Chronic ectopic pregnancy presenting as a suspected tubo-ovarian abscess: a diagnostic dilemma.

Though there is no definite agreement on diagnostic criteria or definition of chronic ectopic pregnancy (CEP), it could be deemed to be a variant of pregnancy of unknown location with non-specific clinical signs and symptoms. This was a case of a para 2+2 who presented with lower abdominal pain and bleeding per vaginum, and initial ultrasound was suggestive of a tubo-ovarian abscess/mass. With a further MRI scan and a diagnostic laparoscopy, she was found to have a CEP and had a laparoscopic salpingectomy for management. The diagnosis of CEP could be quite challenging as a result of the protracted symptoms, often negative/low serum B-HCG and ultrasound features mimicking a pelvic mass. A high index of suspicion is needed, and an MRI scan and diagnostic laparoscopy often aid in diagnosis and management.

Vaginal fluid urea and creatinine, an untapped diagnostic tool for premature rupture of membranes.

PURPOSE: The diagnosis of premature rupture of membranes (PROM) can be difficult in equivocal cases. This study was designed to test the validity of vaginal fluid urea and creatinine in the diagnosis of PROM against the gold standard, the Amnisure ROM test™ METHODS: The study was a prospective observational study. All consenting eligible pregnant women between gestational ages of 28 weeks to 41 weeks + 6 days were recruited from the obstetrics emergency and antenatal clinic of the Federal medical centre, Keffi. Patients with history of drainage of liquor were recruited as the case group, and controls who match for age, parity and gestational age were recruited from the antenatal clinic to constitute the control group. Vaginal fluid aspirated was assessed in the laboratory for urea and creatinine levels and an Amnisure ROM test™ done. The sensitivity, specificity, negative and positive predictive values of vaginal fluid urea and creatinine were assessed in the diagnosis of PROM. RESULTS: Vaginal fluid urea and creatinine had sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), respectively, of 94%, 82%, 93.18% and 83.93%, and 98%, 90%, 97.82% and 90.74%. The cutoff values for vaginal fluid urea and creatinine were 1.25 mg/dl and 0.23 mg/dl, respectively. CONCLUSIONS: This study has found that vaginal fluid urea and creatinine are very effective tests in diagnosis of PROM. It is a cheaper and more readily available alternative to the Amnisure test. It is especially useful in our environment, especially in cases of equivocal PROM, as a cost-effective means to confirm the diagnosis. TRIAL REGISTRATION NUMBER (NIGERIA CLINICAL TRIAL REGISTRY): 72961653, retrospectively registered on the 2020-07-09.

Single-dose versus multiple-dose antibiotics prophylaxis for preventing caesarean section postpartum infections: A randomized controlled trial.

BACKGROUND: Caesarean section, a common obstetric surgical procedure, is a major predisposing factor for puerperal infections, requiring the need for antibiotic prophylaxis. Evidence suggests that single-dose antibiotic prophylaxis has comparable efficacy to multiple-dose antibiotic prophylaxis, but with a lower cost and risk of antibiotic resistance. However, single-dose antibiotic prophylaxis after caesarean section is not generally used in many centres in sub-Saharan Africa. OBJECTIVE: This study aimed to compare the effectiveness of single- versus multiple-dose antibiotic prophylaxis to prevent post-caesarean section infections. METHODOLOGY: This open-label, randomized controlled trial involved 162 consenting patients admitted for caesarean section (elective or emergency) at the Federal Medical Centre Keffi. They were distributed randomly into treatment arm A or B. Subjects in both arms received intravenous ceftriaxone (1 g) and metronidazole (500 mg) 30-60 min before incision; subjects in arm B received additional parenteral doses for 48 h and then cefuroxime 500 mg tablets every 12 h and metronidazole 400 mg tablets every 8 h for 5 days. The patients were monitored for 2 weeks for evidence of wound infection, febrile morbidity and clinical endometritis. RESULT: There was no statistical difference in the incidence of wound infection (6.6% versus 7.4%; p = .882) and febrile morbidity (11.8% versus 11.1%, p = .807). However, clinical endometritis (0.0% versus 6.1%, p = .028) was statistically significant with none reported in the single-dose arm. CONCLUSION: Single-dose ceftriaxone and metronidazole is as effective as multiple doses for antibiotic prophylaxis to prevent post-caesarean section infections. Adoption of this approach in low-risk patients would reduce the cost of prophylactic antibiotics, workload for staff and antibiotic resistance.

Pyomyoma in a primigravida at term: a case report.

Pyomyoma is a rare complication of uterine fibroid occurring most commonly in pregnancy, post-partum, post-abortion, and post-menopausal periods. It results from infarction, necrosis and secondary infection of leiomyoma. We report a case of 29-year-old primigravida with breech at term co-existing with cystic degenerative uterine fibroid, who presented with recurrent fever and abdominal pain. She had caesarean section and was found to have pyomyoma intraoperatively. She subsequently had drainage of pus, caesarean myomectomy and antibiotics therapy. She had good outcome and was discharged on fifth postoperative day. Pyomyoma should be suspected in pregnant women with leiomyoma, unexplained recurrent fever, abdominal pain and cystic degenerative changes on ultrasound.

Ultrasonographic foetal head circumference and cheek-to-cheek diameter at term as predictors of labour outcomes.

Background: The clinical uses of ultrasonography have varied and increased over time, especially the ability of ultrasonographic measured parameters to predict the outcomes of labour. The proper understanding of the association between these ultrasonographic parameters, mode of delivery, adverse maternal and foetal outcomes will further improve patient counselling as well as the planning of intrapartum care. Aim: The study explored the ultrasonographic measurement of foetal head circumference (HC) and cheek-to-cheek diameter (CCD) at term as predictors of labour outcomes. Methodology: Eligible pregnant women at term were recruited from the antenatal clinic and had obstetric ultrasound scans done with HC and CCD measured. Maternal and foetal outcomes were measured and included progress in labour, obstetric lacerations, mode of delivery and suspected foetal distress. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. Results: One hundred and thirty-two patients were recruited into the study. Foetal HC measurements ≥35 cm were closely associated with caesarean delivery odds ratio - 2.40 (95% confidence interval - 1.02-5.66. P = 0.046). Neither CCD nor CCD/HC ratio was predictive of the modes of delivery. The occurrence of perineal lacerations and poor progress of labour were observed more frequently with increasing HC and CCD. Conclusions: HC performed well in predicting caesarean delivery as well as perinatal outcomes among parturients. The ultrasonographic measured HC (≥35 cm) is associated with a higher incidence of both obstetric interventions for poor progress of labour and adverse perinatal outcomes in comparison to CCD. The association between HC and labour dystocia was found to be linear. The CCD did not perform well as a predictor of the mode of delivery.