficiency Virus Positive Women in Nigeria

Background: The contribution of Human Papillomavirus (HPV) to the etiology of cervical cancer is well established. Vaccination of at risk population is recommended best practice. Aim: To determine the awareness of HPV and uptake of HPV vaccination among Human immunodeficiency virus (HIV) positive women attending the antiretroviral clinic. Study Design: A cross sectional questionnaire based survey Place and Duration of Study: Antiretroviral clinics in the University of Port Harcourt Teaching Hospital between 21 October -21 of December 2014. Methods: Questionnaire based survey of 162 HIV positive patients was conducted. Data on sociodemographic characteristics, awareness of HPV infection and previous uptake of HPV vaccination was collated and analyzed using SPSS Version 20. Data was presented as frequency, percentages and P< 0.05 set as significant. Results: The mean age of respondents was 35.17±7.14 years. Fourteen percent (23) were aware of HPV causing cervical cancer with 10.4%(17) aware of the existence of HPV vaccination. None of the patients were ever vaccinated against HPV. The main reason for lack of uptake was nonOriginal Research Article Nyengidiki et al.; IJTDH, 15(2): 1-7, 2016; Article no.IJTDH.25241 2 availability of the HPV vaccine. Conclusion: Awareness of HPV as a precursor of cervical cancer and HPV vaccine uptake among this high risk population is abysmally poor. There is an urgent need for more sensitization of this group of patients to embrace preventive strategies to reduce the scourge of cervical cancer while concerted efforts should be made to increase availability of vaccine.

An evaluation of the characteristics of patients with gestational choriocarcinoma in south-south, nigeria

Background: Gestational trophoblastic diseases have been generally associated with the good outcome, especially in developed countries where early presentation and diagnosis is the norm. Objective: This study seeks to determine the characteristics of patients with gestational choriocarcinoma at the University of Port Harcourt Teaching Hospital(UPTH), Nigeria. Methods: This was a retrospective study of women who were treated for gestational choriocarcinoma at the UPTH over a 5-year period from January 1, 2008 to December 31, 2012. Results: Atotal of 13 cases of gestational choriocarcinoma were treated in UPTH during the study period, and there were 16,720 deliveries giving a prevalence of 0.8/1000 deliveries. The majority of patients (76.9%) were of low socioeconomic class. 92.3% of patients presented with amenorrhea for 28 weeks. Histological examination of tissues extracted from previous miscarriages was not performed in 100% of patients. Eighty percent of all mortalities were associated with antecedent pregnancies being miscarriages. All patients managed were lost to follow-up within 32 weeks. Conclusion: Gestational choriocarcinoma in Port Harcourt is associated with high mortality. Most patients with choriocarcinoma were of low socioeconomic class, presented late with lack of histological examination of previously extracted products of conception. Most of the patients were lost to follow-up within 32 weeks.

Outpatient non -surgical management of unruptured ectopic pregnancy in a specialist hospital in Nigeria: a report of three cases

Background : Ectopic pregnancy is a major contributor to maternal morbidity and mortality in the first trimester of pregnancy especially when ruptured. Most patients with this condition present to the health facility with features of rupture, warranting the traditional approach of an emergency exploratory laparotomy which puts a burden on available infrastructure, causes distortion of family dynamics and reduces reproductive potentials. Aim : To report the successful outpatient medical management of three cases of unruptured ectopic pregnancy using multidose intramuscular methotrexate in a specialist health facility in Port Harcourt. Case report: We present three cases of unruptured ectopic pregnancy diagnosed early using serum β HCG and ultrasound scan managed successfully with multidose intramuscular methotrexate on an outpatient basis. Conclusion : Early confirmation of pregnancy immediately after a missed period and localization of gestation site will facilitate identification of patients suitable for medical management of extrauterine pregnancy using a readily available anti-folate, methotrexate, which can be performed as an office procedure. This modality of treatment will reduce surgical risk, reduce demand on the already stretched health system and improve reproductive outcome. Keywords : Unruptured ectopic, Methotrexate, Ultrasound scan, Serum β human chorionic gonadotrophin hormones