Myomectomy during cesarean section.

OBJECTIVES: To assess the intra- and post-operative complications of cesarean myomectomy. METHODS: The study design was descriptive, and the setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital and two private consultant units, all in Benin City. The subjects were 25 pregnant women undergoing elective or emergency cesarean section at these units. The outcome measures were blood loss and need for blood transfusion, intra- and post-operative complications and duration of hospital stay. RESULTS: Eighty-four fibroids of various sizes (2-10 cm) were removed from the 25 women. The fibroids were on the anterior uterine wall with most (94.8%) being sub-serous or intramural, and only few (five) sub-mucous. The mean blood loss was 876+/-312 ml, range 400-1700 ml. Five patients (20%) had two units of whole blood transfusion. There was no case of severe hemorrhage necessitating hysterectomy. Eighteen patients (72%) had post-operative morbidities mainly of anemia [15 (60%); hematocrit 26+/-2.9%). The average duration of post-operative hospital stay was 7.4+/-2.2 days (range 3-12 days). Three (12%) patients have subsequently become pregnant, two (66.7%) of whom had normal vaginal deliveries, while the third had a repeat elective cesarean section. CONCLUSIONS: With adequate experience and the use of high dose oxytocin infusion (intra- and post-operatively), myomectomy at cesarean section is not as hazardous as many now believe.

Elevated serum glucose levels following ketamine intravenous anaesthesia: a report of 2 cases.

Ketamine is widely used as a sole anaesthetic agent in Nigeria, although data on its use and the associated side effects are generally lacking. This paper presents two cases of elevated blood glucose levels during caesarean deliveries under intravenous ketamine anaesthesia. Literature on complications of ketamine use is reviewed and the need for caution in the use of this drug as a single anaesthetic agent is emphasised.

The challenges of vaginal atresia and stenosis: Nigerian experience.

From July 1973 to December 1980, 6942 patients were admitted to the Gynaecology unit of the University of Benin Teaching Hospital, Benin City, Nigeria. Fifty-nine patients presented with gynatresia (vaginal atresia and stenosis), an incidence of 8.5 1000. The most common causes of this condition were caustic vaginitis, secondary to local herb pessary insertion, and circumcision. The resulting vaginal adhesions were effectively treated surgically by simple adhesiolysis . There was a low incidence of congenital gynatresia . As the large proportion of cases of acquired gynatresia were preventable, improvement in health education should further reduce incidence of this condition in our community.