Experience with Diagnostic Laparoscopy for Gynecological Indications

Context: Diagnostic laparoscopy is an endoscopy procedure; which has become indispensable in the evaluation of the female reproductive organs especially in infertility. Aim: Experience with conversion to open laparotomy is presented and ways of averting this complication are discussed. Settings and Design: A retrospective study was performed. Materials and Methods: All the 1654 diagnostic laparoscopies performed at a private fertility center over a 10-year period (January 2000 to December 2009) were analyzed for indications; cases of conversion to open laparotomy; and measures taken to prevent this complication. Statistical Analysis Used: Simple percentage method was used. Results: Infertility was the commonest indication for 1627 (98.4) procedures; while primary amenorrhoea and chronic pelvic pain were responsible for 20 (1.2) and 7 (0.4) procedures; respectively. There was no mortality in this series. There was conversion to open laparotomy due to hemorrhage in only 2 (0.12) procedures and this happened at the first year of practice. Conclusions: The low rate of conversion was attributed to the surgeons experience; proper patient selection; and the use of Palmers point for insufflation in some patients with previous pelvic surgeries and use of supraumbilical access in patients with pelvic masses. Diagnostic laparoscopy for gynecological indications is safe and wider application of this modern technology is recommended for our practice

Clinical Presentation of Uterine Fibroids in Nnewi; Nigeria: A 5-year review

Uterine leiomyomas are the commonest benign tumors in women; with a higher preponderance amongst Africans. Several etiological factors have been suggested; with subtle variations in clinical presentation being reported in different studies. This may constitute a determinant for the management measures undertaken. Aim: To review the clinical presentation and management measures undertaken for uterine leiomyoma. Subjects and Methods: A retrospective study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH); Nnewi; from January 2002 to December 2006. A review of case records of patients with a diagnosis of uterine leiomyoma was done. The data were analyzed and presented in tables using comparative percentages. Results: Uterine leiomyoma constituted 117 of the 1094 gynecological admissions during this study period (10.7; 117/1094). The mean (SD) age of presentation was 35.7 (6.1) years. Most of the patients were nulliparous (76.7; 79/103) and 51.5 (53/103) were married. The commonest mode of presentation was lower abdominal mass (66.9; 67/103) and the least was recurrent abortion (1; 1/103). Surgery was employed in all cases; with myomectomy being the commonest modality used in 90.3 (93/103) of cases. The common postoperative complications were prolonged pain (49.5; 51/103) and postoperative pyrexia (34.9; 36/103). Conclusion: The symptom of lower abdominal mass correlates with late presentations in our setting. This makes the application of newer therapies like laparoscopic myomectomy difficult even when they are available. Other therapies which are independent of fibroid size (like uterine artery embolization) are not readily available in our environment. This further emphasizes the importance of myomectomy as the most important treatment modality in our environment

Sexual abuse among juvenile female street hawkers in Anambra State, Nigeria

Street hawking exposes young girls to all forms of hazards, including sexual abuse. This descriptive study examines the size of the problem and the consequences of sexual abuse on juvenile female street hawkers randomly recruited from two urban towns in Anambra State of Nigeria. Data was collected with semi structured, interviewer administered questionnaires. The mean age of the female hawkers was 13.0 + 2.2 years. Out of 186 respondents, 130 (69.9%) had been sexually abused with 32 (17.2%) having had penetrative sexual intercourse (28.1% were forced and 56.3% submitted willingly) while hawking. Majority (59.4%) of the sexual partners were adults. Other types of sexual abuse experienced include inappropriate touches (106 cases; 81.5%) and verbal abuses (121 cases; 93.1%).. There was low awareness of the twin risks of pregnancy (43.1%) and sexually transmitted infections (54.3%) following sexual abuse among the respondents. Sexual abuse of young female hawkers is an issue of great public health importance. Poverty alleviation, health education and protective child right policies will decrease its prevalence and the associated risks. (Afr J Reprod Health 2008; 12[2]:111-119)

Placenta Praevia: Review of Clinical Presentation and Management in a Nigerian Teaching Hospital

Background: The study aims at reviewing the clinical presentation and management of placenta praevia in a tertiary health facility. Method: This is a retrospective study of 59 cases of placenta praevia managed at the Nnamdi Azikiwe University Teaching Hospital; Nnewi from January 1997 to December 2001. The case records of 44 of the patients were obtained from the hospital medical records department and analysed. Results: During the five year period; there were 3565 deliveries and 59 cases of placenta praevia giving an incidence of 1.65. Thirty four (77.3) occurred in women aged 35 years and below. The commonest was type III (12 cases; 27.3) followed by type IV (10 cases; 22.7). Previous uterine scar was associated with 22 (50.0) cases. Age had no statistically significant effect on the prevalence. The commonest GA range at presentation (13; 29.6) and at delivery (18; 40.9) was 37-40 weeks. The commonest mode of presentation was antepartum haemorrhage (34;77.3) followed by abnormal lie and malpresentation (4 each; 9.1). The average admission delivery interval was one week in 33 (75.0) cases and only two (4.5) received blood transfusion. Forty (90.9) women had caesarean delivery while 12 (27.3) babies were of low birth weight. There were only 2 (4.5) fetal deaths and one (2.3) caesarean hysterectomy. Conclusion: The commonest predisposing factor to placenta praevia in this study is previous uterine scar. Judicious use of caesarean section especially in the primigravida will help reduce the incidence of placenta praevia. Also a screening ultrasonography at 34-36 weeks gestation (especially in women with previously scarred uterus) is recommended

Placenta Praevia: Review of Clinical Presentation and Management in a Nigerian Teaching Hospital

Background:The study aims at reviewing the clinical presentation and management of placenta praevia in a tertiary health facility. Method: This is a retrospective study of 59 cases of placenta praevia managed at the Nnamdi Azikiwe University Teaching Hospital; Nnewi from January 1997 to December 2001. The case records of 44 of the patients were obtained from the hospital medical records department and analysed. Results: During the five year period; there were 3565 deliveries and 59 cases of placenta praevia giving an incidence of 1.65. Thirty four (77.3) occurred in women aged 35 years and below. The commonest was type III (12 cases; 27.3) followed by type IV (10 cases; 22.7). Previous uterine scar was associated with 22 (50.0) cases. Age had no statistically significant effect on the prevalence. The commonest GA range at presentation (13; 29.6) and at delivery (18; 40.9) was 37-40 weeks. The commonest mode of presentation was antepartum haemorrhage (34;77.3) followed by abnormal lie and malpresentation (4 each; 9.1). The average admission delivery interval was one week in 33 (75.0) cases and only two (4.5) received blood transfusion. Forty (90.9) women had caesarean delivery while 12 (27.3) babies were of low birth weight. There were only 2 (4.5) fetal deaths and one (2.3) caesarean hysterectomy. Conclusion: The commonest predisposing factor to placenta praevia in this study is previous uterine scar. Judicious use of caesarean section especially in the primigravida will help reduce the incidence of placenta praevia. Also a screening ultrasonography at 34-36 weeks gestation (especially in women with previously scarred uterus) is recommended