Spontaneous rupture of gravid horn of bicornuate uterus at mid trimester--a case report.

Rupture of gravid uterus in a primigravida is rare and is generally associated with Mullerian duct anomalies. A case of rupture of gravid left horn of bicornuate uterus at 20 weeks gestation is reported in a 25-year-old unmarried primigravida. The ruptured left horn was excited and defect closed. The need for high index of suspicion, early diagnosis and prompt intervention is highlighted.

The Society of Gynaecology and Obstetrics of Nigeria (SOGON) plan for sustainable reduction in maternal mortality: a review.

In the year 2000, SOGON formulated a strategic plan on women's health based on the reproductive health approach with the aim of reducing maternal mortality by 50% by the year 2010. In 2005, the Nigerian Road Map for accelerating the attainment of Millennium Development Goals 4 and 5 was launched. One of the key guiding principles of the Road Map was promoting partnerships and joint programming among stakeholders including professional associations. In response, SOGON decided to align her strategic plan with the Road Map by refocusing the plan to the key objectives of the Road Map. The new SOGON Plan involves interventions with a focal objective of reducing the case-fatality of emergency obstetric conditions. The plan is anchored on interventions where SOGON has comparative advantage such as providing human resources and promoting capacity building for emergency obstetric care and skilled attendance at delivery, and advocacy and information dissemination on maternal health.

The society of gynaecology and obstetrics of Nigeria (SOGON) plan for sustainable reduction in maternal mortality: a review

In the year 2000, SOGON formulated a strategic plan on women's health based on the reproductive health approach with the aim of reducing maternal mortality by 50% by the year 2010. In 2005, the Nigerian Road Map for accelerating the attainment of Millennium Development Goals 4 and 5 was launched. One of the key guiding principles of the Road Map was promoting partnerships and joint programming among stakeholders including professional associations. In response, SOGON decided to align her strategic plan with the Road Map by refocusing the plan to the key objectives of the Road Map. The new SOGON Plan involves interventions with a focal objective of reducing the case-fatality of emergency obstetric conditions. The plan is anchored on interventions where SOGON has comparative advantage such as providing human resources and promoting capacity building for emergency obstetric care and skilled attendance at delivery, and advocacy and information dissemination on maternal health (Afr. J. Reprod. Health 2010; 14[2]: 139-147)

Gynaecologic mortality in Enugu, Nigeria.

A retrospective review of 79 deaths in 2033 gynaecologic admissions at a referral centre showed that the leading causes of mortality were cervical cancer, choriocarcinoma, septic abortion and ovarian cancer, in that order. The results suggest a need for an organized cancer programme to limit morbidity and mortality from malignant disease of the female genital tract.

Placenta percreta: a review of literature.

BACKGROUND: Placenta percreta is a very rare but serious complication of pregnancy. Diagnosis is difficult. Uterine perforation and invasion into adjacent organs makes life threatening haemmorrhage inevitable. Management is usually based on intraoperative findings from case reports. METHOD: Literature on clinical decisions, diagnostic and treatment modalities were critically reviewed using PUBMED and MEDLINE computerized search. Additional Information was also obtained by cross referencing, texts and journals in the medical library of University of Nigeria. RESULTS: Most of the literature was from developed countries with very little report from our environment. There was lack of comprehensive management plan in most textbooks. CONCLUSION: Rare complications are usually very difficult to manage due to lack of experience. It is thus important to identify the patients at risk, attempt to make antenatal diagnosis and involve experienced obstetricians in management.

Intraoperative uterine packing with mops: an effective, but under utilized method of controlling post partum haemorrhage-experience from South Eastern Nigeria.

BACKGROUND: Uterine packing is a simple noninvasive technique for controlling postpartum haemorrhage. However, its effectiveness has been underestimated and the procedure underutilized leading to lack of experience and expertise especially in the intraoperative usage of mops. The aim of the study was to re-evaluate the significance of intraoperative uterine packing in controlling post partum haemorrhage and preserving menstrual and reproductive functions. METHOD: Twenty cases of intraoperative uterine packing with mops performed by the authors over a three-year period (December 2000-December 2003) at three different hospitals were reviewed. Mops were removed after 24 hours. RESULTS: The mean age of the patients was 28.9 +/- 5.6 years, and the mean parity 3.1 +/- 1.8. The mean estimated blood loss was 1500 + 461.1 millilitres and the mean number of units of blood transfused was 1.45 + 1.2. The commonest indication for surgery was placenta praevia (55%). None needed further treatment. CONCLUSION: In carefully selected cases, intraoperative uterine packing is a simple and effective life saving option in our local environment with peculiar beliefs, lack of equipment and expertise.

Maternal mortality in health institutions with emergency obstetric care facilities in Enugu State, Nigeria.

In order to assess the current level of maternal mortality in health institutions with comprehensive emergency obstetric care in Enugu State, South Eastern Nigeria, a retrospective analysis of maternal deaths for the years 1999-2003 was carried out to establish the maternal mortality ratios in the eligible health institutions. Each maternal death was studied in detail to establish the socio-demographic characteristics of the women who died; their referral sources, type of delay (if any), medical causes of death and their preventability. In-depth interviews of the service providers were carried out to throw more light on the maternal mortality situation in the state. Five out of seven eligible health institutions were studied. Within the 5-year period (1999-2003), there were 141 maternal deaths and 18,257 live births giving a maternal mortality ratio of 772 maternal deaths per 100,000. The folders of 89 out of the 141 women who died were retrieved. Of these 89 maternal deaths, 51.7% of them were unemployed, 52.4% were referred from private hospitals; type 3 delay was the commonest type of delay encountered in the care of the women. Referral delay was the main cause of delay accounting for 46.4% of all cases of type 3 delay. The leading causes of maternal deaths among the women were obstetric haemorrhage (19.1%), sepsis (18.0%), prolonged obstructed labour/ruptured uterus (16.9%) and pre-eclampsia/eclampsia (16.9%). The in-depth interviews corroborated the high maternal mortality ratio recorded and the type 3 delays in tackling obstetric emergencies. It also showed some discrepancies between reality and the health providers' perception of the magnitude of maternal mortality situation in the state. It was concluded that in health institutions in Enugu State with comprehensive emergency obstetric care facilities, the maternal mortality ratio remains high due to type 3 delays. Most of the referrals come from private hospitals, hence the need to retrain the private practitioners in emergency obstetric care.

The effects of menopause on the serum lipid profile of normal females of South East Nigeria.

Dyslipidemia in menopause is a known feature in women, whether it leads to significant increase in the development of coronary heart disease (CHD) is still controversial, more so in our environment where little work has been done. The present study is aimed at comparing the level of total serum cholesterol, including its subunits in premenopausal with that of their postmenopausal counterparts. This is to enable us ascertain the relative risk of developing cardiovascular disease in postmenopausal women in our environment. One hundred and twenty six (126) apparently healthy, non-pregnant females (74 premenopausal and 52 postmenopausal) were recruited for the study. Serum total cholesterol and their subfractions- high-density lipoproteins (HDL), low-density lipoproteins (LDL), very low-density lipoproteins (VLDL) and triglycerides (TG) were estimated using enzymatic and established mathematical methods. There was no significant difference in the total serum cholesterol and triglyceride between the two groups. There was however, a significant reduction of HDL and VLDL in the postmenopausal group [P < 0.005] and a significant increase in the level of LDL in the postmenopausal group [P < 0.005]). The elevated LDL and the reduction of cardio protective HDL and VLDL is an indication that menopause is an independent risk factor for developing cardiovascular disease in our environment.

Accidental incision of the fetus at caesarian section.

BACKGROUND: Caesarian section is the most common major surgical procedure among women of reproductive age. It is thought to be safer for the baby than the mother. However, the baby is at risk of laceration injury. METHODS: Retrospective review of clinical records of women who were delivered by caesarian section during a seven-year period from January 1, 1991 to December 31, 1997. RESULTS: Fetal laceration injury was documented in 0.55% of live caesarian section births. Accidental incision of the fetus was associated with emergency caesarian section, ruptured membranes and relative inexperience of the operating surgeon. Documentation of injury was poor and there was no evidence that parents were counselled. CONCLUSION: Laceration of the fetus is an occasional complication of caesarian section. Proper documentation and counselling of parents are required especially as there are potential medicolegal implications. Careful attention to the technique of uterine entry at caesarian section should reduce the risk of injury to the fetus.

Maternal mortality at the University of Nigeria Teaching Hospital, Enugu, before and after Kenya.

A comparative retrospective analysis of maternal deaths at the University of Nigeria Teaching Hospital, Enugu, Nigeria, was carried out for two ten-year periods--1976-1985 and 1991-2000--in order to evaluate the effect of Safe Motherhood Initiative on maternal mortality in the hospital. Variables for the two periods were compared by means of the t-test at 95% confidence level. Maternal mortality ratio was significantly higher in Period II than in Period I (1406 versus 270 per 100,000, p = 0.00). The leading causes of maternal death were uterine rupture for Period I and septicaemia for Period II. Although from the first to the second ten-year period there was a significant decrease in the number of midwives, physicians and nurse anaesthetists, there was more than a proportionate decrease in the number of deliveries. There was also increase in the incidence of anaemia due to diminished standards of living and in the mean decision-intervention interval (1.5 +/- 0.5 versus 5.8 +/- 1.2 hours; p = 0.000) as a result of worker dissatisfaction and changes in hospital policies. We conclude that since the launching of the Safe Motherhood Initiative, MMR at the University of Nigeria Teaching Hospital, Enugu, Nigeria, has increased five-fold as a result of institutional delays and a deterioration in the living standards of Nigerians, both consequences of a depressed economy. To halt this trend, we recommend that the living standard of all Nigerians should be improved. Furthermore, healthcare personnel should be motivated through enhanced salaries and provision of working materials including efficient mobile telephone services.

Emergency obstetric referrals at a university teaching hospital, Nigeria.

OBJECTIVE: To identify factors in our unbooked obstetric emergency cases that contribute to the increase in maternal mortality. DESIGN: A retrospective study. SETTING: Maternity Ward, University of Nigeria Teaching Hospital, Enugu, Nigeria, between January 1966 and December 1999. SUBJECTS: Four hundred and thirty five cases of emergency obstetric referrals treated during the review period. RESULTS: The incidence of unbooked obstetric emergencies is 9.5% and the high risk obstetric group, the primigravida and grand multiparous women constituted 63% of it. Majority (80%) of the patients belonged to the lower socio-economic class and prolonged and obstructed labour were the commonest mode of presentation. Sources of referrals were hospital/clinics (46%), maternity homes (23%), traditional birth attendants (TBAs)(16%) and prayer houses (2.3%). There were obvious delays at the referral sources and most of the patients presented in poor clinical states. Forty per cent of total maternal mortality in the hospital were attributed to unbooked cases with haemorrhage and sepsis being the major causes. Also perinatal mortality of 40.2% was recorded. CONCLUSION: Lack of basic education and poverty are the major identifiable risk factors. Improving health care facilities, female education, regular training courses for medical personnel and elimination of quacks are advocated.

Contraception in teenage Nigerian school girls.

Contraception is reviewed in 314 teenage Nigerian school girls comprising 128 students at secondary and 186 at tertiary levels of institution. Out of all the teenagers, 26.8% were sexually exposed, among whom there was a total pregnancy rate of 19.05%. The rate of sexual exposure was higher in teenagers from tertiary institutions, 38.7% compared with 9.4% from secondary institutions. However, the pregnancy rate was higher among the sexually exposed secondary school girls, 33% vs. 16.7% for tertiary school girls. The mean level of contraceptive awareness for the various methods of contraception was 38.2% for the entire survey group: 22.6% for the secondary school girls and 54.4% for the tertiary school girls. Mean true contraceptive usage (TCU) among sexually active students, on the other hand, was 17.7%: 5% and 16.5% for the secondary school girls and tertiary school girls, respectively. The source of information on contraception for the study group was highest from 'a friend' (37.3%) and from the 'newsprint' (36.9%) and was lowest from routine 'lectures and sex instructions' (9.2%). Twenty-five point five per cent of the entire study group, 43% of the secondary school girls and 13.4% of the tertiary school girls, had never had any information on contraception. Instruction on contraception, as part of the academic curricula at the primary, secondary and tertiary levels of education, would improve contraceptive knowledge and forestall the emotional and social problems resulting from unwanted teenage pregnancies.

Burkitt's lymphoma of the vulva. Case report.

A 13-year-old Nigerian girl with Burkitt-type metastatic malignant lymphoma of the vulva is presented. Diagnosis and treatment are discussed and the literature is reviewed.

Two cases of perinatal listeriosis.

Two cases of neonatal listeriosis are described. The incidence in the UK is given and the treatment of the pregnant woman is briefly discussed.