Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.63
Benjamin Elly, Francis Were, James Njiru, Marian Esiromo
Background: Complex umbilical cord entanglement occurs less frequently and is associated with an increased risk of adverse perinatal outcomes. It is associated with umbilical artery pH and base excess levels that are significantly unfavorable, higher incidence of nonreassuring fetal heart rate, meconium-stained amniotic fluid, neonatal intensive care unit admissions, emergency cesarean section, and stillbirth. Case presentation: A 44-year-old para 2+0 gravida 3, with 2 previous cesarean delivery scars at 35 weeks presented with a history of reduced fetal movements for 24 hours. She had attended two antenatal care visits. Her blood group was A, rhesus negative, with hemoglobin levels of 11.2 g/dl, and normal platelets. Urinalysis and serology for HIV, hepatitis B, and Venereal Disease Research Laboratory test were nonreactive. She had received anti-D prophylaxis after her previous deliveries. An urgent obstetric ultrasound scan showed features consistent with intrauterine fetal death. Her coagulation profile was within the normal range. She was admitted for hysterotomy. Intraoperatively, a fresh stillborn baby boy was extracted with a cord around the neck tightly twice and entangled around the trunk. Conclusion: Complex umbilical cord entanglement occurs less frequently and associated with an increased risk of adverse perinatal outcomes. The risk of adverse perinatal outcomes increases with ≥3 loops of the umbilical cord. It is important to look out for cord entanglement antenatally by ultrasonography, particularly when assessing cases of decreased fetal movements.
背景：复杂性脐带缠绕发生率较低，但与围产期不良结局风险增加有关。复杂性脐带缠绕与脐动脉 pH 值和碱过量水平明显不利、胎心率无保证、羊水带蜕膜、新生儿重症监护室住院、急诊剖宫产和死胎的发生率较高有关：一名 44 岁的 2+0 孕 3 级产妇，曾在 35 周时有过两次剖宫产疤痕，因胎动减少 24 小时而前来就诊。她曾接受过两次产前检查。她的血型为 A 型，恒河猴阴性，血红蛋白水平为 11.2 g/dl，血小板正常。她的尿液分析和血清学检查结果显示，HIV、乙型肝炎和性病研究实验室检测均无反应。她在前几次分娩后接受了抗 D 预防治疗。紧急产科超声波扫描显示胎儿宫内死亡。她的凝血功能正常。她入院接受了子宫切开术。术中取出了一个新鲜的死胎男婴，脐带绕颈两圈，缠绕在躯干上：结论：复杂的脐带缠绕发生率较低，与围产期不良结局的风险增加有关。脐带缠绕≥3 圈时，围产期不良结局的风险会增加。产前通过超声波检查，尤其是在评估胎动减少的病例时，注意脐带缠绕非常重要。
{"title":"Complex umbilical cord entanglement: A case report","authors":"Benjamin Elly, Francis Were, James Njiru, Marian Esiromo","doi":"10.59692/jogeca.v36i1.63","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.63","url":null,"abstract":"Background: Complex umbilical cord entanglement occurs less frequently and is associated with an increased risk of adverse perinatal outcomes. It is associated with umbilical artery pH and base excess levels that are significantly unfavorable, higher incidence of nonreassuring fetal heart rate, meconium-stained amniotic fluid, neonatal intensive care unit admissions, emergency cesarean section, and stillbirth.\u0000Case presentation: A 44-year-old para 2+0 gravida 3, with 2 previous cesarean delivery scars at 35 weeks presented with a history of reduced fetal movements for 24 hours. She had attended two antenatal care visits. Her blood group was A, rhesus negative, with hemoglobin levels of 11.2 g/dl, and normal platelets. Urinalysis and serology for HIV, hepatitis B, and Venereal Disease Research Laboratory test were nonreactive. She had received anti-D prophylaxis after her previous deliveries. An urgent obstetric ultrasound scan showed features consistent with intrauterine fetal death. Her coagulation profile was within the normal range. She was admitted for hysterotomy. Intraoperatively, a fresh stillborn baby boy was extracted with a cord around the neck tightly twice and entangled around the trunk.\u0000Conclusion: Complex umbilical cord entanglement occurs less frequently and associated with an increased risk of adverse perinatal outcomes. The risk of adverse perinatal outcomes increases with ≥3 loops of the umbilical cord. It is important to look out for cord entanglement antenatally by ultrasonography, particularly when assessing cases of decreased fetal movements.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"17 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964031","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.v36i1.65
Benjamin Elly, Francis Were, James Njiru
Background: Cosmetic and functional gynecology is a novel specialty that is rapidly gaining tractionacross the globe, particularly in Europe, Asia, and America. These intricate procedures enhance theesthetics and restore the physiological function of the genitalia. This relates very closely to womensexuality, dignity, self-esteem, and overall confidence. Self-esteem is often closely mirrored anddependent on a person’s perception of her genitalia, both functionally and more recently esthetically. Anincreasing number of gynecologists are gradually embracing this art of restoration as the demand rapidlyincreases among patients. The outcomes are sometimes not pleasing to the patients and may requirerevision.Case series: We present four case series of undesirable outcomes from labiaplasty andperineovaginoplasty. The surgical procedures had to be repeated in two instances because of spousaldemand or from the lady herself.Case 1: Reconstruction after Type IV female genital mutilation (FGM)A 46-year-old grand multipara with Type IV FGM presented with sexual dysfunction and psychosexualproblems arising from FGM. She requested reconstruction of the labia minora, restoration of the labiamajora, and perineovaginoplasty. Examination revealed partial clitoridectomy, a narrowed vaginalintroitus with the removal of the labia minora, and excision of the labia majora. The missing tissues madethe reconstruction technically difficult. Labia minora was reconstructed from the labia majora by thegrooving technique, and labia majora fat augmentation with perineoplasty was performed with goodoutcomes.Case 2: Perineoplasty revision.A 43-year-old, para 3+0, presented with complaints of lax vaginal muscles after her third delivery. All herdeliveries were normal, vertex. She sustained a second-degree perineal tear after her last delivery, whichwas repaired. She was started on Kegel’s exercises with no improvement. She had a perineoplasty donesuccessfully, but she healed with a small rent. A revision was performed with good results.Case 3: Perineoplasty revisionThe patient underwent vaginoperineoplasty, but the perineum healed with a little bump, which both thepatient and the spouse did not like. Revision of perineoplasty was performed with excellent outcomes.Case 4: Revision of an overly tight vagina after vaginoperineoplastyThe patient had previously undergone vaginoperineoplasty but felt it was not tight enough. However,three months after revision, the spouse complained of incomplete penetration, whereas the patientcomplained of pain at the fourchette. Another revision was performed to address their concerns withgood outcomes. Conclusion: Cosmetic gynecological procedures must achieve satisfactory outcomes and restore theclient’s genital esthetics and functionality. Although some procedures are technically challenging and mayrequire repeat procedures, patient satisfaction is key. Knowledge of pelvic anatomy and restoration techniques is a prerequisite for achieving accepta
{"title":"Challenges in cosmetic gynecology surgery: A case series","authors":"Benjamin Elly, Francis Were, James Njiru","doi":"10.59692/jogeca.v36i1.65","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.65","url":null,"abstract":"Background: Cosmetic and functional gynecology is a novel specialty that is rapidly gaining tractionacross the globe, particularly in Europe, Asia, and America. These intricate procedures enhance theesthetics and restore the physiological function of the genitalia. This relates very closely to womensexuality, dignity, self-esteem, and overall confidence. Self-esteem is often closely mirrored anddependent on a person’s perception of her genitalia, both functionally and more recently esthetically. Anincreasing number of gynecologists are gradually embracing this art of restoration as the demand rapidlyincreases among patients. The outcomes are sometimes not pleasing to the patients and may requirerevision.Case series: We present four case series of undesirable outcomes from labiaplasty andperineovaginoplasty. The surgical procedures had to be repeated in two instances because of spousaldemand or from the lady herself.Case 1: Reconstruction after Type IV female genital mutilation (FGM)A 46-year-old grand multipara with Type IV FGM presented with sexual dysfunction and psychosexualproblems arising from FGM. She requested reconstruction of the labia minora, restoration of the labiamajora, and perineovaginoplasty. Examination revealed partial clitoridectomy, a narrowed vaginalintroitus with the removal of the labia minora, and excision of the labia majora. The missing tissues madethe reconstruction technically difficult. Labia minora was reconstructed from the labia majora by thegrooving technique, and labia majora fat augmentation with perineoplasty was performed with goodoutcomes.Case 2: Perineoplasty revision.A 43-year-old, para 3+0, presented with complaints of lax vaginal muscles after her third delivery. All herdeliveries were normal, vertex. She sustained a second-degree perineal tear after her last delivery, whichwas repaired. She was started on Kegel’s exercises with no improvement. She had a perineoplasty donesuccessfully, but she healed with a small rent. A revision was performed with good results.Case 3: Perineoplasty revisionThe patient underwent vaginoperineoplasty, but the perineum healed with a little bump, which both thepatient and the spouse did not like. Revision of perineoplasty was performed with excellent outcomes.Case 4: Revision of an overly tight vagina after vaginoperineoplastyThe patient had previously undergone vaginoperineoplasty but felt it was not tight enough. However,three months after revision, the spouse complained of incomplete penetration, whereas the patientcomplained of pain at the fourchette. Another revision was performed to address their concerns withgood outcomes.\u0000Conclusion: Cosmetic gynecological procedures must achieve satisfactory outcomes and restore theclient’s genital esthetics and functionality. Although some procedures are technically challenging and mayrequire repeat procedures, patient satisfaction is key. Knowledge of pelvic anatomy and restoration\u0000techniques is a prerequisite for achieving accepta","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"30 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964229","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.v36i1.143
C. K. Nyariki, Cyprian Nyariki, Mary Maina, Grace Wambura Mbuthia, Eric Yegon
Background: Perinatal mortality and morbidity remains high in Kenya over the years, and this has been attributed to the Three Delays, the third focusing on access to care once the client is in the health facility. Structured frameworks for obstetric triage have been shown to improve perinatal outcomes across the globe. In Kenya, anecdotal evidence suggests that there is no formal framework for conducting obstetric triage in public facilities. This study sought to assess the effect of a Structured Integrated Obstetric Triage Model (SIOTEL) on patient waiting time in maternity units of Kiambu Referral Hospitals. Methods: A quasi experimental design was applied in the study. The intervention facility was Kiambu County Referral Hospital and control facility was Thika Level 5 Hospital. Study population included files of patients admitted in the labour wards. The intervention (SIOTEL) was a 3-scale modified Obstetric Triage Acuity Scale, a client assessment tool that was used to conduct obstetric triage. A baseline survey was conducted followed by development, validation and implementation of the tool, then an end line survey conducted to assess effect of the model on waiting time. Quantitative data was analyzed using STATA and presented in tables and graphs. T-statistic was used to test for significance of mean waiting time in the two facilities. Results: A total of 455 files were reviewed, 231 at baseline and 224 at endline survey. The mean client waiting time at baseline was 113.19 and 124.91 minutes in the intervention and control facilities respectively. At endline, the mean waiting time was 57.46 minutes in the intervention facility and 112.92 minutes in the control facility. Findings thus revealed a significant effect of the SIOTEL on client waiting time in the intervention facility (t-3.77;p value 0.00) compared to the control facility (t-0.78; p value 0.44) Conclusions and recommendations: The study concludes that implementation of structured models for obstetric triage contributes to reduction in client waiting time, and recommendations are made to adopt such models for triage in public facilities in Kenya
{"title":"Effect of a Structured Integrated Obstetric Triage Model (SIOTEL) on Patient Waiting time in Maternity Units in Kiambu County – A Quasi Experimental Study","authors":"C. K. Nyariki, Cyprian Nyariki, Mary Maina, Grace Wambura Mbuthia, Eric Yegon","doi":"10.59692/jogeca.v36i1.143","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.143","url":null,"abstract":"Background: Perinatal mortality and morbidity remains high in Kenya over the years, and this has been attributed to the Three Delays, the third focusing on access to care once the client is in the health facility. Structured frameworks for obstetric triage have been shown to improve perinatal outcomes across the globe. In Kenya, anecdotal evidence suggests that there is no formal framework for conducting obstetric triage in public facilities. This study sought to assess the effect of a Structured Integrated Obstetric Triage Model (SIOTEL) on patient waiting time in maternity units of Kiambu Referral Hospitals. \u0000Methods: A quasi experimental design was applied in the study. The intervention facility was Kiambu County Referral Hospital and control facility was Thika Level 5 Hospital. Study population included files of patients admitted in the labour wards. The intervention (SIOTEL) was a 3-scale modified Obstetric Triage Acuity Scale, a client assessment tool that was used to conduct obstetric triage. A baseline survey was conducted followed by development, validation and implementation of the tool, then an end line survey conducted to assess effect of the model on waiting time. Quantitative data was analyzed using STATA and presented in tables and graphs. T-statistic was used to test for significance of mean waiting time in the two facilities. \u0000Results: A total of 455 files were reviewed, 231 at baseline and 224 at endline survey. The mean client waiting time at baseline was 113.19 and 124.91 minutes in the intervention and control facilities respectively. At endline, the mean waiting time was 57.46 minutes in the intervention facility and 112.92 minutes in the control facility. Findings thus revealed a significant effect of the SIOTEL on client waiting time in the intervention facility (t-3.77;p value 0.00) compared to the control facility (t-0.78; p value 0.44) \u0000Conclusions and recommendations: The study concludes that implementation of structured models for obstetric triage contributes to reduction in client waiting time, and recommendations are made to adopt such models for triage in public facilities in Kenya","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"29 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964367","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.v36i1.291
A. Kihara, K. Omanwa, Maureen Owiti, Kinuthia, Mukhwana, Inwani, Kamuri, R. Kosgei, Cheserem E.
Background: High-intensity frequency ultrasound (HIFU), a noninvasive ultrasound beam is focused onan exact tissue area that requires treatment. The highly focused energy from ultrasound causes thetemperature of the tissue to rise, and the heat ablates the targeted tissue area. This therapy is gainingpopularity and momentum globally for treating of brain, breast, prostate, thyroid, liver, kidney, bonetumors, fibroids, adenomyosis, and endometriosis. Additionally, it is used in placenta accreta syndromeand cesarean scar pregnancy. Cosmetics include rejuvenation of connective tissue on the face andvulva. Exploration of uses for the treatment of postpartum hemorrhage and cervical cancer is underway.Methods: An orientation meeting was held among Kenyatta National Hospital and the University ofNairobi multidisciplinary clinical and administrative personnel. This was followed by a study tour to Chinathat engaged academia, researchers, clinicians, and radiologists to gain a first-hand understanding of theinvention process, setup for procedures, and innovative applications of HIFU in both private and publichealth institutions.Results: Promising success data are generated in high-income counties. Recently introduced in WestAfrica with the possibility of introduction in Eastern Africa.Conclusion: Noninvasive targeted therapies are the new vogue, and there seems to be a globusapplication for HIFU. Acquisition of this technology, addressing the normative environment, competenciesof multidisciplinary HCP, and research are needed in low- and middle-income countries. This noveltechnology can be cost-effective for the health system and improve patients’ experience. Furthermore, acombination of machine learning and clinical radiological imaging can be used as a predictor of tumorregrowth potential.
{"title":"High-intensity frequency ultrasound: Noninvasive targeted therapy, the new vogue in globus treatment of benign and cancerous solid tumors and rejuvenation procedures","authors":"A. Kihara, K. Omanwa, Maureen Owiti, Kinuthia, Mukhwana, Inwani, Kamuri, R. Kosgei, Cheserem E.","doi":"10.59692/jogeca.v36i1.291","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.291","url":null,"abstract":"Background: High-intensity frequency ultrasound (HIFU), a noninvasive ultrasound beam is focused onan exact tissue area that requires treatment. The highly focused energy from ultrasound causes thetemperature of the tissue to rise, and the heat ablates the targeted tissue area. This therapy is gainingpopularity and momentum globally for treating of brain, breast, prostate, thyroid, liver, kidney, bonetumors, fibroids, adenomyosis, and endometriosis. Additionally, it is used in placenta accreta syndromeand cesarean scar pregnancy. Cosmetics include rejuvenation of connective tissue on the face andvulva. Exploration of uses for the treatment of postpartum hemorrhage and cervical cancer is underway.Methods: An orientation meeting was held among Kenyatta National Hospital and the University ofNairobi multidisciplinary clinical and administrative personnel. This was followed by a study tour to Chinathat engaged academia, researchers, clinicians, and radiologists to gain a first-hand understanding of theinvention process, setup for procedures, and innovative applications of HIFU in both private and publichealth institutions.Results: Promising success data are generated in high-income counties. Recently introduced in WestAfrica with the possibility of introduction in Eastern Africa.Conclusion: Noninvasive targeted therapies are the new vogue, and there seems to be a globusapplication for HIFU. Acquisition of this technology, addressing the normative environment, competenciesof multidisciplinary HCP, and research are needed in low- and middle-income countries. This noveltechnology can be cost-effective for the health system and improve patients’ experience. Furthermore, acombination of machine learning and clinical radiological imaging can be used as a predictor of tumorregrowth potential.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"65 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894263","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}
Background: Complete hydatidiform mole with a coexisting normal pregnancy is an exceptionally rareoccurrence with a reported incidence of 1 in 22,000-100,000 pregnancies. Management remainscontroversial due to the risk of maternal and fetal complications and limited data on optimalmanagement.Case presentation: A para 1 + 0 presented to the Maternal Fetal Unit at 19 weeks. Ultrasound revealed atwin pregnancy with a single live fetus in one sac and a second sac with multiple cystic lesions and atypical snow-storm appearance consistent with a complete molar pregnancy. The placenta of the molarpregnancy was also low-lying, covering the internal cervical os. She had several episodes of antepartumhemorrhage, which was managed expectantly because she was keen on conception. At 25 weeks, shepresented with copious vaginal bleeding and chills. Speculum examination revealed vesicles withultrasound revealing a single live fetus, but complete molar pregnancy was not observed. Afteradmission, the patient became febrile with tachycardia. Amniocentesis was performed to rule outintraamniotic infection in viable pregnancy. A decision was made to undertake an emergencyhysterotomy because of deteriorating maternal status, placenta previa, and breech presentation.Maternal blood culture was positive for group B Streptococcus, with fetal blood and amniotic fluid culturesbeing sterile. Histopathology of the placenta revealed features consistent with acute chorioamnionitis andperipheral molar pregnancy.Conclusion: This case highlights the difficulty in the management of such cases, as illustrated bymultiple episodes of antepartum hemorrhage and subsequent maternal sepsis. Multidisciplinary care andshared decision making remain integral to management.
{"title":"Complete mole coexisting with a normal fetus in a dichorionic diamniotic pregnancy: A case report","authors":"Maryanne Mwangi, Mjahid Hassan, Wambugu Justus, Wanyonyi Shikolia","doi":"10.59692/jogeca.v36i1.295","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.295","url":null,"abstract":"Background: Complete hydatidiform mole with a coexisting normal pregnancy is an exceptionally rareoccurrence with a reported incidence of 1 in 22,000-100,000 pregnancies. Management remainscontroversial due to the risk of maternal and fetal complications and limited data on optimalmanagement.Case presentation: A para 1 + 0 presented to the Maternal Fetal Unit at 19 weeks. Ultrasound revealed atwin pregnancy with a single live fetus in one sac and a second sac with multiple cystic lesions and atypical snow-storm appearance consistent with a complete molar pregnancy. The placenta of the molarpregnancy was also low-lying, covering the internal cervical os. She had several episodes of antepartumhemorrhage, which was managed expectantly because she was keen on conception. At 25 weeks, shepresented with copious vaginal bleeding and chills. Speculum examination revealed vesicles withultrasound revealing a single live fetus, but complete molar pregnancy was not observed. Afteradmission, the patient became febrile with tachycardia. Amniocentesis was performed to rule outintraamniotic infection in viable pregnancy. A decision was made to undertake an emergencyhysterotomy because of deteriorating maternal status, placenta previa, and breech presentation.Maternal blood culture was positive for group B Streptococcus, with fetal blood and amniotic fluid culturesbeing sterile. Histopathology of the placenta revealed features consistent with acute chorioamnionitis andperipheral molar pregnancy.Conclusion: This case highlights the difficulty in the management of such cases, as illustrated bymultiple episodes of antepartum hemorrhage and subsequent maternal sepsis. Multidisciplinary care andshared decision making remain integral to management.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894371","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.v36i1.153
Kristina Sule, Francis Were
Case presentation: A para 4+0 with a history repeated of macrosomic fetuses and four subsequent spontaneous vaginal deliveries highlighted by third- and fourth-degree perineal tears presented with vaginal laxity requiring surgical vaginoplasty. Postoperatively, she developed acute urinary retention, weakness, lethargy, and pallor and was noted to have a massive posterior vaginal wall hematoma, which was soon evacuated, and vaginoplasty was successfully revised. Discussion: Urinary retention is a unique symptom of retrovaginal hematoma, but it must be considered following vaginoplasty. During vaginoplasty, the posterior vaginal wall expands to abut the anterior vaginal wall and inferior urethral wall, preventing evacuation of the bladder. The posterior vaginal wall is elastic and able to discretely accommodate a large amount of blood loss with no signs of vaginal bleeding and should be a point of examination following vaginoplasty. Conclusion: The expected signs and symptoms of vaginoplasty complications are vaginal bleeding and perineal tenderness. Urinary retention, pallor, and other signs can indicate a retrovaginal hematoma. Cosmetic gynecology practitioners should consider the elasticity and discreetness of the posterior vaginal wall and its ability to accommodate massive hematomas with few signs.
{"title":"Massive postvaginoplasty retrovaginal hematoma: A case report","authors":"Kristina Sule, Francis Were","doi":"10.59692/jogeca.v36i1.153","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.153","url":null,"abstract":"Case presentation: A para 4+0 with a history repeated of macrosomic fetuses and four subsequent spontaneous vaginal deliveries highlighted by third- and fourth-degree perineal tears presented with vaginal laxity requiring surgical vaginoplasty. Postoperatively, she developed acute urinary retention, weakness, lethargy, and pallor and was noted to have a massive posterior vaginal wall hematoma, which was soon evacuated, and vaginoplasty was successfully revised.\u0000Discussion: Urinary retention is a unique symptom of retrovaginal hematoma, but it must be considered following vaginoplasty. During vaginoplasty, the posterior vaginal wall expands to abut the anterior vaginal wall and inferior urethral wall, preventing evacuation of the bladder. The posterior vaginal wall is elastic and able to discretely accommodate a large amount of blood loss with no signs of vaginal bleeding and should be a point of examination following vaginoplasty.\u0000Conclusion: The expected signs and symptoms of vaginoplasty complications are vaginal bleeding and perineal tenderness. Urinary retention, pallor, and other signs can indicate a retrovaginal hematoma. Cosmetic gynecology practitioners should consider the elasticity and discreetness of the posterior vaginal wall and its ability to accommodate massive hematomas with few signs.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894686","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.v36i1.304
R.K Kamau, P. Koigi, M. K. Koigi, Francis Anitha, Gerald Moniz
Background: The primary objective of individualized controlled ovarian hyperstimulation (iCOS) is to obtain sufficient numbers of good-quality oocytes. This is pursued to increase the chances of obtaining good-quality embryos following fertilization to restore fertility potential. Case presentation: A 34-year-old nulliparous presented with a 3-year history of primary infertility. A thorough investigation of the couple failed to definitively diagnose the cause of infertility. Following a satisfactory response to controlled ovarian hyperstimulation, meticulous follicular aspiration yielded no oocytes. Given the high cost of treatment and the inherent risk of recurrence of the problem for repeat stimulation, the couple opted for oocyte donation. This decision was implemented, and the treatment process was continued. Discussion: Empty follicle syndrome (EFS) is a rare but frustrating complication of in vitro fertilization. Without viable alternatives, this usually leads to cycle cancelation. Repeat stimulation often yields similar results although in some cases dual triggering may confer benefits. Conclusion: Although rare, there is value in considering the possibility of EFS in women undergoing iCOS and counseling the patients accordingly.
{"title":"Empty follicle syndrome – an assisted reproductive technology disaster: A case report","authors":"R.K Kamau, P. Koigi, M. K. Koigi, Francis Anitha, Gerald Moniz","doi":"10.59692/jogeca.v36i1.304","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.304","url":null,"abstract":"Background: The primary objective of individualized controlled ovarian hyperstimulation (iCOS) is to obtain sufficient numbers of good-quality oocytes. This is pursued to increase the chances of obtaining good-quality embryos following fertilization to restore fertility potential. \u0000Case presentation: A 34-year-old nulliparous presented with a 3-year history of primary infertility. A thorough investigation of the couple failed to definitively diagnose the cause of infertility. Following a satisfactory response to controlled ovarian hyperstimulation, meticulous follicular aspiration yielded no oocytes. Given the high cost of treatment and the inherent risk of recurrence of the problem for repeat stimulation, the couple opted for oocyte donation. This decision was implemented, and the treatment process was continued. \u0000Discussion: Empty follicle syndrome (EFS) is a rare but frustrating complication of in vitro fertilization. Without viable alternatives, this usually leads to cycle cancelation. Repeat stimulation often yields similar results although in some cases dual triggering may confer benefits. \u0000Conclusion: Although rare, there is value in considering the possibility of EFS in women undergoing iCOS and counseling the patients accordingly.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"410 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894709","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.v36i1.119
Elaine Nyaga, Steve Mutiso
Background: Sigmoid during in pregnancy is the most common cause of intestinal obstruction. Despitethis, diagnosis remains the largest challenge. The diagnosis of sigmoid volvulus in pregnancy is oftendelayed because the symptoms mimic typical pregnancy-associated complaints. Clinical examination isusually limited because of the gravid uterus, and radiological evaluation presents another challengebecause of the risks of teratogenicity to the fetus, especially in the first trimester. Delays in diagnosisinvariably lead to ischemia, necrosis, and colon perforation, and prompt surgical intervention isnecessary to minimize maternal morbidity and fetal mortality.Case presentation: A 36-year-old para 4+0 gravida 5 presented initially at 29+1 weeks of gestation withabdominal symptoms. A diagnosis of acute gastritis and pyelonephritis was made, and the patient wasallowed home. She later presented with severe abdominal pain and vomiting, after which a diagnosis ofsigmoid volvulus was made at 30+5 weeks of gestation. The patient underwent laparotomy where thevolvulus was detorted. However, she experienced fetal demise in utero two days after the laparotomy.She was induced into labor and expelled the fetus.Conclusion: Sigmoid volvulus complicating pregnancy is rare. However, when it occurs, it may lead toconsiderable maternal and fetal morbidity and mortality. In patients who present with abdominal pain,distension, and absolute constipation, a high index of clinical suspicion is required for prompt diagnosis.Early diagnosis and appropriate surgical intervention are crucial to improve maternal and fetal outcomes,as shown in this case.
{"title":"Sigmoid volvulus during pregnancy: A case report and literature review","authors":"Elaine Nyaga, Steve Mutiso","doi":"10.59692/jogeca.v36i1.119","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.119","url":null,"abstract":"Background: Sigmoid during in pregnancy is the most common cause of intestinal obstruction. Despitethis, diagnosis remains the largest challenge. The diagnosis of sigmoid volvulus in pregnancy is oftendelayed because the symptoms mimic typical pregnancy-associated complaints. Clinical examination isusually limited because of the gravid uterus, and radiological evaluation presents another challengebecause of the risks of teratogenicity to the fetus, especially in the first trimester. Delays in diagnosisinvariably lead to ischemia, necrosis, and colon perforation, and prompt surgical intervention isnecessary to minimize maternal morbidity and fetal mortality.Case presentation: A 36-year-old para 4+0 gravida 5 presented initially at 29+1 weeks of gestation withabdominal symptoms. A diagnosis of acute gastritis and pyelonephritis was made, and the patient wasallowed home. She later presented with severe abdominal pain and vomiting, after which a diagnosis ofsigmoid volvulus was made at 30+5 weeks of gestation. The patient underwent laparotomy where thevolvulus was detorted. However, she experienced fetal demise in utero two days after the laparotomy.She was induced into labor and expelled the fetus.Conclusion: Sigmoid volvulus complicating pregnancy is rare. However, when it occurs, it may lead toconsiderable maternal and fetal morbidity and mortality. In patients who present with abdominal pain,distension, and absolute constipation, a high index of clinical suspicion is required for prompt diagnosis.Early diagnosis and appropriate surgical intervention are crucial to improve maternal and fetal outcomes,as shown in this case.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963533","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.v36i1.94
Wangeci Kihara
Lactation specialists, comprising certified lactation consultants or counselors, play a significant role in fostering and safeguarding maternal mental health throughout the perinatal period. Their expertise in breastfeeding support transcends mere technical guidance, extending into the realm where emotional support and mental health advocacy converge. During consultations, lactation specialists create a safe, empathetic space, allowing mothers to openly discuss concerns and challenges related to breastfeeding. This nurturing environment fosters trust and confidence, which is crucial for mothers navigating the complex journey of breastfeeding. Importantly, breastfeeding itself is deeply intertwined with maternal mental health. Lack of milk, lack of breastfeeding support, and painful experiences all negatively affect maternal mental health greatly. Lactation specialists, attuned to emotional cues and stressors during breastfeeding interactions, play a critical role in identifying signs of distress or anxiety. They offer compassionate listening and, when necessary, provide resources or referrals to mental health professionals for specialized support. Moreover, these specialists serve as educators, equipping mothers with knowledge about the emotional aspects of breastfeeding and its potential impact on mental well-being. By empowering mothers with information and strategies to manage stress or challenges, lactation specialists contribute significantly to mitigating potential mental health concerns during the perinatal period. Beyond individual consultations, lactation specialists often facilitate support groups or communities for breastfeeding mothers. These forums create a sense of camaraderie and solidarity among mothers, alleviating feelings of isolation, which is a common trigger for maternal mental health challenges. Their multifaceted approach emphasizes the holistic nature of breastfeeding support, recognizing its impact on both the physical health of the child and the mother’s mental well-being. By providing comprehensive care that combines technical guidance with emotional support, lactation specialists play a vital role in promoting and preserving maternal mental health during the transformative phase of childbirth and early motherhood.
{"title":"Role of lactation specialists in maternal health and improvement of maternal mental health","authors":"Wangeci Kihara","doi":"10.59692/jogeca.v36i1.94","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.94","url":null,"abstract":"Lactation specialists, comprising certified lactation consultants or counselors, play a significant role in fostering and safeguarding maternal mental health throughout the perinatal period. Their expertise in breastfeeding support transcends mere technical guidance, extending into the realm where emotional support and mental health advocacy converge. During consultations, lactation specialists create a safe, empathetic space, allowing mothers to openly discuss concerns and challenges related to breastfeeding. This nurturing environment fosters trust and confidence, which is crucial for mothers navigating the complex journey of breastfeeding. Importantly, breastfeeding itself is deeply intertwined with maternal mental health. Lack of milk, lack of breastfeeding support, and painful experiences all negatively affect maternal mental health greatly. Lactation specialists, attuned to emotional cues and stressors during breastfeeding interactions, play a critical role in identifying signs of distress or anxiety. They offer compassionate listening and, when necessary, provide resources or referrals to mental health professionals for specialized support.\u0000Moreover, these specialists serve as educators, equipping mothers with knowledge about the emotional aspects of breastfeeding and its potential impact on mental well-being. By empowering mothers with information and strategies to manage stress or challenges, lactation specialists contribute significantly to mitigating potential mental health concerns during the perinatal period. Beyond individual consultations, lactation specialists often facilitate support groups or communities for breastfeeding mothers. These forums create a sense of camaraderie and solidarity among mothers, alleviating feelings of isolation, which is a common trigger for maternal mental health challenges. Their multifaceted approach emphasizes the holistic nature of breastfeeding support, recognizing its impact on both the physical health of the child and the mother’s mental well-being. By providing comprehensive care that combines technical guidance with emotional support, lactation specialists play a vital role in promoting and preserving maternal mental health during the transformative phase of childbirth and early motherhood.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"101 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963540","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.v36i1.152
Maxwell Maina, Claire Mwangi, Ronald Moemi, Alfred Mokomba
Background: Abdominal pregnancies are rare pathologic ectopic pregnancies that occur in 1:10,000-30,000 pregnancies. Implantation sites include the pelvic and abdominal peritoneum, uterine surface, omentum, and abdominal organs, including the intestine, liver, spleen, diaphragm, and large blood vessels. They are frequently missed antenatally, especially because there are no specific clinical signs and symptoms for abdominal pregnancy making diagnosis difficult. Diagnosis is often made during cesarean delivery. Ultrasonography modalities have high diagnostic errors between 50 and 90%. Case presentation: A 41-year-old presented with copious purulent vaginal discharge that was mixed with blood and was foul-smelling for two months as a referral to the Kenyatta National Hospital. Abdominopelvic computed tomography revealed a heterogeneous lesion in the left hemi abdomen. Her last menstrual period was December 2022 with DMPA in the same month. Her PDT was negative. She was sick-looking and had a purulent vaginal discharge. Intraoperatively, 500 mls of serous fluid was observed, and abdominal pregnancy, approximately 24–28 weeks of gestation with mummified skull bone, brain tissue, ribs, and long bones of the lower and upper limbs in their multiples suggestive of twin gestation. The patient’s postoperative period was uneventful, and she was later discharged in good condition. Conclusion: Proper and timely diagnosis of abdominal pregnancy is required to improve outcomes, especially maternal outcomes. In this case, the pregnancy was fatal to the fetus, although maternal mortality have been reported. The diagnosis may come as a surprise finding intraoperatively theatre-like in this case and in some cases postemergency cesarean delivery for failed labor induction. The diagnostic modality of choice is ultrasonography, although our patient had ultrasound and computed tomography but ended up with a misdiagnosis because of the complexity of the diagnosis of abdominal pregnancy.
{"title":"A missed mummified twin abdominal pregnancy: A case report","authors":"Maxwell Maina, Claire Mwangi, Ronald Moemi, Alfred Mokomba","doi":"10.59692/jogeca.v36i1.152","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.152","url":null,"abstract":"Background: Abdominal pregnancies are rare pathologic ectopic pregnancies that occur in 1:10,000-30,000 pregnancies. Implantation sites include the pelvic and abdominal peritoneum, uterine surface, omentum, and abdominal organs, including the intestine, liver, spleen, diaphragm, and large blood vessels. They are frequently missed antenatally, especially because there are no specific clinical signs and symptoms for abdominal pregnancy making diagnosis difficult. Diagnosis is often made during cesarean delivery. Ultrasonography modalities have high diagnostic errors between 50 and 90%.\u0000Case presentation: A 41-year-old presented with copious purulent vaginal discharge that was mixed with blood and was foul-smelling for two months as a referral to the Kenyatta National Hospital. Abdominopelvic computed tomography revealed a heterogeneous lesion in the left hemi abdomen. Her last menstrual period was December 2022 with DMPA in the same month. Her PDT was negative. She was sick-looking and had a purulent vaginal discharge. Intraoperatively, 500 mls of serous fluid was observed, and abdominal pregnancy, approximately 24–28 weeks of gestation with mummified skull bone, brain tissue, ribs, and long bones of the lower and upper limbs in their multiples suggestive of twin gestation. The patient’s postoperative period was uneventful, and she was later discharged in good condition. \u0000Conclusion: Proper and timely diagnosis of abdominal pregnancy is required to improve outcomes, especially maternal outcomes. In this case, the pregnancy was fatal to the fetus, although maternal mortality have been reported. The diagnosis may come as a surprise finding intraoperatively theatre-like in this case and in some cases postemergency cesarean delivery for failed labor induction. The diagnostic modality of choice is ultrasonography, although our patient had ultrasound and computed tomography but ended up with a misdiagnosis because of the complexity of the diagnosis of abdominal pregnancy.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"107 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963666","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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