Biomedical subjects
Publications and source records attributed to B Adelusi.
Further studies on the obstetric performance of women after recurrent ectopic pregnancies are needed to adequately counsel women who are still interested in future fertility, even after their third ectopic pregnancy.
This study aimed at determining the outcome of pregnancy in unbooked mothers with regard to maternal complications and foetal outcome. This retrospective study was based on investigations of medical records of 467 unbooked mothers who presented for delivery at the Obstetrics Unit at King Khalid University Hospital, Riyadh, during the period 1991 and 1992, and 415 booked mothers with regular clinic attendance selected as controls. Data collected from the records included patients' socio-demographic characteristics, past obstetric history, prevalence of pregnancy-related diseases, and data relating to labour, delivery, and foetal outcome. Chi-square test and Fisher's exact test were used for assessing the statistical significance of the association between the various factors which were investigated. The tendency for mothers to be booked was found to be significantly associated with their age, occupation, parity, and gestational age at delivery. Booked and unbooked mothers did not differ significantly in relation to the mode of delivery and foetal outcome, although the prevalence of previous complications of pregnancy was generally lower among unbooked mothers. There was no statistically significant association between the absence of antenatal care and outcome of pregnancies, unbooked mothers had a higher proportion of MICU admissions and dead babies compared with the controls. Educating the community about the benefits of receiving regular antenatal care, even if at primary care level, may be of great importance in improving the pregnancy outcome.
BACKGROUND: To identify important covariates related to retained placenta using logistic regression analysis. METHODS: The study was carried out in the King Khalid University Hospital, Saudi Arabia, and involved 114 women who had retained placenta, and 116 women with normal deliveries. Chi-square test and logistic regression analysis were used for analysis of data. Adequacy of predictor variables was examined using indices of sensitivity and specificity and plots of probability histograms for prediction of retained placenta among patients and controls. RESULTS: Logistic regression analysis highlighted multiparity, induced labor, small placenta, and large amount of blood loss to be significantly associated with retained placenta. In addition, high pregnancy number, previous injury to uterus, and pre-term labor related significantly to retained placenta. Predictor variables had sensitivity of 65.5% and 87.9% specificity and achieved 77% overall correct classification. CONCLUSIONS: These findings could be used to develop a predictive procedure for identifying high-risk cases of retained placenta.
OBJECTIVE: To review the cases of ruptured uterus at King Khalid University Hospital (KKUH) over the 11 years of the hospital's existence (1984-1994), to analyze the causative factors of uterine rupture with a view to its prevention, and to highlight the management approach in relation to maintaining the patients' future fertility. METHODS: Case notes were reviewed for all patients with ruptured uterus at KKUH over a period of 11 years from January 1984 to December 1994. Relevant data relating to the clinical features, characteristics of labor, operative procedures, and maternal and perinatal outcome were assessed. RESULTS: There were 11 cases of ruptured uterus, six of which occurred in patients with previous cesarean scars. Two patients were primigravidas, one of whom ruptured her uterus following a road traffic accident. In one patient with six previous preterm labors, rupture resulted from non-removal of cervical cerclage during labor. The rupture occurred in the fundus in one case, and in the lower segment in the remaining 10. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in three cases, two of which were total and the third subtotal. The remaining eight patients had suture repair, all of whom became pregnant later and were delivered by cesarean section. CONCLUSION: Even though rupture of the uterus was a rare complication of pregnancy at KKUH, it occurrence should be suspected when there are sudden fetal heart abnormalities during labor, or unexplained postpartum shock. Suture repair should be considered whenever possible in order to preserve the patients' reproductive potential.
OBJECTIVES: To study and analyze the factors related to repeat cesarean section and to highlight the problems that may be associated with it. METHODS: The study was carried out in the Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh, Saudi Arabia, and involved 395 patients who had had two or more previous cesarean sections prior to the current pregnancy. Various factors which may be associated with repeat cesarean sections, as well as the outcome of the operations, were assessed and analyzed. The chi2-test and other analyses were used to examine the association between the number of cesarean sections and the various variables. RESULTS: Four or more previous cesarean sections was significantly associated with dense adhesions. On the other hand, height, parity, antenatal clinic attendance, postoperative complications, fetal weight and fetal outcome had no significant effect on, nor influenced, the multiplicity of cesarean sections. CONCLUSION: No specific risk is associated with repeat cesarean sections that is not normally associated with single cesarean sections.
OBJECTIVE: To study and compare the obstetric outcome in term pregnancies and uncomplicated prolonged pregnancies. METHODS: The study was a retrospective review of 596 cases. The case notes of 286 patients with uncomplicated prolonged pregnancies (> or = 42 weeks) and 310 patients with normal term pregnancies (37 to < 42 weeks) were analyzed. The Gold Stat package was used for statistical coding and analysis. RESULTS: There was no fetal morbidity or mortality among the two groups. However, the number of previous abortions were significantly higher in prolonged pregnancies compared with term pregnancies. Similarly, fetal and placental weights, labor induction and operative delivery rates were significantly higher in prolonged pregnancies. However, there were no significant differences between the patients who were induced and those who had spontaneous labor among the prolonged pregnancies. CONCLUSIONS: There is no doubt that prolonged pregnancy may be associated with certain risks factors. However, there is no outcome variable to justify whether or not to induce those pregnancies which are prolonged.
OBJECTIVE: To compare the diagnostic accuracy of two methods of assessment of tubal patency, viz, hysterosalpingography (HSG) and laparoscopic hydrotubation. DESIGN: One hundred four infertile women who were investigated with both HSG and laparoscopy in King Khalid University Hospital were selected for the study. Complete history of factors that may predispose to tubal occlusion was obtained. Patients with problems of ovulatory failure or poor semen analysis that may contribute to their infertility were excluded. RESULTS: The overall agreement between the two methods was 62.5%. However, the diagnostic accuracy of the two methods differed significantly. CONCLUSION: It would appear that laparoscopic hydrotubation, despite its invasive nature, had an edge in diagnostic accuracy when compared with HSG. It would be advantageous to subject patients in whom HSG has shown tubal blockage to laparoscopy or any of the newer techniques of hysteroscopy or sonographic hydrotubation.
OBJECTIVE: To measure statistically how soon pregnancy can occur after an ectopic pregnancy (EP) so as to determine the cumulative pregnancy rate and the risk factors involved in nonpregnancy. DESIGN: The risk of not getting pregnant after an EP (survivorship) was estimated for 120 patients followed up for up to 60 months using the actuarial life-table technique. The risk factors involved in nonpregnancy, abortions, or live births were analyzed, using Cox regression models. SETTING: King Khalid University Hospital, Riyadh, Saudi Arabia. RESULTS: There were 68 pregnancies over the study period, with a conception rate of 56.7%. Using the actuarial life table, the cumulative probability of not achieving pregnancy in a patient decreased sharply during the first 12 months, followed by a gradual decrease up to 48 months. The Cox regression analysis showed a correlation between pregnancy and two variables, namely, age and history of prior EP. The chances of a pregnancy resulting in abortion or live birth also correlated with the presence of prior infertility, pelvic inflammatory disease (PID), or postoperative complications. CONCLUSION: Age and prior EP are important determinants in pregnancy rates after an EP. Similarly, history of PID, infertility, and postoperative complications are important risk factors in whether the pregnancy goes to term or ends in abortion.
Ovarian ectopic pregnancy occurs very rarely; the reported incidence is only 1:7000-40,000 deliveries, despite various reports in recent years. We present four cases of primary ovarian pregnancy which were managed in the King Khalid University Hospital (KKUH) over a 5-year period representing a prevalence rate of 19.9 per 100,000 deliveries. All four cases complied with the four criteria of Spiegelberg. None of the patients were known to have used an intrauterine contraceptive device which had been suggested as the cause of ovarian pregnancies in several studies. Fertility after surgery in these cases was unaffected.
A case of three consecutive repeated ectopic pregnancies is presented in a 36-year-old woman who was being managed for infertility. The first two ectopic pregnancies occurred in the right fallopian tube, and both were treated conservatively. All three ectopic pregnancies were confirmed histopathologically. The aetiology, symptoms and management of the case are discussed, and the literature is reviewed.
The urographic findings in 52 patients with histologically proven carcinoma of the cervix were studied. Obstructive changes observed were classified according to the severity of calyceal distension and related to the clinical staging of the disease. Obstructive urographic changes were present in 46% of cases, which is three times as high as reported in Caucasian populations, and the severity correlated significantly with the stage of disease. Urography is advocated as a useful pre and post-treatment index of the progress of cervical treatment.
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Eclampsia is a common complication of pregnancy in Ibadan, although its long term effects on subsequent pregnancies is unknown. In a prospective study of 64 women who had eclampsia in their previous pregnancies and were followed up in their current pregnancies, 15.6% of them had recurrent eclampsia, in spite of optimal antenatal care. Of the 18 patients with diastolic blood pressure of 80 mmHg 22.2% or over at booking had antepartum or intrapartum eclampsia as compared with only 2.2% of 46 patients with diastolic blood pressure of less than 80 mmHg at booking. This finding was statistically significant (P less than 0.01), showing that the diastolic blood pressure at booking can be a measure of the potential for developing eclampsia because of the possibility of residual hypertension on which pre-eclampsia may be superimposed. Similarly, there was a significant association (P less than 0.05) between the birthweight of the babies and the diastolic blood pressure at booking, and may be a measure of the effect of vascular effect of pre-eclampsia on the placenta. However, there was no difference in the perinatal mortality rate in this study and the overall hospital figures in spite of the high risk pregnancies being managed. It was concluded, therefore, that the outcome of these pregnancies would depend much on the standard of antenatal care provided for the patients.
The etiological role of viruses in various animal cancers is no longer in doubt; a similar role in human cancers is, however, yet to be confirmed. Indeed, until recently, virus infections were considered to be responsible for only a small proportion of the clinical states encountered in humans and the view that viruses may be etiological agents for human malignant tumours was not seriously entertained. With the introduction of more advanced techniques in immunovirology, the role of viruses in clinical syndromes the etiology of which had been obscure became clearer. The Emory University Group first postulated in 1964 an association between herpes simplex virus (HSV) infection and cervical neoplasia, following studies of an infant with neonatal HSV infection and his mother's cervical HSV infection. This postulate was based on the observation that women with genital HSV (herpes simplex virus type-2 (HSV-2] infection have a greater frequency of cervical neoplasia than women in the general population. Demographic surveys of cancer of the cervix have established patterns of high risk that strongly suggest that the disease may be transmitted venereally. Similarly, evidence has accumulated to show that HSV-2 is a sexually transmitted disease. It has thus been postulated that this virus may be an initiating or promoting carcinogenic factor transmitted to the female during sexual intercourse. Various multicentric approaches, from epidemiological studies to molecular studies, have been employed to substantiate this association. Even though the weight of circumstantial evidence supporting the role of HSV-2 in human carcinoma of the cervix has increased, no definitive 'cause-and-effect' association has been established between the virus and carcinoma of the cervix. The question arises, therefore, whether or not an etiological association between the virus and the disease can be confirmed. To prove a definitive cause-and-effect relationship, further studies will be required, such as the recent demonstration of the involvement of papillomavirus.
The loss of a very precious pregnancy in abortion could affect both the health of the patient and the outcome of her subsequent pregnancies. In a study of the outcome of the pregnancies that immediately follow an abortion, it was found that among women who had D&C to induce abortions in their previous pregnancies a higher incidence of abortion was found, and that these may be due to possible damage to the cervix, resulting from forcible dilatation of the cervix during the operation. It was also found, however, that a higher percentage of those who had abortions after 16 weeks in the previous pregnancies had premature deliveries in the current pregnancies. It was suggested that this may be attributable to cervical incompetence, although congenital or functional defects of the cervix may be contributory.
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Hyperimmune rabbit sera to partially purified human cervical cancer tissue antigen (CaCxTAA) and to human cervical cancer culture cell line antigens (C-4II-TAA) were used to demonstrate circulating tumour-associated antigens (C-TAA) in the sera of women with cervical neoplasia. Rabbit anti-CaCx serum detected C-TAA in 80% of the 60 sera from women with invasive cancer, cancer in situ and severe dysplasia and the rabbit anti-C-4II serum detected 67% of these cases. Negative reactions were obtained in over 95% of the 154 control sera with either rabbit serum. These results suggest that, in view of the difficulty of obtaining large specimens of cervical cancer tissues for the development of immunodiagnostic procedures, the use of a cervical cancer cell line, such as C-4II, appears desirable. Such cell lines would also be advantageous for studies aimed at providing further support for the association between genital herpes simplex virus infection and human cervical cancer.
Sera from patients attending a sexually transmitted diseases (STD) clinic, a family planning clinic, and an antenatal clinic in Ibadan, Nigeria, as well as from male blood donors from the same area were tested for the presence of type specific antichlamydial antibodies using a modified micro-immunofluorescence test. Among men and women attending the STD clinic the exposure rates to Chlamydia trachomatis serotypes D to K (genital pathogens) were 18.7% and 26.7% respectively. Antibody titres suggesting active disease in these men and women were found in 11.8% and 22.7% respectively. The highest rate of exposure (35%) was among women attending the family planning clinic; of these women 25% had antibody suggesting active disease. Titres of IgG antibody in this study were similar to those found among men and women with chlamydial genital infections in the United Kingdom. Antibodies to serotypes D to K were also detected in 10.3% of women attending an antenatal clinic and in 9.9% of male blood donors. The prevalence of antibodies to C trachomatis serotypes A to C and lymphogranuloma venereum serotypes was low. These results suggest that the prevalence of chlamydial genital infections in Ibadan, both among STD patients and especially among those individuals not seeking treatment (family planning and antenatal clinic patients), is high. Since serious sequelae can follow chlamydial genital infections it is imperative to carry out further investigations in this area.