Rupture of the Gravid Uterus: A Two-Decade Experience at a University Teaching Hospital in South-West, Nigeria.

BACKGROUND: Uterine rupture is an obstetric emergency associated with significant maternal and perinatal mortality and morbidity, especially in resource-constraint countries such as Nigeria. OBJECTIVE: To determine the incidence and feto-maternal outcome of uterine rupture in a Nigerian teaching hospital. METHODS: This was a retrospective review of all cases of uterine rupture managed over 21 years. The case notes of all affected women were retrieved, and information on sociodemographic and obstetric characteristics, clinical presentation, intraoperative findings, and fetal and maternal outcomes were extracted. Data were analyzed using SPSS version 23.0 and descriptive statistics were computed. Factors associated with maternal deaths secondary to rupture of the gravid uterus were determined using binary logistic regression analyses. Statistical significance was reported at P<0.05. RESULTS: There were 31,616 deliveries during the review period, out of which were 182 cases of uterine rupture giving an incidence of 5.76 per 1,000 deliveries. Most of the cases of uterine rupture (65.2%) were treated by uterine repair. Maternal and fetal deaths were recorded in 8.1% and 82.7% of cases respectively. Women aged at least 35 years (P=0.035), women who had laboured at home or traditional birth attendant's (TBA) place (P=0.002), women who had multiple sites rupture (P=0.049) and those who developed hypovolemic shock (P=0.002) were more likely to die from uterine rupture. CONCLUSION: Ruptured uterus remains a significant cause of maternal and perinatal morbidity and mortality in Nigeria. Strategies for prevention include effective health education of the masses, the conduct of labour in a well-equipped health facility, and prompt referral of at-risk women.

CONTEXTE: La rupture utérine est une urgence obstétrique associée à une mortalité et une morbidité maternelles et périnatales significatives, en particulier dans les pays à ressources limitées comme le Nigeria. OBJECTIF: Déterminer l'incidence et l'issue fœto-maternelle de la rupture utérine dans un hôpital universitaire nigérian. MÉTHODES: Il s'agit d'une étude rétrospective de tous les cas de rupture utérine pris en charge sur une période de 21 ans. Les notes de cas de toutes les femmes concernées ont été récupérées et des informations sur les caractéristiques sociodémographiques et obstétriques, la présentation clinique, les résultats peropératoires et les issues fœtales et maternelles ont été extraites. Les données ont été analysées à l'aide de la version 23.0 de SPSS et des statistiques descriptives ont été calculées. Les facteurs associés aux décès maternels consécutifs à la rupture de l'utérus gravide ont été déterminés à l'aide d'analyses de régression logistique binaire. La signification statistique a été rapportée à P<0,05. RÉSULTATS: Il y a eu 31 616 accouchements pendant la période examinée, dont 182 cas de rupture utérine, soit une incidence de 5,76 pour 1 000 accouchements. La plupart des cas de rupture utérine (65,2 %) ont été traités par réparation utérine. Les décès maternels et fœtaux ont été enregistrés dans 8,1% et 82,7% des cas respectivement. Les femmes âgées d'au moins 35 ans (P=0,035), les femmes ayant accouché à domicile ou chez une accoucheuse traditionnelle (P=0,002), les femmes ayant eu des ruptures multiples (P=0,049) et celles ayant développé un choc hypovolémique (P=0,002) étaient plus susceptibles de mourir d'une rupture utérine. CONCLUSION: La rupture de l'utérus reste une cause importante de morbidité et de mortalité maternelles et périnatales au Nigeria. Les stratégies de prévention comprennent une éducation sanitaire efficace des masses, la conduite du travail dans un établissement de santé bien équipé et l'orientation rapide des femmes à risque. Mots-clés: Rupture utérine, Lagos, Mortalité maternelle, Mortalité périnatale, Incidence, Ligature tubaire bilatérale.

Prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer.

AIMS: This study was aimed at investigating the prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer (EOC) patients in Lagos, Nigeria. METHODS: This was a retrospective cohort study involving the review of the clinical record of 72 patients with histologically confirmed EOC who were managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. Information on the sociodemographic data and platelet counts at diagnosis of EOC were retrieved from the patients' medical records. Descriptive statistics were then computed for all baseline patients' characteristics. Survival analyses were carried out using the Kaplan-Meier estimates. Multivariate analysis of these data was performed with the Cox proportional hazards model. RESULTS: This study revealed that the prevalence of pretreatment thrombocytosis was 41.7% among the women with EOC. Fifty-three (73.6%) of the women had the advanced-stage disease (FIGO stage III-IV) while 52 (72.2%) had high-grade disease (II-III). The majority (66.7%) of the women had a serous histological type of EOC while 76.4% had documented recurrence. Pretreatment thrombocytosis was significantly associated with the women's parity (P = 0.009), serum carbohydrate antigen 125 levels (P = 0.018), median progression-free survival (PFS) (P < 0.001), 3-year median overall survival (OS) (P < 0.001), type of primary treatment (P = 0.002), extent of cytoreduction (P < 0.001), presence of ascites (P = 0.002), International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.008), and histological type (P = 0.011). Pretreatment thrombocytosis was negatively associated with PFS (hazard ratio [HR] = 0.25; 95% CI 0.83, 0.75; P = 0.014) and 3-year OS (HR = 0.03; 95% CI 0.03, 0.27; P = 0.002). CONCLUSIONS: The study suggests that pretreatment thrombocytosis may be a useful predictor of survivals in EOC patients.

THE DISTRIBUTION, HISTOLOGIC PROFILE AND CLINICAL PRESENTATION OF GASTROINTESTINAL MALIGNANCIES IN LAGOS, NIGERIA.

BACKGROUND: Gastrointestinal malignancies have continued to record higher incidence and therefore pose significant public health burden in terms of morbidity and mortality. AIM: To evaluate the sociodemographic, histologic and clinical distribution of patients with gastrointestinal malignancies diagnosed between July 2009 and March 2016. SETTING: Lagos University Teaching Hospital, Idi-Araba, south-west Nigeria. METHODOLOGY: Using a retrospective study design, all the patients with histologic diagnosis of gastrointestinal malignancies were recruited and their bio-data, clinical, histologic and treatment data were extracted from their hospital records. RESULTS: Of the 106 cases of gastrointestinal malignancies in this study, the age range was 30-82 years with a mean of 55.9±13 years and a peak age bracket of 50-59 years; the male/female ratio was 1.2:1. The most common sites were colorectum (79.3%), stomach (7.6%), anus (6.6%), liver (4.7%), and pancreas (0.9%). Adenocarcinoma was the most common histologic subtype (89.62%), followed by squamous cell carcinoma (2.83%) and gastrointestinal stromal tumors (1.89%). The most common complaints were abdominal pain (54.7%), constipation (38.7%), palpable abdominal swelling/masses (35.9%), bleeding (33.0%), and weight loss (17.0%). The tumors were treated with chemotherapy, surgery, and radiotherapy, either singly or in combination, in 97.2%, 83.0%, and 30.2% respectively. CONCLUSION: In this study, colorectal cancers are still the most prevalent type of gastrointestinal malignancies with a male preponderance, and individuals between 40-59 years are at greater risk. The significant involvement of individuals who constitute the bulk of the workforce and are the most productive labor in the country points at the need to develop strategies aimed at reducing the incidence of gastrointestinal malignancies.

Diarrhoea, constipation and intestinal transit in a northern Nigerian population.

Healthy Nigerians from Zaria have a short intestinal transit time. It is usual for them to open their bowels daily and their concept of diarrhoea and constipation differs widely from the standard medical definition. To avoid confusion care must be taken to inquire exactly what patients mean when they present with these symptoms.