Medico-social characteristics of patients with eclampsia in a metropolitan hospital in North western Nigeria: is there a changing pattern?

Background: Eclampsia is a recognized cause of maternal and neonatal morbidity and mortality in North western Nigeria. It's a preventable obstetrics calamity were adequate antenatal care services are provided. Objective: To review medico-social characteristics of patients with eclampsia at a metropolitan Specialist Hospital in North-western Nigeria. Methodology: Eighty consecutive patients that presented with eclampsia at Murtala Mohammed Specialist Hospital were recruited for the study from 1st December, 2016 to 28th February, 2017. Data were collected using structured questionnaire, administered by research assistants. Information obtained included sociodemographic data, duration of fits before presentation and maternal-fetal outcome. Results: A total of 1931 patients delivered within the study period, among them 80 had eclampsia. This gives an incidence of 4.0%. Teenage pregnancy accounted for 35%. Forty-nine patients (61.2%) were primigravidae and up to 95% were booked. Majority of the patients 40(50%) had antepartum eclampsia while only 10(12.5%) had postpartum eclampsia. Most of the patients (73.8%) presented within 12 hours of convulsions and (87%) had vaginal delivery. There were 3 maternal deaths with case fatality rate of 3.8%. Live birth was achieved in 65%. Fresh still birth and Macerated still births were recorded in 20% and 12.5% respectively. Conclusion: The incidence of eclampsia is still high despite introduction of free maternity care services. Socio medical factors and poor quality of Antenatal Care services may be the contributing factors to development of eclampsia. There is need to review and improve the quality of antenatal care services offered at the primary health care centers

Review of Intrauterine Adhesiolysis at the Aminu Kano Teaching Hospital; Kano; Nigeria

Background: Hysteroscopic adhesiolysis is shown to significantly improve the outcome of intrauterine adhesions (IUA). The Minimally Invasive Surgical Unit (MISU) of our Department recently acquired a hysteroscope which is being used for hysteroscopic adhesiolysis among others. Materials and Methods: There were 57 patients diagnosed to have IUA of which 54 case notes were available for analysis; giving a retrieval rate of 95. The information extracted includes age; parity; and menstrual pattern; predisposing factors; treatment option; outcome; complications and the year of the procedure. The data extracted were analyzed using Epi info Version 3.4.1. Chi squared test (Fisher's exact test) was used to test for statistical difference in the outcome of the modalities of treatment. P value of less than 0.05 was considered significant. Results: There were 57 cases of IUA out of 4160 gynecological patients seen; giving a prevalence of 14/1000. The mean age was 28.9 years (SD 4.5) and mean parity was 1.4 (SD 1.4). Etiologic factors include Dilatation and curettage (D and C) (33.3); Caesarean section (C/S) (31.5); manual removal of placenta and Pelvic Inflammatory Disease (PID) (7.4each); and unexplained (3.7). Mode of presentation was secondary amenorrhoea (50); oligomenorrhoea (22.2); and hypomenorrhoea (10). As for the management; 68had blind procedure while 25.9had hysteroscopic procedure. Lippes loop was used in all except three patients who had pediatric Foleys catheter instead. Upon follow-up 59.3resumed normal menses; 11.1had oligomenorrhoea; hypomenorrhoea 13and amenorrhoea 5.6. There was no statistical difference in the outcome of treatment between hysteroscopic adhesiolysis and the blind procedure when return to normal menses is considered as the end point; OR=2.27; CI 0.45-12.65; Fisher exact test (one-tailed) P=0.2184818. Conclusion: There was no significant difference between the blind and hysteroscopic procedures. Dilatation and curettage was found to be the commonest cause of IUA

Cancer of the cervix in unscreened West African women

Background: Cancer of the cervix remains an important health problem amongst women worldwide. Widespread comprehensive cervical cancer control programs have resulted in a marked reduction in the incidence and mortality in most developed countries. Developing countries bear over 80 of the global burden; with only 5 of the global resources for the control of cancer. Majority of the cases in these countries present late and are incurable at the time of diagnosis. Aim: To review the presentation and histopathological types of cervical cancer cases seen in Aminu Kano Teaching Hospital Kano; over a sixteen-year period (1995-2010). Materials and Methods: Case records of histopathologically diagnosed cases of cancer of the cervix were retrieved. Demographic data; stage of the tumor at presentation; and histopathologic type were extracted. The results were analyzed using descriptive statistics. Results: Six hundred and sixty gynecological cancers were seen during the study period; with cancer of the cervix accounting for 58.5 (386/660) cases. Among these cases with cancer of the cervix 71.1 (275/386) were grand multiparous and majority 89.7 346/386 presented with advanced disease. Squamous cell carcinoma (SCC) accounted for 86.3 (333/386) of the cancers; adenocarcinoma contributed 12.4;(48/386) and others contributed 1.3(5/386). Conclusion: Cancer of the cervix is the commonest gynecological cancer at Aminu Kano Teaching Hospital; Kano; Nigeria. SCC is the commonest histological type