ABSTRACT
Emergency peripartum hysterectomy is a challenging but life-saving procedure. In this descriptive study carried out in a rural Nigerian hospital, we found an incidence of emergency peripartum hysterectomy of 5.4 per 1000 deliveries and a significant association with abdominal mode of delivery, unbooked status, previous caesarean section and placenta previa. The most common indications for peripartum hysterectomy were placenta accreta (47.6%) and uterine rupture (28.6%). There were five (23.8%) maternal deaths and other complications included sepsis (five), bladder injury (three) and prolonged hospital stay (11).
Subject(s)
Emergency Treatment/statistics & numerical data , Hysterectomy/statistics & numerical data , Maternal Mortality , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/surgery , Adult , Cesarean Section , Female , Humans , Hysterectomy/mortality , Length of Stay , Nigeria/epidemiology , Obstetric Labor Complications/mortality , Parity , Placenta Accreta/epidemiology , Placenta Accreta/mortality , Placenta Accreta/surgery , Pregnancy , Risk Factors , Uterine Rupture/epidemiology , Uterine Rupture/mortality , Uterine Rupture/surgeryABSTRACT
Heterotopic pregnancy, although rare, is occurring more frequently because of an increase in genital infection and the escalating use of new reproductive technologies in infertility patients. The case of a 30-year-old para 2 + 1 prophetess is presented. She had a spontaneous vaginal delivery at term. Persistent abdominal pain and distension led to suspicion of heterotopic pregnancy. This was confirmed by ultrasonography. Laparotomy revealed a macerated fetus in the peritoneal cavity The purpose of this report is to sensitise practitioners about the reality and existence of the condition.
Subject(s)
Laparotomy , Natural Childbirth , Pregnancy, Abdominal/diagnostic imaging , Pregnancy, Abdominal/surgery , Pregnancy, Multiple , Adult , Delivery, Obstetric/methods , Female , Follow-Up Studies , Humans , Infant, Newborn , Parity , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Third , Risk Assessment , Treatment Outcome , Twins , Ultrasonography, PrenatalABSTRACT
Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6-45). Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/µL than those with counts >500 (95% CI 1.69-13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05-3.36), especially those with CD4 count <200 cells/µL. Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators.