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The Fetal Outcome and Fetal Wastage Pattern among Different Types of Obstetric Fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria

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Open Journal of Obstetrics and Gynecology 2020年第4期10卷 538-545页

作者： kenneth chinedu ekwedigwe Onwe O. Emeka Isikhuemen E. Maradona Iwe Bobby Azubuike K. Onyebuchi Obuna Johnson Ezeonu P. Olisaemeka Onoh C. Robinson ekwedigwe P. Ifeanyi Clinical Services National Obstetric Fistula Centre Abakaliki Nigeria Department of Obstetrics and Gynaecology Alex-Ekwueme Federal University Teaching Hospital Abakaliki Nigeria Department of Paediatrics Alex-Ekwueme Federal University Teaching Hospital Abakaliki Nigeria Department of Obstetrics and Gynaecology University of Benin Teaching Hospital Benin Nigeria

BACKGROUND: Obstetric Fistula is a major public health problem in developing world. It is associated with a high fetal wastage rate. The objective of this study was to evaluate different types of obstetric fistula and their fetal wastage rate. METHOD: A retrospective population study was done at the National Obstetric Fistula Centre, Abakaliki between 1st January-31st December, 2016. The calculated minimum sample size was 3, however, the total number of 203 patients were studied. The case notes of all the women who had obstetric fistula repairs over the period were analyzed. RESULTS: The mean age from this study was 38 ± 12.1 years. The fetal wastage rate from this study was 82.76% while the live birth was 17.24%. Seventy percent of the stillbirth were delivered via SVD, while 11% of stillbirth were delivered through EmCS. Twelve different types of fistula were identified in this study using anatomical classifications. Large extensive fistula, urethral loss and multiple fistula had the highest fetal wastage of 100% respectively. This was followed by mid-vaginal fistula (95.7%), Juxtaurethral fistula 94.4%, Juxtacervical fistula 88.5%, Intracervical fistula 85.71%, Ureteric fistula 85.71%, Vesicouterine 84.21%, Vault fistula 62.5%. Rectovaginal fistula had the least fetal wastage of 15.79% and the highest live birth of 84.2%. CONCLUSION: The findings showed a high fetal wastage rate amongst women with obstetric fistula. There was high fetal wastage across different types of obstetric fistula. Rectovaginal fistula had the best outcome in terms of live births.

关键词： Obstetric Fistula Fetal Wastage/Stillbirth Live Birth

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Prevalence and Pattern of Abnormal Pap Smear among Pregnant Women Attending Antenatal Clinic in a Missionary Hospital in Abakaliki, Southeast Nigeria

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Open Journal of Obstetrics and Gynecology 2018年第8期8卷 728-740页

作者： kenneth chinedu ekwedigwe Paul Olisaemeka Ezeonu Felix Edegbe Chidi Esike Anthony Tagbo Agbata Chukwuemeka Ikechi Ukaegbe Okechukwu Bonaventure Anozie Obiorah Godfrey Asiegbu Maradona Isikhuemen Department of Obstetric & Gynaecology Federal Teaching Hospital Abakaliki Nigeria Department of Pathology Federal Teaching Hospital Abakaliki Nigeria Department of Obstetrics & Gynaecology University of Benin Teaching Hospital Benin Nigeria

BACKGROUND: Cervical cancer is the most common type of cancer affecting the genital tract among women in developing countries. Screening programmes have been well talked about in Nigeria, but they are not well organized. Hence, the incidence of cervical cancer does not appear to be reducing. A possible way of solving this problem is by doing an opportunistic pap smear among women attending antenatal clinics, since a good number of women do access antenatal care. OBJECTIVES: To determine the prevalence, knowledge, awareness, practice, risk factors and pattern of Pap smear among women attending antenatal clinic in Mile 4 hospital, Abakaliki. METHOD: This is a cross-sectional study carried out at the antenatal clinic of Mile 4 Hospital, Abakaliki, Nigeria. A total of 110 consecutive pregnant women who fulfilled the inclusion criteria and have given their consent were recruited into the study at the time of their first prenatal (booking clinic) visit for antenatal care. Data was collected using a questionnaire. Conventional Papanicolaou smear was taken using the standard procedure. The cytopathologic findings were documented in the questionnaire. RESULTS: Out of the 110 pregnant women who had cervical cytology by Pap smear, 7 had pre-invasive cervical lesion, giving a prevalence rate of 6.3%;5 (71.4%) were low-grade squamous intraepithelial lesion (LGSIL) while 2 (28.6%) were high-grade squamous intraepithelial lesion (HGSIL). Fifty women (45.5%) had negative smears. Inflammatory smears were seen in 50 women (45.5%). Insufficient smear was seen in 3 women (2.7%). Fifty-six women had knowledge about cervical cancer (50.9%), while thirty-six women (32.7%) were aware of a screening program for cervical cancer and only 2 women (1.8%) had been screened in the past. Hence, from this study, the population screening rate was approximately 2%. The risk factors were age of coitarche years, number of sexual partners, previous history of sexual transmitted infection, genital warts,

关键词： Pregnancy Pap Smear Cervical Cancer

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A Six-Year Review of Caesarean Sections at the Federal Teaching Hospital Abakaliki, Ebonyi State, South East Nigeria

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Open Journal of Obstetrics and Gynecology 2020年第12期10卷 1669-1676页

作者： Johnbosco E. Mamah Obiora G. Asiegbu Uzoma V. Asiegbu kenneth C. ekwedigwe Ugochukwu U. Nnadozie Love Okafor Obstetrics and Gynaecology Department Alex Ekwueme Federal University Teaching Hospital Abakaliki Nigeria Paediatrics Department Alex Ekwueme Federal University Teaching Hospital Abakaliki Nigeria Division of Plastic Surgery Department of Surgery Alex Ekwueme Federal University Teaching Hospital Abakaliki Nigeria

Background: Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). Subjects and Methods: This was a six-year retrospective study covering January 1st 2012 to December 31st 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed by means of Epi Info version 7. Results are presented in tables, means and simple percentages. Results: During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. The most common indication for an emergency caesarean section was failure

关键词： Abakaliki Caesarean Section Rate Maternal Mortality Perinatal Mortality

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Experimental Evaluation of the Mechanical Properties of Recycled Low Density Polyethylene/Bean Pod Ash Particulate Bio-Composites

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Journal of Minerals and Materials Characterization and Engineering 2015年第5期3卷 362-372页

作者： M. C. ekwedigwe E. E. Nnuka C. U. Atuanya Department of Metallurgical and Materials Engineering Nnamdi Azikiwe University Awka Nigeria

The evaluation of bean pod ash particles on the properties of recycled low density polyethylene (RLDPE) composites was studied. The RLDPE/bean pod ash particles (CBPp) composites were produced using compounding and compressive moulding techniques. Factorial design of experiment and analysis of variance (ANOVA) were employed for optimization. The mechanical properties and microstructure of the composites were determined. The results obtained showed that the optimum values of flexural strength were obtained at 140°C, 12 minutes, 40 wt% CBPp and 6 Mpa. The hardness values, tensile and bending strengths of the composite increased by the addition of beans pod ash particles to RLDPE composites. Compressive properties of RLDPE matrix and composites were 13.00 and 18.25 N/mm2. The fairly uniform distribution of the bean pod ash particles in the microstructure of the composites is the major factor responsible for the improvement in the mechanical properties. The obtained results of the developed composites have shown that the beans pod waste could be used as a biodegradable eco-friendly reinforcement.

关键词： Microstructure Mechanical Properties Statistical Studies and Composites Fabrication

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Epidemiological Pattern of Closed Femoral Shaft Fractures in a Regional Tertiary Hospital in Enugu, Nigeria

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Journal of Biosciences and Medicines 2019年第5期7卷 180-188页

作者： E. C. Iyidobi R. T. Ekwunife U. M. Enweani C. U. Nwadinigwe I. C. Okwesili H. C. ekwedigwe National Orthopedic Hospital Enugu Nigeria City Specialist Hospital Enugu Nigeria College of Medicine University of Nigeria Eungu Campus Enugu State University Teaching Hospital Parklane Enugu Nigeria

Background: The femur is the longest and strongest tubular bone in the human body. The femoral shaft is the portion of the bone between 5 cm distal to the lesser trochanter and 6 cm proximal to the most distal point of the medial femoral condyle. Femoral shaft fractures often result from high energy forces. These fractures occur mostly among young adults. Objective: This was to determine the epidemiological pattern of closed femoral shaft fractures in a regional tertiary hospital in Enugu, Nigeria. Method: The study was a prospective study over a 12 month period (June 2015-May 2016) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients were consecutively recruited. The patients were clinically and radiographically evaluated at presentation. The diagnosis of closed femoral shaft fractures were made from the physical examination finding of absent open wound communicating with the fracture hematoma in the thigh and anteroposterior (AP) and lateral x-rays of the affected thigh confirming the fracture pattern. The data collected included patients’ demographics, the cause of injury, the side of injury and anatomic site of the injury among other parameters. The data were collected using well designed and structured proforma. Results: A total of 52 femoral shaft fractures in 50 patients were included and analyzed using SPSS version 20.0. The age range of the patients is 18 - 85 years with a median age of 39.1 ± 14.9 years. The most commonly affected age group is 21 - 30 years. There was male preponderance with a male to female ratio of 2.3:1. Majority of the fractures (76.9%) resulted from road traffic crashes most commonly following motor vehicular accident (36.5%). Majority of the fractures (92.3%) are unilateral with right side to left side ratio of 1.2:1. Majority of the patients (51.9%) had Winquist Hansen grade III type of fracture. The most common associated injury is fractures of tibia/fibula followed by fracture

关键词： Epidemiology Closed Femoral Shaft Fracture

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Non-Fistulous Complications of Prolonged Obstructed Labour among Obstetric Fistula Patients in Southern Nigeria

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Open Journal of Obstetrics and Gynecology 2019年第10期9卷 1372-1387页

作者： O. N. Abodunrin A. B. C. Daniyan B. Okusanya K. C. ekwedigwe S. M. Uguru E. N. Yakubu I. Sunday-Adeoye Department of Obstetrics & Gynaecology Lagos University Teaching Hospital Lagos Nigeria National Obstetric Fistula Centre Abakaliki Nigeria.

Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women. These included cervical retraction (42.2%), obstetric nerve palsy (30.4%), vaginal scarring (29.8%), partial urethral loss (16.1%

关键词： Non-Fistulous Complications Obstructed Labour Obstructed Labour Injuries Obstetric Fistula

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Endocervical Swab Microbial Isolates among Women with Third Degree Uterovaginal Prolapse

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Open Journal of Obstetrics and Gynecology 2017年第3期7卷 369-375页

作者： K. C. ekwedigwe I. Sunday-Adeoye M. E. Isikhuemen M. O. Eliboh A. B. C. Daniyan E. N. Yakubu I. C. Amamilo National Obstetric Fistula Centre Abakaliki Nigeria

Background: Uterovaginal prolapse is the descent of the uterus through the vaginal canal. This may be a predisposing factor to infections in the urogenital system. This study aimed to assess the endocervical swab microscopy, culture and sensitivity in patients with third degree uterovaginal prolapse at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria. Methodology: This is a cross-sectional prospective study to assess the endocervical swab microbial findings in patients with third degree uterovaginal prolapse using simple random sampling technique. Data on sociodemographic variables, risk factors for pelvic organ prolapse, and endocervical swab findings among women with third degree uterovaginal prolapse were collated and analysed using statistical methods. Results: The mean age and parity were 50.5 years ± 9.1 and 6.7 ± 2.0 respectively. Thirty-six (85.7%) of the clients were grandmultipara and 37 (88.1%) were farmers. Pus cells were present in all samples while 27 (64.3%) had microbial isolates. Streptococcus pyogenes was isolated in 7 (16.7%), Streptococcus faecalis in 5 (11.9%), Escherichia coli in 5 (11.9), Staphylococcus aureus in 4 (9.5%), Klebsiella pneumoniae in 2 (4.8%) and Yeast cells in 4 (9.5%) of the endocervical swabs. All isolates were sensitive to gentamicin. Bacterial isolates were resistant to amoxicillin/clavulanic acid. Conclusion: This study showed growth of pathogenic organisms from the endocervix of women with third degree uterovaginal prolapse. A 100% sensitivity to gentamicin was observed in the study.

关键词： Uterovaginal Prolapse Endocervical Swab Microscopy Culture Sensitivity

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Prostate Specific Antigen Screening among Men in Abakaliki, South East Nigeria

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Open Journal of Urology 2017年第5期7卷 79-85页

作者： E. N. Afogu I. Sunday-Adeoye K. C. ekwedigwe M. E. Isikhuemen S. C. Okenwa S. A. Popoola M. O. Eliboh I. C. Amamilo Urology Unit Department of Surgery Federal Teaching Hospital Abakaliki Nigeria National Obstetric Fistula Centre Abakaliki Nigeria

Background: Prostate cancer is the most common type of cancer among Nigerian men. Prostate specific antigen (PSA) is produced by the prostate gland and it is an important tumor marker in the screening and diagnosis of prostate cancer because the latter is often associated with elevated PSA levels. The aim of this study was to evaluate the profile and PSA levels of men presenting for prostate cancer screening at the National Obstetric Fistula Centre, Abakaliki, Nigeria. Methods: This was a retrospective study of 103 patients who were seen between January 2014 and December 2015 and screened for prostate cancer using PSA assay. Data was extracted from folders of patients using a proforma and analysed using the Statistical Package for Social Sciences (SPSS), version 21. Result: Out of the 103 clients studied, 67 (65%) were between the ages of 40 and 59 years. The mean age was 54.38 ± 12.5 years. Eighty-one (78.6%) of the study population had PSA levels 4 ng/ml and below, 5 (4.9%) had PSA levels of 4.1 - 10 ng/ml, while 17 (16.5%) had PSA levels > 10 ng/ml. The mean PSA was 4.75 ± 8.2 ng/ml. None of the patients with family history of cancer had PSA levels of >4 ng/ml. Those who were positive for HIV also had normal PSA results. Conclusion: The findings from this study showed that the prevalence of men with raised PSA (>4 ng/ml) was high (21.4%) especially in the 60 - 69 years age group. There is need to increase prostate cancer screening using PSA in our setting. The use of other parameters such as digital rectal examination, PSA density, PSA velocity and free PSA will be helpful to determine the need for histological diagnosis in these patients.

关键词： Prostate Cancer PSA Screening

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Awareness of Obstetric Vesicovaginal Fistula among Pregnant Women in a Rural Hospital

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Advances in Reproductive Sciences 2017年第3期5卷 39-46页

作者： P. O. Ezeonu K. C. ekwedigwe M. E. Isikhuemen M. O. Eliboh R. C. Onoh L. O. Lawani L. O. Ajah E. I. Dimejesi Department of Obstetrics and Gynecology Federal Teaching Hospital Abakaliki Nigeria Department of Obstetrics and Gynaecology University of Benin Teaching Hospital Benin City Edo State Nigeria National Obstetric Fistula Centre Abakaliki Nigeria

Background: Giving birth should be a period of joy, but for more than half a million women, their pregnancy and childbirth end in death while some develop vesicovaginal fistula. Vesicovaginal fistula is an abnormal communication between the bladder and the vagina leading to continuous leakage of urine through the vagina. Little is known about the perception of pregnant women about obstetric fistula and this group of women are those who are at risk of the disease. Our aim therefore was to evaluate the level of awareness of vesicovaginal fistula among pregnant women attending antenatal clinic in a rural hospital. Methodology: This was a cross sectional study conducted at Mile 4 missionary Hospital, Abakaliki, between 1st of May and 1st of July, 2017. Data was collected with the use of questionnaire. Ethical clearance was gotten from the institutions ethical committee. Results: Their mean age was 27 ± 5 years and mean parity was 2 ± 2. Awareness of vesicovaginal fistula was 57.8%. Risk factors identified for vesicovaginal fistula were prolonged obstructed labour, instrumental vaginal delivery, caesarean section and short stature. Only 80 (39.2%) believed vesicovaginal fistula could be treated. Conclusion: Awareness of vesicovaginal fistula in the study population was 57.8%. A significant number of women were not aware that vesicovaginal fistula could be treated.

关键词： Vesicovaginal Fistula Awareness Pregnancy Prolonged Obstructed Labour

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Enterovesical Fistula Complicating Myomectomy: A Case Report

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Open Journal of Urology 2017年第4期7卷 75-78页

作者： K. C. ekwedigwe I. Sunday-Adeoye S. Lengman M. E. Isikhuemen A. B. C. Daniyan E. N. Yakubu M. O. Eliboh I. E. A. Uguru National Obstetric Fistula Centre Abakaliki Nigeria

Background: Enterovesical fistula is an abnormal communication between the bladder and the gastrointestinal tract. It is an uncommon type of genital fistula, occasionally complicating pelvic surgeries. However, it is the most common type of fistula associated with diverticular disease of the colon. Other causes include cancer, trauma and iatrogenic injuries. Pneumaturia and fecaluria usually implies enterovesical fistula. Enterovesical fistula complicating myomectomy is an uncommon finding. Our aim is to report a case of enterovesical fistula following myomectomy. Case presentation: She is a 33-year-old nullipara who presented at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State, South-Eastern Nigeria with a history of fecaluria, pneumaturia and haematochezia which started after myomectomy. Feculent fluid was obtained on urethral catheterization. Cystography was suggestive of enterovesical fistula. Conclusion: Enterovesical fistula is a possible complication of myomectomy. A high index of suspicion for this rare but potentially devastating condition is important for early diagnosis and appropriate management.

关键词： Enterovesical Fistula Myomectomy Uterine Fibroid

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