ABSTRACT
Background: Pelvimetry is a poor predictor of obstetric outcome. The predictive value of clinical pelvimetry remains limited except in extreme pelvic contracture or an excessively large fetus. Objective: To determine the attitudes of primigravidae to routine clinical pelvimetry. Subjects and Methods: This was a cross-sectional study of primigravidae at the University of Nigeria Teaching Hospital (UNTH), Enugu between January 1st and December 31st, 2009. Selfadministered, structured, and pre-tested questionnaires were distributed to the consenting selected women by trained medical interns. Data was analyzed using SPSS version 16. P< 0.05 was considered statistically significant. Results: A total of 195 primigravidae were selected at random for this study. One hundred and thirty eight primigravidae (138/195, 70.77%) were aware of clinical pelvimetry while 29.23% (57/195) were not aware of clinical pelvimetry. One hundred and twenty five primigravidae (90.58%, 125/138) desired clinical pelvimetry to continue while thirteen (9.42%, 13/138) did not desire clinical pelvimetry to continue. There was statistically significant difference between those who were aware and unaware of pelvimetry in their desire for pelvimetry [X2=18.903, p=0.0001, OR 5.2, 95% confidence interval=2.20 to 12.44]. Conclusion: There is profound awareness and the desire to continue clinical pelvimetry among primigravidae at the UNTH, Enugu, Nigeria, where majority of the women showed strong preference for it.
ABSTRACT
Background: Amniotic fluid embolism (AFE) is a rare obstetric emergency with unclear aetiology, pathophysiology, diagnosis and management. The true incidence is unclear and diagnosed largely by exclusion. It can neither be predicted nor prevented and its management is fraught with controversy. Objective: To provide clinicians with current knowledge regarding the epidemiology, pathophysiology and management of AFE. Methods: This was a descriptive review of AFE. We searched several databases (Medline, Google scholar and Pubmed) with keywords, amniotic fluid, amniotic fluid embolism, amniotic fluid embolus and sudden postpartum collapse from inception to June 2014. Results: Data regarding the presence of risk factors for AFE are inconsistent, complex and contradictory. No risk factor has been identified that would justify modification of standard obstetric practice to reduce the risk of AFE. Further understanding of this syndrome has been hampered by lack of universally accepted diagnostic criteria. Diagnosis of AFE is clinical, largely by exclusion, and maternal treatment is primarily supportive and not causative. Mortality is still high despite improved modalities for diagnosing AFE, and better intensive care support facilities. Conclusion: AFE is a rare and dreadful obstetric emergency with a high morbidity and mortality rate. Our understanding of its aetiology and pathophysiology is incomplete and the criteria used to make its diagnosis are controversial. Inspite of advances in the care of critically ill patients, no management interventions have been found to improve survival or long-term outcome of patients with AFE.
ABSTRACT
Background: The quest for ideal treatment and understanding of fibroid biology has resulted in further studies in pharmacological, radiological and surgical options with the goals of being safe, less invasive, cost-effective and enhancing reproductive potentials. However, surgery remains the mainstay of present effective management for large symptomatic fibroids. Aim: The aim is to review the treatment options available for women with uterine fibroids. Methods: Publications on the management of uterine fibroids were accessed using medline, google scholar and pubmed databases. Relevant materials on treatment of uterine fibroids, selected references from internet services, journals, textbooks and lecture notes on management of uterine fibroids were also accessed and critically reviewed. Results: The mainstay of management for large symptomatic fibroids is surgical (myomectomy or hysterectomy). Minimally invasive procedures are becoming more commonly performed via both laparoscopic or hysteroscopic approaches, minimizing recovery time, postoperative pain and morbidity. Uterine artery embolization (UAE) carries a risk of pelvic infection with limited evidence regarding the risks for future pregnancies. Levonorgestrel-releasing intrauterine system (LNG-IUS) is effective as a treatment for heavy menstrual bleeding. However, it is not recommended if the uterine cavity is markedly enlarged or distorted by fibroids. Gonadotrophin releasing hormone analogue (GnRHa) is the most widely used medical option. It can reduce the size of fibroids by about 30-35%, but only used for short-term course or preoperative mode of management since the resulting hypoestrogenic state can cause osteoporosis in long-term course. Furthermore, it can restore haemoglobin levels and apparently reduce blood loss at operation but notorious for rebound growth of fibroids upon cessation of therapy with major adverse effects. Newly introduced treatment options are poorly understood, still unclear with lots of theoretical advantages not fully backed with long-term effects. Little is known about their risks, cost and adverse effects. Conclusion: Fibroids are commonly found in women of reproductive age. Most women do not require treatment because fibroids are benign and most times asymptomatic. For symptomatic fibroids, many treatment options exist and should be considered before the decision to perform hysterectomy which precludes future fertility.
ABSTRACT
Background: Female genital mutilation is known to exist especially in many third world countries including Nigeria with many women being victims of this harmful practice and its complications. The practice is rife in Southeast Nigeria and efforts have been made to discourage it. Objective: To determine women's views on aspects of female genital mutilation and the prevalence among the study population. Method: Women attending the antenatal clinics of two university teaching hospitals in Southeast Nigeria were interviewed by means of structured pre-tested interviewer- administered questionnaires. The data obtained were analysed using SPSS version 10.0 and the results expressed in descriptive statistics as percentages. Results: The prevalence of FGM was 42.1. However; only 14.3of the respondents circumcised their own daughters or showed willingness to circumcise their daughters indicating considerable reduction in uptake of the practice. A larger proportion (63.7) would support legislation against FGM. Conclusion: There is a high opinion against the practice of FGM in Southeast Nigeria; with the majority of the women showing support for legislation