Emergency peripartum hysterectomy in Nnewi, Nigeria: a 10-year review.

BACKGROUND: Emergency peripartum hysterectomy has remained a challenging and very life saving surgical procedure in obstetrics. Its indications are emerging. AIMS: This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south-east Nigeria. MATERIALS AND METHODS: A retrospective study of the case files of patients requiring an emergency peripartum hysterectomy between January 2000 and December 2009 was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment within 24 hours of delivery. The findings were analyzed using Epi info version 3.5.1. RESULTS: During the 10-year period, there were 6,137 deliveries and 38 cases of emergency peripartum hysterectomies, giving an incidence of 6.2 per 1000 deliveries. Of the 38 hysterectomies, only 29 (76.3%) case files were available for analysis. The mean age of the patients was 28.1 ± 5.4 years and 22 (75.9%) patients were unbooked. There were four primigravidae (13.8%) while 25 (86.2%) were parous. The main indications for hysterectomy were placenta praevia 14 (48.3%) and uterine rupture 10 (34.5%). Subtotal hysterectomy was performed in majority (72.4%) of cases. The commonest postoperative morbidities were postoperative fever (37.9%), postoperative anemia (24.1%), and wound infection (20.7%). The maternal case fatality rate was 31.0%, while the perinatal mortality was 44.8%. The mean duration of hospital stay was 9.8 ± 2.4 days. CONCLUSION: The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention by a skilled surgeon are crucial.

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

Seroprevalence of venereal disease among pregnant women attending antenatal care (ANC) in Onitsha, Anambra State, Southeast, Nigeria.

BACKGROUND: Venereal Syphilis if not properly and timely treated has been noted to have devastating effects on the fetus and baby. Of all the sexually transmitted infections, however, venereal syphilis is one of the most commonly screened among antenatal women. This screening is usually limited to the tertiary institutions thereby leaving the women who attend private hospitals to a disadvantage. OBJECTIVE: This current research is to determine the seroprevalence of venereal disease among women attending ANC in an Onitsha specialist private hospital and to ascertain the acceptability, and the feasibility of conducting the screening in a private setup. METHODS: This cross sectional prospective study was conducted among women, who were on their first ANC visit at Grace Specialist Hospital, Nkpor, Southeast Nigeria. They were offered VDRL test by ELISA method and TPHA confirmation test to those who were seropositive to VDRL test. RESULT: Two thousand nine hundred and ninety six women attended antenatal care during the study period but 1393 women took part in this study giving an uptake rate of 46.5%. The seroprevalence rate to venereal syphilis was 0.6%. Three out of the 8 seropositive results were confirmed with TPHA test. This gives a TPHA/VDRL ratio of 0.43. The highest range of occurrence was 25 29years. There was neither a significant association between age distribution and VDRL screening result (chi2 = 1.13; df =5; p = 0.951) nor between parity distribution and VDRL screening result (chi2 = 6.2; df = 6; p = 0.4007). Although the seroprevalence of venereal syphilis is low but routine universal screening of Venereal syphilis is possible in private hospitals and its establishment should be encouraged.

Pattern of semen fluid abnormalities in male partners of infertile couples in southeastern, Nigeria.

BACKGROUND: The incidence of male infertility is increasing in our environment. There is a need to evaluate the pattern of abnormality with a view to recommending appropriate interventions. We aimed to to analyze the seminal fluid parameters of the male partners of the infertile couples managed in the hospital over a 12 month period and to identify the pattern of abnormalities. METHODS: A retrospective study of all the semen samples of male partners of infertile couples submitted for analysis to the microbiology laboratory of Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria between 1st January 2006 and 31st December 2006 The reports of the semen fluid analysis were retrieved from the records department and supplemented with the laboratory register. RESULT: Out of the 348 semen sample reports evaluated, 237 (68.0%) had semen fluid abnormalities. 104 (30.0%) had single factor abnormalities while 133 (38.0%) had combined factor anomalies. Asthenozoospermia 58 (16.7%) was the main single abnormality, while Astheno-oligozoospermia 51 (14.7%) and Astheno-oligoteratozoospermia (13.2%) were the major combined factor abnormalities detected. Very few 5 (1.4%) of the patients had azospermia. CONCLUSION: The study showed a high rate of semen fluid abnormalities among the male partners of infertile women in our environment. The high preponderance of poor motility emphasizes the need to include men in programmes aimed at reducing sexually transmitted infections in Nigeria.

Vaginal hysterectomy in a Nigerian tertiary health facility.

BACKGROUND: Despite evidence that vaginal hysterectomy offers advantages in regard to operative time, complication rates and return to normal activities, gynaecologists remain reluctant to change their practice patterns because of concerns about safety and feasibility of the vaginal approach. We reviewed cases of vaginal hysterectomies done in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a ten year period. METHOD: This is a retrospective analysis of cases of vaginal hysterectomy that were done in the hospital between 1st January 1998 and 31st December 2007. Data was analyzed with Epi info version 3.3.2. Outcome measures include duration of hospital stay, indication for the surgery, postoperative morbidity and mortality and the need for blood transfusion. RESULT: Hysterectomy accounted for 224 of 1,370 gynaecological surgeries (16.4%). Vaginal hysterectomy was responsible for 47 (21.0%) of these 224 cases and accounted for 3.7% of all gynaecological surgeries. Majority of the patients were in the 7th decade of life with a mean age of 65.2 +/- 6.8. Most (87.5%) patients were retired farmers and grandmultiparous with a mean parity 6.5 +/- 2.4). Utero-vaginal prolapse was the only indication for the surgery. The only postoperative complication accounted was febrile morbidity which was reported in 5 (10.6%) of the patients had febrile morbidity. There were no cases of conversion to abdominal procedure. All the surgeries were done by the consultants. CONCLUSION: Vaginal hysterectomy was safe and associated with minimal morbidity to the patient. The only indication was uterovaginal prolapse and all the procedures were done by the consultants. There is need to transfer the skill to the Residents.

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.

Pattern of Semen Fluid Abnormalities in Male Partners of Infertile Couples in Southeastern; Nigeria

Background: A retrospective study of all the semen samples of male partners of infertile couples sumitted for analysis to the microbiology laboratory of Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria between 1 January 2006 and 31 December 2006 The reports of the semen fluid analysis were retrieved from the records department and suplemented with the laboratory register. Methods:Aretrospective study of all the semen samples of male partners of infertile couples sumitted for analysis to the microbiology laboratory of Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria between 1 January 2006 and 31 December 2006 The reports of the semen fluid analysis were retrieved from the records department and suplemented with the laboratory register. Results :Out of the 348 semen sample reports evaluated; 237 (68.0) had semen fluid abnormalities. 104(30.0) had single factor abnormalities while 133(38.0) had combined factor anomalies. Asthenozoospermia 58(16.7) was the main single abnormality; while Astheno-oligozoospermia 51(14.7) and Astheno-oligoteratozoospermia (13.2) were the major combined factor abnormalities detected. Very few 5(1.4) of the patients had azospermia.Conclusion : The study showed a high rate of semen fluid abnormalities among the male partners of infertile women in our environment. The high preponderance of poor motility emphasizes the need to include men in programmes aimed at reducing sexually transmitted infections in Nigeria

The Pattern of Cervical Cytology in Obstetrics and Gynaecology Clinics in Nnewi; South-Eastern Nigeria

Background: Cervical cytology screening has decreased the incidence of and mortality from invasive cervical cancer in developed and even some developing countries. The story is still different in Nigeria because there is no national screening programme in place.Objectives: The aim of this study was to evaluate the pattern of cervical cytology and relate it to some known risk factors such as age; parity; age at coitarche; number of sexual partners and clinical presentation.Subjects and Methods: A total of 100 women were seen at two Obstetrics and Gynaecology clinics in Nnewi over a three month period (May-July 2005) were screened. Conventional method of staining was used. The first fifty sexually active women that consented to completing the study questionnaire in the two clinics were included.Main Outcome Measures: The work noted the pattern of reports in relation to some known risk factors and adequacy of the sampling.Results: Sampling adequacy was 93; epithelial cell abnormality was reported in only one smear; 58 were reported as normal; 14 showed benign cellular changes (i.e. infective); and 18 reactive changes (i.e. atrophy). Conclusion: Now that infective aetiology has been established in cancer of the cervix; the co-factors may be some of these causes of benign cellular changes of the cervix

Knowledge attitude and practice of cervical cancer screening among sexually active women in Onitsha, southeast Nigeria.

BACKGROUND: Cervical cancer is a major cause of death in the developing world. This high fatality is due to late presentation. It is believed that widespread screening of women for precursor lesion and early detection of the invasive disease can lead to a reduction in cervical cancer and cervical cancer deaths. This study assesses the knowledge, attitude and practice of cervical cancer among sexually active women in Onitsha Southeast Nigeria. METHODS: Three major layouts in Onitsha were chosen as the areas of study In these areas, 5 sites each where major economic activities take place were chosen for the distribution of the questionnaire. A total of 400 pretested questionnaires were administered to women who gave their verbal consent to participate in this study. The data were analyzed using SPSS package for windows version 11.0. RESULTS: The result showed that 76 (26.85%) of the respondents were aware of cervical cancer screening. Thirty six (47.4%) of the aware group knew that the test was a screening test for cervical cancer There was significant association between the educational status and the knowledge of Pap test but there was no significant association between the educational status and the utilization of the Pap test. CONCLUSION: This study shows that there is poor awareness and utilization of cervical screening test in our environment. There is therefore an urgent need to establish an aggressive and sustainable awareness campaign on the preventive nature of cervical cancer and further establish an organized cancer screening programme.

Knowledge Attitude and Practice of Cervical Cancer Screening among Sexually Active Women in Onitsha; Southeast Nigeria

Background: Cervical cancer is a major cause of death in the developing world. This high fatality is due to late presentation. It is believed that widespread screening of women for precursor lesion and early detection of the invasive disease can lead to a reduction in cervical cancer and cervical cancer deaths. This study assesses the knowledge; attitude and practice of cervical cancer among sexually active women in Onitsha Southeast Nigeria. Methods: Three major layouts in Onitsha were chosen as the areas of study. In these areas; 5 sites each where major economic activities take place were chosen for the distribution of the questionnaire. A total of 400 pretested questionnaires were administered to women who gave their verbal consent to participate in this study. The data were analyzed using SPSS package for windows version 11.0. Results: The result showed that 76(26.85) of the respondents were aware of cervical cancer screening. Thirty six (47.4) of the aware group knew that the test was a screening test for cervical cancer. There was significant association between the educational status and the knowledge of Pap test but there was no significant association between the educational status and the utilization of the Pap test. Conclusion: This study shows that there is poor awareness and utilization of cervical screening test in our environment. There is therefore an urgent need to establish an aggressive and sustainable awareness campaign on the preventive nature of cervical cancer and further establish an organized cancer screening programme

Incidence of pelvic organ prolapse in Nigerian women.

OBJECTIVE: To establish the incidence and types of utero-vaginal prolapse. METHODS: Retrospective medical records analyses of women who were subjected to reconstructive pelvic surgery for various types of pelvic relaxation at the Nnamdi Azikiwe University Teaching Hospital, Nnewi and the University Of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. The study was conducted from January 1996 to December 1999 during which there were 7515 surgical admissions. The inclusion criteria were those women who complained of feeling a mass in the vagina with demonAstrable descent of the anterior and/or posterior and/or apical vaginal walls and/or perineal descent. Excluded were patients who had other symptoms other than utero-vaginal prolapse and those whose grades and sites of prolapse were not determinable from the clinical or surgical notes. Also excluded were patients with nerve injury or disease, connective tissue disorders and neuromuscular diseases. The subjects were divided into two groups. Group I consisted of 54 women (age < or = 40 years), and group II included 105 women (age > or = 40 years). The findings between those two groups were compared with reference to sites, types and degree of prolapse. Also, coexistence of pelvic relaxation and underlying medical conditions were evaluated. RESULTS: A total of 159 subjects out of 492 charts studied met the inclusion criteria for the study. In group I, mean age was 32.839 with a standard deviation (SD) of +/- 6.012 years; and in group II the mean age was 56.543 with a SD of 8.094. Hypertrophic (elongated) cervix was determined in 15 (6.3%) subjects in group I for an incidence of 1.58% per year, cystocele (vaginal anterior wall descent) was present in 21 (8.9%) women for an incidence of 2.2% per year; rectocele (posterior vaginal wall descent) was identified in 15 (6.3%) women for an incidence of 1.58% per year; vaginal cough prolapse (apical descent) was present 21 (8.9%) women for an incidence of 2.2% per year. Perineal descent was absent in this group. In group II, there was no hypertrophic cervix; cystocele was present in 39 (16.5%) cases for an incidence of 4.13% per year; rectocele was identified in 27 (11.4%) women, amounting to an incidence of 2.85% per year; vaginal cough prolapse was present in 36 (15.%) women, an incidence of 3.75% per year; perineal descent was present in 63 (25.6%) women, for an incidence of 6.4% per year. CONCLUSION: (1) The incidence of hypertrophic cervix without any other abnormality amounted to 1.58% per year. This medical entity can present as uterine prolapse and was noted only in group I. (2) The annual incidence for hospital admission with a diagnosis of uterine prolapse was 2.1%. (3) The incidence of cystocele, and rectocele was not statistically different in the two groups; but the incidence of perineal descent and uterine prolapse were significantly more in group II than group I. (4) The etiology of hypertrophic cervix is not known, but it is of importance especially in the childbearing age when it may be related to prolonged pregnancy, cervical dystocia, etc.

Seminal fluid indices of men attending infertility clinic at St. Charles Borromeo Hospital, Onitsha, Nigeria (1994-1998).

The result of seminal fluid analysis of 628 men attending an infertility clinic in Onitsha, between 1994-1998; were collated and analysed. The result showed that 62.7% (n = 3394) had normal sperm density, while 37% (n = 234) of the men, had sperm density less than 20 million per ml ejaculate. 6.2% (n = 39) of these patients were azoospermic. 44% (n = 270) of these patients had sperm motility that was less than 50% while 20.5% (n = 129) of the samples contained pathogens, with commonest pathogen being staphylococus aureus in 46% (n = 60) of the sampled patients with pathogens. This high rate of oligospermia and azoospermia calls for proper education of the populace as regards, prevention and treatment of sexually transmitted diseases and urinary tract infections. Also, there is the urgent need to establish centres for assisted reproduction, which will help in solving the already overwhelming problem of infertility in our community.

Anal incontinence among Igbo (Nigerian) women.

Anal incontinence in patients who present to the gynaecology clinic for symptoms other than pelvic organ prolapse dysfunction is fairly common. A structured pre-tested 41-item pelvic organ prolapse questionnaire was administered by doctors to 3963 gynaecological patients, recruited from three states of south-eastern Nigeria, who were in the clinic for reasons other than pelvic organ prolapse dysfunction. This report considers only anal incontinence. We found a prevalence of 6.96% for anal incontinence. Of these, 2.67% were incontinent for liquid stool, 2.17% for solid stool and 2.12% for flatus. There appears to be a higher frequency of flatus incontinence in the reproductive years: 36.6% of primiparas aged <30 years had faecal incontinence. Flatus incontinence was present in 28 (43.7%) of 198 para 4 and below, and in 36 (56.3%) of 78 para 5 and above. There was thus a significant association between flatus incontinence and parity (chi2=32.4; p<0.001). Spontaneous vaginal delivery had a significant effect on anal incontinence (p=0.04). Physicians should, be able to detect this embarrassing condition and be alert to factors that may avert or ameliorate it.

Knowledge, awareness and perception of sexually transmitted diseases (STDs) among antenatal patients at Nnewi, Nigeria.

This study investigates STD knowledge, awareness and perception among antenatal patients at a Nigerian teaching hospital. There was general awareness of the common STDs, such as gonorrhoea, 95.5% (n=127) and syphilis 66.92% (n=89), while the least awareness was recorded in chlamydial diseases, 6% (n=8). HIV/AIDS recorded the highest awareness, 96.2% (n=128). There knowledge of causes and treatment was remarkably poor. Only 58.6% (n=78) could recognise bacteria as causing STD. Surprisingly more than half, 72.2% (n=96) still believed that remedy could be obtained from prayer houses, herbs and other non-scientific means. The most common source of information was through media houses: radio 72.9% (n=97), television 64.7% (n=86). Preventive awareness was high, more than half believing that STD is preventable either by abstinence, barrier contraception or by mutual fidelity. Superstitious beliefs, greater influence of traditional medical practices and poverty are some of the numerous problems the few existing STD clinics face in the developing countries. Efforts should be geared towards establishing standard STD clinics and appropriate information disseminating organs. A situation where the herbalists and traditional medical personnel capture the mostly ignorant populace through unrestricted access to the media houses, as currently practiced in Nigeria, should be checked.