Correlation between colposcopic impression and histologic diagnosis of premalignant lesions of the cervix

Background: Cervical cancer is the commonest cancer in sub-Saharan African with majority of the women presenting with an advanced disease stage. This is largely due to the unavailability of an established cervical cancer screening programme in most countries. This also includes the use of colposcopy which is still not available to many gynaecologists practicing in Nigeria. Aim: To review reports of colposcopy carried out at the University of Abuja Teaching Hospital, Abuja, Nigeria and to determine the degree of concurrence between colposcopic impression and histologic diagnosis. Methods: A retrospective analysis of the colposcopic findings of 84 patients was done. Subsequent correlation with histopathology report was carried out in 53 patients who had colposcopically directed biopsies between March 2012 and February 2014. Results: The commonest impression made on colposcopy was high grade CIN in 40(47.6%) patients. The concurrence rate between colposcopic findings and histology diagnosis was 64.2% (34/53) {K =0.302, 95%CI= -0.010-0.436}. The concurrence rate was higher for high grade CIN 29/40(72.5%) than for low grade CIN 5/12 (41.7 %). There was an overestimation of colposcopic diagnosis in 13(24.5%) patients and an underestimation in 6(11.3%) patients. The sensitivity of colposcopy for detecting high grade lesions or more was 32/36(88.9%) while the specificity was 8/17(47.1%). False positive rate for high grade lesions was 9/17(52.9%) and false negative rates for low grade lesions was 4/36(11.1%). Positive predictive value (PPV) of high grade colposcopic diagnosis or more was 32/41(78.04%) while the negative predictive value (NPV) was 8/12(66.73%). Conclusion: The strength of agreement between colposcopic diagnosis and cervical pathology was fair and colposcopy performs better in the detection of high grade lesions

Epstein-Barr virus-positive mucocutaneous ulcer of the oral cavity in a patient who had had a renal transplant.

The Epstein-Barr virus-positive mucocutaneous ulcer is a new phenomenon that was first described in 2014, and we know of only 67 reported cases. We describe a case in a patient who had had a renal transplant.

Uterine rupture: trends and feto-maternal outcome in a Nigerian teaching hospital.

OBJECTIVE: To determine the trends, predisposing factors, maternal and fetal outcome of cases of uterine rupture managed at the University of Abuja Teaching Hospital. METHOD: A retrospective review of all cases of ruptured uterus managed at the University of Abuja teaching hospital, Gwagwalada, between January 2006 and December 2010 was conducted. RESULT: There were 9604 deliveries in the hospital during the period of review out of which 82 were cases ruptured uterus, giving an overall incidence of 0.85% or 1 in 117 deliveries. They were mainly women of low parity with a mean age of 31.8 years. The commonest predisposing factor was injudicious use of oxytocin occurring in 38.7% of cases and was followed closely by previous caesarean section scar (28.0%). Prolonged obstructed labour was the third commonest cause of uterine rupture (18.7%) and occurred only in the unbooked patients. There were 11 maternal deaths which gave a maternal case fatality rate of 14.7%. All the deaths occurred in women who had intrapartum care in places other than the teaching hospital. There were 68 perinatal deaths which gave a fetal case fatality rate of 90.7% and all the babies that survived were in patients that had intrapartum care in the teaching hospital. CONCLUSION: Ruptured uterus is a common obstetric emergency in Nigeria's Federal Capital territory and is associated with high maternal and perinatal morbidity and mortality. It is however preventable when the quality of antenatal care, intrapartum care and medical facilities are improved.

Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory.

OBJECTIVE: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. MATERIALS AND METHODS: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. RESULTS: The knowledge of malaria and its preventive measures in pregnancy was 71.5%. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053, P = 0.035). Intermittent preventive treatment was used by 15.9% of the respondents. Insecticide-treated net ownership was 42.6%; however, its use declined from 28.5% before pregnancy to 24.6% during pregnancy. CONCLUSION: There is adequate knowledge about malaria and its preventive measures in pregnancy, but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions.

Fetal outcome of twin gestations in a Nigerian teaching hospital.

BACKGROUND: Although twin gestation is associated with increased perinatal morbidity and mortality, optimal management of this high risk pregnancy is associated with improved outcome for the mother and her baby. Globally, Nigeria has the highest incidence of twinning. This makes studies on twin gestation important, especially on the outcome of the babies which is reflection of the type of care received during the antenatal and intrapartum period. STUDY OBJECTIVE: This study was designed to determine the fetal outcomes of twin deliveries in a tertiary hospital in Nigeria's Federal Capital Territory. METHOD: This was a retrospective study of babies following twin pregnancies delivered in the hospital from 1st January 1998 to 31st December 2007. RESULTS: Out of the 600 babies reviewed, 10.2% were still births giving a still birth rate of 102 per 1000 births. Majority of the stillbirths (73.8%) occurred amongst the unbooked mothers and was higher amongst the second twins. More of the booked mothers had their babies delivered at term compared to the unbooked ones, 115 (38.3%) Vs 66 (22.0%).There was a statistically significant association between gestational age at delivery and booking status of the paturients. (X2 = 16.257, P = 0.001). The mean fetal weight was 2.395 kg +/- 0.63. There was no statistically significant difference when the weights of the first and second twin were compared. (t = 0.343, P = 0.732). Out of the 539 babies born alive, 85.0% had good Apgar score of = 7 in5 minutes, 13.0% of the first twins had moderate birth asphyxia compared to 16.0% of the second twins. The female to male ratio was 1:1.1. CONCLUSION: Twin gestation is associated with low birth weights and high still birth rate in this centre. Fetal outcome is better in the first twin compared to the second twin. Outcome for babies whose mothers were booked were better compared to the unbooked. Quality antenatal care and intrapartum management will help improve fetal outcome.

Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory

Objective: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. Materials and Methods: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. Results: The knowledge of malaria and its preventive measures in pregnancy was 71.5. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053; P = 0.035). Intermittent preventive treatment was used by 15.9 of the respondents. Insecticide-treated net ownership was 42.6; however; its use declined from 28.5 before pregnancy to 24.6 during pregnancy. Conclusion: There is adequate knowledge about malaria and its preventive measures in pregnancy; but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions

Ectopic pregnancy in Nigeria's federal capital territory: a six year review.

BACKGROUND: Ectopic pregnancy is a major public health issue and remains a major challenge to the reproductive Performance of women worldwide. The incidence and management approach to ectopic pregnancy over the past few decades has been revolutionized with various modalities of treatment currently in practice. The objective of the study was to determine the incidence, mode of presentation, diagnosis and treatment of ectopic pregnancy at the University of Abuja teaching hospital, Gwagwalada. METHOD: This was a retrospective study of ectopic pregnancy cases managed in the hospital between January 2001 and December 2006. RESULTS: There were 186 ectopic pregnancies out of 6,865 deliveries giving an overall incidence of 2.7%. Ectopic pregnancy accounted for 6.86% of all gynaecological admissions. Presentation was mainly as acute emergencies. Majority, 83.1% had ruptured while 16.9% were unruptured at presentation. The commonest finding on physical examination was abdominal tenderness which occurred in 90.4% of cases. Diagnosis was made solely on clinical findings in 36.7%. All cases had laparotomy and 95.0% had radical tubal surgery. CONCLUSION: Ectopic pregnancy is still a major health problem amongst women of reproductive age group presenting in the gynaecological unit of the University of Abuja teaching hospital. Laparotomy for salpingectomy is the mainstay of treatment as the patients present acutely, haemodynamically unstable and unfit for conservative management.