Clinical presentation and management outcome of emergency adolescent gynecological disorders at federal teaching hospital, abakaliki, Nigeria

Background: Gynecological emergencies which affect the adolescents may pose a serious challenge to both the patient and the gynecologist. Objectives: The objective of this study is to determine the clinical presentations and management outcomes of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki. Materials and Methods: This is a retrospective review of all cases of adolescent gynecological emergencies managed at Federal Teaching Hospital Abakaliki between January 1, 2012, and December 31, 2014. Data obtained from their case notes were analyzed using the IBM statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using percentages and pie chart. Results: The prevalence of adolescent gynecological emergency disorders was 5.1%. The majority (82%) of the patients belong to the age bracket 15­19 with a mean age of 16.7 (2.4) years. About 90% of the patients were nulliparous. Unmarried patients comprised 80% of the study group. Vaginal bleeding was the most common clinical presentation (86%). The two most common diagnoses were abortion (60%) and sexual assault (26%). Only 10% of sexually active adolescent were using any form of contraception. Care received includes manual vaccum aspiration, laparotomy, and antibiotics. Blood transfusion was given in 18% of the cases. No death was recorded in all the cases. Conclusion: Abortive conditions and sexual assault were the most common clinical diagnosis among adolescents in the study. The percentage of adolescent assaulted in our study is unacceptable and should be prevented and efforts should be made to reduce the high unmet need for contraception seen in the study

Clinical Abdominal Palpation for Predicting Oligohydramnios in Suspected Prolonged Pregnancy

Objective. In view of the scarcity of ultrasound in low-resource settings; to evaluate abdominal palpation for prediction of oligohydramnios in suspected prolonged pregnancy; using the ultrasound-obtained amniotic fluid index (AFI) as a gold standard; taking into account maternal and fetal factors that may affect amniotic fluid volume. Methods. A cross-sectional analytical study at Chris Hani Baragwanath Academic Hospital; Johannesburg; South Africa; on women referred from midwife-run clinics with suspected gestational age ?41 weeks. Eligible women had their AFI measured; then had abdominal palpation by the researcher; who was blinded to exact gestational age and AFI findings. Palpation focused on ballottability of fetal parts; ease of feeling fetal parts; and impression of fetal compaction. Gestational age was then recalculated using information from earlier ultrasound scans and menstrual dates. Univariable and multivariable logistic regression was performed with oligohydramnios (AFI 5 cm) as the dependent variable.Results. Of 100 women; 45 had a recalculated gestational age ?41 weeks. Twenty-three had oligohydramnios. Gestational age was a significant independent predictor for oligohydramnios (odds ratio (OR) 1.78; 95 confidence interval (CI) 1.08 - 2.94). The only component of palpation significantly associated with oligohydramnios; after adjustment for gestational age; was non-ballottability of the presenting part (adjusted OR 4.02; 95 CI 1.05 - 15.4). Non-ballottability had a sensitivity and specificity for oligohydramnios of 87 and 40; respectively; with a negative predictive value of 91.Conclusion. When ultrasound is not available; ballottability of the presenting part may have value for excluding oligohydramnios and assisting clinical decisions in suspected prolonged pregnancy

Presence of Chaperones during Pelvic Examinations in Southeast Nigeria: Women's Opinions; Attitude; and Preferences

Objectives: To assess the opinions; attitude; and preferences of Nigerian women to the presence of chaperones during pelvic examinations.Materials and Methods: A cross-sectional survey of first time gynecology clinic attendees on their opinions; attitudes; and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi-structured; researcher-administered questionnaires.Results: One hundred and nineteen (51.7) of the respondents preferred female physicians for pelvic examination; 23 (10) preferred male physicians and 88 (38.3) had no gender preference. When the examining physician is a male; 124 (53.9) respondents would like to have chaperones during pelvic examinations while 106 (46.1) would not. Eighty-three percent of respondents preferred nurse chaperones. Age; level of education; and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones (P = 0.503; 0.525; and 0.605 respectively).Conclusions: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients' right to refuse the offer

Pattern of childhood gynaecological presentations in a Nigerian tertiary health facility

Background: Gynaecological problems in children and adolescents are often both medically and psychologically unique and require a highly skilled approach differing from those utilized for an adult female population. There is paucity of data on childhood gynaecological problems in our environment. The purpose of this study was to document the prevalence and pattern of common gynaecological problems in the prepubertal child at Ahmadu Bello University Teaching Hospital Zaria; Northern Nigeria. Materials and Methods: This was a retrospective study involving case file-based data analysis over a 10-year period (1995-2004) of 62 children aged 1 month-12 years at the Gynaecology unit of Ahmadu Bello University Teaching Hospital Zaria; Northern Nigeria. Results: Sixty-two children were seen; 17 infants; 14 under 5 years of age; and the rest (31) were aged 6-12 years. The commonest condition was labial fusion (33.9); urethral prolapse (14.5); and suspected sexual assault (12). Ambiguous genitalia (9.7); vaginitis (6.5); and ovarian tumour (4.8) were also encountered. Conclusion: Labial fusion; urethral prolapse; and suspected sexual assault are the commonest childhood gynaecological morbidities in Zaria. Provision of gynaecological services at every level of health care system to cater for young females is advocated