Endometriosis: incidence among the Igbos of Nigeria.

A retrospective study of the incidence of endometriosis among the Igbos was undertaken. The incidence was 4.3% in patients with pelvic operations. This is the highest incidence ever reported for Nigeria. Differences in educational standards, ethnic habits and improved diagnostic resources of this hospital were the possible influencing factors; 90.8% of the cases were not diagnosed before operation, demonstrating the lack of awareness. Differential diagnostic considerations for menstrual disorders should include endometriosis in this environment.

Cesarean and postpartum hysterectomy in Enugu, 1973-1986.

Obstetric hysterectomies were performed on 163 patients over a period of 13 years out of 56,823 deliveries. Seventy-one percent of the patients received no antenatal care in the index pregnancies. The majority were of high parity. Ruptured uterus was the commonest indication. Inadequate transfusion and late presentation affected the prognosis adversely. Ignorance, availability of suitable maternity care units and uncontrolled reproductive patterns were the main predisposing factors.

PIP: Obstetric hysterectomies (in labor and puerperium) were performed from January, 1973 through December, 1986 (13 years). During that period, 56,823 deliveries occurred; 6664 of them (11.7%) were by cesarean section. Obstetric hysterectomies were performed on 163 patients, an incidence of 1 in 349 deliveries and 1 in 41 cesarean sections. Of all the patients who received hysterectomies, 116 (71.2%) received no prenatal care. 86 patients (52.8%) were grand multipara having delivered 5-12 times with an average of 6.2 deliveries. The main indication for hysterectomy was uterine rupture, which resulted from obstructed labor in 119 patients (73%). Of the 152 patients with ruptured uteri, 23 (15.1%) had ruptures which resulted from the rupture of old cesarean section scars. Intractable hemorrhage in the immediate postpartum period, caused by uterine rupture diagnosed at laparotomy was the indication for postpartum hysterectomy in 10 women. 7 patients had a hysterectomy because of hemorrhage caused by morbidly adherent placenta. Inadequate transfusion and late presentation affected the prognosis adversely. Hysterectomy was total in 22, (13.5%). 141 patients (86.5%) had subtotal hysterectomies. Pyrexia, anemia, and wound infection were the commonest complications occurring in 113 (69.3%), 107 (65.6%), and 63 (38.7%), respectively. There were 6.1% maternal deaths from this procedure. Factors leading to the operation were ignorance, lack of suitable maternity centers, and high fertility.

Parity and perinatal mortality amongst diabetics in a Nigerian Teaching Hospital.

The parity and the perinatal mortality of 226 married Nigerian female diabetics, aged 20 to 76 years (mean 47.1 years), and 226 married female nondiabetics matched for age and educational level with the diabetics were studied. There was no statistically significant difference between the diabetics and nondiabetics in terms of primary infertility, irrespective of age of onset of diabetes. In the group with one to four deliveries, the nondiabetics significantly outnumbered the diabetics (P less than 0.001) irrespective of age of onset of diabetes. In the group with seven to nine deliveries, only the diabetics of child-bearing age (P less than 0.01); and in the group with 10 or more deliveries, diabetics significantly outnumbered the nondiabetics irrespective of age of onset of diabetes (P less than 0.01). There was a statistically significant difference between the diabetics and nondiabetics in terms of the overall perinatal mortality (P less than 0.001). However, this difference was not significant in diabetics of childbearing age. In Nigeria, where large families are common and children often born in rapid succession, high parity appears not only to increase the chances of a woman developing diabetes in late life but also in early life. Effective birth control practice may thus help in reducing the incidence of diabetes amongst Nigerian women. Additionally, a programme extending to the rural areas aimed at early detection of diabetes and proper management of the pregnant diabetic by a team of medical personnel with special interest in diabetes will help in reducing the perinatal mortality in Nigerian diabetics.