The efficacy of pentazocine + diclofenac versus paracetamol + diclofenac for post- caesarean section analgesia.

BACKGROUND: The most common major obstetric procedure is caesarean section (CS) and one of the greatest concerns for women after CS is to have optimal pain relief. AIM: This study aims to compare the efficacy of pentazocine + diclofenac and paracetamol + diclofenac on post-operative analgesia after CS. METHODOLOGY: This was a single-blind, randomised trial. Pregnant women that had CS were randomized into two groups. Group A received intramuscular pentazocine + rectal diclofenac postoperatively. Group B received intramuscular paracetamol + rectal diclofenac postoperatively. Post-operative pain was assessed by numeric rating scale at 1 h after the surgery, at 6 h, 12 h and 24 h. The result obtained was analysed using SPSS Version 22 and P < 0.05 was considered statistically significant. RESULTS: The median pain scores in both groups ranged from 2 to 3 across all periods of assessment. The pain relief was slightly better in the pentazocine + diclofenac group with no significant difference in the pain score between the two groups at all periods of assessment. The satisfaction level was good in 66.3% and 69.5% of the participants in the pentazocine + diclofenac and paracetamol + diclofenac group respectively but the difference was not statistically significant (χ2 = 4.14, P = 0. 12). Nausea, vomiting and drowsiness were significantly more in the pentazocine + diclofenac combination (P < 0.001). CONCLUSION: Both combination of analgesics provided adequate analgesia but pentazocine + diclofenac combination had better pain relief but was more associated with side effects.

Knowledge of Palliative Care Among Medical Interns in a Tertiary Health Institution in Northwestern Nigeria.

BACKGROUND: Palliative care is the proactive care which seeks to maximize quality of life for people and families facing life-threatening illnesses. OBJECTIVES: To ascertain the existing knowledge of palliative care among medical interns and determine the effect of a structured educational intervention on improvement of their knowledge levels. SUBJECTS AND METHODS: This is a quasi-experimental, interventional study with a one group pre- and post-test design involving medical interns rotating through the various departments of the Usmanu Danfodiyo University Teaching Hospital, Sokoto. The study population was chosen by convenience sampling method. The interns completed a pre- and a post-test assessment following a structured educational intervention for the evaluation of knowledge of palliative care. Knowledge was evaluated by a self-administered structured questionnaire. RESULTS: A total number of 49 medical interns were recruited, among whom were 41 males and 8 females. Their ages ranged from 21 to 36 years with a mean of 27.7 (standard deviation 2.14) years. In the pretest, 11/49 (22.5%) of the respondents had poor knowledge level of palliative care; however, in the postintervention, only 2/49 (4.1%) of the respondents had poor knowledge. Similarly, good knowledge levels appreciated from 9/49 (18.4%) to 14/49 (28.6%) while very good knowledge increased from 10/49 (20.4%) to 19/49 (38.8%). This effect was statistically significant (Chi-square test 11.655 df = 3, P = 0.009). CONCLUSION: There is poor knowledge of palliative care among the interns due to ignorance. Following an educational intervention, the knowledge levels appreciated significantly. Palliative care should be part of the medical curriculum.

Abdominal pregnancy in Usmanu Dan-Fodiyo university teaching hospital, Sokoto: A 10-year review

Background: Abdominal pregnancy, a rare condition with high maternal mortality (up to 50%), and even higher perinatal mortality (40 ­ 95%), is often associated with diagnostic difficulties. Objectives: To determine the mode of presentation and management of abdominal pregnancy, from cases in the Usmanu Dan-Fodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: A retrospective review of the case records of all abdominal pregnancies managed in UDUTH, Sokoto, between January 2000 and December 2010. Results: During the 10-year study period, there were eight cases of abdominal pregnancies, 285 extrauterine pregnancies, and 25,506 total deliveries. All the patients were not booked for antenatal care and their ages ranged between 20 and 39 years (mean=28.1±3.4 years). The majority (88%) were grand multipara. The main presenting symptoms were persistent abdominal pain, vaginal bleeding, and prolonged pregnancy. Seven cases (87.5%) were diagnosed accurately by an ultrasound scan. There were seven perinatal deaths (87.5%) and one live birth. There was one maternal death (12.5%), which occurred in the patient whose placenta was left in-situ. Conclusion: Presence of persistent lower abdominal pain, vaginal bleeding, and prolonged pregnancy should raise the suspicion of abdominal pregnancy. Removal of the placenta, where feasible, improves the outcome of maternal health

The use of the condom-catheter for the treatment of postpartum haemorrhage - the Sokoto experience.

Postpartum haemorrhage (PPH) is the most common cause of maternal mortality globally. In about 50% of cases PPH is due to uterine atony. When conservative and medical methods of treating PPH due to uterine atony fail, surgical intervention is required to save the woman's life. As an alternative in such cases, intrauterine tamponade has been used successfully to stop bleeding, thus avoiding surgery. We report four cases of PPH due to uterine atony in which intrauterine tamponade with an inflated condom was effective in arresting haemorrhage. We advocate the use of a similar device in carefully selected cases, especially in low-resource settings.