Pub Date : 2023-09-30DOI: 10.59692/jogeca.v35i3.54
Bare Omar, Miji Ernesto, Rose Kosgei, Kulthum Ali
Background: Uterine perforation following an unsafe abortion is rare but can lead to severe maternal morbidity and mortality.
Case presentation: A 28-year-old para 0+1 at 34 weeks gestation, presented with a history of generalized abdominal pain and reduced fetal movements for one week. Ultrasound revealed severe oligohydramnios; however, she did not have a history of liqor drainage. She was scheduled for emergency cesarean delivery. Intraoperatively, approximately 300mls of free clear fluid was noted. A live female infant weighing 2200 grams and with Apgar scores of 9, 10, and 10 at 1, 5, and 10 minutes was extracted. Perforation at the fundus of the uterus, which was probably due to unsafe abortion, was noted. The edges of the uterine perforation were refreshed and closed in two layers. Her postoperative period was uneventful, and the mother and the neonate were discharged home.
Conclusion: A high suspicion index should be indicated in patients presenting with isolated oligohydramnios with a previous history of unsafe abortion and uterine perforation, particularly in regions where unsafe abortion is common.
{"title":"A rare cause of severe oligohydramnios in the third trimester secondary to uterine perforation due to unsafe abortion: A case report","authors":"Bare Omar, Miji Ernesto, Rose Kosgei, Kulthum Ali","doi":"10.59692/jogeca.v35i3.54","DOIUrl":"https://doi.org/10.59692/jogeca.v35i3.54","url":null,"abstract":"
 Background: Uterine perforation following an unsafe abortion is rare but can lead to severe maternal morbidity and mortality.
 Case presentation: A 28-year-old para 0+1 at 34 weeks gestation, presented with a history of generalized abdominal pain and reduced fetal movements for one week. Ultrasound revealed severe oligohydramnios; however, she did not have a history of liqor drainage. She was scheduled for emergency cesarean delivery. Intraoperatively, approximately 300mls of free clear fluid was noted. A live female infant weighing 2200 grams and with Apgar scores of 9, 10, and 10 at 1, 5, and 10 minutes was extracted. Perforation at the fundus of the uterus, which was probably due to unsafe abortion, was noted. The edges of the uterine perforation were refreshed and closed in two layers. Her postoperative period was uneventful, and the mother and the neonate were discharged home.
 Conclusion: A high suspicion index should be indicated in patients presenting with isolated oligohydramnios with a previous history of unsafe abortion and uterine perforation, particularly in regions where unsafe abortion is common.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135132096","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: Nonpuerperal uterine inversion is a rare gynecological condition that is not preceded by pregnancy. It may be induced by uterine tumors or may be idiopathic.
Case presentation: A 28-year-old presented with a vaginal mass associated with urine retention, vaginal bleeding, and an off-white discharge. Pelvic sonography performed earlier revealed uterine procidentia features. On examination under anesthesia, the vaginal mass turned out to be an inverted uterus with a submucosal fibroid. The fibroid was avulsed. Bladder dissection and hysterotomy were performed, and the uterus was reduced into the abdominal cavity. She recovered well postoperatively with complete symptom resolution.
Conclusion: Nonpuerperal uterine inversion is a rare and potentially life-threatening condition, which presents with nonspecific symptoms and presents diagnostic and management challenges. Management is usually surgical as conservative measures have been shown to be less effective. Timely diagnosis and management is key in reducing associated morbidity and mortality.
{"title":"Nonpuerperal uterine inversion with a submucosal leiomyoma: A case report","authors":"Everett Lwamulungi, Khuweillah Rudainy, Weston Khisa","doi":"10.59692/jogeca.v35i3.53","DOIUrl":"https://doi.org/10.59692/jogeca.v35i3.53","url":null,"abstract":"Background: Nonpuerperal uterine inversion is a rare gynecological condition that is not preceded by pregnancy. It may be induced by uterine tumors or may be idiopathic.
 Case presentation: A 28-year-old presented with a vaginal mass associated with urine retention, vaginal bleeding, and an off-white discharge. Pelvic sonography performed earlier revealed uterine procidentia features. On examination under anesthesia, the vaginal mass turned out to be an inverted uterus with a submucosal fibroid. The fibroid was avulsed. Bladder dissection and hysterotomy were performed, and the uterus was reduced into the abdominal cavity. She recovered well postoperatively with complete symptom resolution.
 Conclusion: Nonpuerperal uterine inversion is a rare and potentially life-threatening condition, which presents with nonspecific symptoms and presents diagnostic and management challenges. Management is usually surgical as conservative measures have been shown to be less effective. Timely diagnosis and management is key in reducing associated morbidity and mortality.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135131944","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 : 2023-09-30DOI: 10.59692/jogeca.v35i3.55
Cyprian Nyariki, Rose Kosgei
Background: Hydatidiform mole is a benign form of gestational trophoblastic disease with potential for malignant transformation. It is characterized by abnormal trophoblastic proliferation with placental villi vascular welling with or without embryo formation.
Objective: To determine patient clinical characteristics and management outcomes of hydatidiform mole diagnosed at Kenyatta National Hospital, Nairobi, Kenya.
Methods: A descriptive retrospective study design was employed. The medical records of patients admitted with a clinical diagnosis of hydatidiform mole at the Kenyatta National Hospital between January 2013 and December 2017 were retrieved. Data were collected using an abstraction tool, entered, and analyzed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM, Armonk, NY, USA). Categorical data were summarized into frequencies and proportions and continuous data into means, standard deviations, medians, and interquartile ranges.
Results: During the study period, 137 records of patients admitted and managed for hydatidiform mole were retrieved. Most, 110 (80%) and 97 (71%) patients were 20-34 years old and multiparous, respectively. The mean gestational age at presentation was 17 weeks (SD 7.4), and bleeding was the most common symptom in 105 (77%) patients. Only 46 (34%) patients had documented histological confirmation of the hydatidiform mole. None of the patients completed six months of follow-up; hence, there was no documentation of treatment outcomes.
Conclusion: In this study, the clinical presentation of the hydatidiform mole was relatively uniform, but the approach to definitive diagnosis, management, and follow-up was suboptimal and inadequately documented. Hence, management outcomes cannot be objectively determined.
{"title":"Clinical characteristics and management outcomes of patients with hydatidiform mole in a national referral hospital in Kenya: A retrospective study","authors":"Cyprian Nyariki, Rose Kosgei","doi":"10.59692/jogeca.v35i3.55","DOIUrl":"https://doi.org/10.59692/jogeca.v35i3.55","url":null,"abstract":"Background: Hydatidiform mole is a benign form of gestational trophoblastic disease with potential for malignant transformation. It is characterized by abnormal trophoblastic proliferation with placental villi vascular welling with or without embryo formation.
 Objective: To determine patient clinical characteristics and management outcomes of hydatidiform mole diagnosed at Kenyatta National Hospital, Nairobi, Kenya.
 Methods: A descriptive retrospective study design was employed. The medical records of patients admitted with a clinical diagnosis of hydatidiform mole at the Kenyatta National Hospital between January 2013 and December 2017 were retrieved. Data were collected using an abstraction tool, entered, and analyzed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM, Armonk, NY, USA). Categorical data were summarized into frequencies and proportions and continuous data into means, standard deviations, medians, and interquartile ranges.
 Results: During the study period, 137 records of patients admitted and managed for hydatidiform mole were retrieved. Most, 110 (80%) and 97 (71%) patients were 20-34 years old and multiparous, respectively. The mean gestational age at presentation was 17 weeks (SD 7.4), and bleeding was the most common symptom in 105 (77%) patients. Only 46 (34%) patients had documented histological confirmation of the hydatidiform mole. None of the patients completed six months of follow-up; hence, there was no documentation of treatment outcomes.
 Conclusion: In this study, the clinical presentation of the hydatidiform mole was relatively uniform, but the approach to definitive diagnosis, management, and follow-up was suboptimal and inadequately documented. Hence, management outcomes cannot be objectively determined.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135132273","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 : 2023-09-30DOI: 10.59692/jogeca.v35i3.52
Doreen Wekesa, Cyprian Nyariki, Elizabeth Ochieng', Anne Pulei
Background: Spontaneous hemoperitoneum during pregnancy is a rare occurrence and an obstetric emergency that presents with acute abdominal pain and shock.
Case presentation: A 25-year-old primigravida at 38 weeks of gestation presented to the emergency unit in shock. She had a history of severe generalized abdominal and back pain of sudden onset, dizziness, and syncope with no history of trauma. Ultrasonography revealed free peritoneal fluid with a live intrauterine fetus. Blood transfusion, emergency laparotomy, and cesarean delivery were performed. A live female infant was delivered and admitted to the newborn unit. Postoperatively, the patient was started on antibiotics and analgesics and was stable at discharge.
Conclusion: Spontaneous hemoperitoneum in pregnancy is a rare cause of maternal collapse, which may mimic uterine rupture and abruptio placentae. A high index of suspicion is required in women with acute onset of abdominal pain and abnormal maternal hemodynamics during pregnancy.
{"title":"Spontaneous hemoperitoneum in a term pregnancy mimicking uterine rupture: A case report","authors":"Doreen Wekesa, Cyprian Nyariki, Elizabeth Ochieng', Anne Pulei","doi":"10.59692/jogeca.v35i3.52","DOIUrl":"https://doi.org/10.59692/jogeca.v35i3.52","url":null,"abstract":"Background: Spontaneous hemoperitoneum during pregnancy is a rare occurrence and an obstetric emergency that presents with acute abdominal pain and shock. 
 Case presentation: A 25-year-old primigravida at 38 weeks of gestation presented to the emergency unit in shock. She had a history of severe generalized abdominal and back pain of sudden onset, dizziness, and syncope with no history of trauma. Ultrasonography revealed free peritoneal fluid with a live intrauterine fetus. Blood transfusion, emergency laparotomy, and cesarean delivery were performed. A live female infant was delivered and admitted to the newborn unit. Postoperatively, the patient was started on antibiotics and analgesics and was stable at discharge.
 Conclusion: Spontaneous hemoperitoneum in pregnancy is a rare cause of maternal collapse, which may mimic uterine rupture and abruptio placentae. A high index of suspicion is required in women with acute onset of abdominal pain and abnormal maternal hemodynamics during pregnancy.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135131950","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: Reactionary hemorrhage is a severe complication of a cesarean section (CS) that may result from uterine atony, retained placental tissue, or ligature slippage. This case presents a rare cause of reactionary hemorrhage due to focal placenta invasion after CS presenting as hemoperitoneum.
Case presentation: A 32-year gravida 2 para 1 presented to the outpatient department at 39 gestational weeks. She was scheduled for elective CS and bilateral tubectomy given previous CS and cephalopelvic disproportion. Her antenatal routine ultrasound was unremarkable. Eight hours later, she was scheduled for an emergency relaparotomy for intraabdominal collection. Intraoperatively, there was bleeding from a focal placental invasion at the left cornua with omentum covering the placental mass and massive hemoperitoneum. She was transfused with 4, 4, and 6 units of packed cells, platelets, and fresh frozen plasma, respectively, and was discharged home.
Conclusion: Focal placenta percreta may present with hypotension and massive hemorrhage in the postpartum period; therefore, a high index of suspicion is required to detect and prevent complications intrapartum.
{"title":"Focal placenta percreta mimicking subserous fibroid presenting as massive reactionary hemorrhage following cesarean delivery: A case report","authors":"Priyadharshini Muruganandam, Rajalakshmi Kumar, Bhabani Pegu, Sasirekha Rengaraj, Veena Pappampatti","doi":"10.59692/jogeca.v35i2.14","DOIUrl":"https://doi.org/10.59692/jogeca.v35i2.14","url":null,"abstract":"Background: Reactionary hemorrhage is a severe complication of a cesarean section (CS) that may result from uterine atony, retained placental tissue, or ligature slippage. This case presents a rare cause of reactionary hemorrhage due to focal placenta invasion after CS presenting as hemoperitoneum.
 Case presentation: A 32-year gravida 2 para 1 presented to the outpatient department at 39 gestational weeks. She was scheduled for elective CS and bilateral tubectomy given previous CS and cephalopelvic disproportion. Her antenatal routine ultrasound was unremarkable. Eight hours later, she was scheduled for an emergency relaparotomy for intraabdominal collection. Intraoperatively, there was bleeding from a focal placental invasion at the left cornua with omentum covering the placental mass and massive hemoperitoneum. She was transfused with 4, 4, and 6 units of packed cells, platelets, and fresh frozen plasma, respectively, and was discharged home. 
 Conclusion: Focal placenta percreta may present with hypotension and massive hemorrhage in the postpartum period; therefore, a high index of suspicion is required to detect and prevent complications intrapartum.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136365191","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 : 2023-06-30DOI: 10.59692/jogeca.v35i2.50
Brenda Nyamu, Eunice Cheserem
Background: Ovarian lymphoma is rare. Extranodal non-Hodgkin lymphoma (NHL) represents 0.5% of malignant genital diseases. Due to its rarity, there are no accepted treatment protocols. Diffuse large B cell lymphoma (DLBCL) has a central nervous system (CNS) involvement rate of 3-5%.
Case presentation: A 38-year-old presented to the gynecological oncology clinic with abdominal pain and distension. Her tumor marker CA-125 levels were elevated. She developed right-sided facial nerve palsy and blindness. A diagnosis of aggressive NHL with a differential of DLBCL was made by histopathological and immunohistochemical examination of the excised ovarian tissue. A head computed tomography scan revealed subtle enhancing opacity suspicious of lymphomatous deposits. She was lost to follow-up after ten months of chemotherapy and cranial radiotherapy.
Conclusion: Primary lymphoma of the ovary is rare, and the prognosis is often poorer when compounded with CNS involvement. Because of poor prognosis in the presence of CNS involvement, this case highlights the need for timely diagnosis and management.
{"title":"Ovarian non-Hodgkin lymphoma with central nervous system involvement: A case report","authors":"Brenda Nyamu, Eunice Cheserem","doi":"10.59692/jogeca.v35i2.50","DOIUrl":"https://doi.org/10.59692/jogeca.v35i2.50","url":null,"abstract":"Background: Ovarian lymphoma is rare. Extranodal non-Hodgkin lymphoma (NHL) represents 0.5% of malignant genital diseases. Due to its rarity, there are no accepted treatment protocols. Diffuse large B cell lymphoma (DLBCL) has a central nervous system (CNS) involvement rate of 3-5%.
 Case presentation: A 38-year-old presented to the gynecological oncology clinic with abdominal pain and distension. Her tumor marker CA-125 levels were elevated. She developed right-sided facial nerve palsy and blindness. A diagnosis of aggressive NHL with a differential of DLBCL was made by histopathological and immunohistochemical examination of the excised ovarian tissue. A head computed tomography scan revealed subtle enhancing opacity suspicious of lymphomatous deposits. She was lost to follow-up after ten months of chemotherapy and cranial radiotherapy.
 Conclusion: Primary lymphoma of the ovary is rare, and the prognosis is often poorer when compounded with CNS involvement. Because of poor prognosis in the presence of CNS involvement, this case highlights the need for timely diagnosis and management.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136369830","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 : 2023-06-30DOI: 10.59692/jogeca.v35i2.51
Faustine James, Irene Kimeu, David Jalloh, Rose Kosgei
Background: Peritoneal tuberculosis is a rare form of extrapulmonary tuberculosis, which can result from the reactivation of latent foci in the peritoneal cavity.
Case presentation: A 19-year-old female presented to the gynecological oncology clinic with a two-month history of generalized abdominal pain and progressive abdominal distention. An abdominopelvic computed tomography scan revealed a cystic right adnexal lesion with massive simple ascites. A frozen abdomen was noted during exploratory laparotomy. Histological examination of the peritoneal biopsy reported granulomatous nodules with numerous epithelioid histiocytes. Postoperatively, she was managed with rifampicin, isoniazid, pyrazinamide, ethambutol, and pyridoxine for six months and recovered fully.
Conclusion: Peritoneal tuberculosis may mimic ovarian and peritoneal malignancies. A high suspicion index of peritoneal tuberculosis should be entertained in patients presenting with nonspecific symptoms of ovarian or peritoneal cancers.
{"title":"Peritoneal tuberculosis with a frozen abdomen in an adolescent female: A case report","authors":"Faustine James, Irene Kimeu, David Jalloh, Rose Kosgei","doi":"10.59692/jogeca.v35i2.51","DOIUrl":"https://doi.org/10.59692/jogeca.v35i2.51","url":null,"abstract":"Background: Peritoneal tuberculosis is a rare form of extrapulmonary tuberculosis, which can result from the reactivation of latent foci in the peritoneal cavity. 
 Case presentation: A 19-year-old female presented to the gynecological oncology clinic with a two-month history of generalized abdominal pain and progressive abdominal distention. An abdominopelvic computed tomography scan revealed a cystic right adnexal lesion with massive simple ascites. A frozen abdomen was noted during exploratory laparotomy. Histological examination of the peritoneal biopsy reported granulomatous nodules with numerous epithelioid histiocytes. Postoperatively, she was managed with rifampicin, isoniazid, pyrazinamide, ethambutol, and pyridoxine for six months and recovered fully. 
 Conclusion: Peritoneal tuberculosis may mimic ovarian and peritoneal malignancies. A high suspicion index of peritoneal tuberculosis should be entertained in patients presenting with nonspecific symptoms of ovarian or peritoneal cancers.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136370126","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 : 2023-06-30DOI: 10.59692/jogeca.v35i2.36
Moses Obimbo, Kireki Omanwa
In sub-Saharan Africa, pregnancy-related complications are a significant contributor to morbidity, mortality, and rising healthcare costs (1). The membrane of human red blood cells (RBCs) may contain the Rhesus (Rh) antigen. There are several types of Rh antigens but most important is the RhD antigen. Along the whole RhD protein, a group of conformation-dependent epitopes make up the D antigen. The most clinically significant blood group antigens that determine whether fetomaternal blood compatibility exists are the RhD and ABO systems (2). While the D-negative phenotype is linked to a deletion of RHD in most Caucasians, it is uncertain why the D antigen is not expressed other populations like the Japanese and Africans where it is linked to a grossly normal RHD (3). Accordingly, if a mother is Rh D-negative and the fetus is Rh D positive, she may produce antibodies through a process called RhD sensitization if she is exposed to fetal antigens. Sensitization is unlikely to damage the index fetus in normal conditions, but it may result in recurrent pregnancy losses, an infant with sensitized RBCs or to severe types of hemolytic disease of the newborn presenting with jaundice, anemia, developmental problems, or stillbirth (4).
Rhesus isoimmunization can be prevented, but most Sub-Saharan African countries have not fully utilized these opportunities. As a result, many women are at risk due to poor medical records following potentially sensitizing events and a lack of access to crucial diagnostic and therapeutic commodities. These have significantly increased the difficulty of managing Rh-negative pregnancies (5).
There has been a contentious suggestion for the universal prophylactic use of anti-D immunoglobulin in all pregnancies, including those following termination or ectopic pregnancy (6). We know that only a few at-risk women will profit from this strategy, which will unquestionably be highly expensive. However, there is no question that the Rh-negative pregnant population of Africa needs to have access to anti-D immunoglobulin on a global basis (7)(8). It follows that appropriate strategies should be instituted to effectively identify at-risk women and treat them accordingly (9).
Leaders in obstetrics practice from various African countries met towards the end of last year to discuss the unmet need to address the burden of Rhesus disease. They noted that, despite being entirely preventable, Rhesus disease was identified as one of the roadblocks to achieving maternal universal health coverage. The team recommended all stakeholders to facilitate access to anti-D immunoglobulin and screening tools for widespread screening and treatment.
{"title":"Rhesus isoimmunization: An underappreciated reproductive risk","authors":"Moses Obimbo, Kireki Omanwa","doi":"10.59692/jogeca.v35i2.36","DOIUrl":"https://doi.org/10.59692/jogeca.v35i2.36","url":null,"abstract":"In sub-Saharan Africa, pregnancy-related complications are a significant contributor to morbidity, mortality, and rising healthcare costs (1). The membrane of human red blood cells (RBCs) may contain the Rhesus (Rh) antigen. There are several types of Rh antigens but most important is the RhD antigen. Along the whole RhD protein, a group of conformation-dependent epitopes make up the D antigen. The most clinically significant blood group antigens that determine whether fetomaternal blood compatibility exists are the RhD and ABO systems (2). While the D-negative phenotype is linked to a deletion of RHD in most Caucasians, it is uncertain why the D antigen is not expressed other populations like the Japanese and Africans where it is linked to a grossly normal RHD (3). Accordingly, if a mother is Rh D-negative and the fetus is Rh D positive, she may produce antibodies through a process called RhD sensitization if she is exposed to fetal antigens. Sensitization is unlikely to damage the index fetus in normal conditions, but it may result in recurrent pregnancy losses, an infant with sensitized RBCs or to severe types of hemolytic disease of the newborn presenting with jaundice, anemia, developmental problems, or stillbirth (4).
 Rhesus isoimmunization can be prevented, but most Sub-Saharan African countries have not fully utilized these opportunities. As a result, many women are at risk due to poor medical records following potentially sensitizing events and a lack of access to crucial diagnostic and therapeutic commodities. These have significantly increased the difficulty of managing Rh-negative pregnancies (5).
 There has been a contentious suggestion for the universal prophylactic use of anti-D immunoglobulin in all pregnancies, including those following termination or ectopic pregnancy (6). We know that only a few at-risk women will profit from this strategy, which will unquestionably be highly expensive. However, there is no question that the Rh-negative pregnant population of Africa needs to have access to anti-D immunoglobulin on a global basis (7)(8). It follows that appropriate strategies should be instituted to effectively identify at-risk women and treat them accordingly (9).
 Leaders in obstetrics practice from various African countries met towards the end of last year to discuss the unmet need to address the burden of Rhesus disease. They noted that, despite being entirely preventable, Rhesus disease was identified as one of the roadblocks to achieving maternal universal health coverage. The team recommended all stakeholders to facilitate access to anti-D immunoglobulin and screening tools for widespread screening and treatment.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136364495","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 : 2023-06-30DOI: 10.59692/jogeca.v35i2.49
Consolata Kihagi, Eunice Cheserem, John Kamau, Dorel Ndayisaba, Alfred Mokomba, Rose Kosgei
Background: Vulvar malignancies are the fourth commonest of genital malignancies. The sarcoma type is associated with neurofibromatosis disease.
Case presentation: A 29-year-old nulliparous presented to the outpatient gynecological clinic with a five-year history of a recurrent right vulvar mass. The mass was initially excised without histological analysis. Histological examination of a reexcised mass diagnosed a spindle cell sarcoma. She was then lost to follow-up for one year. The mass recurred and she received external beam radiation. On admission, she was in good general status with generalized café-au-lait spots and neurofibromas. Perineal examination revealed an ulcerated right vulvar mass. Toilet vulvectomy and diversion colostomy were performed followed by chemotherapy. She was discharged after five months with a well-granulated wound. Colostomy was reversed six months later.
Conclusion: Vulvar sarcoma is a rare vulvar malignancy type usually associated with neurofibromatosis. This case highlights the missed opportunities in its management. A high suspicion threshold is critical for early diagnosis and management to curb the morbidity and mortality rate.
{"title":"Vulvar sarcoma in a young patient with neurofibromatosis syndrome with missed opportunities: A case report","authors":"Consolata Kihagi, Eunice Cheserem, John Kamau, Dorel Ndayisaba, Alfred Mokomba, Rose Kosgei","doi":"10.59692/jogeca.v35i2.49","DOIUrl":"https://doi.org/10.59692/jogeca.v35i2.49","url":null,"abstract":"Background: Vulvar malignancies are the fourth commonest of genital malignancies. The sarcoma type is associated with neurofibromatosis disease.
 Case presentation: A 29-year-old nulliparous presented to the outpatient gynecological clinic with a five-year history of a recurrent right vulvar mass. The mass was initially excised without histological analysis. Histological examination of a reexcised mass diagnosed a spindle cell sarcoma. She was then lost to follow-up for one year. The mass recurred and she received external beam radiation. On admission, she was in good general status with generalized café-au-lait spots and neurofibromas. Perineal examination revealed an ulcerated right vulvar mass. Toilet vulvectomy and diversion colostomy were performed followed by chemotherapy. She was discharged after five months with a well-granulated wound. Colostomy was reversed six months later.
 Conclusion: Vulvar sarcoma is a rare vulvar malignancy type usually associated with neurofibromatosis. This case highlights the missed opportunities in its management. A high suspicion threshold is critical for early diagnosis and management to curb the morbidity and mortality rate.","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136369839","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}
P M Ndavi, C Sekadde-kigondu, J M Nyagero, D J Nichols, K Jesencky, S B Ojwang, M Gachara
{"title":"A survey of attitude of Kenyan medical doctors on family planning (FP): secondary data analysis.","authors":"P M Ndavi, C Sekadde-kigondu, J M Nyagero, D J Nichols, K Jesencky, S B Ojwang, M Gachara","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":85009,"journal":{"name":"Journal of obstetrics & gynaecology of Eastern and Central Africa","volume":"11 1","pages":"38-44"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22018204","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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