A 10-year clinicopathological analysis of ovarian lesions in a tertiary hospital in Southern Nigeria.

Background: Ovarian tumours are the most lethal of all gynaecological cancers and they are usually diagnosed in advanced stages when the prognosis is very poor. Objective: To determine the pattern of ovarian lesions, their frequency, presentation, and associated clinical symptoms in Uyo, Nigeria. Methods: A 10-year retrospective study of all ovarian specimens that were surgically removed and histologically diagnosed. Results: The patients were between the ages of 5 and 73 years with median age of 34.1 years. Benign tumours occurred most commonly among the 20-39-year age group (31.3%) while malignant tumours were predominant among those aged 50-69 years (10.0%). Surface epithelial tumours (45.4%) were the most common neoplastic tumours while the mature cystic teratoma (33.2%) was the most common tumour overall. Surface epithelial malignancies accounted for 70.6% of all ovarian malignancies and the serous cyst adenocarcinoma (10.2%) was the most common surface epithelial tumour as well as the most common malignant tumour. Conclusion: There has been an increase in the number of malignant ovarian specimens in our centre. Though surface epithelial tumours were the most common category of ovarian tumours, overall, the mature cystic teratoma was the most common tumour. Serous cyst adenocarcinoma was the most common surface epithelial tumour and the most common malignant tumour.

Prevalence and predictors of hepatitis C infection among antenatal attendees in a tertiary hospital in Southern Nigeria.

Background: Hepatitis C virus infection as it specifically relates to pregnancy has been a neglected condition, thus its recognition and treatment in pregnancy is relevant because of the risks of the long-term complications of the infection in the mother, potential effects of the infection on the pregnancy and risk of vertical transmission to the newborn. Objectives: To determine the proportion of pregnant women with serologic markers of hepatitis C infection, identify risk factors as well as factors that predict the occurrence of the infection in them. Methodology: Over a 3-week period, blood samples from 456 pregnant women were assessed for antibodies to hepatitis C virus, while a pre-tested questionnaire was used to obtain socio-demographic data and the presence of risk factors in the University of Uyo Teaching Hospital, Nigeria. Results: The prevalence of HCV infection in pregnancy was 4.6%. No known risk factors for HCV infection in pregnancy were identified. Only increasing gestational age was a predictor of HCV infection in pregnancy in the study. Conclusion: The prevalence of hepatitis virus infection among the study population was high. Second trimester and increasing gravidity were protective of the infection in pregnancy. There is therefore need for introduction of general routine screening of all pregnant women presenting for antenatal care.

Early outcome of incisional hernia repair using polypropylene mesh: A preliminary report.

BACKGROUND: The use of prosthetics for open repair of incisional hernia is very recent in our practice. We highlight our experience repairing incisional hernias with polypropylene mesh. PATIENTS AND METHODS: Patients presenting with incisional hernia >5 cm in length or width received open polypropylene mesh repair and were followed for two years. Data obtained included age, sex, primary surgery causing the hernia, the length of the fascial defect and previous attempts at repair. Post-operative wound complications were recorded. The integrity of the scar and patient satisfaction or concerns with the repair was assessed at each visit. RESULTS: Nineteen females with a mean age of 35 years (range 30-54) underwent repair; most arising from obstetric or gynaecological procedures. Sixteen (82.2%) had midline, 2 (10.5) transverse and 1 (5.3) Pfannenstiel scars. One patient had no previous repair (R0), 7 had undergone one repair (R1), 9 had undergone two repairs (R2) and 1 had three previous repairs (R3). The length of fascial defects ranged from 8 to 18 cm and seroma collection and stitch sinus were the common problems encountered. Two (10.5%) recurrences were recorded in two years. CONCLUSION: Open mesh repair of incisional hernia carries a low risk of infection and recurrence in two years.

Prevalence of anaemia among pregnant women at booking in the University of Uyo Teaching Hospital, Uyo, Nigeria.

BACKGROUND: Anaemia with an estimated prevalence of 35-75% among pregnant women is a major cause of maternal deaths in Nigeria. objective: To determine the prevalence of anaemia, associated sociodemographic factors and red cell morphological pattern among pregnant women during booking at the University Teaching Hospital, Uyo. MATERIAL AND METHODS: A cross-sectional analytical study of 400 women at the booking clinic over a 16-week period. The packed cell volume and red cell morphology of each pregnant woman were determined. Their biodata, obstetric and medical histories, and results of other routine investigations were obtained with questionnaires and analyzed with SPSS Package version 17.0. RESULTS: The mean packed cell volume was 31.8% ±3.2 and 54.5% of the women were anaemic. The commonest blood picture was microcytic hypochromia and normocytic hypochromia suggesting iron deficiency anaemia. Anaemia was significantly and independently related to a history of fever in the index pregnancy (OR = 0.4; P = 0.00; 95% CI = 0.3-0.7), HIV positive status (OR = 0.2; P = 0.01; 95% CI = 0.1-0.6), and low social class (OR = 0.3; P = 0.00; 95% CI = 0.2-0.7). CONCLUSION: Women need to be economically empowered and every pregnant woman should be encouraged to obtain antenatal care, where haematinics supplementation can be given and appropriate investigations and treatment of causes of fever and management of HIV can be instituted.

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria.

INTRODUCTION: Emergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman's life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria. METHODS: The case records of all women who underwent emergency peripartum hysterectomy between 1(st) January 2004 and 31(st) December 2011 were studied. RESULTS: There were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%. CONCLUSION: Emergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.

Grandmultiparity: outcome of delivery in a tertiary hospital in southern Nigeria.

BACKGROUND: Grandmultiparity is traditionally associated with increased risk of complications during pregnancy and delivery. Reports from developed countries where obstetric facilities are excellent and the standard ofperinatal care is high indicate that currently, obstetric complications among grandmultipara are now independently associated with progressive maternal age. In Nigeria and other developing nations however, grandmultiparity still contributes a significant proportion of the obstetric population. The aim of this study is to evaluate the outcome of delivery of grandmultiparous patients at the University of Uyo Teaching Hospital. METHODS: The case records of all grandmultiparous patients who delivered at the University of Uyo Teaching Hospital, Uyo over a six-year period were studied. RESULTS: Grandmultiparous women constituted 6.4% of the parturients who delivered in the hospital during the study period. Their ages ranged from 20-45 years with majority (71.5%) being 30-39 years. Majority (77.9%) were para 5 and 6 and 326 (80.1%) of the patients booked and received antenatal care in the hospital. Majority of the booked patients (79.8%) initiated antenatal care after 32 weeks of gestation while all the unbooked patients 68 (16.7%) and the antenatal clinic defaulters 8 (2.0%) were brought from unorthodox health facilities when they developed obstetric complications. Two hundred and forty three patients (59.7%) had spontaneous vaginal delivery, 15 (3.7%) of the patients had laparotomy for ruptured uterus and out of these ten of them (66.7%) had a subtotal abdominal hysterectomy while five (33.4%) had uterine repair and bilateral tubal ligation. The perinatal mortality rate was 128/1000 births. There were three maternal deaths, two from eclampsia while one followed postpartum haemorrhage resulting in a maternal mortality rate of 7.4/1000. CONCLUSION: The prevalence of grandmultiparity in our centre is relatively low. It is, however, associated with high perinatal and maternal morbidity and mortality. We advocate widespread community enlightenment on the importance of limitation of family size and number of child births. There is need for community based studies in our environment accessing the knowledge and attitude of women with high parity towards contraception.

Quality of life following successful repair of vesicovaginal fistula in Nigeria.

INTRODUCTION: The impact of obstetric vesicovaginal fistula (VVF), which continues to occur among women in developing countries, can severely affect the health of the women while the condition persists. This study was designed to discover the effect of successful VVF repair on affected women's quality of life. METHODS: A comparison of the quality of life of a cross-section of women who had VVF was carried out before and 6 months after successful repair. Quality of life was assessed using the WHO Quality of Life (WHOQOL)-BREF Questionnaire. RESULTS: Of the 150 women studied, only 20% felt satisfied with their general state of health and quality of life before the repair, while this increased to 90% following successful repair (highly statistically significant at p<0.000). In the physical health domain, the mean quality of life score was 67.9 ± 4.4 before and 69.3 ± 3.4 after successful repair (p<0.01). In the mental health domain, the mean quality of life score was 32.4 ± 8.7 before and 74.7 ± 3.2 after successful repair (p<0.005). In the social health domain, the mean score was 20.2 ± 2.7 before and 69.7 ± 2.3 after successful repair (p<0.001). In the environment domain, the mean score of quality of life was 60.3 ± 4.3 before repair and 59.7 ± 2.7 after successful repair (comparable at p<0.2). CONCLUSION: Successful repair of VVF is associated with significant improvement in the multidimensional quality of life among affected women.

Demographic risk factors in domestic violence among pregnant women in Uyo, a community in the Niger Delta region, Nigeria.

There has been increasing global concern about the level of violence against pregnant women. Anecdotal evidence from general observations shows that there may be higher prevalence in the Niger Delta region of Nigeria. Unfortunately, in spite of the emerging and alarming social indicators for violence against women in the area, little effort has been made to address this dangerous trend. One major concern has been the effects of violence on pregnancy and the difficulty in protecting the pregnant women, since managing violence is often unsuccessful. There is therefore the need to evaluate the magnitude, as well as the risk factors for violence and the sociodemographic characteristics of the women, for purposes of prevention.

Depot medroxyprogesterone injectable contraception at the University of Uyo Teaching Hospital, Uyo.

BACKGROUND: Depot medroxyprogesterone acetate is the most studied injectable contraceptive and also one of the most effective methods of contraception currently available. It is reversible, its use is independent of intercourse, and can be provided by trained non-medical staff making it particularly suitable for use in developing countries. The aim of this study is to determine the socio-demographic characteristics of its acceptors, the timing of use and complications at the University of Uyo Teaching Hospital, Uyo. MATERIALS AND METHODS: The record cards of all clients who accepted medroxyprogesterone acetate injectable contraception over a nine-year period were studied. RESULTS: There were 1065 new contraceptive acceptors out of which 166 (15.1%) accepted depot medroxyprogesterone acetate. The modal age group of the clients was 30-34 years (35.0%). Majority of clients were grandmultiparous (63.9%), married (82.0%), and 50.6% had primary level education. Majority of the clients (84.2%) derived their sources of information on contraception from clinic personnel and friends/relatives. All the clients received their injections within seven days of menstruation. The most common side effects were amenorrhea (12.0%) and spotting of blood per vaginam (10.8%). CONCLUSION: Depot medroxyprogesterone acetate is a safe form of contraception, which was mostly accepted by grandmultiparous women and those in their thirties. The involvement of the print and electronic media in the propagation of accurate information about depot medroxprogesterone acetate to members of the community and the introduction of post-abortal and puerperal administrations of depot medroxyprogesterone acetate and its new formulation; depo sub-Q provera in all our hospitals are advocated.

Intrauterine contraceptive device with rectal perforation and strings presenting at the anus.

A 36-year-old grand multiparous midwife presented to the gynaecological unit of the University of Uyo Teaching Hospital with the string of an intrauterine contraceptive device (IUCD) protruding from her anus. She had had a copper IUCD inserted at a health centre 8 years earlier. However, 4 months later she noticed that she no longer felt its strings and had another IUCD inserted in the same facility when the first device was not located. Four months prior to presentation, she presented to a private clinic when she no longer felt the strings of the second IUCD. The device in the uterus was removed in the private clinic and she was referred to the teaching hospital. At the teaching hospital rectal examination and plain x-ray revealed the presence of a device. Under general anaesthesia, the device was successfully removed in theatre through the rectum with no postoperative complications.

A Five-year review of uterine fibroids at the University of Uyo Teaching Hospital, Nigeria

Background: Uterine fibroids are benign tumours that arise from myometrial smooth muscle cells. They are the most common tumours found in humans and are particularly common in Negros. We determined the prevalence modes of presentation and treatment modalities of uterine fibroid at the University of Uyo Teaching Hospital; Uyo; Nigeria. Methods: The case notes of all patients with uterine fibroids over a 4-year period were studied. Results: Uterine fibroids accounted for 7.1of gynaecological admissions and 21.2of major gynaecological surgeries. The patients' age ranged from 21 to 55 years with modal age group being 31-40 years (38.8). Majority of the patients were of low parity (75.4). The most common presenting complaints were abdominal swelling (25.5) and infertility (21.4). Myomectomy was the most common surgical procedure performed (77.6) and the most common post operative omplications were anaemia (21.4) and pyrexia (18.4). Conclusion: Uterine fibroids are common in our environment. The patients are predominantly of low parity and myomectomy is the most common surgical procedure performed

National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria.

BACKGROUND: The lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria. OBJECTIVE: The primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country. METHODS: This will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels. MANAGEMENT: Overall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria. EXPECTED OUTCOMES: The outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.

Reasons for gynaecological consultations in children in Calabar, South Eastern Nigeria.

Childhood gynaecological disorders as seen in the University of Calabar Teaching hospital (UCTH), Calabar, Nigeria, over a 10-year period were studied. The aim was to establish the incidence and pattern of presentation of these disorders. Childhood gynaecological disorders constituted 3.1% of gynaecological admissions in UCTH. Vaginal laceration following rape was the most common disorder accounting for 54.8% of the cases. This was most common in the 8 to 11-year age group (52.2%). Vaginal bleeding was the most common presenting symptom (63.1%) and repair of vaginal laceration the most common procedure performed (54.8%).

Vaginal injuries during coitus in Calabar: a 10-year review.

UNLABELLED: Injuries during coitus could result in considerable morbidity and mortality in women. Identifying their pattern of presentation and predisposing factors will aid in their prevention. STUDY DESIGN AND SETTING: A descriptive study of patients with coital injuries seen in the University of Calabar Teaching Hospital (U.C.T.H) Calabar, between 1991 and 2000, with data obtained from case records. RESULTS: Coital injuries constituted 0.7/1000 gynaecological emergencies. Rape (68.0%) was the commonest aetiological factor. It was more common in nulliparous patients (88.0%) and toddlers and teenagers formed the age group most affected. The lower vagina was the most common site of injury (44.0%). Vaginal bleeding was the commonest mode of presentation and hypovolaemic shock, the most common complication. CONCLUSION: Rape is the commonest cause of coital injury in Calabar. Coital injuries should be considered as a differential diagnosis in all cases of abnormal vaginal bleeding particularly in children.