Pregnancy outcome in the elderly gravida in Addis Ababa.

OBJECTIVE: To determine the difference in selected antepartum obstetric problems and pregnancy outcome between women delivering at the age of 35 or above and women delivering at the age of 20-34 in the Ethiopian setting. DESIGN: A prospective case control study. SETTING: Saint Paul's and Tikur Anbessa Teaching Hospitals, Faculty of Medicine, Department of Obstetrics and Gynaecology, Addis Ababa University, Addis Ababa, Ethiopia. SUBJECTS: A hundred and seventy four gravidae delivering at the age of 35 or above and 174 gravidae delivering at the age of 20-34 from December 1,1997 to August 30,1998 in the above setting fulfilling inclusion criteria were cases and controls respectively. MAIN OUTCOME MEASURES: Included current obstetric problems, labour induction, operative delivery, low birthweight, apgar scores, prenatal death, neonatal intensive care admission rates and mean foetal birthweight. RESULTS: Pregnancy at old age was more likely to be complicated by hypertension (p<0.05, OR=2, 95% CI=1.04-4). Cases were more likely to undergo induction of labour (p<0.0001, OR=2.3, 95% CI=2.7-12) than controls. Although the rates of poor foetal and neonatal outcome indices seem to increase for the older gravidae, the difference was not statistically significant. CONCLUSION: Consistent with other studies, hypertension was the most common disorder complicating pregnancy at age 35 and above. Cases were more likely to undergo induction of labour and operative delivery. Larger studies are needed to establish the exact magnitude of these associations and to show any significant difference in antepartum obstetric problems and fetal and neonatal outcome measures.

Lower genital tract infections among pregnant women: a review.

OBJECTIVES: To determine the prevalence of lower genital tract infections, discuss briefly common maternal foetal complications associated with them and assess the usefulness of diagnostic algorithms in their management among pregnant women in the developing countries. DATA SOURCE: Articles published in English language since 1987 were looked through MEDLINE and OVID using key words supplemented by manual search in libraries except when full text of a subject was accessible via internet. STUDY SELECTION: Original and review articles addressing genital tract infections, associated complications and diagnostic evaluation in pregnant women were included. Emphasis was given to articles reported from developing countries. DATA EXTRACTION: A total of thirty five articles were retrieved and reviewed for information on the performance of diagnostic algorithms, prevalence rates and adverse maternal-foetal effects of lower genital tract infections in pregnancy. DATA SYNTHESIS: Lower genital tract infections are very common among apparently healthy looking pregnant women with an overall prevalence of 40-54%. Specific pathogens that were isolated from the vagina and/or cervix of asymptomatic pregnant women include: C. albicans (14-42%), T. vaginalis (11-20%), C. trachomatis (7-31%), N. gonorrhoea (0.5-14%) and group B streptococcus (4-25%). Untreated, genital tract infections in pregnant women may result in: foetal loss, preterm labour, preterm birth, premature rupture of the membranes, low birthweight, eye and lung damage in the newborn. Although the feasibility is good, the performance of clinical algorithms in the evaluation and management of lower genital tract infections is worse in pregnant women and better results are achieved for vaginal infections than cervical infections. CONCLUSION: Routine screening for clinically important pathogens should be considered during antenatal service. There is a need to develop simple, cheap and reliable laboratory tests and better clinical algorithms for the diagnosis of reproductive tract infections among pregnant women.

Aggressive angiomyxoma of the pelvis and perineum: case study.

Aggressive angiomyxoma (AAM) is a rare locally aggressive tumor affecting the pelvis and perineum of young females. Histopathologically, it is characterized by fibreoblasts in a myxoid background with vascular proliferation, scanty mitotic figure and no real capsule. AAM needs to be considered in the differential diagnosis of vulval mass in a reproductive age woman. We describe the first Ethiopian case of huge, recurrent, AAM of the pelvis and perineum in a 35 year old para II lady and stress that early diagnosis offers a better option for treatment by wide local excision and low recurrence rate.

Exaggerated psychomotor response to intravenous bolus dose administration of ketamine.

The case of a 40-year old female patient with exaggerated psychomotor response to intravenous bolus dose administration of ketamine is presented. The mechanism of action and some of the untoward effects of the drug are discussed. The need for proper evaluation of underlying psychiatric history, especially in the elderly, before the administration of the drug is stressed.