Cervical leiomyosarcoma in a teenage girl: A rare form of uterine leiomyosarcoma.

Sarcomas arising from the cervix are rare, and the reported prevalence is 0.20-0.55%. A 15-year-old Para 0+0 secondary school student presented to the emergency department in shock with a 1-year history of painless vaginal protrusion, vaginal bleeding, foul-smelling vaginal discharge, occasional passage of blood clots, fatigue, fainting episodes, and weight loss. She was resuscitated with intravenous fluids and blood transfusions. General examination revealed a young girl with a 16-week sized abdominal mass. Vaginal examination revealed a large mobile fleshy mass 14 cm by 10 cm with an offensive discharge and odour. It was externally friable, bled actively on contact, had areas of tissue necrosis, and was oedematous. It was difficult to determine the adnexa structures because of tenderness. Examination under anaesthesia showed that the mass was continuous with the cervix and was not attached to the vagina or vulva. The histology report of the biopsied specimens showed features consistent with cervical leiomyosarcoma (LMS). Cervical LMS was confirmed by immunohistochemistry and a total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed as definitive treatment. Postoperative hormone replacement therapy was initiated. The patient's postoperative condition was stable and there was no tumour recurrence for >2 years on follow-up. Making a diagnosis and instituting surgical and adjuvant treatments for LMS in a low-resource setting are challenging. This is due to lack of access to universal healthcare coverage. A multidisciplinary approach with early diagnosis and complete surgical resection of the tumour provides the most favourable possibility of an improved survival and quality of life.

Lassa fever in pregnancy: Report of two maternal deaths in a tertiary center in the middle-belt region of Nigeria.

Lassa fever is endemic in West Africa, with an estimated 300,000 to 500,000 infections occurring annually and approximately 5,000 deaths. Two Lassa fever cases in pregnancy with maternal and fetal complications were presented. The age range was 20 to 30 years and the range of parity was 1 to 3. The duration of symptoms was 13 to 14 days. Clinical presentation and complications common to the two cases were fever, abnormal bleeding, cough/sore throat, anaemia, IUFD/Stillbirth, and maternal deaths. Others are vomiting, restlessness/confusion, hypotension and thrombocytopaenia. Major challenges encountered are late presentation, delay in confirming diagnosis and instituting definitive treatment, limited facility, and the impact of traditional and religious factors in safe burial for Lassa fever cases. In resource-constrained settings; diagnosis, treatment and surveillance for Lassa fever may be challenging. Early clinical suspicion and appropriate case management are critical for good reproductive outcome.

Primary umbilical endometriosis: Radical excision (omphalectomy) and laparoscopic management of associated pelvic endometriosis in a low resource tertiary hospital.

Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 - 1% of all extragenital endometriosis cases. We reviewed the data of five women with umbilical endometriosis retrospectively. The age range was 29 - 46 years, and they were all nulligravid at presentation. Common clinical presentation was umbilical pain and masses, dysmenorrhea, and primary infertility. Radical umbilical excision was performed to remove the nodule as a definitive treatment. Diagnostic laparoscopy was performed, followed by varying degrees of operative laparoscopic procedures. They all had endometriosis in the pelvis. Three out of five women operated became pregnant and had live births. Complete resolution of clinical symptoms with a reduction in umbilical and menstrual pain scores occurred. In resource-constrained settings, diagnosis, and treatment of PUE may be challenging. Clinical suspicion and appropriate case management are critical for good reproductive outcomes and quality of life.

Snake bite in third trimester of pregnancy with systemic envenomation and delivery of a live baby in a low resource setting: A case report.

BACKGROUND: Snake bite in the third trimester of pregnancy with late presentation, systemic envenomation; disseminated intravascular coagulopathy and delivery of a live neonate is uncommon in a low resource setting. CASE: We present a 22 year old unbooked Gravida 3 Para 1+ 1 1alive lentiviral positive woman at 32 weeks gestation with snake bite, leg swelling, vaginal bleeding and labour pains. At presentation, there were anemia, tachycardia, hypotension; a gravid uterus with a single fetus in longitudinal lie, cephalic presentation, regular fetal heart rate and cervical dilatation of 3 cm. Preterm labour with antepartum hemorrhage due to venomous snake bite was diagnosed. Multidisciplinary management instituted led to the survival of both mother and baby. CONCLUSION: In resource constrained setting, disseminated intravascular coagulopathy arising from systemic envenomation due to snake bite in pregnancy could be challenging. Obstetric outcome depends on the degree of envenomation, gestational age at presentation, timing, duration and quality of treatment.

Haematological and biochemical effects of etonogestrel subdermal implant (Implanon) in Ilorin Nigeria.

OBJECTIVES: To evaluate the effect of etonogestrel subdermal implant (Implanon) on haematological and biochemical parameters of its users. METHODOLOGY: A prospective observational study among healthy women using Implanon for contraception. The study site was the family planning clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Informed consent was obtained and participants were followed up for three years. Follow up parameters were haematological and biochemical evaluation at insertion (baseline), first and third years post-insertion. Statistical analysis was with SPSS-version 20.0; p value <0.05 was significant. RESULTS: 124 participants of age 20-44 years were included in the study. During the period of study, a progressive increase in the weight as well as in the level of alanine transaminase and systolic blood pressure was recorded. As compared to the baseline values, statistically significant difference in the mean values of systolic blood pressure (p<0.01), alanine transaminase (p<0.01) and weight (p=0.001) were recorded at the first year. Packed Cell Volume (p=0.001), weight (p=0.001), alanine transaminase (p=0.001) and alkaline phosphatase (p<0.05) were significant at the third year. Between the first and third year post-insertion, there was statistically significant difference in Packed Cell Volume (p=0.001), urea (p<0.05), aspartate (p=0.001) and alanine transaminase (p=0.001) and weight (p=0.001). However, there were no clinically detectable abnormalities or pregnancy during the study period. CONCLUSION: Haematological and biochemical parameters change with Implanon use but they were not significant to cause clinical sequelae. Implanon remains a safe long term contraceptive.