Journal of Obstetrics and Gynaecology of Eastern and Central Africa

We should all learn to perform vaginal hysterectomy

F.G. Muriithi — 2017-04-03

No Abstract

Vaginal hysterectomy as the primary approach in managing benign gynaecological conditions: a review of local practice

A Wameyo — 2017-04-03

Background: Hysterectomy is the commonest major gynaecological surgery performed. Traditionally this has been done abdominally, although the vaginal route could confer more benefits if well performed.

Objective: To determine the outcome of vaginal hysterectomies done at the Kapenguria County Hospital in West Pokot County, Northern Kenya.

Methods: A cross sectional study was undertaken between May 2013 and August 2016. A total of 50 vaginal hysterectomies were revised during this period.

Results: Approximately 40% of all hysterectomies were performed vaginally. More than half of these patients were aged 36 to 45 years. The indications for surgery were symptomatic uterine fibroids (36%), adenomyosis (20%) and uterine prolapse (24%). In more than half of the patients (54%) of the patients, the uterus was palpable above the sypmphisis pubis. There were 4 patients with peri-operative complications; 2 fistulas, 1 torn ovarian pedicle and one laparotomy. None of the patients required post-operative blood transfusion. Total hospital stay was 48 hours post-surgery in 78% of the patients.

Conclusion: Vaginal hysterectomy reduced patient morbidity, reduced hospital stay and was cost effective. We concluded that although the use of vaginal hysterectomy is unpopular in Kenya, the technique would improve surgical outcomes in public hospitals.

Keywords: Vaginal hysterectomy, Hysterectomy outcomes, Abdominal incision free hysterectomy

Exploring the practice and attitude of circumcisers in the eradication of female genital mutilation/cutting

A.S. Adeniran — 2017-04-03

Background: Female Genital Mutilation/Cutting (FGM/C) remains a form of violence against women despite efforts aimed at its eradication.

Objectives: To explore the practice and attitude of circumcisers towards eradication of FGM/C.

Methods: A descriptive (pilot) study involving local circumcisers in Kwara State, Nigeria using interviewer-administered questionnaire; analysis was done using SPSS version 21.0 and p <0.05 was significant.

Results: There are 57 circumcisers including 36(63.2%) males, 49(86%) acquire the skill for circumcision as a family tradition, 3(5.3%) practice circumcision as sole occupation and 49(79%) derive higher average monthly income from other sources. Forty-two (73.7%) have a dedicated knife used for multiple clients, 44(77.2%) clean the instrument before use, 17(29.8%) wear protective gloves, 55(96.5%) apply substances to the wound mostly iodine 15(26.3%) and shea butter 11(19.3%) while 27(47.4%) have encountered complications previously. Among circumcisers, 44(77.2%) believe FGM/C prevent sexual promiscuity while 26(45.6%) think it is for culture/tradition. Thirty (52.6%) are aware of government activities to stop FGM/C, 53(93.0%) are willing to stop the act if support is provided in form of money to establish a trade 33(57.9%) or new employment 12(21.1%).

Conclusions: Circumcisers are willing to discontinue FGM/C if necessary support including vocational skill acquisition, credit facilities to start a trade or new employments are provided. Efforts should be expedited to support their rehabilitation to achieve the eradication.

Keywords: Female genital mutilation, Female circumcision, Circumcisers, Violence against women

The efficacy of intravenous hyoscine-n-butylbromide for the acceleration of labour in primiparous women: a randomised controlled trial

A.M. Mukaindo — 2017-04-03

Background: Antispasmodic agents have been used to hasten labour despite little high-quality evidence to support their efficacy.

Objective: To establish the safety and efficacy of hyoscine-N-butylbromide in accelerating labour in primiparous women.

Methods: A randomised, double-blinded, placebo-controlled clinical trial was conducted at the Aga Khan University Hospital Nairobi, Kenya. Consenting primiparous women in spontaneous labour at term were randomised to receive either 40mg of hyoscine-N-butylbromide or sterile water-for-injection intravenously once confirmed to be in active labour. The dose could be repeated once after four hours. The main outcome measure was the duration of labour. Secondary outcome measures were rate of cervical dilatation and postpartum satisfaction score. Safety aspects such as drug adverse effects, APGAR scores and postpartum hemorrhage were also explored.

Results: Between October 2009 and July 2010 a total of 85 women were randomised and 79 yielded data for analysis. Of these 37 received hyoscine-N-butylbromide and 42 received placebo. There was no significant difference in the mean duration of active labour to second stage between the drug and placebo arms (396.2 versus 389.3 minutes, respectively, p=0.881, 95% CI -85.9 to 99.8). The mean rate of cervical dilatation in the drug arm was 1.17 centimetres per hour (cm/hr) compared to 1.22cm/hr in the placebo arm. This difference was not statistically significant (p value=0.832). The postpartum satisfaction scores were similar between the two arms. Hyoscine-N-butylbromide was well tolerated without any major adverse effects observed in either arm.

Conclusion: Hyoscine-N-butylbromide does not shorten the duration of labour in first time parturients in spontaneous labour. It also does not change maternal satisfaction with care received and is not associated with major adverse outcomes in the mother or newborn.

Keywords: Antispasmodics, Hyoscine-N-butylbromide, Labour

Term pregnancy in breech presentation in a unicornuate uterus: a case report

M.W. Njoroge — 2017-04-03

Mullerian anomalies are rare and are associated with poor reproductive outcomes such as pregnancy wastage, preterm birth and malpresentation. This is a case report of an eighteen-year-old woman who presented at 38 weeks gestation in labour with the fetus in breech presentation. A caesarean section was performed, intraoperatively she was found to have a unicornuate uterus with a rudimentary horn. Term pregnancies are possible in patients with mullerian anomalies, however they should be considered high-risk pregnancies with close follow-up and management individualized.

Unusual cause of abdominal pain in the second trimester in a primigravida: case report

D Kibii — 2017-04-03

A 26-year-old primigravida, at 22 weeks gestation by dates, was admitted to our institution after having presented with a two-day history of abdominal pain and vaginal spotting. An abdominal ultrasound revealed an abdominal pregnancy with fetal demise at 20 weeks and an empty uterus. Intra-operatively, the placenta was noted to adhere to the posterior wall of the bladder and the fundus of the uterus. A macerated stillbirth with missing limbs was removed and the placenta left in place. The patient improved post-operatively and was later discharged, follow up serum B-HCG were noted to decline. We report this case since ectopic pregnancies are more common now, and therefore we need to highlight the importance of early scans to confirm viability and site of conceptus implantation.

Keywords: Abdominal pregnancy, Macerated, Abdominal pain

Perimortem caesarean section; successful neonatal outcome after preterm delivery: a case report

G Watau — 2016-04-07

Perimortem caesarean section presents a unique opportunity to successfully resuscitate a pregnant woman who has suffered cardio-vascular collapse, and potentially save the fetus as well. Outcomes for cardio-pulmonary resuscitation have been reported to improve with ‘emptying of the uterus’, by increasing the maternal venous return and cardiac output. The case presented is of a 40 year old multiparous woman at 30 weeks gestation admitted with systemic vasculitis, bilateral deep venous thrombosis of the lower limbs, with gangrene of the distal phalanx of the index finger on the right, and thrombocytopenia. She suffered acute cardio-pulmonary arrest and a perimortem caesarean delivery was done after 27 minutes of cardiopulmonary resuscitation. A live female infant was delivered and admitted to the new born unit. She was subsequently discharged with no neurological sequelae. This case highlights how decisive action for a perimortem caesarean delivery can result in good neonatal outcomes, even after exceeding the 4 minute rule.

Keywords: Perimortem caesarean section, Cardiopulmonary arrest, Maternal resuscitation

A pregnant virgin with microperforate hymen: A noteworthy obstetric case

A Pulei — 2017-03-03

A Pinhead-sized hymenal opening can permit spontaneous pregnancy. A 26-year-old primigravida presented to our institution for antenatal care in the late 2^nd trimester. She reported to have conceived through contact of semen with her vulva, but had never had penetrative vaginal sex. On subsequent follow up, a decision to have an elective caesarean at 39 weeks was made. We report this example because management of such cases can be challenging especially if a timely diagnosis is not made due to lack of awareness and the patient presents when pregnant.

Keywords: Pregnant virgin, Elective caesarean, Microperforate hymen, Dilation