Gynaecological Admissions Research Articles

Pelvic abscess at Jos University teaching hospital, Jos, north central Nigeria

Background: Despite the availability of antibiotics and surgery, pelvic abscess remains one of the major gynaecological problems of developing societies. It remains a source of concern because of its potential for life threatening morbidity and mortality which may approach 100% if not effectively managed. Objectives The study objectives were to determine the incidence of pelvic abscess in this institution, identify risk factors, review the management of these patients and suggest ways of improving the services offered. Methods A retrospective analysis of 35 cases of pelvic abscess admitted and managed at the Jos University Teaching Hospital over a three year period (January 1998- December 2000) was carried out. The data extracted from the case notes include the age of patient, ethnicity, religion, parity marital status, complications and interventions instituted Results During the period, there were 2135 gynaecological admissions; thus the incidence of pelvic abscess in the hospital was 1.79% (35). Most of the patients (82.7%) were aged below 30 years, and 86% were of parity 2 and below. In 19 patients (54.3%), the abscess followed induced termination of pregnancy. After an initial preparation with intravenous fluids, broad spectrum antibiotics, correction of fluids and electrolytes imbalance and blood transfusion (where indicated), for about 24- 9 72 hours, the patients were subjected to definitive surgery; laparotomy. Conclusion Pelvic infection is a disease of the young and low parity woman and there is a strong relationship between induced abortion and pelvic abscess in this environment. Laparotomy and drainage is advocated after adequate pre-operative resuscitation so as to decrease mortality and morbidity.Key words: management, pelvic abscess, Jos University Teaching Hospital.

Vesico vaginal fistula (VVF): a shift in epidemiology in northeastern Nigeria.

Background: Vesico vaginal fistula is not only a medical disorder, but a serious social calamity. It reflects the state of health system failing to meet the basic needs of a growing population. Objective: To determine the epidemiological variables and outcome of the VVF patients.Methodology: Eighty cases of VVF managed over the 10 year period was retrospectively studied. Information pertaining to age, parity, and cause of VVF and outcome of management were retrieved from the case notes. The data was analyzed using SPSS package. Results: VVF Constituted 1.4%, of the total Gynecological admissions during the period. About 76 % were over 20 years, with a peak-age specific prevalence rate of 33.8% at the 20-24 years age group. Teenagers accounted for 23.8%. Most (51.3%) sustained the VVF during their first childbirth, by the second delivery 78.8% were involved. All the teenagers had only one delivery. Majority had no supervised antenatal care and had their deliveries at home under TBAs. Prolonged obstructed labour was the leading cause in 90% and most were in social class IV and V ( using standard occupational classification, OPCS.). Seventy five percent had successful repair, while about 50% were either divorced or neglected by their husbands. Conclusion: Vesico-vaginal fistula remains one preventable medical/social calamity too many. Now, afflicting not just teenagers and primipara, but predominantly, older and parous women. Public health education with the provision of accessible and efficient intrapartum care is the cornerstone to eradicating this problem.Key words: VVF, epidemiology, northeastern, Nigeria, Maiduguri

Clinical presentation and complications in patients with unsafe abortions in University of Calabar Teaching Hospital, Calabar, Nigeria

Unsafe abortion still contributes significantly to high maternal morbidity and mortality particularly in developing countries despite concerted efforts being made to reduce it. Our objective is to determine the incidence, mode presentation and complications of Unsafe abortion. This prospective study was carried out by directly interviewing patients managed for unsafe abortion over one and half years period (1" June 2003, to 31st' December, 2004) in Maternity Annex of the University of Calabar Teaching Hospital Calabar, Nigeria. Incidence of Unsafe abortion of 27.6% of all gynaecological admissions was established. Most Patients (55.7%) were age 20 30 years while 25.4% were teenagers. There were 33(27.1%) students, 38.2% were single women and 38.5% had secondary education. The major reasons given for terminating the pregnancy included completion of education (25.4%), fear of parental action (18.8%) and in 17.2% the father of the pregnancy was unknown. Medical officers (32.8%) performed majority of the abortions while 10.7% were self induced by the patients themselves. Main complications encountered included retained product of conceptions, haemorrhage, sepsis, injuries to genital tracts and intra-abdomal organs. Unsafe abortion and it complications occurs in all socioeconomic groups. Efforts directed at reducing unintended pregnancy by comprehensive family planning programs and effective emergency post abortal care services will reduce the problem while the legal status of abortion is being debated.

Five Year Review Of Complicated Induced Abortions In University Of Benin Teaching Hospital, Benin City

This is a retrospective study of 104 cases of complicated induced abortion, seen at the University of Benin over a 5 year period. One hundred and four cases constituting 3.93% of gynaecological admissions were studied. This represents 27.4 cases per 1000 live births. The mean age of patients was 21.37 ± 5.7 years with almost 80% being between 16 and 25 years. About 90% of patients were nulliparae, unmarried and had at the most a secondary school education. Over 70% of the patients had at least a previous abortion. The mean gestational age at abortion was 11.8 ± 4.7 weeks with almost two-thirds of the women having procured the abortion in the first trimester. Greater than 70% had dilatation and curettage or suction evacuation as the mode of abortion. A ‘doctor’ was the attending abortionist in a majority of the cases. The major presenting features were vaginal bleeding, lower abdominal pain and vaginal discharge. The major indications for admission included incomplete abortion and post abortal sepsis. Close to a tenth of cases had abdominal visceral involvement. All the patients had antibiotic therapy, half had evacuation of retained products of conception, a fifth had laparotomy while about a sixth had blood transfusion. Over 90% of the patients were discharged in stable condition. The case fatality rate was 4%. The major causes of death were sepsis with visceral injury and acute renal failure.

Effectiveness of manual vacuum aspiration (MVA) in the management of first trimester miscarriage: Experience in a specialist centre in North-Eastern Nigeria

Background: Safe management of abortion with an easy, simple and effective procedure is mandatory to minimise abortion related morbidities and mortalities. Aim: To assess the pattern of presentation of cases of first trimester miscarriage and the value of manual vacuum aspiration (MVA) in the management of abortion. Methods: Clinical records of 251 cases of miscarriage managed over a 3-year period 2005 - 2007 using MVA ipas aspirator were retrieved and information pertaining to age parity, gestational age at presentation, indication for MVA use, duration of hospital stay and complications encountered were retrieved for analysis and interpretation. Results: A total of 1899 gynaecological procedures were carried out over the 3-year period, out of which 251 were MVA procedures performed for various first trimester miscarriages, accounting for 13.2 % of the total gynaecological admissions. Sixty one (24.3%) of the patients who benefited from MVA were in the 25-29 years age group, while those in the age 20-24 and 30-34 years group constituted 21.5% and 20.7% respectively. Grandmultiparas (53.7%) constituted the majority. The procedure was performed for 50.2% of the patients at 9-11 wks of gestation. Most (88.0%) of the patients had the procedure performed for incomplete abortion and while the remaining 12.0% were for check MVA after complete abortion and missed abortion. Most (67%) of the cases were perform as outpatient procedures. There were three maternal deaths which were not related to the procedure. Conclusions: First trimester miscarriage appeared to be most common among grandmultipara and during the 9-11weeks of gestation. Most of the patients fell into the 25-29 years age group. It appears MVA is being effectively utilized in our centre. Key words: Manual vacuum aspiration, Miscarriage, Experience, North eastern Nigeria

A Review of Clinical Pattern and Outcome of Vesicovaginal Fistula

ObjectivesThe aim of this study was to determine the incidence, sociodemographic parameters, and outcome of surgical repairs of obstetric fistula in our center. MethodsCase files of patients managed for genital tract fistula over a 10-year period (January 1, 1997 to December 31, 2006) were retrieved and analyzed. ResultsFifty-five patients with of genital tract fistula were managed in the period under review, constituting 1.17% of total gynecological admissions. Obstetric fistula accounted for 51 (93%) of genital fistula, and 92.7% of cases were caused by prolonged obstructed labor. The most common form of fistula was the midvaginal type, and 89% of affected women were married with primiparous women mostly affected (43.6%). Menstrual function was lost in 51% of the patients, while obstetric palsy complicated 18.2% of the cases. Half of the women (51%) were abandoned by their spouses, and surgical repair was successful in only 32% of the cases. ConclusionObstetric fistula continues to show the deficiency in women’s general health status occasioned by poor childbirth attendance in developing countries. Affected women suffer double jeopardy as a result of dearth of appropriate experts in fistula repair.

Management of uterine fibroids at the University of Ilorin Teaching Hospital: A 5 year review

Uterine fibroid is a cause of significant morbidity in women of reproductive age group and could lead to death. This was a retrospective review of the case notes of all surgically treated cases of uterine fibroids at the University of Ilorin Teaching Hospital from the 1 st of January 2006 to the 31 st of December 2011. The results show that uterine fibroids constituted 3.0% of new gynaecology admissions. More than onethird of the patients (39.6%) were within the 30-39 years age-group and 62% occurred among women with the parity of 0 and 1. The majority (42.9%) of the women were nulipara. Infertility (78.4%), menstrual disturbances (70.5%) and abdominal swelling (52%) were common presenting features. Evidence of pelvic inflammatory disease in association with uterine fibroids was demonstrated in 58.8% of the patients. Abdominal Myomectomy was the commonest method of treatment in 60.4% of patients; the choice mainly based on age, parity and patient’s desire to maintain her reproductive potential. Anaemia occurred in 40.7% of patients mainly due to intraoperative heamorrhage. Sarcomatous change in the fibroids was present in two (0.6%) of the patients. Surgical operations for uterine fibroids are common kind of gynaecological operations at the University of Ilorin Teaching Hospital. It is therefore suggested that administration of vasopressin into the myoma bed will go a long way to reduce intraoperative haemorrhage.

Audit of gynaecological cancers Queen Elizabeth Central Hospital, Blantyre.

The aim of the audit was to assess the trend of the gynaecological cancers for the first quarter of 2008, and the prevalence of HIV and syphilis among the cases. Gynaecological cancer cases accounted for 6% of gynaecological admissions at QECH between January and April 2008. The findings show that cervical cancer still remains the leading gynaecological cancer among women in the unit. Among the cases where HIV testing was done, 50% of cases tested HIV positive and these were all cervical, vaginal and vulval cancer cases. Syphilis was prevalent in 10% of the cases. Low socioeconomic status and young age was associated with cervical cancer. A majority of the cases of advanced cervical cancer had been sub optimally managed by health workers at initial visit when the disease was at its early stage hence missing an opportunity for adequate treatment.

Uterine Fibroids In A Tertiary Health Centre South East Nigeria

Uterine fibroids are common benign tumours of the female reproductive tract. This study evaluated the clinical presentations and the treatment of fibroids at Ebonyi State University Teaching Hospital over the 5-year period (2001-2005). A retrospective analysis of all cases of uterine fibroids admitted into the gynaecological ward of the Ebonyi State University Teaching Hospital (EBSUTH) over the five-year period (2001-2005). Uterine fibroids accounted for 13.6% of all gynaecological admissions during the period. It was found predominantly during the third and fourth decades of life in nulliparas and women of the higher socio economic class. Primary infertility (22.9%), lower abdominal mass (21. 6%), menstrual abnormalities (15.9%), lower abdominal pain (15.9%) and anaemia (11.8%) were the common clinical presentations while abdominal myomectomy was the commonest modality of treatment employed (90%). Uterine fibroid is common among gynaecological admissions in Igbo women of Southeastern Nigeria. Infertility is a common presentation necessitating abdominal myomectomy in majority of the cases.

Uterine Leiomyoma – An Appraisal Of Presentation And Management Outcome At The University Of Benin Teaching Hospital, Benin City

The clinical presentation and management outcome of 262 cases of uterine fibroids managed in the University of Benin Teaching Hospital over a 5 year period was retrospectively analysed. Uterine fibroids constituted about 10.3% and 18.9% of new gynaecological admissions and surgeries respectively. It was commoner amongst nullipara or low parity women (67.9% i.e.178/262) and within the 3rd and 4th decade of life (68.7% i.e. 180/262). Majority of the patients presented with abdominal swelling (56.9%) and menorrhagia (53.8%). Myomectomy was done in 69.9% while hysterectomy was performed for 30.1% of cases. Anaemia (13.7%), pyrexia (20.2%) and prolonged hospital stay (24.6%) were the major post operative morbidities suffered by the patients. Uterine fibroid is a significant gynaecological problem that afflicts women in the reproductive age group in our environment. Surgery, in form of myomectomy or hysterectomy remains the main treatment modality in this centre, with anaemia, pyrexia and prolonged hospital stay constituting major post-operative complications, particularly with myomectomy. Keywords:Uterine fibroids, myomectomy, hysterectomy, post-operative complicationsAnnals of Biomedical Sciences Vol. 6 (1) 2007: pp. 10-17

Exploring the pattern of complications of induced abortion in a rural mission tertiary hospital in the Niger Delta, Nigeria

Unsafe abortion remains a major cause of maternal morbidity and mortality in developing countries including Nigeria. We report a 10-year descriptive review of 118 consecutive cases of complicated induced abortions. At our centre, complications of induced abortion constituted 2.3% of maternal admissions, 5.6% of gynaecological admissions and 22.6% of maternal deaths. Fifty-nine percent of the women were married and the mean age was 25.6 +/- 7.9 years. Doctors performed 51.7% of the induced abortion and nurses performed 13.9%. Of the mortalities, medical doctors did 61 of the abortions in which 18 died (29.5%); traditional medical practitioners were responsible for 13 of the abortions in which two died (15.4%); of the 16 abortions performed by nurses, two died (12.5%). Sepsis was the most common cause of death (73%). There is an urgent need to improve the knowledge and utilization of modern contraception by rural women in order to prevent unwanted pregnancies. Doctors need to be continuously trained inn the basic principles of postabortion care.

Socio-demographic characteristics of patients admitted with gynaecological emergency conditions at the provincial general hospital, Kakamega, Kenya

To determine the magnitude of gynaecological emergencies and the socio demographic characteristics of patients admitted at Provincial General Hospital Kakamega (PGHK). Retrospective cross-sectional study. Provincial General Hospital Kakamega, the referral hospital for Western Province, Kenya. Four hundred patients admitted at the gynaecological wards during the period 1st January 2002 to 31st December 2002. In this study 80% of gynaecological patients admitted at PGH Kakamega were of an emergency nature with 45% being teenagers. The mean age was 17 +/- 3 (mean +/- SD). The majority had primary level of education or below (69%), unemployed (87%) and were rural residents (71%). Patients with abortion formed about 43% of the study group while those with inflammatory disease, pelvic abscess and ectopic pregnancy formed about 24%, 10% and 8% respectively. Most gynaecological admissions in PGH Kakamega are of acute nature, with abortion being the most common diagnosis. Hence, trained staff, equipment, supplies and drugs for management of acute gynaecological conditions should be available in hospitals in Western Kenya.

Cancer of the Cervix at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, in the last decade of the last Millennium

Objective: To evaluate the incidence and clinical presentation of cervical cancer in a Nigerian tertiary health institution. Methods: A review of retrieved retrospective data relating to patients managed for cancer of the cervix at the University of Benin Teaching Hospital (UBTH), Benin City between January 1991 and December, 2000 was done and is presented as frequency tables. Results: Cancer of the cervix constituted 72.9% of all gynaecological malignancies seen at the University of Benin Teaching Hospital (UBTH) and accounted for 4.8% of all new gynaecological admissions. The mean age at presentation was 49.1+5.7 years, with a peak age of 41 years to 50 years. Commonest presenting feature was abnormal vaginal bleeding while the modal stage at presentation was IIIB. The squamous cell variety was commonly encountered. Conclusion: Cancer of the cervix is of Public health importance in Benin City, Nigeria. Late presentations render curative protocols ineffective. Public enlightenment targeting sexually active women in the lower socio economic strata to boost uptake of screening services should be undertaken. Keywords: cancer, cervix, late, Benin City Orient Journal of Medicine Vol. 19 (1-4) 2007: pp. 24-30

Genital bleeding in premenarcheal girls

Background: Premenarcheal vaginal bleeding is not a common complaint. This study was undertaken to outline the major causes in our environment. Method: A retrospective study of 68 cases managed in the University of Port Harcourt Teaching Hospital(UPTH) over a 20-year period was studied. Simple percentages were used to analyse the results. Results: Sixty-eight cases of premenarcheal vaginal bleeding out of a total of 9,876 gynaecological admissions between January 1985 and December 2005 in UPTH were reviewed. The major causes were urethral prolapse in 34 girls (50%), straddle injuries in 11(16.2%), foreign bodies 10 in (14.7%), rape/sexual abuse 9 (13.2%), female genital mutilation 3 (4.4%), unknown in 1 (1.5%). In some cases, presentation in the clinic occurred days to weeks after onset of symptoms.The ages ranged between 0 and 8 years. Associated presenting complaints were mass protruding from the vagina, pelvic pain, dysuria, foul smelling discharge and fever. Laboratory investigations, examination under anaesthesia, abdominal and pelvic ultrasound scans aided the management. Treatment options were individualized to the causes. They were satisfactory except in one case lost to follow-up.Two of the girls had blood transfusion.There was no mortality in this series. Conclusion: Good care of young girls, early presentation to hospital and competent treatment of presenting cases give satisfactory outcome. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 186-189

Reasons for gynaecological consultations in children in Calabar, South Eastern Nigeria

Childhood gynaecological disorders as seen in the University of Calabar Teaching hospital (UCTH), Calabar, Nigeria, over a 10-year period were studied. The aim was to establish the incidence and pattern of presentation of these disorders. Childhood gynaecological disorders constituted 3.1% of gynaecological admissions in UCTH. Vaginal laceration following rape was the most common disorder accounting for 54.8% of the cases. This was most common in the 8 to 11-year age group (52.2%). Vaginal bleeding was the most common presenting symptom (63.1%) and repair of vaginal laceration the most common procedure performed (54.8%).

Recombinant Factor VIIa in the Management of Postpartum Bleeds: An Audit of Clinical Use

Background. This paper presents an analysis of 25 patient cases in which recombinant factor VIIa was used in the management of postpartum hemorrhage, including severe and/or life-threatening bleeds. Anecdotal experiences in the empirical use of this agent are described and dosing regimens, effects on bleeding, and safety data are presented.Methods. Data were extracted from the international, internet-based, voluntary registry, haemostasis.com. Search results were manually cross-checked against monthly summary reports and cases of confirmed postpartum hemorrhage were analyzed by the authors. Case providers were contacted individually to approve the use of their cases, supply any missing data, and validate the data already held.Results. Of 43 reported gynecological admissions for hemorrhage, 13 were excluded as they did not relate to childbirth, and 5 due to insufficient data. The remaining 25 records, all associated with postpartum hemorrhage, were submitted by 14 doctors from 5 countries. Following admini...

Urethral prolapse: A retrospective anlysis of hospitalised cases in Port Harcourt

Urethral prolapse is a disease of the prepubertal girls and postmenopausal women. It is rare and seen in most cases as a circular protrusion of the distal urethra through the external meatus. A retrospective study of cases managed in University of Port Harcourt Teaching Hospital (UPTH) between January 1989 and December 2000 were analysed. Nineteen (0.4%) excisions of urethral mucosal prolapse out of a total of 4351 gynaecological surgeries were carried out between January 1989 and December 2000 in UPTH. Of the 35 total paediatric gynaecological admissions, there were 17 (49%) cases of urethral prolapse. It occurred commonly between ages 4 and 7 years (63%). Common presenting complaints included vaginal bleeding, vaginal discharge and mass protruding from the urethral opening. Excision was found curative in all cases. There is a place for promotion of female education and community sensitization to encourage early presentation and treatment. This will reduce infectious morbidity and its sequelae in our environment.

Trend of Induced Abortions in Ilorin, Nigeria

Context: Induced abortion remains a major cause of maternal mortality in developing countries. Reports from Nigeria put it's contribution to maternal death at between 15-40%. Prevention of maternal mortality project (Which trys to eliminate hospital delay in the treatment of complication of induced abortion) was introduced in Ilorin over a decade ago. There is need to review its impact on mortality from induced abortion. Objectives: To determine Social-demographic factors associated with induced abortion complications. To determines mortality pattern from induced abortion in Ilorin. To compare the result to the previous findings at this center. Study Design: A descriptive retrospective study. Date was generated from case notes of patients treated for complications from induced abortion in a teaching hospital in Nigeria, to identify social-demographic factors associated with induced abortion. Outcome measure: Maternal death, specific complications. Prevalence of induced abortion. Results: Induced abortion accounted for 3.28 percent of gynecological admission. Case fatality rate is 61.0 per 1000. Multiple complications are common, Age group 24 years and below accounted for 73.05%. Causes of death are hemorrhage and septicemia. Conclusion: Mortality from induced abortion has not changed significantly despite the implementation of prevention of maternal mortality project in Ilorin. There is need to redefine intervention strategy. Effort to increase contraceptive use especially by single women will reduced unwanted pregnancy and by extension induced abortion with its attendant complications. Keywords : Induced Abortion, Maternal Mortality, Hemorrhage, Teenagers, Trend. Nigerian Medical Journal Vol. 48 (3) 2007: pp. 65-68

Recombinant factor VIIa in the management of postpartum bleeds: an audit of clinical use

This paper presents an analysis of 25 patient cases in which recombinant factor VIIa was used in the management of postpartum hemorrhage, including severe and/or life-threatening bleeds. Anecdotal experiences in the empirical use of this agent are described and dosing regimens, effects on bleeding, and safety data are presented. Data were extracted from the international, internet-based, voluntary registry, haemostasis.com. Search results were manually cross-checked against monthly summary reports and cases of confirmed postpartum hemorrhage were analyzed by the authors. Case providers were contacted individually to approve the use of their cases, supply any missing data, and validate the data already held. Of 43 reported gynecological admissions for hemorrhage, 13 were excluded as they did not relate to childbirth, and 5 due to insufficient data. The remaining 25 records, all associated with postpartum hemorrhage, were submitted by 14 doctors from 5 countries. Following administration of recombinant factor VIIa, bleeding stopped in 18 cases (72%), markedly decreased in 2 (8%), and decreased in 4 (16%). Bleeding increased following recombinant factor VIIa administration in only 1 patient (4%). Requirements for replacement blood products and crystalloids/colloids were also greatly curtailed. A full recovery was achieved by most patients (22/25, 88%) with few complications, even when recombinant factor VIIa was administered as salvage therapy. There were no thrombotic complications associated with recombinant factor VIIa administration. This review provides the largest aggregate of cases in which recombinant factor VIIa has been used to control obstetrical bleeding. A review of these cases suggests that this agent may be a useful and safe adjunctive therapy in the management of postpartum hemorrhage.

Use of case fatality and readmission measures to compare hospital performance in gynaecology

To identify suitable outcome measures for comparing gynaecology performance between hospitals. Analysis of routinely collected statistics. England. POPULATION A total of 1.45 million gynaecology admissions in 1999/2001. The database used was a linked file of English NHS hospital admission statistics and death certificate data. Case fatality rates (CFRs)and emergency readmission (ERA) rates were calculated for different components of gynaecology workload. Funnel plots, using age-sex standardised measures, were displayed to compare the outcomes. CFRs and ERA rates. The CFR within 30 days after admission for patients with cancer was 5.1%. These patients accounted for only 3% of all the admissions but for 73% of all 30-day deaths. All other 30-day CFRs were extremely low-below 0.5%. The 30-day ERA rates ranged from 1.8% after day case care to 17.4% after emergency admissions for people who did not have an operation. Funnel plots showed considerable variation between hospitals for ERA after day case care but not after elective abdominal hysterectomy. There are no measures of mortality that could be used routinely and meaningfully to compare the performance of gynaecology units. We suggest that two suitable comparative measures of outcome, derivable from routine hospital statistics, are 30-day ERA rates after day case admissions and after elective abdominal hysterectomy, excluding those records with a cancer diagnosis. These measures are relatively homogeneous with respect to their likely rates of adverse events and have sufficient numbers to produce potentially useful comparative results.