African Journals OnLine
Tropical Journal of Obstetrics and Gynaecology

Volume 18, Number 1, April 2001
Abstracts

Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

At the beginning of another millennium, it seems appropriate to take stock of the major developments that have taken place in reproductive health care, particularly in the last century. Although reproductive health has become a truly multidisciplinary enterprise, the co-ordination of reproductive health care services will continue to rest on the Obstetrician/Gynaecologist because pregnancy and childbirth are at the very core of the reproductive process. Specialists in the discipline therefore have a crucial role to play in training, advocacy, community education and mobilisation of resources to improve the standard of reproductive health in the society and provide wholesome reproductive health care services to their communities.

Key Words: Reproductive Health; Advocacy; Services; Maternal Care. [Trop J Obstet Gynaecol, 2001, 18: 2-7]

Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Context: Female sterilisation is the most widely used method of fertility control in the world. Pregnancy following the procedure is often associated with significant morbidity due to delay diagnosis and management.

Objective: The aim of this study is to examine the peculiarities and factors leading to failed female sterilisation in Ile-Ife Nigeria.

Study Design, Setting And Subjects: A descriptive study of all cases of pregnancy following bilateral tubal ligation encountered at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from October 1 1987 to September 30 1998.

Main Outcome Measures: Incidence and crude failure rate of female sterilisation, types and methods of sterilisation, types of pregnancy and sterilisation-pregnancy interval.

Results: During the period of study, there were 16,847 births, 533 cases of voluntary surgical contraception and 4 patients with pregnancy following bilateral tubal ligation. The incidence of female sterilisation was 31.5 per 1000 births while the crude failure rate was 7.5/1000. Postpartum and interval voluntary surgical contraception were done in 91.4% and 8.6% respectively. In all the cases of failed female sterilisation, Pomeroy method of female sterilisation was employed and they were all done in the post partum period, with the sterilisation-pregnancy interval ranging from 14 to 42 months.

Conclusion: This study advocates the postponement of tubal sterilisation till 6 weeks postpartum in order to reduce the failure rate.and the use of techniques that involve burying the outer ends of the fallopian tubes in the broad ligament if sterilisation is done in the immediate puerperium.

Key Words: Failed Female Sterilisation; Contraception; Ectopic Pregnancy. [Trop J Obstet Gynaecol, 2001, 18: 8-11]

Department of Obstetrics & Gynaecology, University College Hospital, Ibadan, Nigeria.

Context: In marriage, great importance is placed on a satisfactory sexual life and child bearing. Whereas companionship is the primary purpose of marriage in many western societies, here in Nigeria procreation is the central issue in marriage. Acquired gynaetresia is commonly associated with infertility in tropical Africa.

Objective: To determine the prevalence of acquired gynaetresia in our gynaecological practice and assess the outcome of its management.

Study Design: A retrospective analysis of patients presenting with acquired gynaetresia between January 1984 and December 1998, at the University College Hospital, Ibadan.

Main Outcome Measures: The relative proportion of cases of acquired gynaetresia compared to the total number of the gynaecological cases seen during the study period. The definitive treatment modalities employed, treatment outcome and the complications encountered.

Result: Acquired gynaetresia accounted for 0.52% of all major gynaecological admissions during the study period. The patients’ ages ranged from 5 to 54 years. Chemical vaginitis from pessary insertion into the vagina was the commonest aetiological factor, followed by complications of female genital mutilation. The 2-stage vaginoplasty (Mcindoe's Operation) was the most commonly employed procedure to restore vaginal patency. Post-operative morbidity was low. Pregnancy was recorded in 5 patients during the follow-up period.

Conclusion: Acquired gynaetresia contributes significantly to reproductive health morbidity in the developing world, often resulting from ignorance and harmful traditional practices. Public health education and wide spread enlightenment of the populace to eliminate the preventable causes is suggested, to reduce the burden of acquired gynaetresia in contemporary gynaecological practice.

Key Words: Acquired Gynaetresia; Treatment Outcome; Vaginoplasty. [Trop J Obstet Gynaecol, 2001, 18: 12-15]

Adesina Oladokun, Isaac A. Babarinsa and Isaac F. Adewole

Department of Obstetrics & Gynaecology, College of Medicine, University College Hospital, Ibadan, Nigeria.

Context: Myomectomy is usually performed when uterine fibroids are associated with infertility. Serosal and endometrial reconstitution are some of the subtle challenges that the gynaecologist has to deal with during myomectomy, in an attempt to minimise postoperative pelvic and intrauterine adhesions.

Objective: This study was conducted to evaluate the effect of careful apposition of the serosa and endometrium on subsequent development of post-myomectomy pelvic and intrauterine adhesions and to assess the effect of resection of redundant endometrium on subsequent menorrhagia.

Study Design, Setting, and Subjects: A review of 17 patients with previous myomectomy who eventually had a subsequent laparotomy for various indications between June 1992, and July 1998 in the University College Hospital, Ibadan was carried out.

Main Outcome Measures: Operative findings at myomectomy, as well as therapeutic procedures performed on them were recorded. Patients’ observation of changes in menstrual blood loss postoperatively was also recorded. The presence of pelvic adhesions at re-laparotomy and intrauterine adhesions on hysterosalpingography in those who had endometrial reconstitution was also noted.

Results: Continuous closure was found to be beneficial in all cases of serosal defects. Excision of redundant endometrium in 11 women was associated with subjective reduction of menorrhagia in 9 of them.

Conclusion: It is advisable that gynaecological surgeons strive to minimise areas of visceral trauma, ischaemia and abrasion during myomectomy.

Key Words: Myomectomy; Fibroid; Endometrium; Menorrhagia; Infertility. [Trop J Obstet Gynaecol, 2001, 18: 16-18]

Department of Obstetrics & Gynaecology, University College Hospital, Ibadan, Nigeria

Context: Total abdominal hysterectomy is one of the commonly performed major gynaecological operations in our hospital and it is desirable to review its safety in view of the advanced pathology that is frequently encountered.

Objective: To determine the indications for and the pattern of morbidity and mortality in abdominal hysterectomy done for benign conditions over a 10-year period.

Study Design: A retrospective study of all cases of abdominal hysterectomy for benign conditions over a ten-year period.

Main Outcome Measures: The relative proportion of cases of abdominal hysterectomy compared to the total number of operations, the prevalence of various peri- and post-operative complications or mortality.

Results: Total abdominal hysterectomy accounted for 10.2% of all major gynaecological operations during the study period. The indication was uterine fibroids in 82% of cases done for benign indications. The crude morbidity rate was 31% and there was no mortality.

Conclusion: In spite of advanced pathology, abdominal hysterectomy for benign conditions is a fairly safe procedure in UCH Ibadan. There is a need to further reduce the high morbidity rate associated with the procedure especially the use of peri-operative antibiotic prophylaxis.

Key Words: Abdominal Hysterectomy; Morbidity; Mortality; Antibiotics. [Trop J Obstet Gynaecol, 2001, 18: 19-23]

Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex,

Ile-Ife, Nigeria.

Context: Despite the proliferation of health centres in Nigeria, the number of ‘unbooked’ obstetric patients seen in tertiary institutions remains high, and their obstetric outcome is usually poor. Since many of these patients are referred from these health centres, it is important to determine their contributions to the tragedy of these patients.

Objectives: To assess the contribution of referring centres to the morbidity and mortality seen in unbooked patients.

Study Design and Setting: Cross-sectional study at a University Teaching Hospital in Ilesa, Nigeria.

Subjects and Methods: All unbooked patients admitted into the obstetric wards of the Wesley Guild Hospital, Ilesa between January and July 2000 had a proforma completed to record information on age, parity, social class, source of referral, the management given at the source of referral and the condition of the patient on admission.

Results: Of the 148 unbooked patients admitted during the study period, 87 (58.8%) received care in various referring centres. Sixty-five of these 87 patients (74.7%) were mismanaged. The sources of referral were traditional birth attendants (TBA), mission houses and private hospitals where 100%, 87.5% and 80% respectively of the patients were mismanaged before being allowed to come to the hospital. Among referred patients, 62.1% were received in poor clinical condition compared to 39.3% of those who did not receive prior care anywhere. (P < 0.05)

Conclusion: Inadequate care at sources of referral is a major contributor to morbidity and mortality in unbooked patients. We suggest that these health facilities be supervised and monitored to reduce the current high morbidity and mortality among unbooked patients.

Key Words: Unbooked; Antenatal; Referral Source; Obstetric Outcome. [Trop J Obstet Gynaecol, 2001, 18: 24-26]

Department of Obstetrics & Gynaecology, University of Benin Teaching Hospital, P.M.B 1111,

Benin-City, Nigeria

Background: Grandmultipara have always been and still are sources of apprehension to the obstetrician when in labour. The relative prevalence of grandmultiparity may be declining but it remains a major contributor to maternal mortality.

Objective: To determine the current prevalence of grandmultiparity and the pattern of utilisation of maternity services by grandmultipara in Benin City.

Subjects and Methods: A total of 1280 antenatal patients were interviewed in four large maternity centres between the months of June and September 1998 using a structured questionnaire.

Results: Grandmultipara made up 7.34% of the antenatal population. Their average age was 33.7 ± 5.08 years. Social classes 3 and 4 constituted the majority with a frequency of 37.8% and 35.6% respectively. The incidence of high parity increased with social class up to social class 3 and declined thereafter. The majority (57.5%) of the patients had only primary school education. The odds against a grandmultipara being educated more than primary school compared to the multipara was significant (OR = 4.96 (95% CI 3.13-7.86, P<0.0001). Most grandmultipara (64.4%) booked late for antenatal care. They were more likely to have delivered at home -31.91% (OR = 2.18; 95% CI: 1.34-3.52, P=0.001, and in church — 9.75% (OR = 12.45; 95% CI: 4.51-34.24, P = 0.0002) in their last pregnancy

Conclusion: The relative prevalence of grandmultiparity in the community is low and it is associated with poor utilisation of maternity services. This group of mothers should be actively discouraged from delivering at home and in churches. Reproductive health care services in the community should be strengthened.

Key Words: Grandmultipara; Maternity Services; Utilisation; Maternal Mortality. [Trop J Obstet Gynaecol, 2001, 18: 27-30]

Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Context: Despite widespread availability of modern contraception, grandmultiparous women still constitute a significant proportion of our obstetric population. Although the socio-economic characteristics of these patients are well known, we need to know why they decide to get pregnant again despite the dangers involved. Such knowledge may help us find a lasting solution to this problem.

Objective: This study aims at finding out from grandmultiparous women their reasons for the index pregnancy.

Design: Cross-sectional study

Setting: Department of Obstetrics and Gynaecology, State Specialist Hospital Ondo, Ondo State, Nigeria.

Subjects: All grandmultiparous women that booked between January 1999 and September 1999.

Methods: The mothers were asked to fill a questionnaire on the first day of visit. Items of information requested include the reasons for the current pregnancy, knowledge of family planning and demographic characteristics.

Main Outcome Measure: Mother’s reason for the current pregnancy.

Results: Among the women, 94:1% were aware of family planning with a usage rate of 7.8 percent. The reasons given for the current pregnancy were: desire for large family (25.9%); loss of previous children (24.1%), mistake (16.7%); desire for male child (14.8%); desire to have a child for a new husband (11.1%) and failed contraception (7.4%).

Conclusion: The major reasons grandmultipara conceive again are desire for large families and loss of previous offspring. To reduce the incidence of grandmultiparity in our society efforts must be geared towards raising the social status of our women through universal formal education and reducing the currently high childhood mortality.

Key Words: Grandmultiparity; Childhood Mortality; Family Planning. [Trop J Obstet Gynaecol, 2001, 18: 31-33]

Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.

Context: The place of caesarean section in the delivery of eclamptics has remained controversial, thereby creating the need for further studies.

Objective: To evaluate the place of caesarean section in the delivery of eclamptics using the experience at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria.

Study Design, Setting and Subjects: Retrospective descriptive analysis of 44 ante- and intra-partum eclamptics treated at the University of Nigeria Teaching Hospital over a 4-year period.

Main Outcome Measures: Caesarean section rate, maternal mortality ratio, maternal morbidity rates, perinatal mortality rate and perinatal morbidity rates.

Results: A caesarean section rate of 91% was recorded due to superimposed ante- and intra-partum factors. The maternal and fetal outcomes were better in those who had caesarean section than in those who delivered vaginally.

Conclusion: The results suggest the need for a more liberal and early use of caesarean section in Nigerian eclamptics.

Key Words: Caesarean Section, Morbidity, Eclampsia, Nigeria. [Trop J Obstet Gynaecol, 2001, 18: 34-37]

Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, P.M.B. 1111,

Benin City, Nigeria

Mrs. I. M. was a 23 years old primipara referred to UBTH with traumatic rupture of the symphysis pubis and posterior fracture dislocation of the left femoral head, after a delay in the second stage of labour that lasted 3 hours and a crude manoeuvre to deliver the fetus. The baby suffered severe birth asphyxia and convulsive seizures three days postpartum.

She had a closed reduction of the hip joint dislocation and traction. Recovery was satisfactory. Considering this outcome, a properly timed symphysiotomy would have been a better option to the traumatic rupture of the symphysis pubis, if personnel with the appropriate skills were available.

Key Words: Symphysis Pubis; Rupture; Fracture; Symphysiotomy. [Trop J Obstet Gynaecol, 2001, 18: 38-39]

Departments of *Obstetrics and Gynaecology, **Surgery and ^#Medicine, University College Hospital, P.M.B. 5116 Ibadan, Oyo State, Nigeria.

Adult Polycystic Kidney disease (ADPKD) is a known but uncommon cause of haematuria in pregnancy in this environment. Other causes include, haemaglobinopathies, calculi, pyelonephritis, schistosomiasis, haemangiomata and neoplasms. Although ADPKD is the commonest single gene disorder of man affecting both sexes, it usually presents in adulthood. It often presents in pregnancy with features of renal impairment, with or without haematuria. We present this case of ADKPD with life-threatening haematuria, acute renal failure, spontaneous abortion and recovery following nephrostomy tube insertion.

Key Words: Adult Polycystic Kidney; Autosomal Dominant; Pregnancy. [Trop J Obstet Gynaecol, 2001, 18: 40-42]