Comparison of pregnancy outcomes of triangular 3-bites and mcdonald techniques of cervical cerclage in women with cervical insufficiency: A pilot study.

Background: Cervical cerclage is the procedure of choice for preventing preterm birth due to cervical insufficiency. Despite the simplicity of the McDonald's method of cerclage application, it is still technically difficult to take four bites around the cervix before knotting. There is a need to develop a simpler method of cervical cerclage application with similar or improved pregnancy outcomes. Aim: This is to compare the ease/duration of application and pregnancy outcomes of the new triangular three-bite cervical cerclage technique and McDonald's technique in women with cervical insufficiency. Patients and Methods: This is a pilot study with 20 participants that met the inclusion criteria. They were randomly grouped into triangular three-bite method (n = 10) and McDonald's method (n = 10). The pregnancy outcomes were compared between the groups with the Chi-square test and student's t-test. A P value of <.05 was set as level of significance. Results: The sociodemographic characteristics of the two groups were similar. There was no statistically significant difference between the two groups regarding the pregnancy outcome (spontaneous miscarriage P = 1.00, preterm delivery P = 0.61, and neonatal birthweight P = 0.96). However, the duration of cerclage application (5.98 ± 1.79 minutes vs. 14.25 ± 7.5 minutes; P <.002) and estimated blood loss (29 ± 9.94 mls vs. 48.5 ± 25.82 mls; P = .04) were significantly lower in the triangular three-bite arm than in the McDonald's arm. Conclusion: The new triangular three-bite technique has similar pregnancy outcomes with the conventional McDonald's technique and has shown a lower duration of procedure and blood loss. Since this is a pilot study, a well-structured randomized control trial to compare the two methods is recommended.

Management outcomes of abruptio placentae at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

BACKGROUND: The objective of this study is to determine incidence, risk factors and management outcomes of abruptio placentae (AP) and comparing them with cases without AP who delivered within the same period. METHODS: A 10 year retrospective study of AP managed at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, between January 2001 and December 2010 was undertaken. Proforma was initially used for data collection before transfer to Epi-info 2008 software. Test of associations were evaluated and P < 0.05 was considered significant. RESULTS: Sixty nine cases out of a total delivery of 8,811 were seen, giving an incidence of 0.8%. The mean age and parity of women with AP were 30.8 +/- 0.9 years and 4.1 +/- 0.6 respectively and majority (78.3%) of cases were unbooked (p = 0.0019). Grand multiparity and age = 35 years were significant risk factors ( p < 0.05). Fifty two (75.4%) cases were delivered by caesarean section (c/s) ( P = 0.0000). The sex ratio was 160 ( p = 0.0134). The overall maternal mortality ratio during the study period was 987 per 100,000 live births with AP contributing 3.8% of the maternal deaths while perinatal mortality rate was 52.2%. CONCLUSION: A significant number of cases have high perinatal mortality. Unbooked, high parity, advanced maternal age and previous c/s scar were significant aetiological risk factors.

Vaginal myomectomy of a prolapsed gangrenous cervical leiomyoma.

We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties.