Leaking Ectopic Pregnancy Following In vitro Fertilization with Associated Acute Appendicitis.

BACKGROUND: Ectopic pregnancy associated with appendicitis is rare, with very few cases reported in the literature. It is unclear if appendicitis is coincidentally associated with ectopic pregnancy or a possible risk factor for the development of ectopic pregnancy. Ruptured ectopic pregnancy has also been postulated as a possible risk factor leading to appendicitis because of the probable inflammatory reaction involving the adjacent appendix. METHODS: We present a 34-year-old female who presented with right lower abdominal pain and bleeding per vaginam, three weeks after in-vitro fertilization and embryo transfer. RESULTS: A diagnosis of ectopic pregnancy was made following a positive ß-HCG and empty uterine cavity on pelvic ultrasound scan. Intraoperatively, the appendix was noted to be inflammed and it was removed and confirmed on histology examination as acute appendicitis. CONCLUSION: Ruptured ectopic pregnancy associated with acute appendicitis is rare, with few cases reported in the literature. We recommend an examination for other possible differentials of ruptured ectopic pregnancy like appendicitis during surgery for ectopic pregnancy on the right side.

CONTEXTE: L'association de la grossesse extra-utérine avec l'appendicite est rare, avec très peu de cas rapportés dans la littérature. Il n'est pas clair si l'appendicite est associée de manière fortuite à la grossesse extra-utérine ou si elle constitue un facteur de risque possible pour le développement de celle-ci. On a également postulé que la grossesse extra-utérine rompue pourrait être un facteur de risque conduisant à l'appendicite en raison de la probable réaction inflammatoire impliquant l'appendice adjacent. MÉTHODES: Nous présentons le cas d'une femme de 34 ans qui s'est présentée avec une douleur abdominale basse à droite et des saignements vaginaux, trois semaines après une fécondation in vitro et un transfert d'embryon. RÉSULTATS: Un diagnostic de grossesse extra-utérine a été posé suite à un test de ß-HCG positif et une cavité utérine vide à l'échographie pelvienne. En peropératoire, l'appendice a été noté comme étant inflammé et a été retiré. L'examen histologique a confirmé une appendicite aiguë. CONCLUSION: La grossesse extra-utérine rompue associée à une appendicite aiguë est rare, avec quelques cas rapportés dans la littérature. Nous recommandons un examen pour d'autres diagnostics différentiels possibles de la grossesse extra-utérine rompue, comme l'appendicite, lors de la chirurgie pour grossesse extra-utérine du côté droit. MOTS CLÉS: Grossesse extra-utérine hémorragique, Appendicite, Fécondation in vitro, Laparotomie.

Standard of care for HIV prevention technology research: a consensus document from Nigeria.

AIM: A framework of care includes the notion that care is that received from outside an individual and nurtures its body and soul. Defining care and the context of providing it is difficult especially with the ever changing and evolving field like that found operational in the HIV and AIDS research field. The standard of care for HIV and AIDS prevention trials continues to evolve and countries/communities are encouraged to define locally relevant standard of care guidelines. The paper reports on the consensus reached by stakeholders in Nigeria on the standard of care to be provided during HIV prevention research. It is an attempt by the community of stakeholders involved with New HIV Prevention Technology trials in Nigeria to define the standard of care for HIV prevention research in Nigeria. METHOD: Four consultative meetings involving policy makers, the national government and government agencies, representatives of donor communities, regulatory agencies in the country, community advocates, people living with HIV/AIDS, sex workers, people who engage in sae sex practices, researchers, women, youths, journalists and organizations that serve these various communities, were held. This is a report of the consensus reached on the standard of care for HIV prenvention in Nigeria. RESULTS: Such obligations include the provision of counselling and testing for trial participants throughout the trial and during the post trial period using the most sensitive and specific test kits for the most prevalent HIV strains in the country. ART provision should also be provided for trial participants who seroconvert during the trial by the sponsors after which the trial participants are rolled unto the national governments' ART programme. Researchers and sponsors also have defined obligatory responsibilities to volunteers who screen out of the trial and to trial participants' spouse. The report also defines good research practice with respect to access to health care services as well as moral obligatory responsibilities of researchers and sponsors to trial participants. CONCLUSION: The consensus on standard of care for HIV prevention research in Nigeria is a step forward with respect to mapping the path for future HIV prevention research in Nigeria is a step forward with respect to mapping the path for future HIV preventive research in the country. As emerging issues emerge, there will be a need to review and define these standards again.

Small bowel obstruction following perforation of the uterus at induced abortion.

BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had full clinical assessment and laboratory investigations which indicated small bowel obstruction following perforation of the uterus at induced abortion, and was commenced on treatment. RESULTS: She was para 5+0. Her main complaints were abdominal and weight loss following induced abortion of a 12- week pregnancy, four months prior to presentation. At presentation the tools (ultrasound scan, plain abdominal radiograph and barium enema) used for diagnoses only suggested some form of intestinal obstruction and were unremarkable. Correct diagnoses indicating small bowel obstruction was only made at laparotomy. An exploratory laparotomy, adhesiolysis, small bowel resection, end to end anastomosis and bowel decompression was done after bowel preparation. CONCLUSION: Laparotomy has an enviable place in bowel injuries secondary to uterine perforation especially when there is a diagnostic dilemma. Nigerian female population requires continuous health education on widespread and effective use of contraception. Physicians need training and retraining on abortion techniques and management of abortion complications.

Incidence and aetiological factors of incisional hernia in post-caesarean operations in a Nigerian hospital.

Caesarean operations accounted for most of the postoperative incisional hernias seen in our surgical clinic. In order to determine the incidence and aetiological factors of incisional hernia, all the women who had caesarean operations were reviewed retrospectively. There were 22 cases of incisional hernia, accounting for 3.1% of total 701 patients who had caesarean sections during the period of the study. The incidence of incisional hernia was influenced by the type of incision, as all those who developed incisional hernia had a midline incision, the need for additional operative procedures and antibiotic administration longer than usual with more potent antibiotics. Presence of postoperative abdominal distention, intra-abdominal sepsis, residual intra-abdominal abscess, wound infection and wound dehiscence and postoperative fever also contributed significantly to the incidence of incisional hernia. Those who developed incisional hernias also suffered other postoperative complications and stayed longer in the hospital after the operation. The age of the patients, the parity and indication for caesarean section did not influence the incidence of incisional hernia in this study.

Forceps delivery at Wesley Guild Hospital, Ilesa, Nigeria: a ten year review.

In a ten year review in a Nigerian teaching hospital, forceps delivery accounted for 2.1% of the total births. Delivery was at 36-40 weeks in majority (79.3%) of the patients and primiparae accounted for 45.4% of the cases. The procedures were performed as emergencies in 78.6%, while the majority (91.1%) were outlet forceps deliveries. The common indications were prolonged second stage of labour (58.7%), hypertension in pregnancy/pre-eclampsia (10.3%), fetal distress (9.2%), eclampsia (8.1%) and maternal distress (5.9%). Bruises of the fetal head and fracture of the skull complicated 9.2% and 2.2% of the cases respectively. The main maternal complications were post-partum haemorrhage (3.3%), puerperal sepsis (2.9%), broken down episiotomy repair (2.9%), third degree perineal tear (2.2%) and vaginal lacerations (2.2%). Measures aimed at reducing the associated hazards are suggested.

Socio-economic factors and dental health in an obstetric population.

The relationship between socio-economic factors and dental health in an Obstetric Nigerian population was studied. The mean gestational age (+/-standard deviation) was 30.16 + 5.45 weeks (range 16-40 weeks). Acquisition of dental education was found to be unrelated to level of education. When the prevalence of dental caries and periodontal disease were considered, the difference between the high, middle and low socio-economic groups were found to be significant (p < 0.05).

Trends in maternal deaths in Ilesa, Nigeria, 1977-1988.

Cases of maternal deaths at Wesley Guild Hospital, Ilesa, Nigeria, from January 1977 to June 1988 were reviewed. The maternal mortality rate of 2.85 per 1000 births recorded is an improvement over earlier figures due at least in part to improved obstetric care services. Illegally induced abortion was the most significant cause of maternal deaths (32.7%). Other causes were sepsis (17.3%), obstetric haemorrhage (15.4%), ruptured uterus (9.6%) and anaemia (7.7%). The problems of illegal abortion, poor antenatal and delivery supervision and late referral of cases were implicated as aetiologic factors.

Rupture of the gravid uterus in Ile-Ife, Nigeria.

PIP: To study cases of ruptured gravid uterus in Ile-Ife, Nigeria, medical records were examined. From January 1979 to December 1986, the records indicated 30,511 deliveries and 120 cases of ruptured uterus; the incidence rate was 0.4%. 112 patient records were studied. Findings included a mean patient age of 28.5 for 4.0 years, parity of 3-4 children (42%), 74% unbooked cases, and 29 booked cases. 41% of the booked cases had previous cesarean sections. 88% of the patients' labor started at home. Spontaneous uterine rupture occurred in 75% of the cases; 58% had complications of feto-pelvic disproportion and grand multiparity (30%). 15% of booked and unbooked patients had previous cesarean sections. Additional findings include iatrogenic rupture in 10% of the cases, involvement of lower uterine segment in 82%, lacerated urinary bladder (14%). Surgical procedures employed included uterine repair (50%), subtotal hysterectomy (25%), and total hysterectomy (24%). Patients receiving total hysterectomy had a mortality rate of 4% compared to 21% of all other groups. The most common maternal complications included maternal death (17%), prolonged hospital stay (58%), wound sepsis (32%), genital tract sepsis (26%), and septicemia (10%). The primary causes of death were septicemia and hemorrhagic shock. Booked patients had low mortality rates (10%) compared to unbooked patients (19%). The perinatal mortality rate was 94%. It is suggested that adequate, affordable antenatal and delivery care could decrease the complications involved with uterine rupture.^ieng

Ovarian pregnancy causing obstructed labor at term in a heterotopic gestation.

A case of advanced heterotopic pregnancy in which an ovarian pregnancy caused obstructed labour with incomplete uterine rupture is presented. A live baby that weighed 3.25 kg was delivered at caesarean section. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The left ovarian mass contained a fetus papyraceus of about 24 weeks gestation.

Fertility after ectopic pregnancy in an African population.

Cases of ectopic pregnancy were studied retrospectively at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, for the period from January 1, 1977 to June 30, 1987. The records of 108 patients who had at least 1 year of follow-up were reviewed to determine their subsequent reproductive performance. Thirty-eight patients (35.9%) subsequently conceived, 15 (13.9%) had recurrent ectopic pregnancy, 21 (19.4%) delivered at term, and 40 (37%) remained secondarily infertile. Thirty patients were sterilized or using contraception.