National Obstetric Fistula Centre Research Articles

Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria - A qualitative study.

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

Comparison of patterns of obstetric fistula between two periods in South-East Nigeria

Obstetric fistula continues to be a reproductive health problem among women in low- and middle-income countries. The study aimed to compare the demographics, aetiology, presentation, management of fistula patients seen at two different periods. It was a retrospective comparative cross-sectional study of fistula patients managed in 2015 and 2020 at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria. A total sampling of all the patients who had obstetric fistula repair within the study periods was done. Medical records of the women were obtained. Data was analysed using the SPSS version 21. Numerical variables were compared with the student’s t-test while categorical variables were compared using the Chi-square test. A p-value of less than 0.05 was considered significant. A total of 229 women had repair of obstetric fistula, 143 in 2015 and 86 in 2020. The mean ages of the women treated in 2015 and 2020 were 35.3±10.8 years and 35.0±11.8 years respectively (P=0.333). In 2015, the commonest cause of fistula was prolonged obstructed labour while in 2020, it was Caesarean section (60.3% vs 43.0%, P<0.001). Stillbirth was the commoner (65.4%) fetal outcome in 2015 as against live birth in 2020 (65.4% vs 54.4%, P=0.004). Abdominal approach to repair increased from 4.2% of procedures in 2015 to 11.6% in 2020 (P=0.033). There was no change in the socio-demographic characteristics of the women treated within the two periods. Caesarean section is now the commonest aetiology of obstetric fistula. Most babies now survive the antecedent pregnancy with abdominal repairs now on the increase.

Prevalence of Dermatophytosis Infection Among Patients Attending National Obstetric Fistula Centre Babbar-Ruga Hospital, Katsina State

This study aimed to determine the prevalence of dermatophytosis infections among patients attending National obstetrics fistula center Babbar-ruga hospital, Katsina state. A total number of 100 patients were diagnosed, (40/100) were males and 60% (60/100) were females, giving a gender ratio of 3:2 (males: females), 40% of the participants were of the age range 10-29 years and 60% of age from 14-21 years respectively. Out of 60 cases, a total of 53 dermatophytes were isolated belonging to the genera Trichophyton and Microsporum. The most frequently isolated dermatophytes were Trichophyton mentagrophyte (26.41% 14/53), followed by Microsporum audouinii (22.64% 12/53), Trichophyton rubrum (15.09% 8/53), Trichophyton schoenleinii (7.547% 4/53), Microsporum gypseum (5.660% 3/53) and the least were Microsporum canis (9.433% 5/53) and Trichophyton tonsurans (9.433% 5/53), Trichophyton verrucosum (3.77% 2/53). Although 38 cases (63.33%) had single infections with dermatophytes, mixed infections with 2-4 dermatophytes of the genera Microsporum and Trichophyton were observed in 15 cases (36.67%). 67% (10/15) of the mixed infections were with Microsporum and Trichophyton species, 20% (3/15) were with Microsporum species alone, and 13.3 %( 2/15) were with Trichophyton species alone. This study indicates an outstanding prevalence of dermatophytosis infection among patients who shared combs and scarves and who owned pets; this suggests a thriving animal-human transmission route of dermatophytes and the potentiality of the fomites. The research proposes intensive health promotion and education interventions to promote hygiene practices among patients.

Sexual Assault;Our experience at One Stop Shop for Women and Girls, National Obstetric Fistula Centre, Abakaliki , Ebonyi State. South East Nigeria: A retrospective study

Sexual Assault;Our experience at One Stop Shop for Women and Girls, National Obstetric Fistula Centre, Abakaliki , Ebonyi State. South East Nigeria: A retrospective study

Metal and organic characterization of bladder stones removed surgically from VesicoVaginal Fistula patients at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State

Objectives: Complication of obstetric fistula is the formation of bladder stones which rarely occur in Vagina-Vesico Fistula (VVF) patients. In this study, the metal and organic characterization of bladder stones removed between 2010-2019 from vesicovaginal fistula patients managed at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Ebonyi State, Nigeria were carried out. Methods: The solubility of the bladder stones in different solvents were investigated and metal compositions were determined using Inductively Coupled Plasma- Optical Emission Spectrometry (ICP-OESS). The qualitative chemical composition was determined following standard procedures while the structural chemical characterization and functional groups were determined using the Gas Chromatography-Mass Spectrometry (GC-MS) and Fourier-Transform Infrared spectroscopy (FTIR). Results: Distilled water and aqueous solvent chloroform extract of W. lateritia demonstrated significant capacity to dissolve bladder stones in-vitro. Chemical compounds identified include uric acid, oxalate, cysteine, and phosphate from the bladder stones. The metals found in the bladder stones were: Ca, Na, Cu, Zn, Mg, B, Pb, and Al. Trace elements can influence the external morphology of growing crystals and may increase or decrease the speed of the crystallization process. The GC-MS revealed the presence of the following compounds: methyl 2-Hydroxyethyl sulfoxide; methylene chloride; mercaptamine;1,1diethoxy, dichloroactealdehyde; Cyclopentasiloxane; monoammonium salt; di-Allo-Cystathionine; dichloroacetaldehyde; 2-(2Furyl)-2,5-dimethyltetrahydrofuran; Methenamine; 1,1-Difluoro-1-sila-5-thiacyclooctane; Triacetonetriperoxde; 4-Aminosalicylic acid, 3-Trimethylsilyl (3TMS) derivative;Pentanethiol; and 2,5-Bis-(5-hexyl-[1,3,2]dioxaborinan-2-yloxy)-benzene. FTIR revealed the following: hydroxyl, carboxylic, ester, aromatic, and aliphatic groups, confirming the compounds identified. Conclusion: Metals (Mg, Ca, Pb, etc), organic metabolites (oxalate, cystine, uric acid, phosphate, methenamine, methylene chloride, 4-Aminosalicylic acid, 3-Trimethylsilyl, etc) were found in the bladder stones.

Economic burden of obstetric fistula among patients in the National Obstetric Fistula Centre, Nigeria

Economic burden of obstetric fistula among patients in the National Obstetric Fistula Centre, Nigeria

Biofilm Detection on Catheter Associated Uropathogenic Bacteriuria among Fistula Patients Attending National Obstetric Fistula Centre Ningi, Bauchi State, Nigeria

Background: Biofilm production caused by bacteria plays a vital role in catheter associated urinary tract infection (UTI) or bacteriuria being responsible for persistence and recurrent infection. Biofilms forming bacteria are difficult to eradicate due to antimicrobial resistance to the commonly used antibiotic. Biofilms are currently estimated to be responsible for over 65% of nosocomial infections and 80% of microbial infections. This study aimed to perform biofilm detection on uropathogenic bacterial isolates among fistula patients attending National Obstetric Fistula centre Ningi and investigate the antimicrobial susceptibility pattern.
 Methods: A total of 217 strains of significant bacteriuria were isolated from vesico vaginal fistula (VVF) patients. A cross sectional study was conducted at the hospital. The urine samples were collected and cultured on CLED and blood agar media while confirmation was done using their biochemical reaction. The detection of biofilms formation on the isolates was performed using tube adherence and Congo red agar method. Antimicrobial susceptibility testing was carried out by disc diffusion method on Muller Hinton agar.
 Results: Out of 217 significant bacteriuria isolated, 38 strains produced biofilms;28 strains tested positive on tube adherence method while 15 strains were positive on Congo red agar method. Bacteria that produced biofim showed multiple drug resistance compared to the platonic bacterial cells. All the biofilm producers showed 100% resistant to septrin, ampiclox, gentamycin and amoxicillin. There was no significant value between tube adherence and Congo red agar method with P value > 0.05.
 Conclusion: Biofilm detection should form part of routine testing while antimicrobial susceptibility testing is paramount on better choice of antibiotic therapy for proper management to reduce economic lost, treatment failure and drug resistance.

Selected Clinical Characteristics and Determinants of Obstetric Palsy Among Patients With Obstetric Fistula

Background: Obstetric fistula is a major maternal health issue with its attendant physical, psychosocial, and economic correlates. The morbidity worsens with physical challenges associated with neurological and musculoskeletal injury in the patient. Objectives: The major objective of this study was to examine selected clinical characteristics and determinants of obstetric palsy among patients with obstetric fistula. Study Design: Descriptive retrospective study. Methods: Medical records of 452 patients who were treated for obstetric fistula at the National Obstetric Fistula Centre, Abakaliki, from January 2014 to May 2018 were retrieved and analyzed for clinical characteristics and clinical determinants using the SPSS for Windows (SPSS version 20). Results: Results revealed that 23.5% of the subjects neither registered for nor attended antenatal care in a health facility. While 50.9% of the subjects had lived with fistula for less than a year, 31.4% lived with obstetric fistula between 1 and 9 years. Labor lasting for 2 days or more was reported by 46.7%. Vaginal births were reported by 34.1%. Intracervical fistula was the most frequently encountered fistula. Maternal obstetric paralysis of one or both lower limbs was found in 31.4% of the subjects. Results of a binary logistic regression model also reveals that antenatal care, duration of labor, mode of delivery, and circumferential fistula were significant determinants of obstetric palsy among patients with obstetric fistula. Conclusion: There is need to increase public enlightenment and make antenatal care and delivery readily available to reduce obstetric fistula and maternal obstetric palsy. Therapists' awareness of these determinants also aids in clinical diagnosis, prognosis, and prevention.

Bladder Stone: An Uncommon Cause of Urinary Incontinence

Background: Bladder stones contribute about 5% to urinary tract stones. Bladder calculi is not a common cause of urinary incontinence and huge bladder stones are not common in routine clinical practice. Our aim, in this case, was to report a patient with huge bladder stone and share our experience in the management. Case presentation: She is a 41-year-old grand multipara who presented to the National Obstetric Fistula Centre, Abakaliki with a history of urinary incontinence. Presence of bladder stone was felt with a metal urethral catheter during clinical examination and this was confirmed with imaging. She was managed with transvaginal cystolithotomy. Conclusion: Huge bladder stone is uncommon but can be a cause of urinary incontinence. Transvaginal cystolithotomy is a safe approach to its management. Keywords: Bladder stone; Urinary incontinence; Cystolithotomy

The Fetal Outcome and Fetal Wastage Pattern among Different Types of Obstetric Fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria

BACKGROUND: Obstetric Fistula is a major public health problem in developing world. It is associated with a high fetal wastage rate. The objective of this study was to evaluate different types of obstetric fistula and their fetal wastage rate. METHOD: A retrospective population study was done at the National Obstetric Fistula Centre, Abakaliki between 1st January-31st December, 2016. The calculated minimum sample size was 3, however, the total number of 203 patients were studied. The case notes of all the women who had obstetric fistula repairs over the period were analyzed. RESULTS: The mean age from this study was 38 ± 12.1 years. The fetal wastage rate from this study was 82.76% while the live birth was 17.24%. Seventy percent of the stillbirth were delivered via SVD, while 11% of stillbirth were delivered through EmCS. Twelve different types of fistula were identified in this study using anatomical classifications. Large extensive fistula, urethral loss and multiple fistula had the highest fetal wastage of 100% respectively. This was followed by mid-vaginal fistula (95.7%), Juxtaurethral fistula 94.4%, Juxtacervical fistula 88.5%, Intracervical fistula 85.71%, Ureteric fistula 85.71%, Vesicouterine 84.21%, Vault fistula 62.5%. Rectovaginal fistula had the least fetal wastage of 15.79% and the highest live birth of 84.2%. CONCLUSION: The findings showed a high fetal wastage rate amongst women with obstetric fistula. There was high fetal wastage across different types of obstetric fistula. Rectovaginal fistula had the best outcome in terms of live births.

Comorbidities among women with pelvic organ prolapse

BACKGROUND: Comorbidities are a source of worry in women with pelvic organ prolapse. With increasing age, incidence of other medical conditions tends to increase hence it is not surprising to find comorbidities in women with pelvic organ prolapse.OBJECTIVE: To document the comorbidities among women with pelvic organ prolapse.
 METHODS: This retrospective study was conducted at the National Obstetric Fistula Centre, Abakaliki South-East Nigeria. This study involved the review of medical records of women with uterovaginal prolapse between June 2012 and May 2017. The data of 1168 women were available for review.
 RESULTS: The mean age was 49.76 ± 13.57 years. Comorbidities occurred in 250 (21.4%) of the cases reviewed. The comorbidities commonly encountered were hypertension in 139 (11.9%), obesity in 56 (4.8%), peptic ulcer disease in 17 (1.5%) and diabetes mellitus in 16 (1.4%). Others were anaemia and human immunodeficiency virus infection. Sixty-three women (5.4%) experienced a delay in surgery as a result of these comorbidities.
 CONCLUSION: The comorbidities encountered in this study were obesity, hypertension, diabetes, anaemia, peptic ulcer disease and human immunodeficiency virus infection. There is need to adequately manage these comorbid conditions so as to prevent adverse surgical outcome.

Non-Fistulous Complications of Prolonged Obstructed Labour among Obstetric Fistula Patients in Southern Nigeria

Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women. These included cervical retraction (42.2%), obstetric nerve palsy (30.4%), vaginal scarring (29.8%), partial urethral loss (16.1%), anal sphincter injury (3.1%), cervical stenosis (5.0%) and urethral stenosis (3.7%). Others were ammoniacal dermatitis (29.2%), secondary amenorrhoea (21.7%), secondary infertility (9.3%), dyspareunia (6.8%), hypomenorrhea (1.2%) and bladder stone (3.7%). Majority (79.4%) of the women with cervical retraction had caesarean section (CS) as against 20.6% who had vaginal delivery. This was statistically significant (P 0.001). A higher proportion of participants with amenorrhea were delivered via CS (44.3%) compared to those who had vaginal delivery (21.2%). This was also statistically significant (P = 0.012). Neurologic injury was associated with primiparity although this was not statistically significant (P = 0.171). Conclusion: Almost all fistula patients also have non-fistulous complications of prolonged obstructed labour. Efforts to manage the fistula should equally address these complications. We advocate comprehensive care for identification and management of these injuries to improve the quality of life and overall well-being of these women. To reduce complications like cervical retraction, there should be an emphasis on safer caesarean section for women with prolonged obstructed labour.

Pattern of body mass index among women with pelvic organ prolapse

BACKGROUND: Overweight and obesity are usually regarded as risk factors for pelvic organ prolapse. This may not be the case in Sub-Saharan Africa where there is chronic malnutrition, physical stress and underweight.OBJECTIVE: To determine the pattern of body mass index in women with pelvic organ prolapse.METHODS: This was a retrospective study which involved the review of medical records of patients between June 2012 and May 2016. Data of 917 women who presented for management of pelvic organ prolapse met the inclusion criteria. Ethical clearance for the study was obtained from Research and Ethics committee of the National Obstetric Fistula Centre, Abakaliki.RESULTS: The mean age was 49.46±13.2 years. The mean weight was 52.04±11.96 kg. The mean body mass index was 21.37±4.73kg/m2. Two hundred and thirty four (25.5%) were underweight and 540 (58.9%) had normal weight. Overall, 15.7% of the study population had obesity and overweight. In women that had first degree uterovaginal prolapse, 20% had obesity and overweight. For women that had second and third degree uterovaginal prolapse, obesity and overweight occurred in 17.7% and 10.6% respectively.CONCLUSION: Most women with pelvic organ prolapse in our setting tend to have normal body mass index or are underweight. Increasing severity of prolapse does not appear to correspond with increasing body mass index in our setting.

Prevalence and antimicrobial susceptibility of asymptomatic bacteriuria among women with pelvic organ prolapse in Abakaliki, South-East Nigeria

BackgroundPelvic organ prolapse (POP) is the herniation of pelvic organs from its anatomical confines, and it is of considerable importance to the practicing gynaecologist in middle and low income countries. It is commonly associated with, urinary tract infection (UTI), both symptomatic and asymptomatic due to anatomical and physiological changes. The aim of this study was to determine the prevalence of asymptomatic bacteriuria among women with pelvic organ prolapse, to know the organisms commonly implicated and the sensitivity pattern.MethodsThis study was conducted among 96 women with POP at the National Obstetric Fistula Centre Abakaliki. A cross sectional descriptive study was done. Standard microbial technique was used to analyze the urine. Data was analysed using the Statistical Package for Social Sciences version 17.ResultsOut of the 96 patients, 76 were found to have asymptomatic bacteriuria giving a prevalence of 79.2%. Nine different bacteria species isolated include E. Coli (34.2%), Streptococcus pneumonia (23.7%), Staphylococcus aureus (7.9%), Proteus Spp (7.9%) others (5.3%). The highest level of microbial sensitivity to the antimicrobials was with Ciprofloxacin.ConclusionsThis study suggests that prevalence of asymptomatic bacteriuria is very high among women with POP. More than 50% of the bacterial isolates were mainly E.coli and Streptococcus pneumonia. The highest level of microbial sensitivity was with ciprofloxacin while the least was with cotrimoxazole.

Intravenous urography findings in women with ureteric fistula.

IntroductionUreteric fistula is one of the major morbidities that can arise from pelvic surgeries. It mainly results from gynaecological and obstetric procedures. Intravenous urography is an imaging modality for the upper urinary tract. Its features may be suggestive of ureteric fistula and it is of great value when medicolegal issues arise. It is however expensive and requires expertise. There are other useful and cheap methods for evaluating ureteric fistula including the use of dye test. There is need to determine if IVU (Intravenous urography) should be recommended for women with this disease. The aim of this study was to determine the features of intravenous urography among women with ureteric fistula and therefore determine its relevance in the management of such patients.MethodsThis was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki between January 2012 and March 2017. All patients with ureteric fistula during the study period who were assessed with intravenous urography before surgery were included in this study.ResultsThe mean age was 38 ± 16 years. Twelve (92.3%) were Christians. IVU showed hydroureters in 46.15% hydronephrosis in 53.85%, non-functioning kidney in 46.15% and ureteric stricture in 7.69%. IVU gave an insight into the side with ureteric fistula except in one who had normal result.ConclusionHydronephrosis, hydroureters and silent (non-functioning) kidneys are features of IVU in women with ureteric fistulas, however these features are not pathognomonic for the disease.

Outcome of open excisional breast biopsies in Abakaliki, South-East Nigeria.

Introductionopen excisional breast biopsy is a known modality for treatment of breast lumps especially in developing countries. Other sophisticated methods are available for management of breast lumps in more advanced nations. Our aim in this study was to review the outcome of open excision breast biopsies in our setting with a view to improving patient management.Methodsthis study was conducted at the National Obstetric Fistula Centre, Abakaliki, South East Nigeria among women who had excision breast biopsy between January 2015 and December 2016. Data was analysed using Statistical Package for Social Sciences (SPSS), version 21.Resultsa total of 107 case folders were reviewed in this study. The mean age of the women was 27 ± 10 years. Overlying breast incision was the preferred route in 78(72.9%), periareolar incision in 28(26.2%), and Gillard Thomas's method (infero-lateral submammary sulcus incision) used in one patient with bilateral multiple breast lumps (0.9%). The complications recorded in this study were haematoma in 3(2.8%), wound infection in 5(4.7%) and wound breakdown in 1(0.9%). Hypertrophic scar was found in 2(1.8%) patients at follow-up. Overall, most patients were satisfied with the aesthetic outcome of their surgery.Conclusionopen excision breast biopsy is a useful modality for management of breast diseases in our setting. Complication rates are minimal. Both overlying and periareolar breast incisions results in aesthetically satisfactory scar in our practice. Inferior-lateral sub mammary sulcus skin incision is useful when the lumps are multiple and located at different quadrants of the breast. Appropriate use of drain helps to reduce the incidence of haematoma.

Bladder spasm following urogenital fistula repair.

To examine the occurrence of bladder spasms following surgical repair of urogenital fistula. The present retrospective study included data from patients who underwent surgical repair of urogenital fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria, between June 1, 2015, and May 31, 2016. Patients who underwent rectovaginal fistula repair and those who experienced persistent postoperative pain requiring high doses of analgesia were excluded. Bladder spasm was defined as the sudden onset of intermittent pain in the region of the bladder lasting for short periods of time in patients who were previously comfortable with routine postoperative analgesia. The incidence of bladder spasm was calculated and the presence of an association between repair outcome and bladder spasms was investigated. There were 133 patients included in the present study with a mean age of 36±11years. Bladder spasms were experienced by 60 (45.1%) patients during the study period; of these patients, failed fistula repair was recorded for 13 (22%). Good surgical outcome (closed fistula) was associated with not experiencing postsurgical bladder spasms (P=0.044). The incidence of bladder spasm following surgical repair of urogenital fistula appeared high. The occurrence of bladder spasms could influence repair outcomes.

Audit of mammography requests in Abakaliki, South-East Nigeria

BackgroundBreast cancer is the leading cancer in women in both developed and developing countries. Screening mammography detects breast cancer even before a lump can be palpated, with better prognosis. The introduction of mammographic technique for screening breast cancer, despite its importance, has been slow to adopt and virtually non-existent in many parts of Sub-Saharan Africa including Nigeria. For this reason, the indications of mammography have not been well defined in our setting. The aim of this study was to audit our mammography requests, with a view to improving its application in our setting.MethodsThis is a descriptive study carried out on 69 female patients who had mammography at the National Obstetric Fistula Centre, Abakaliki, from January 2014 to December 2015. Findings on clinical examination were entered in a proforma. Mammography was performed in craniocaudal and mediolateral views using the Lorad M-IV (film-screen) mammography machine. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21.ResultsAll 69 patients were females. Their mean age was 42.1 ± 11 years. Majority of the patients (69.6%) were between 30 and 49 years. The commonest indication for mammography was breast lump which was found in 46 patients (66.7%). Breast pain was present in 36 (52.2%) of patients. The different Breast Imaging Reporting and Data System (BIRADS) categories were BIRADS 0: 20 (28.99%), BIRADS 1: 8 (11.59%), BIRADS 2: 9 (13.04%), BIRADS 3: 4 (5.8%), BIRADS 4: 19 (27.54%) and BIRADS 5: 9 (13.04%).ConclusionsDiagnostic mammography remains the commonest indication for mammography in our setting. Public awareness, poverty reduction and ready availability of mammography facilities are required to improve screening mammography in our setting.

Enterovesical Fistula Complicating Myomectomy: A Case Report

Background: Enterovesical fistula is an abnormal communication between the bladder and the gastrointestinal tract. It is an uncommon type of genital fistula, occasionally complicating pelvic surgeries. However, it is the most common type of fistula associated with diverticular disease of the colon. Other causes include cancer, trauma and iatrogenic injuries. Pneumaturia and fecaluria usually implies enterovesical fistula. Enterovesical fistula complicating myomectomy is an uncommon finding. Our aim is to report a case of enterovesical fistula following myomectomy. Case presentation: She is a 33-year-old nullipara who presented at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State, South-Eastern Nigeria with a history of fecaluria, pneumaturia and haematochezia which started after myomectomy. Feculent fluid was obtained on urethral catheterization. Cystography was suggestive of enterovesical fistula. Conclusion: Enterovesical fistula is a possible complication of myomectomy. A high index of suspicion for this rare but potentially devastating condition is important for early diagnosis and appropriate management.

Endocervical Swab Microbial Isolates among Women with Third Degree Uterovaginal Prolapse

Background: Uterovaginal prolapse is the descent of the uterus through the vaginal canal. This may be a predisposing factor to infections in the urogenital system. This study aimed to assess the endocervical swab microscopy, culture and sensitivity in patients with third degree uterovaginal prolapse at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria. Methodology: This is a cross-sectional prospective study to assess the endocervical swab microbial findings in patients with third degree uterovaginal prolapse using simple random sampling technique. Data on sociodemographic variables, risk factors for pelvic organ prolapse, and endocervical swab findings among women with third degree uterovaginal prolapse were collated and analysed using statistical methods. Results: The mean age and parity were 50.5 years ± 9.1 and 6.7 ± 2.0 respectively. Thirty-six (85.7%) of the clients were grandmultipara and 37 (88.1%) were farmers. Pus cells were present in all samples while 27 (64.3%) had microbial isolates. Streptococcus pyogenes was isolated in 7 (16.7%), Streptococcus faecalis in 5 (11.9%), Escherichia coli in 5 (11.9), Staphylococcus aureus in 4 (9.5%), Klebsiella pneumoniae in 2 (4.8%) and Yeast cells in 4 (9.5%) of the endocervical swabs. All isolates were sensitive to gentamicin. Bacterial isolates were resistant to amoxicillin/clavulanic acid. Conclusion: This study showed growth of pathogenic organisms from the endocervix of women with third degree uterovaginal prolapse. A 100% sensitivity to gentamicin was observed in the study.