Cancer of the cervix in Zaria, Northern Nigeria.

OBJECTIVE: Carcinoma of the cervix is still the most common gynecological malignancy among women in the developing nations. The purpose of this study is to review the pattern of carcinoma of the cervix in Zaria, Northern Nigeria. METHOD: This is a retrospective study of patients seen at the Gynecologic oncology unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria between November 2005 and November 2009. RESULTS: A total of 406 gynecological cancers were identified during the period under review. Carcinoma of the cervix accounted for 65.7 % (267) of histologically confirmed gynecological cancers. Most of the patients were married 265 (99.2 %) and 40% were in the second order of marriage; 57.1% of these women were in a polygamous setting. Two hundred and two (75.6 %) patients fell in the 40Œ69 year age bracket, with a mean age of 44.5 years. The disease appears to be associated with high parity (range of 0Œ14); grand multiparous patients constituted 145 (68.3%) of the cases. Abnormal vaginal bleeding (219 patients: 82 %), offensive vaginal discharge (120 patients: 44.9%) and post-coital bleeding (56 patients: 20.9%) were the most common symptoms. About 78% of the patients had advanced disease, stage III disease being the commonest stage accounting for 159 (59.5 %). Fifty-six (21%) of these patients presented with vesico-vaginal fistula. CONCLUSION: This study demonstrates that in the northern part of Nigeria 65.7% of all gynecological cancers are carcinoma of the cervix. This high percentage appears to be connected with some detrimental sociocultural practices, such as early onset of sexual activity, which should be addressed. More emphasis should be given to screening programs for women in under-developed countries.

Cisplatin chemotherapy for haemostasis in bleeding cervical cancer: experience from a resource-poor setting.

BACKGROUND: Cervical cancer is the commonest cancer in northern Nigeria. There are only two radiotherapy centers in the north and four centres in the south, each with only one megavoltage machine for a population of over 140 million. The number of patients requiring radiotherapy for various malignancies is beyond the available facilities and expertise leading to long waiting time and disease progression with its attendant sequelae. This is the basis of using other orthodox treatment modalities as first line. PATIENTS AND METHODS: Between January 2006 and December 2007, 116 patients with histologically confirmed cervical cancer with vaginal bleeding as the predominant symptom were treated. Patients presenting with torrential haemorrhage were excluded from this study as they constitute oncologic emergencies. Patients were interviewed with a structured pro forma on a 3-weekly basis during chemotherapy schedules to assess and evaluate per vaginal bleeding and discharge. Dose of chemotherapy was 70 mg/m² every 3 weeks. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: The median age was 49 years (27-80 yrs). 62 patients were having per vagina bleeding for more than 6 months before commencement of chemotherapy (range 1-60 months). 49 patients had blood transfusion before chemotherapy, average of 2.7 pints of blood transfused per patient. 84 had at least FIGO stage IIIA disease. Squamous cell carcinoma is the commonest histology type followed by adenocarcinoma with 95 and 16 patients respectively. 81 patients had complete cessation of per vagina bleeding with 69 having complete cessation on or before 4th course of chemotherapy (9th week) and complete cessation of per vagina discharges was seen in 52 patients. 115 patients had a performance status KPS of below 80 prior to chemotherapy, and after completing 6 cycles, 100 patients had KPS of 80 and above. CONCLUSION: In resource-poor setting, Cisplatin based chemotherapy can be used by medical, gynaecological oncologists and general practitioners to control vaginal bleeding and improve the quality of life of patients pending radiotherapy. For optimal treatment with chemoradiotherapy, government and non-governmental agencies must do all it takes to remedy the problems of shortage of resources.

Heterotopic gestation with subsequent live birth in a Jehovah s Witness: a case report.

Heterotopic gestations occurring in spontaneous conception cycles are rare. An incidence of in has been documented. However there is a rising rate mostly attributed to ovulation induction and assisted reproduction techniques where it occurs in to of all clinical pregnancies. A high index of suspicion and use of ancillary investigations will aid diagnosis. The management of this condition in a Jehovah s Witness presents an uncommon challenge as surgical intervention aims to salvage the intrauterine pregnancy whilst giving scrupulous attention to haemostasis. This is because blood transfusion is precluded in the management of haemorrhage in members of this sect. We present a case of heterotopic gestation that occurred spontaneously in a Jehovah s Witness she had emergency salpingectomy and subsequently had spontaneous vertex delivery of a live baby at term.

Fetal outcome following umbilical cord prolapse in Ahmadu Bello University Teaching Hospital, Kaduna (ABUTHK), northern Nigeria.

BACKGROUND: Umbilical cord is a clinical condition that calls for emergency decision making and action especially with a live and mature fetus. The objective of this study is to determine, fetal outcome and how various factors influence it. METHODS: This is a 12 1/2 year retrospective study of all 34 fetuses who suffered from cord prolapse at Ahmadu Bello University Teaching Hospital. RESULTS: There were 34 cases of cord prolapse, 23 perinatal deaths and a perinatal mortality rate of 67.64%. About 55% of babies of registered women died, while about 92% of the unregistered died. Eleven babies of the 22 women admitted with cervical dilatations of 7 cm and less, died and all the babies of women with cervical dilatations of 8 cm and above died. All 19 babies delivered vaginally and 3 of the 14 delivered abdominally, died. About eighty eight percent of the low-birth weight, and 37.5% of normal size babies died. Seventeen (51.5%) of the 33 babies delivered, had Apgar score 0. All babies with Apgar scores 1-4 died, 40% with Apgar scores 5-7 and 16.7% with Apgar scores 8-10 died. Maternal age, parity, ethnicity, gestational age, presentation and sex of the fetus did not influence outcome.

Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria.

CONTEXT: The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. METHODS: Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. RESULTS: Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D and C). Nearly 28% reported the use of MVA followed by D and C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. CONCLUSIONS: These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.