Incidence and outcome of umbilical cord prolapse: experience in a tertiary health facility south eastern Nigeria

BACKGROUND: Umbilical cord prolapse is a rare obstetric emergency with adverse perinatal outcomes. The incidence has been on the decline, hence necessitating the need for periodic evaluation in order to document its contribution to perinatal indices. We sought to determine the incidence, predisposing factors and fetal outcome of umbilical cord prolapse.METHODS: This was a retrospective descriptive study carried out in Federal Medical Centre(FMC), Umuahia over a 5-year period from January 1, 2009 to December 31, 2013. Data was analyzed using WinPepi version 11.65. Statistical analysis was done using Chi-squared test with level of significance set at P < 0.05. RESULTS: The incidence of umbilical cord prolapse was 0.3%. The mean age was 31.8 ± 5.1 years. Multiparous women constituted 80% of those diagnosed with the condition while 84% of the women were unbooked. Although multiple risk factors were noted in the parturient, multiparity ranked highest (80%) while artificial rupture of membrane contributed the least (4%). Most (84%) of the women were delivered by emergency cesarean section. The perinatal mortality rate was 12%. CONCLUSION: Umbilical cord prolapse remains a high risk condition to the fetus. Therefore, early presentation to the health care facility in the event of membrane rupture may improve its outcome

Risk factors and perinatal outcome of umbilical cord prolapse in Sagamu, Nigeria

Background: Umbilical cord prolapse is an obstetric emergency that threatens the life and well-being of the fetus and also increases maternal morbidity. Fetal survival in umbilical cord prolapse can be enhanced by prevention where risk factors are identified and prompt diagnosis and decisive intervention.Objective: The aim of this study was to determine the incidence, identify the risk factors associated with umbilical cord prolapse and document the perinatal outcome of cases of cord prolapse.Methods: This was a 13-year retrospective case-control study of cases of umbilical cord prolapse seen at the OOUTH, Sagamu, Southwestern Nigeria between January 1, 2000 and December 31, 2012.Result: During the study period, the incidence of umbilical cord prolapse was 1 in 122 deliveries (0.82%). The umbilical cord prolapse occurred in association with breech presentation five times (33.3%) and transverse lie eleven times (18.5%). The occurrence of breech presentation among the control cases was 8.6% (p<0.001) and that of transverse lie was 1.9% (p<0.001). There were also significant statistical differences between the cases of cord prolapse and controls in terms of prematurity, low birth weight, unbooked status and multiparity. The perinatal rate was 222/1000 (22.2%) compared to the perinatal mortality of 68/1000 (6.8%) for the control group.Conclusion: It is suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care as this will enhance early identification of the risk factors and appropriate management instituted to reduce perinatal mortality

Urethral mucosal prolapse in young girls: a report of nine cases in Cotonou

Background: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. Materials and Methods: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. Results: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The main presentation was vaginal bleeding (five cases). Physical examination revealed a soft; non-tender mass that bleeds on touch (six cases); with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery; one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. Conclusion: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical

Risk Factors and Perinatal Outcome of Umbilical Cord Prolapse in Ebonyi State University Teaching Hospital; Abakaliki; Nigeria

Aim: The goal of this study was to identify risk factors associated with umbilical cord prolapse and to document the perinatal outcome of cases of cord prolapse. Materials and Methods: During the period of the study (from July 1; 2001 and June 30; 2007); forty-six cases of umbilical cord prolapse were identified from the labor ward record and analyzed retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. Results: During the period of the study; 46 cases of cord prolapse were encountered out of 10;080 deliveries which was 0.46of all deliveries. Of the 46 fetuses with umbilical cord prolapse 32.6had a fetal weight of less than 2.5 kg compared with 15.2for fetuses in control group (P0.012). The umbilical cord prolapse occurred in association with breech presentation eleven times (23.9) and transverse presentation seven times (15.2). The occurrence of breech presentation among the control cases was 4.3(P0.00031); and that of transverse lie was 4.4(P0.02007). Among the women that had cord prolapse; 47.8had unbooked pregnancies compared with the control group with 14.5(P0.0000033). Multiparity accounted for 78.3in the cord prolapse cases and 68.1in the controls (P=0.19). The perinatal mortality rate was 413/1000. (41.3); compared to the perinatal mortality of 58/1000 for the control group. Conclusions: Our findings in this study has confirmed an association between increased risk of umbilical cord prolapse and abnormal fetal presentation; low birth weight and unbooked status. It is therefore suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care and this will enhance the early identification of these risk factors and an appropriate management instituted to reduce perinatal mortality

Interet du remplissage vesical au cours des procidences du cordon ombilical pulsatile a propos de 14 cas observes a la maternite du CHUA de Befelatanana (Antananarivo- Madagascar)

La procidence du cordon ombilical ou chute de celui-ci en avant de la presentation apres rupture spontanee ou artificielle de la poche des eaux constitue une extreme urgence obstetricale par le risque majeur de mortalite perinatale qu'il represente. La technique du remplissage vesical decrite depuis les annees 80 est unmoyen simple; efficace de reduction du risque de deces foetal; meme en cas de retard a la sanction chirurgicale. L'objectif de notre etude est de rapporter l'experience du service de Gynecologie Obstetrique de Befelatanana (CHU d'Antananarivo) sur cette technique; qui prouve sa fiabilite et son interet par des resultats identiques a ceux de la litterature. Sa simplicite de mise en oeuvre et son efficacite sur le risque foetal merite; tout particulierement dans les pays a faible infrastructure obstetricale; d'etre enseignee et utilisee

Vault Prolapse Treated by Sacrocolpopexy

Objective. To evaluate the success rate of sacrocolpopexy in 153 patients with stage 3 and 4 vault prolapse. Methods. A retrospective review was done on 153 patient records from a database in a urogynaecological unit. For the sacrocolpopexy procedure; semi-absorbable mesh was placed along the anterior and posterior vaginal walls; and attached to the anterior longitudinal ligament of the sacrum. Results. The median age was 65 years and parity 3.0; 94of the patients were white. Previous surgery for prolapse was reported by 48of the patients and 25were on thyroid hormone treatment. The vault prolapse was stage 3 in 81 patients (52.9) and stage 4 in 72 (47.1). At surgery; the mesh extended from the vaginal vault to the sacrum in 7 patients (4.6). In the remaining 146 patients (95.4) the mesh was attached to the posterior vaginal wall and in 133 (86.9) a second strip of mesh was fixed to the anterior vaginal wall. Follow-up was possiblein 149 patients (97.4); with a median of 29 months. Recurrent prolapse (any type) occurred in 22 patients (14.4)and 12 had repeat surgery for recurrent prolapse (7.8). In total; 25 patients (16.3) had repeat surgery for anyindication. Conclusions. Vault prolapse is difficult to treat owing to absence of support of the upper vagina; but sacrocolpopexy delivered acceptable results

Combined Abdominal Sacrocolpopexy and Burch Colposuspension for the Treatment of Stage 3 and 4 Anterior Compartment Prolapse

Objective. To review our experience with sacrocolpopexy and Burch colposuspension for stage 3 and 4 anterior compartment prolapse. Methods. Review of 154 patient records drawn from a urogynaecological database; with stage 3 and 4 anterior compartment prolapse treated by sacrocolpopexy and Burch colposuspension. Results. The median age of the patients was 60 years and a third of them had had previous prolapse surgery. Patients presented with bladder (41) and bowel (55) symptoms; and most complained of prolapse protruding through the vaginal introitus (86). Recurrent prolapse; stage 2 - 4; occurred in 24 patients (15.6); 9.7were anterior compartment prolapses. Where mesh was omitted from the anterior vaginal wall but placed on the posterior vaginal wall; significantly more recurrent anterior compartment prolapses occurred (95confidence interval (CI) 0.2; 34.8) compared with cases where mesh was placed both anteriorly and posteriorly to the vagina. Perioperative complications occurred in 13of patients. A tension-free vaginal tape (TVT) procedure for urinary stress incontinence was done at a later stage in 8of the patients. Conclusion. Sacrocolpopexy effectively treated anterior compartment prolapse where mesh was attached to the anterior vaginal wall as well. A Burch colposuspension probably did not make a difference

Urgences gynecologiques prepubertaires : aspects diagnostiques et therapeutiques a propos de 239 cas colliges dans le service de Gynecologie et d'Obstetrique du CHu de Treichville

Nous avons a partir d'une etude retrospective s'etendant sur une periode de 11 ans; etudie les pathologies gynecologiques pre pubertaires recensees aux urgences gynecologiques du CHU de Treichville (ABIDJAN); chez 239 patientes agees de 0 a 9 ans. Notre etude i. etait axee sur l'analyse des donnees epidemiologiques et sur les aspects diagnostiques et therapeutiques. Elle a permis de faire les constatations suivantes: -les pathologies gynecologiques prepubertaires sont de frequence tres faible; dans notre service; representant 0.76pour cent des admissions aux urgences; -le prolapsus de l'uretre est la pathologie gynecologique prepubertaire la plus frequente (38.9pour cent); suivi des traumatismes genitaux accidentels (14.2pour cent); des violences sexuelles (13.4pour cent) et des infections vulvovaginales (12.1pour cent). Les methodes therapeutiques ont ete soit medicales (43.5 pour cent) avec l'administration d'antibiotique; d'anti inflammatoire; d'antiseptique local; de creme d'oestrogene; soit chirurgicales (41.4pour cent) par des methodes de ligature du prolapsus de l'uretre; de suture genitale et d'extraction de corps etranger. La mise en place d'une cellule specifique integree contribuerait a une meilleure prise en charge des pathologies gynecologiques pre pubertaires

Le prolapsus du meat uretral chez l'enfant feminin de race noire : une cause rare d'hemorragie genitale (a propos de 11 cas personnels)

L'auteur rapporte onze cas personnels observes en Afrique de janvier 1987 a juillet 1993; de prolapsus muqueux du meat uretral chez la fille. Cette affection benigne d'etiologie encore inconnue qui se manifeste le plus souvent par des hemorragies genitales; touche avec predilection l'enfant de race noire. Cause rare de consultation urologique; le diagnostic en est relativement aise devant la survenue d'un epanchement vulvaire sanglant et l'existence d'une tumefaction peri-meatique saillante. Tout en se rappelant les principaux aspects cliniques; etio-pathogeniques; histologiques et therapeutiques de cette tumeur; l'auteur insiste sur l'interet de l'exerese chirurgicale comme etant l'intervention de choix dans la cure du prolapsus muqueux de l'uretre par sa complicite technique; par son absence de complications et ses bons resultats constants