Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.294
Johnstone Miheso
Background: Assisted vaginal birth is an alternative to cesarean delivery where indicated and canreduce both maternal and fetal morbidity and mortality. There is a need to maintain and improve skillsthrough training, research, and mentorship, especially in where access to cesarean delivery remains achallenge.Objective: To determine the incidence and outcome of instrumental deliveries at a university teachinghospital in Nairobi.Methods: A retrospective study was conducted at the Aga Khan University Hospital between Januaryand November 2015. All files of patients who had an instrumental delivery during this period wereextracted, and data were collected on parity, indication, type of instrument, birth weight, perineal status,and Apgar scores.Results: Of 3000 women who delivered during this period, 132 had assisted vaginal birth (4.4%).Nulliparous formed 66.7%, and indication was only given in 12% of the cases. 11 percent of all caseswere forceps, whereas 89% were via vacuum. Trainees performed 36 (27%), instructors performed 10(7.5%), and obstetricians 73 (55.5%) of all instrumental deliveries. Two-thirds of the forceps wereperformed by obstetricians. Most (68.9%) babies weighed between 3 and 4 kg. The perineum was intactin 6%, 51.5% had episiotomy, and 6% had a third-degree tear; however, a fourth-degree tear was notreported. Two procedures failed, and patients underwent emergency cesarean delivery. 116 (87.8%)babies had Apgar scores of >6 at 5 minutes.Conclusion: Assisted vaginal delivery remains a safe and vital skill in the labor ward and has its place inmodern obstetric practice. The rate shown here is much lower than that in most high-income countries.There is a need to improve training and documentation of indications.
{"title":"Audit of assisted vaginal deliveries at Aga Khan University Hospital: A retrospective study","authors":"Johnstone Miheso","doi":"10.59692/jogeca.v36i1.294","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.294","url":null,"abstract":"Background: Assisted vaginal birth is an alternative to cesarean delivery where indicated and canreduce both maternal and fetal morbidity and mortality. There is a need to maintain and improve skillsthrough training, research, and mentorship, especially in where access to cesarean delivery remains achallenge.Objective: To determine the incidence and outcome of instrumental deliveries at a university teachinghospital in Nairobi.Methods: A retrospective study was conducted at the Aga Khan University Hospital between Januaryand November 2015. All files of patients who had an instrumental delivery during this period wereextracted, and data were collected on parity, indication, type of instrument, birth weight, perineal status,and Apgar scores.Results: Of 3000 women who delivered during this period, 132 had assisted vaginal birth (4.4%).Nulliparous formed 66.7%, and indication was only given in 12% of the cases. 11 percent of all caseswere forceps, whereas 89% were via vacuum. Trainees performed 36 (27%), instructors performed 10(7.5%), and obstetricians 73 (55.5%) of all instrumental deliveries. Two-thirds of the forceps wereperformed by obstetricians. Most (68.9%) babies weighed between 3 and 4 kg. The perineum was intactin 6%, 51.5% had episiotomy, and 6% had a third-degree tear; however, a fourth-degree tear was notreported. Two procedures failed, and patients underwent emergency cesarean delivery. 116 (87.8%)babies had Apgar scores of >6 at 5 minutes.Conclusion: Assisted vaginal delivery remains a safe and vital skill in the labor ward and has its place inmodern obstetric practice. The rate shown here is much lower than that in most high-income countries.There is a need to improve training and documentation of indications.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"540 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.299
Susan A.D. Adongo, N. S. Omar, J. Azhary, Esther S.Y. Loh, Nur Azurah A. Ghani, A. A. Zainuddin
Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, a rare urogenital anomaly, presents significant challenges to young girls and women in Africa. As we strive to break barriers and reposition Africa in the global health architecture, the timely recognition and management of OHVIRA becomes crucial. Usingt a retrospective case series approach, we examined OHVIRA cases managed by the Pediatric and Adolescent Gynecology Unit at a Tertiary Health facility in Malaysia, between June and November 2022. The study findings have relevance for Africa because the challenges faced by young girls and women in obtaining adequate healthcare are not confined by borders. Results: The age range of presentation, 11-25 years, mirrors the age group of concern for the African population. The time interval between symptom onset and diagnosis, spanning from 1 to 12 years, raises concerns about delayed identification. We observed that worsening dysmenorrhea, often unresponsive to analgesia, was the main presenting symptom, accompanied by complications, such as persistent vaginal discharge (12.5%), urinary retention (25%), constipation (12.5%), and pelvic masses (37.5%), which resonate with potential cases in Africa. Conclusion: The delayed diagnosis of OHVIRA syndrome emphasizes the pressing need for proactive healthcare interventions, particularly among young girls and women in Africa. By understanding the parallels between our study and the challenges faced by young women on the continent, we can identify opportunities to improve healthcare access and address the barriers that hinder timely diagnosis and management.
{"title":"Addressing the delayed diagnosis of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome for improved women health in Africa: A case series","authors":"Susan A.D. Adongo, N. S. Omar, J. Azhary, Esther S.Y. Loh, Nur Azurah A. Ghani, A. A. Zainuddin","doi":"10.59692/jogeca.v36i1.299","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.299","url":null,"abstract":"Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, a rare urogenital anomaly, presents significant challenges to young girls and women in Africa. As we strive to break barriers and reposition Africa in the global health architecture, the timely recognition and management of OHVIRA becomes crucial. Usingt a retrospective case series approach, we examined OHVIRA cases managed by the Pediatric and Adolescent Gynecology Unit at a Tertiary Health facility in Malaysia, between June and November 2022. The study findings have relevance for Africa because the challenges faced by young girls and women in obtaining adequate healthcare are not confined by borders. \u0000Results: The age range of presentation, 11-25 years, mirrors the age group of concern for the African population. The time interval between symptom onset and diagnosis, spanning from 1 to 12 years, raises concerns about delayed identification. We observed that worsening dysmenorrhea, often unresponsive to analgesia, was the main presenting symptom, accompanied by complications, such as persistent vaginal discharge (12.5%), urinary retention (25%), constipation (12.5%), and pelvic masses (37.5%), which resonate with potential cases in Africa. \u0000Conclusion: The delayed diagnosis of OHVIRA syndrome emphasizes the pressing need for proactive healthcare interventions, particularly among young girls and women in Africa. By understanding the parallels between our study and the challenges faced by young women on the continent, we can identify opportunities to improve healthcare access and address the barriers that hinder timely diagnosis and management.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"175 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.298
Susan A.D. Adongo, Tracy Foran, Sonia Grover
Background: The diagnosis of genital ulcers remains a challenge. Lipschutz ulcers are rare, painful, necrotic, and underdiagnosed lesions that are often found in nonsexually active adolescent females. The onset is acute and follows the prodromal phase of viral illness. Pathogenesis is unclear, but a hypersensitivity reaction to viral or bacterial infection leads to the deposition of an immune complex in the dermal vessels. The disease is self-limiting over two to six weeks. Case presentation: A 17-year-old female presented to the Emergency Department at the Royal Children’s Hospital, Melbourne with painful genital ulcers for five days and acute urinary retention for two days. This was preceded by a flu-like illness a week prior with associated body heat and polyarthralgia. The patient denied any history of sexual activity. There was no relevant medical history, no use of regular medication, and no history of trauma or sexual abuse. Perineal examination revealed “kissing” vulval lesions, 1 cm each, on the lower aspect of the labia majora. The lesions were symmetric with an erythematous border and a necrotic base. Sexually transmitted illness screening and her autoimmune profile were negative. Epstein-Barr virus IgG was positive and inflammatory markers were mildly elevated. Genital culture reported mixed anaerobes. The patient was catheterized, and administered local and systemic analgesia, steroid cream, and oral antibiotics. Wound care was instituted three times a day. She was discharged home after five days to complete medication once she was pain-free and able to pass urine. Conclusion: The diagnosis of Lipschutz ulcer is an exclusion and other causes of genital ulceration such as genital herpes, sexually transmitted infections, and autoimmune diseases must first be ruled out. Healing without scarring is spontaneous, and management involves wound care, local and systemic analgesia, local corticosteroids, and antibiotics if there is evidence of secondary infection.
{"title":"Lipschutz ulcers – acute genital ulceration in a 17-year-old: A case report","authors":"Susan A.D. Adongo, Tracy Foran, Sonia Grover","doi":"10.59692/jogeca.v36i1.298","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.298","url":null,"abstract":"Background: The diagnosis of genital ulcers remains a challenge. Lipschutz ulcers are rare, painful, necrotic, and underdiagnosed lesions that are often found in nonsexually active adolescent females. The onset is acute and follows the prodromal phase of viral illness. Pathogenesis is unclear, but a hypersensitivity reaction to viral or bacterial infection leads to the deposition of an immune complex in the dermal vessels. The disease is self-limiting over two to six weeks. \u0000Case presentation: A 17-year-old female presented to the Emergency Department at the Royal Children’s Hospital, Melbourne with painful genital ulcers for five days and acute urinary retention for two days. This was preceded by a flu-like illness a week prior with associated body heat and polyarthralgia. The patient denied any history of sexual activity. There was no relevant medical history, no use of regular medication, and no history of trauma or sexual abuse. Perineal examination revealed “kissing” vulval lesions, 1 cm each, on the lower aspect of the labia majora. The lesions were symmetric with an erythematous border and a necrotic base. Sexually transmitted illness screening and her autoimmune profile were negative. Epstein-Barr virus IgG was positive and inflammatory markers were mildly elevated. Genital culture reported mixed anaerobes. The patient was catheterized, and administered local and systemic analgesia, steroid cream, and oral antibiotics. Wound care was instituted three times a day. She was discharged home after five days to complete medication once she was pain-free and able to pass urine. \u0000Conclusion: The diagnosis of Lipschutz ulcer is an exclusion and other causes of genital ulceration such as genital herpes, sexually transmitted infections, and autoimmune diseases must first be ruled out. Healing without scarring is spontaneous, and management involves wound care, local and systemic analgesia, local corticosteroids, and antibiotics if there is evidence of secondary infection. ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"83 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.149
Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George Gwako, Jennifer Okore, Jim Kelly Mugambi, I. Gallos, A. Devall, J. Martin, L. Middleton, L. Beeson, H. Galadanci, F. Alwy Al-beity, G.J. Hofmeyr, N. Moran, S. Fawcus, L. Sheikh
Background: Delays in the detection or treatment of postpartum hemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum hemorrhage, and delayed or inconsistent use of effective interventions may be addressed by a treatment bundle. Methods: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum hemorrhage in vaginal delivery patients. The intervention included a calibrated blood-collection drape for the early detection of postpartum hemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe postpartum hemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. The key secondary implementation outcomes were the detection of postpartum hemorrhage and adherence to the treatment bundle. Results: 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary outcome event occurred in 1.6% of the patients in the intervention group compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32-0.50; P<0.001). Postpartum hemorrhage was detected in 93.1% of the patients in the intervention group and 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41-1.76), and the treatment bundle was used in 91.2% and 19.4% patients, respectively (rate ratio, 4.94; 95% CI, 3.88-6.28). Conclusion: Early detection of postpartum hemorrhage and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery. (Funded by the Bill and Melinda Gates Foundation; E-MOTIVE ClinicalTrials.gov number, NCT04341662).
{"title":"Randomized trial of early detection and treatment of postpartum hemorrhage","authors":"Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George Gwako, Jennifer Okore, Jim Kelly Mugambi, I. Gallos, A. Devall, J. Martin, L. Middleton, L. Beeson, H. Galadanci, F. Alwy Al-beity, G.J. Hofmeyr, N. Moran, S. Fawcus, L. Sheikh","doi":"10.59692/jogeca.v36i1.149","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.149","url":null,"abstract":"Background: Delays in the detection or treatment of postpartum hemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum hemorrhage, and delayed or inconsistent use of effective interventions may be addressed by a treatment bundle.\u0000Methods: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum hemorrhage in vaginal delivery patients. The intervention included a calibrated blood-collection drape for the early detection of postpartum hemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe postpartum hemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. The key secondary implementation outcomes were the detection of postpartum hemorrhage and adherence to the treatment bundle.\u0000Results: 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary outcome event occurred in 1.6% of the patients in the intervention group compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32-0.50; P<0.001). Postpartum hemorrhage was detected in 93.1% of the patients in the intervention group and 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41-1.76), and the treatment bundle was used in 91.2% and 19.4% patients, respectively (rate ratio, 4.94; 95% CI, 3.88-6.28).\u0000Conclusion: Early detection of postpartum hemorrhage and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery. \u0000\u0000(Funded by the Bill and Melinda Gates Foundation; E-MOTIVE ClinicalTrials.gov number, NCT04341662).","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"97 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.131
Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George osoti, Joan Mwende, Jennifer Okore
Background: According to the WHO, in 2020, almost 800 women died daily from preventable causes related to pregnancy and childbirth. An estimated 95% of these deaths were in low- and middle-income countries (LMICs). Postpartum hemorrhage (PPH), excessive bleeding after childbirth, is a leading cause of maternal death globally. Of the estimated 95% of maternal deaths in LMIC, an unacceptable 95% were due to PPH. A significant barrier to women receiving PPH treatment is access to quality PPH medicines, which is the basis for reducing maternal mortality. The E-MOTIVE Trial Kenyan hub conducted an online survey on September after the E-MOTIVE trial findings were released. This survey assessed the perception of health care providers’ (HCPs) of the quality of oxytocin in Augmentation of Labour, Active Management of third Third Stage of Labor (AMSTL), including PPH management. Methods: An online survey was conducted using the Survey Monkey platform in Gatundu level 4 hospital, Makindu subcounty hospital, and Vihiga, Embu, Nyeri, and Kakamega county referral hospitals. The survey targeted HCPs working within the respective maternity units. The results were analyzed in Excel. Results: 56 HCPs across the 6 health facilities participated in the survey. On augmentation of labor, Oxymed Medisel and Oxytocin Umedical were perceived to be more effective, while a score of 100% with Curtocin and Oxyt Kilitch were perceived to be very ineffective. On AMSTL, Oxymed Medisel, Syntocinin Norvatis, and Oxytocin Laborate were perceived to be very effective, whereas Curtocin and Oxyt Kilitch were perceived to be very ineffective. On PPH management, Oxytocin Umedical, Syntocinon Norvatis, and Oxytocin Laborate were perceived to be very effective, whereas Curtocin and Oxyt Kilitch were perceived to be very ineffective. Oxytocin Laborate was available across the health facilities, with other brands lacking in some facilities. Conclusion: Access to and availability of quality PPH medicines are key to effectively managing PPH and reducing maternal mortality.
{"title":"Perception of health care providers on the quality of oxytocin across six E-MOTIVE Trial sites in Kenya","authors":"Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George osoti, Joan Mwende, Jennifer Okore","doi":"10.59692/jogeca.v36i1.131","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.131","url":null,"abstract":"\u0000Background: According to the WHO, in 2020, almost 800 women died daily from preventable causes related to pregnancy and childbirth. An estimated 95% of these deaths were in low- and middle-income countries (LMICs). Postpartum hemorrhage (PPH), excessive bleeding after childbirth, is a leading cause of maternal death globally. Of the estimated 95% of maternal deaths in LMIC, an unacceptable 95% were due to PPH. A significant barrier to women receiving PPH treatment is access to quality PPH medicines, which is the basis for reducing maternal mortality. The E-MOTIVE Trial Kenyan hub conducted an online survey on September after the E-MOTIVE trial findings were released. This survey assessed the perception of health care providers’ (HCPs) of the quality of oxytocin in Augmentation of Labour, Active Management of third Third Stage of Labor (AMSTL), including PPH management. \u0000Methods: An online survey was conducted using the Survey Monkey platform in Gatundu level 4 hospital, Makindu subcounty hospital, and Vihiga, Embu, Nyeri, and Kakamega county referral hospitals. The survey targeted HCPs working within the respective maternity units. The results were analyzed in Excel. \u0000Results: 56 HCPs across the 6 health facilities participated in the survey. On augmentation of labor, Oxymed Medisel and Oxytocin Umedical were perceived to be more effective, while a score of 100% with Curtocin and Oxyt Kilitch were perceived to be very ineffective. On AMSTL, Oxymed Medisel, Syntocinin Norvatis, and Oxytocin Laborate were perceived to be very effective, whereas Curtocin and Oxyt Kilitch were perceived to be very ineffective. On PPH management, Oxytocin Umedical, Syntocinon Norvatis, and Oxytocin Laborate were perceived to be very effective, whereas Curtocin and Oxyt Kilitch were perceived to be very ineffective. Oxytocin Laborate was available across the health facilities, with other brands lacking in some facilities.\u0000Conclusion: Access to and availability of quality PPH medicines are key to effectively managing PPH and reducing maternal mortality.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"30 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.170
Sahil Omar, Mital Vaya, Fatma Agil, K. Omanwa
Background: Mesenteric ischemia is a rare condition with a high mortality rate of 24-94%. Acutely, it occurs because of sudden vascular emboli or thrombi and presents with severe abdominal pain disproportionate to physical examination findings with other nonspecific symptoms. Case presentation: A para 2+0 gravida 3 presented at 36 weeks 4 days of gestation with a 1-day history of worsening lower abdominal pain radiating to the back and reduced fetal movements. Mild pallor was observed, and vaginal examination showed a latent phase of labor. Shortly after admission, the patient developed diaphoresis and mild confusion with worsening pain, and an urgent ultrasound confirmed intrauterine fetal demise. Subsequently, she developed dizziness and progressed to loss of consciousness, with resuscitation promptly begun but unsuccessful. A diagnosis of extensive mesenteric ischemia was made postmortem. Discussion: Bowel ischemia can result from occlusions of major abdominal vessels and progress to necrosis, gangrene, and eventually perforation with subsequent severe complications. Uterine vasoconstriction in pregnancy itself contributes to a hypercoagulable state, increasing the risk of mesenteric ischemia, with a 10-fold higher risk in those conceiving by in vitro fertilization and embryo transfer. Other venoocclusive causes include atrial fibrillation, coagulopathic, malignancy, and radiation. Diagnosis is mainly by computed tomography. Confirmation is made by emergency laparotomy and histology. Blood investigations like lactate levels may be elevated in sepsis and screening for coagulopathies after diagnosis is made is indicated. Management involves anticoagulants, thrombolysis, and surgical interventions, such as resection and anastomosis, or endarterectomy, and anterograde bypasses. Masked symptoms, rapid progression, and severe resource limitations made this a difficult case to diagnose and manage. Conclusion: Given the rarity of the incidence of mesenteric ischemia, a very high level of suspicion is required to diagnose and promptly manage this emergency.
{"title":"Mesenteric ischemia in pregnancy - a catastrophe: A case report","authors":"Sahil Omar, Mital Vaya, Fatma Agil, K. Omanwa","doi":"10.59692/jogeca.v36i1.170","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.170","url":null,"abstract":"Background: Mesenteric ischemia is a rare condition with a high mortality rate of 24-94%. Acutely, it occurs because of sudden vascular emboli or thrombi and presents with severe abdominal pain disproportionate to physical examination findings with other nonspecific symptoms.\u0000Case presentation: A para 2+0 gravida 3 presented at 36 weeks 4 days of gestation with a 1-day history of worsening lower abdominal pain radiating to the back and reduced fetal movements. Mild pallor was observed, and vaginal examination showed a latent phase of labor. Shortly after admission, the patient developed diaphoresis and mild confusion with worsening pain, and an urgent ultrasound confirmed intrauterine fetal demise. Subsequently, she developed dizziness and progressed to loss of consciousness, with resuscitation promptly begun but unsuccessful. A diagnosis of extensive mesenteric ischemia was made postmortem.\u0000Discussion: Bowel ischemia can result from occlusions of major abdominal vessels and progress to necrosis, gangrene, and eventually perforation with subsequent severe complications. Uterine vasoconstriction in pregnancy itself contributes to a hypercoagulable state, increasing the risk of mesenteric ischemia, with a 10-fold higher risk in those conceiving by in vitro fertilization and embryo transfer. Other venoocclusive causes include atrial fibrillation, coagulopathic, malignancy, and radiation. Diagnosis is mainly by computed tomography. Confirmation is made by emergency laparotomy and histology. Blood investigations like lactate levels may be elevated in sepsis and screening for coagulopathies after diagnosis is made is indicated. Management involves anticoagulants, thrombolysis, and surgical interventions, such as resection and anastomosis, or endarterectomy, and anterograde bypasses. Masked symptoms, rapid progression, and severe resource limitations made this a difficult case to diagnose and manage.\u0000Conclusion: Given the rarity of the incidence of mesenteric ischemia, a very high level of suspicion is required to diagnose and promptly manage this emergency.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"461 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.192
Reuben Nyongesa, Caren Otadoh, Stephen Gwer
Background: Abdominal pregnancies, a rare form of ectopic pregnancy, pose significant risks to themother and fetus. The severity of complications depends on the gestational age at presentation,abdominal pregnancy location, and attachment to abdominal organs.Case presentation: A 38-year-old, para 3+0 gravida 4 presented with abdominal pain and moderatepallor at 30 weeks gestational age, extrapolated from obstetric ultrasound due to an unknown last normalmenstrual period. She was HIV-positive and on highly active antiretroviral therapy. She had a history oforal contraceptive use before conception. Ultrasound revealed a viable intraabdominal pregnancy at 30weeks with the placenta attached to the mesentery in the right upper quadrant with a nongravid uterus.She was transfused with four units of packed red blood cells before elective laparotomy. Intraoperatively,the gestational sac in the upper quadrants and membranes were ruptured. A live male infant wasdelivered, weighing 990g, Apgar scores of 8 at 1 and 9 at 5. The placenta, which was attached to the leftfallopian tube and the broad ligament was extracted. The infant was admitted to the newborn unitbecause of prematurity. The postoperative period was uneventful, and the mother and baby were doingwell at the writing of this abstract.Conclusion: Early preterm abdominal pregnancy should be managed by elective laparotomy to optimizeoutcomes for both the mother and fetus. Cases with limited attachment to the viscera tend to havefavorable outcomes. Neonatal outcome primarily depends on gestational age at delivery.
{"title":"Early preterm abdominal pregnancy: A case report","authors":"Reuben Nyongesa, Caren Otadoh, Stephen Gwer","doi":"10.59692/jogeca.v36i1.192","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.192","url":null,"abstract":"Background: Abdominal pregnancies, a rare form of ectopic pregnancy, pose significant risks to themother and fetus. The severity of complications depends on the gestational age at presentation,abdominal pregnancy location, and attachment to abdominal organs.Case presentation: A 38-year-old, para 3+0 gravida 4 presented with abdominal pain and moderatepallor at 30 weeks gestational age, extrapolated from obstetric ultrasound due to an unknown last normalmenstrual period. She was HIV-positive and on highly active antiretroviral therapy. She had a history oforal contraceptive use before conception. Ultrasound revealed a viable intraabdominal pregnancy at 30weeks with the placenta attached to the mesentery in the right upper quadrant with a nongravid uterus.She was transfused with four units of packed red blood cells before elective laparotomy. Intraoperatively,the gestational sac in the upper quadrants and membranes were ruptured. A live male infant wasdelivered, weighing 990g, Apgar scores of 8 at 1 and 9 at 5. The placenta, which was attached to the leftfallopian tube and the broad ligament was extracted. The infant was admitted to the newborn unitbecause of prematurity. The postoperative period was uneventful, and the mother and baby were doingwell at the writing of this abstract.Conclusion: Early preterm abdominal pregnancy should be managed by elective laparotomy to optimizeoutcomes for both the mother and fetus. Cases with limited attachment to the viscera tend to havefavorable outcomes. Neonatal outcome primarily depends on gestational age at delivery.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"374 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.64
Benjamin Elly, James Njiru, Marian Esiromo
Background: The occurrence of teeth at birth is a rare phenomenon that can pose challenges for bothparents and health care professionals.Case presentation: A 30-year-old primigravida presented at 41 weeks in latent labor. She progressedwell and delivered by spontaneous vertex delivery, a live female infant, 3700 g with an Apgar score of 8and 10 at 1 and 5 minutes, respectively. On examination, two natal teeth were observed in themandibular anterior region. Vitamin K was administered to the infant after birth. The following day, it wasnoted that the baby had difficulty breastfeeding, and the mother reported bruising of the nipples and painwhile breastfeeding. A pediatric dentist noted that the teeth had severe mobility and planned forextraction. Extraction was performed under topical anesthetic gel successfully. Follow-up visits revealednormal breastfeeding with associated infant weight gain, and the gums had healed well.Conclusion: The occurrence of teeth at birth is a rare phenomenon that can pose challenges for bothparents and health care professionals. It is a culture-bound phenomenon that can cause parents to denytheir baby love and affection. Healthcare professionals need to be aware of this condition in order tocounsel the parents and manage the baby appropriately.
{"title":"Natal Teeth: A Rare Case Report and Management Strategies","authors":"Benjamin Elly, James Njiru, Marian Esiromo","doi":"10.59692/jogeca.v36i1.64","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.64","url":null,"abstract":"Background: The occurrence of teeth at birth is a rare phenomenon that can pose challenges for bothparents and health care professionals.Case presentation: A 30-year-old primigravida presented at 41 weeks in latent labor. She progressedwell and delivered by spontaneous vertex delivery, a live female infant, 3700 g with an Apgar score of 8and 10 at 1 and 5 minutes, respectively. On examination, two natal teeth were observed in themandibular anterior region. Vitamin K was administered to the infant after birth. The following day, it wasnoted that the baby had difficulty breastfeeding, and the mother reported bruising of the nipples and painwhile breastfeeding. A pediatric dentist noted that the teeth had severe mobility and planned forextraction. Extraction was performed under topical anesthetic gel successfully. Follow-up visits revealednormal breastfeeding with associated infant weight gain, and the gums had healed well.Conclusion: The occurrence of teeth at birth is a rare phenomenon that can pose challenges for bothparents and health care professionals. It is a culture-bound phenomenon that can cause parents to denytheir baby love and affection. Healthcare professionals need to be aware of this condition in order tocounsel the parents and manage the baby appropriately.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"119 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.296
Victor Wanjohi,, Karuri, Waruingi
Background: Neostigmine is a drug commonly used, thus making it a possible second line of treatmentafter conservative methods have failed and surgery is not feasible.Case presentation: A para 3+1 gravida 4 was admitted for elective caesarean delivery because of twoprevious scars at term. She had undergone five previous abdominal surgical procdures. Her antenatalfollow-up was uneventful. Perioperative vital signs were within normal limits, with normal systemicexamination findings. She had abdominal surgical scars, three of which were well healed with no herniaorifices. Leopold’s maneuvers and perioperative laboratory parameters were within normal limits.Intraoperatively, dense adhesions involving the omentum and small gut were attached to the anteriorabdominal and uterine walls along the incision site. The washout of the abdomen and close inspection ofthe omentum confirmed no gut or bladder injury. Postoperatively, she had progressive abdominaldistension with constipation on day three. Abdominal X-ray and computed tomography revealed multipleair-fluid levels and grossly dilated bowel loops. There was no improvement after conservativemanagement, and on the sixth postoperative day, the decision to use neostigmine in an intensive careunit setting was reached. Following a single attempt, success was achieved, and the patient opened herbowels. Subsequently, she regained normal bowel function, and after two months of follow-up, the patientis faring well.Discussion: Ogilvie’s syndrome is defined as colon pseudoobstruction. It is rare (1:1000 admissionsannually) but causes severe morbidity and mortality. The rate is noted to be increasing because ofincreased cesarean delivery rates globally. Diagnosis is based on clinical and imaging findings.Challenges in diagnosis due to challenges in identification and reduced clinician index of suspicion leadto delays in treatment. Neostigmine plays a role in medical management, whereas conservativemanagement has not been effective.
背景：新斯的明是一种常用药物，因此在保守疗法无效、手术不可行的情况下，新斯的明可能成为第二种治疗方法：病例介绍：一名 3+1 孕 4 号孕妇因在足月时留下两个疤痕而入院选择剖腹产。她曾接受过五次腹部手术。她的产前随访很顺利。围手术期生命体征在正常范围内，全身检查结果正常。她的腹部有手术疤痕，其中三处愈合良好，没有疝气。术中，网膜和小肠的致密粘连沿着切口部位附着在前腹壁和子宫壁上。冲洗腹部并仔细检查网膜后证实没有肠道或膀胱损伤。术后第三天，她出现了进行性腹胀和便秘。腹部 X 光片和计算机断层扫描显示有多处气液平面和严重扩张的肠道襻。保守治疗后情况没有改善，术后第六天，决定在重症监护室使用新斯的明。经过一次尝试后，手术取得了成功，患者张开了草纸。随后，她恢复了正常的排便功能，经过两个月的随访，患者情况良好：讨论：奥格尔维综合征被定义为结肠假性梗阻。讨论：奥格尔维综合征被定义为结肠假性梗阻，这种疾病非常罕见（每年的发病率为 1:1000），但会导致严重的发病率和死亡率。由于全球剖宫产率的上升，该病的发病率正在上升。诊断基于临床和影像学检查结果。由于识别困难和临床医生的怀疑指数降低，诊断面临挑战，导致治疗延误。新斯的明在药物治疗中发挥作用，而保守治疗效果不佳。
{"title":"Medical management of Ogilvie’s syndrome after cesarean delivery: A case report","authors":"Victor Wanjohi,, Karuri, Waruingi","doi":"10.59692/jogeca.v36i1.296","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.296","url":null,"abstract":"Background: Neostigmine is a drug commonly used, thus making it a possible second line of treatmentafter conservative methods have failed and surgery is not feasible.Case presentation: A para 3+1 gravida 4 was admitted for elective caesarean delivery because of twoprevious scars at term. She had undergone five previous abdominal surgical procdures. Her antenatalfollow-up was uneventful. Perioperative vital signs were within normal limits, with normal systemicexamination findings. She had abdominal surgical scars, three of which were well healed with no herniaorifices. Leopold’s maneuvers and perioperative laboratory parameters were within normal limits.Intraoperatively, dense adhesions involving the omentum and small gut were attached to the anteriorabdominal and uterine walls along the incision site. The washout of the abdomen and close inspection ofthe omentum confirmed no gut or bladder injury. Postoperatively, she had progressive abdominaldistension with constipation on day three. Abdominal X-ray and computed tomography revealed multipleair-fluid levels and grossly dilated bowel loops. There was no improvement after conservativemanagement, and on the sixth postoperative day, the decision to use neostigmine in an intensive careunit setting was reached. Following a single attempt, success was achieved, and the patient opened herbowels. Subsequently, she regained normal bowel function, and after two months of follow-up, the patientis faring well.Discussion: Ogilvie’s syndrome is defined as colon pseudoobstruction. It is rare (1:1000 admissionsannually) but causes severe morbidity and mortality. The rate is noted to be increasing because ofincreased cesarean delivery rates globally. Diagnosis is based on clinical and imaging findings.Challenges in diagnosis due to challenges in identification and reduced clinician index of suspicion leadto delays in treatment. Neostigmine plays a role in medical management, whereas conservativemanagement has not been effective.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"120 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.90
Khushboo Sonigra, Salma Bashir Yussuf, Cynthia Tenai, Alfred Mokomba, K. Omanwa
Background: Juvenile granulosa cell tumors (JGCTs) are rare sex cord stromal tumors diagnosedmainly in premenarchal girls and women younger than 30 years. Case presentation: A 19-year-old primigravida at 36 weeks of gestation presented to the labor ward withcomplaints of generalized abdominal pain, headaches, and reduced fetal movements for two days.Ultrasound revealed a left-sided 15.7 by 15 cm large cyst and a solid mass of increased vascularity withmaternal ascites. The biophysical profile of the fetus was 4/8 (no movement or tone but the presence ofrespiration and amniotic fluid). An emergency exploratory laparotomy was performed, and intraoperativefindings revealed a massive torsed right ovary with a ruptured ovarian mass with grossly edematous and necrosed fallopian tubes. Following a safe cesarean section delivery of the fetus, a right salpingo-oophorectomy with cystectomy was performed. The histopathological results confirmed the diagnosis of JGCT FIGO stage IC2. Postoperatively, the patient was treated with six sessions of chemotherapy(cisplatin and paclitaxel). Post-chemotherapy magnetic resonance imaging showed normal abdominalviscera with minimal free fluid in the posterior cul de sac and a normal left ovary. Inhibin B levels droppedto 3.17, and the patient is on follow-up for the next 5 years with repeated tumor marker testing andcomputed tomography scans.Conclusion: JGCT is a very uncommon pregnancy tumor, and aggressive treatment is necessary foradvanced-stage tumors such as the one in this case to prevent recurrence or even death.
背景：幼年颗粒细胞瘤（JGCTs）是一种罕见的性索间质肿瘤，主要发生在30岁以下的初产少女和妇女身上：超声波检查显示左侧有一个 15.7 x 15 厘米大的囊肿和一个血管增多的实性肿块，伴有孕妇腹水。胎儿的生物物理特征为 4/8（无运动或张力，但有呼吸和羊水）。急诊行剖腹探查术，术中发现右侧卵巢巨大扭转，卵巢肿块破裂，输卵管严重水肿和坏死。在安全剖腹产下胎儿后，进行了右侧输卵管卵巢切除术和囊肿切除术。组织病理学结果确诊为 JGCT FIGO IC2 期。术后，患者接受了六次化疗（顺铂和紫杉醇）。化疗后的磁共振成像显示腹腔粘膜正常，后囊腔有少量游离液，左侧卵巢正常。患者的抑制素 B 水平降至 3.17，在接下来的 5 年中，患者将接受反复的肿瘤标志物检测和计算机断层扫描随访：JGCT是一种非常罕见的妊娠肿瘤，对于像本病例这样的晚期肿瘤，必须进行积极治疗，以防止复发甚至死亡。
{"title":"Successful pregnancy outcome with a large ruptured juvenile granulosa cell tumor: A case report","authors":"Khushboo Sonigra, Salma Bashir Yussuf, Cynthia Tenai, Alfred Mokomba, K. Omanwa","doi":"10.59692/jogeca.v36i1.90","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.90","url":null,"abstract":"Background: Juvenile granulosa cell tumors (JGCTs) are rare sex cord stromal tumors diagnosedmainly in premenarchal girls and women younger than 30 years.\u0000Case presentation: A 19-year-old primigravida at 36 weeks of gestation presented to the labor ward withcomplaints of generalized abdominal pain, headaches, and reduced fetal movements for two days.Ultrasound revealed a left-sided 15.7 by 15 cm large cyst and a solid mass of increased vascularity withmaternal ascites. The biophysical profile of the fetus was 4/8 (no movement or tone but the presence ofrespiration and amniotic fluid). An emergency exploratory laparotomy was performed, and intraoperativefindings revealed a massive torsed right ovary with a ruptured ovarian mass with grossly edematous and\u0000necrosed fallopian tubes. Following a safe cesarean section delivery of the fetus, a right salpingo-oophorectomy with cystectomy was performed. The histopathological results confirmed the diagnosis of\u0000JGCT FIGO stage IC2. Postoperatively, the patient was treated with six sessions of chemotherapy(cisplatin and paclitaxel). Post-chemotherapy magnetic resonance imaging showed normal abdominalviscera with minimal free fluid in the posterior cul de sac and a normal left ovary. Inhibin B levels droppedto 3.17, and the patient is on follow-up for the next 5 years with repeated tumor marker testing andcomputed tomography scans.Conclusion: JGCT is a very uncommon pregnancy tumor, and aggressive treatment is necessary foradvanced-stage tumors such as the one in this case to prevent recurrence or even death.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"120 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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