Genital tract microbial isolate in women with preterm pre-labour rupture of membranes in resource-constrained community setting.

This study determined patterns of microbial isolates in genital tract of women with preterm pre-labour rupture of membranes (PPROM) compared with cases without PPROM. Endocervical swabs of women with confirmed diagnosis of PPROM were examined microbiologically and compared in blinded pattern with gestational-age-matched controls. One hundred and five microbiological results each for cases and controls were analysed. Positive microbial cultures were seen in 79.05% of cases versus 6.67% of controls. Streptococcus spp. (31.43%) was the commonest organism isolated in cases (p < 0.001), while Candida albicans was significantly more in controls (p < 0.001). The highest incidence of PPROM (82.86%) occurred in gestational ages of 28-30 and 34-36 weeks. No fewer than 75.24% cases occurred in low parity (0-2). Majority occurred in extremes of viable preterm gestation and in women of low parity.

Clinical Presentation of Uterine Fibroids in Nnewi; Nigeria: A 5-Year Review

Background: 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

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

Awareness and practice of post abortion care services among health care professionals in southeastern Nigeria.

This study investigates knowledge and practices of post abortion care (PAC) services among health care professionals in the Anambra State of southeastern Nigeria. This was a prospective, cross-sectional, questionnaire based study conducted between 1 June and 30 September, 2006. The study involved a multi-staged sampling of all registered health facilities in Anambra State, with the selection of 60 health facilities from which 450 participants were recruited. A pre-tested, structured questionnaire was employed to obtain information from the studied respondents. Obtained data were analyzed using Epi-Info version 2001. A total of 437 questionnaires out of 450 administered were accurately completed, giving a response rate of 97.1%. The respondents were comprised of general practitioners (214, 49.0%), nurses (161, 36.8%), specialist doctors (56, 12.8%), and resident doctors (5, 1.1%). The mean age of the respondents was 38.2 +/- 10.5 years. Most participants (203, 52.6%) were males; the majority (282, 64.5%) were working in the rural areas of the State, including mission hospitals (165, 37.8%) and general hospitals (145, 33.3%). Three hundred thirty respondents (75.5%) were aware of PAC services. Twenty-seven (6.2%) and 28 (6.4%) of respondents were aware of community partnership and family planning services, respectively, as elements of PAC. Although the majority of respondents (302, 69.1%) treated abortion complications, only 155 (35.5%) used a manual vacuum aspirator. Three hundred thirty-eight (88.8%) offered counseling services, and 248 (56.8%) provided referrals to other reproductive health services.

The use of torniquet to reduce blood loss at myomectomy.

BACKGROUND: Fibroids remain the commonest pelvic tumour seen in women with myomectomy being the major form of treatment in our environment. Techniques to minimize blood loss will reduce patient morbidity and the need for blood transfusions. One such technique is the use of a tourniquet during myomectomy operation. This study examines the effectiveness and safety this tourniquet technique. METHOD: A comparative analysis of the blood loss, transfusion rate and the morbidities associated with the use and non-use of a tourniquet during myomectomy operation at Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria was undertaken. The Foley's urethral catheter was adapted as a uterine tourniquet and applied as low as possible at the base of the uterus before enucleating the fibroid masses. RESULT: The patients who had their myomectomy performed with application of a tourniquet [tourniquet group] and those without [no-tourniquet group] were evenly matched for age, parity and presenting symptoms. The overall mean age of patients was 35.7 +/- 6.1 years and parity was 0.40 +/- 1.25. The main presenting symptoms of the patients were lower abdominal mass 65.6%, menorrhagia 38.7%, infertility 33.3%, abdominal pain 19.4% and dysmenorrhoea 14.0%. There was a statistically significant difference [P < 0.001] in mean blood loss for the no-tourniquet group [756.4 +/- 285.7] and the tourniquet group [515.7 +/- 292.8] as well as the mean blood transfusion rate in no-tourniquet group [1.0 units +/- 1.14] and the tourniquet group [0.24 units +/- 0.51]. However there was no significant difference between the two groups with respect to complication profile. CONCLUSION: The Foley's catheter form of tourniquet is cheap, safe, effectively reduces blood loss during myomectomy and significantly reduces transfusion rate while not adding to the complications due to the operation.