Myomectomy at caesarean section: descriptive study of clinical outcome in a tropical setting

In the tropics, leiomyoma are commonly encountered in women of the reproductive age group, although they are mostly asymptomatic. Surgery for uterine fibroid at caesarean section has remained controversial. To analyse the clinical outcome of women that had selective caesarean myomectomy in a community teaching hospital. Twenty-two women that had selective myomectomy at caesarean section between January 2002 and October 2007 were analysed. The patients mean age was 31.5 years with age range of 27-44 years. Of the 22 patients, 16 [72.7%] were Primigravida, 19 [86.4%] of the patients had caesarean section at term, 2 [9.1%] and 1 [4.5%] of the patients were preterm and post term respectively. A significant number of the patients [16/22, 72.7%] had elective caesarean section and the remaining 6 [27.3%] patients had emergency caesarean section. The 3 leading indications for caesarean section among the patients were malpresentation/abnormal lie 36.4%, uterine fibroids 18.2%, and a previous caesarean section with complication in 13.6% of the patients. Indications for myomectomy at caesarean section were fibroid in lower uterine segment in 15 [68.2%] patients, pedunculated uterine fibroid in 4 [18.2%] patients and anterior subserous fibroid in 3 [13.6%] patients. Intraopertively in the 22 patients, 10 [45.5%] had fibroid[s] removed only in the lower uterine segment; while 6 [27.3%] patients each, had it removed in the upper uterine segment and both upper and lower uterine segments respectively. A total of 46 fibroids were removed in the 22 patients, of which 24 [52.2%] were subserous/pedunculated, 16 [34.8%] intramural and 6 [13.0%] were submucous. Of the 46 fibroids, 32 [69.9%] were between 6 to 10 cm size. Sixteen [72.2%] of the 22 patients lost between 751 to 1000 ml of blood intraoperatively with an average of 806.8 ml of blood loss. Two [9.1%] of the 22 patients had blood transfusion due to anaemia. Other complications encountered were puerperal pyrexia and sepsis in 2 [9.1%] patients, and fracture of the humerus and clavicle of the baby in 1 [2.3%] patient. There was no maternal and perinatal mortality. Selection of patients for caesarean myomectomy reduces blood loss, anaemia and other complications

Inevitable peripartum hysterectomy in a tropical hospital: Indications and maternofetal outcome

To determine the indications for inevitable peripartum hysterectomy [IPH], associated demographic variables and the materno fetal outcome. A retrospective analysis of twenty two patients that had inevitable peripartum hysterectomy [IPH] during the study period of 4 years, July 2001 to June 2005. The mean age of the patients was 32.4 years with a range of 18 to 47 years. The parity ranged from 1 to 9. The parity distribution was positively skewed indicating the rate of IPH increased with parity. Sixteen [72.7%] patients did not have antenatal care and 21[%] out of the 22 patients were refereed from other health facilities. Indications for IPH were ruptured uterus in 16[72.7%] patients, uterine atony in 4[18.2%] patients. Of the 22 patients, 15 [68.2%] delivered per abdomen while 7[31.8%] delivered per vagina. The indications for abdominal delivery were laparotomy for ruptured uterus with extraction of the fetus in 11 [50%] patients and caesarean section in 4[18.2%] patients on account of placenta praevia in 2 patients. Of the 7 patients that delivered per vaginam, 3[13.6%] had spontaneous vertex delivery, 1[4.5%] had vacuum delivery, 2[9.1%] had breech extraction of second twin and 1[4.5%] patient had embryotomy. Subtotal hysterectomy was the most commonly preformed type of hysterectomy in 17[77.5%] of the cases. High maternal mortality of 59.1% and perinatal mortality of 77.3% was recorded in the study. Ruptured uterus which is associated with poor pre-surgical clinical state was the leading indication for IPH in this study. This may be responsible for the high maternal and fetal mortality recorded in this study and not necessarily the hysterectomy procedure itself

Treatment outcome of hyperprolactinaemic infertility with carbegoline in sub saharan Africa

Hyperprolactinaemia is a known cause of infertility. We explored the efficacy of carbegoline, the long acting dopamine agonist that was recently introduced into our medical practice. Seventy six patients with infertility secondary to hyperprolactinaemia were studied over a period of 20 weeks each. All the patients had carbegoline twice weekly for eight weeks. Two dosage regimen were used based on the pretreatment prolactin level; less than 50ng/ml had 0.25mg twice weekly [n=58] and 50ng/ml and above 0.5mg twice weekly [n=18]. Normalization of prolactin level was achieved in 75 [98.7%] patients. At the end of the study period, there was resumption of menstrual flow in 10 [76.9%] of the 13 patients that were amenorrhoiec and all the 39 [100%] patients that were oligomenorrhoeic had their normal menstrual cycle restored. Resumption of ovulatory cycles occurred in 87.7% of those with anovulatory cycles. Of the 76 patients, 69 [90.8%] got pregnant during the 20 weeks study. However, out of the 69 that got pregnant, 13 [18.8%] got pregnant while on carbegoline therapy. There was no case of carbegoline resistance or discontinuation recorded in this study. Carbegoline is a cost effective first line therapy in the management of infertile women with hyperprolactinaemia