Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto; Nigeria

Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications; as a last resort; to prevent maternal mortality. Objectives: This study was designed to determine the rate; indications; and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH); Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH; Sokoto; Nigeria; between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age; parity; booking status; indications; type of hysterectomy; cadre of the surgeon; type of anesthesia; and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the ?2 test was used to analyze some of the results with the confidence limit set at 95. Results: During the 6-year period; 83 EOH were performed out of 16;249 deliveries giving the rate of the former as 0.51; i.e. 1 in 196 deliveries. However; the case records of only 74 patients (82.9) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were unbooked for antenatal care; and the rate of the procedure among these patients (1.82) was significantly higher than 0.07observed amongst booked subjects (P0.001). The main indication for the procedure was ruptured uterus (93.2) and the majority of the patients (95.9) had subtotal hysterectomy. Anemia (66.2); excessive hemorrhage (35.5); septicemia (18.9); and wound infection (16.2) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2) compared to those undertaken by consultants (16.2); P

Histo-Pathological Features of Primary Ovarian Tumours Managed in a Tertiary Hospital; Sokoto

Background: Ovarian tumours are the 2nd most common female genital tract tumour in Sokoto; northwestern; Nigeria. We determined the histo-pathological features of surgically removed ovarian tumours. Methods: A 12-year retrospective study of all surgically removed ovarian tumours at the Gynaecological department of Usmanu Danfodiyo University Teaching Hospital UDUTH) Sokoto; North- Western Nigeria. Results: The highest incidence of ovarian tumours was within the age range of 20-45 years. Of the 125 cases of surgically removed neoplastic ovarian tumours seen during the study period; 83(66.4) were benign; 40(22.4) were malignant and 2(1.6) were of borderline malignancy. Epithelial tumours were the commonest neoplasms 54(43.2); while germ cell tumours were present in 47(37.6) cases. Mucinous cystadenocarcinoma was the ommonest malignant ovarian tumour 14(35) and was closely followed by granulosa cell tumour 10(25); dysgerminoma 17.5); serous cystadenocarcinoma (12.5); malignant teratoma 2(5) and endodermal sinus tumour (5). There were 2 cases of metastatic tumours: one from Burkitts lymphoma; and the other from gestational choriocarcinoma. Conclusion: The high frequency of malignant ovarian tumours in the young age group type in this study underscores the need for histology of all surgically removed tumours irrespective of age

Misoprostol use for cervical ripening and induction of labour in a Nigerian teaching hospital.

CONTEXT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. OBJECTIVES: To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction. MATERIALS AND METHOD: Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor. RESULTS: Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80% (120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture. CONCLUSION: Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.

Spontaneous liver rupture in pre-eclampsia.

Spontaneous liver rupture is a rare complication of pre-eclampsia. A booked, 30-year old woman with pre-eclampsia and twin gestation developed severe abdominal pains 10 hours after a supervised, vaginal delivery. On examination she was in hypovolemic shock with abdominal distension from hemoperitoneum. Uterine rupture was suspected and she had a laparotomy after resuscitation. But at surgery the uterus was intact and instead liver rupture was found which was managed by omental packing after evacuating the clots. Postoperatively, the patient developed acute renal failure that responded well to treatment. The mother and her babies were discharged in good health after 15 days of multidisciplinary management.