Aims: Abdominal pregnancy, especially at the second trimester, is a rare and life-threatening case with a high mortality rate for both mother and fetus [1,2]. An abdominal pregnancy is defined as a pregnancy that occurs in the peritoneal cavity outside the tube, ovary, or intra-ligamentous region, which can occur primarily or secondary. The researcher reported the case of primary abdominal pregnancy [1,3-5].
Presentation Case Report: Patients G4P1A2H1 at 25-26 weeks pregnant without complaint, had an ultrasound examination which showed fetus location in the left hypochondria region, with placenta implantation attached to the abdominal aortic area, this was confirmed by MRI that showed intraabdominal pregnancy. Operative laparotomy in this patient was performed, followed by dissection of placenta attachment to the sigmoid colon and omental mucosa. Bleeding was also found in the uterine fundus without any evidence of the discovery of uteroperitoneal fistulas in intraoperative. The results of histopathological examination showed an appearance of placental tissue with a non-specific chronic inflammatory process from the placenta implantation of the abdominal pregnancy in the posterior fundus.
Conclusion: This case report supports the importance of diagnostic competence of life-threatening conditions, especially in rare cases with less obvious manifestations, in order to reduce maternal and fetal morbidity and mortality.
Widening of the symphysis pubis is a physiological mechanism for vaginal delivery. Hormonal and physiologic influences of pregnancy, mostly due to relaxin cause a two-fold increase from the normal width. A 31-year-old G2A1, developed pain over the pubis along with difficulty in walking from 20 weeks of gestation. The pain initially, was on getting up from bed. It worsened with gestation and was not relieved with analgesics. Again, a 29-year-old G2L1, developed pain over the pubis from 31 weeks of gestation. She had difficulty in turning in bed as well as walking. Both patients were diagnosed with antepartum symphysis pubis diastasis and was confirmed with Xray pelvis postpartum. The risk factors are multiparty, macrosomia, cephalopelvic disproportion, forceps delivery, connective tissue disorders, malpresentation, prior pelvic trauma, intense uterine contractions, abnormally long or short duration of labour, shoulder dystocia, Mc Roberts manoeuvre and epidural anaesthesia. MRI aids in antepartum diagnosis and planning mode of delivery, but is not cost effective in low resource settings. Hence a conservative approach is essential for satisfactory patient outcomes and confirmation of the condition can be carried out postnatally.
Background: Almost 50% of all cervical cancer cases are diagnosed in patients who have never been screened for cervical cancer before. There is an established cause - effect relationship between Hr-HPV infection and cervical cancer. Therefore, knowing the prevalence and high risk HPV genotype distribution in this group of women helps to formulate vaccination policies in a country. There is paucity of such information in Zimbabwean women.
Aim: To determine high risk HPV prevalence and genotypes in women who have never been screened for cervical cancer. To compare HPV positivity rates between women of ages’ <30 and ≥30 years.
Study Design: Cross sectional descriptive study.
Place and Duration of Study: Cimas Medical Laboratories. Between January 2017 to December 2019.
Methodology: High risk HPV DNA screening was done using the Cepheid Xpert HPV qualitative screening test. Specimens positive for the pooled HPV subtypes were further typed using the HPV Genotypes 14 Real-TM Quant test kit to characterize specific subtypes. A t –test was used to compare the HPV positivity rates between women of ages’ <30 and ≥30 years. A p-value <0.05 was regarded as statistically significant.
Results: The HPV positivity rates were 20% and 31% in women of ages’ ≥30 and <30 years respectively. There was a statistically significant difference in HPV positivity between these two groups (p=0.03). HPV 52 was the most common subtype (15.8%) followed by HPV 18 (14.3%), HPV 16 (11.9%), HPV 35 (9.5%) and HPV33 & 58 which both contributed 8.3% of all subtypes detected.
Conclusions: Approximately 20% of women 30 years old and above have an HPV infection. HPV 52, 18 and 16 are the most common HPV subtypes in Zimbabwe.
Recommendation: HPV 52 should be included in the vaccines currently being used in Zimbabwe which are predominantly composed of HPV 16 and 18.
Aims: The objective of the study is to determine the association between maternal serum uric acid levels with the severity and neonatal outcome in preeclampsia/eclampsia.
Study Design: This study was a cross-sectional study with a descriptive-analytic design.
Place and Duration of Study: Department of Obstetrics and Gynecology, Prof. Dr. R. D. Kandou General Central Hospital and affiliated hospitals in Manado, between October 2020 and February 2021.
Methodology: We included 33 normotensive pregnant women and 33 mothers diagnosed with either severe preeclampsia, HELLP syndrome, or eclampsia who delivered at Prof. Dr. R. D. Kandou General Central Hospital and affiliated hospitals in Manado. The serum uric acid of all subjects was examined using the uricase method before delivery.
Results: The mean serum uric acid level in normotensive pregnancy was 4.8 (± 0.73) mg/dL and the median value in preeclampsia / eclampsia was 9.2 (5.2-15.1) mg/dL. One-way Anova test showed a significant association between maternal serum uric acid levels with the severity of preeclampsia/eclampsia with a value of P < .001 and the degree of hypertension with a value of P < .001. At the same time, the Pearson correlation test showed a strong correlation between systolic and diastolic blood pressure with uric acid levels with rho values 0.620 (P < .001) and 0.517 (P = .002), respectively. We found no significant association between maternal serum uric acid levels and the onset of preeclampsia (P-value = .935); with gestational age at delivery (P-value = 0.431); and with the first minute APGAR score (P-value = 0.209).
Conclusion: There was a significant association between maternal serum uric acid levels and the severity of preeclampsia/ eclampsia. There was no association between maternal serum uric acid levels and neonatal outcome. We recommend investigation of maternal uric acid levels could be used to help determine the prognosis in patients with preeclampsia/eclampsia.
Background: Cervical cancer is the most common malignancy in Zimbabwe. This attributed to poorly executed Pap smear based screening programs. Pap smears have poor sensitivity and high specificity while HR-HPV DNA testing has high sensitivity and poor specificity. With reference to the ASCCP guidelines, does combining these two tests have any clinical value in terms of increasing screening intervals from 3 to 5 years, predicting possible future cervical lesion and resolving the dilemma associated with managing patients with borderline ASCUS LBC results.
Aim: To assess the clinical value of LBC and HR-HPV DNA co-testing in terms of increasing screening intervals (in the NILM/HPV- group), predicting possible future cervical lesions (in the NILM/HPV+ group) and the resolution of the dilemma associated with managing patients with borderline ASCUS LBC results.
Study design: Cross sectional descriptive.
Place and duration of study: Cimas Medical Laboratories. February 2020 to November 2020.
Methodology: A Thin Prep 2000 machine was used to process the LBC samples. The slides were then stained using the Papanicolaou stain. Two independent Cytologists interpreted the LBC smears according to the 2014 Bethesda System. Discrepant results were resolved by an independent Pathologist. All interpreters were blinded of the HR-HPV test result. HR-HPV DNA testing was done using the Cepheid Xpert HPV qualitative test.
Results: A total of 542 women of ages’ ≥ 30 years were recruited into the study. The mean (SD) of the women was 39.4 (8.6) years, the median age was 37 years and the age range was 30-83 years. The mean ages’ of the HR-HPV+ and HR-HPV- were comparable (40.1 years vs. 38.9 years, respectively; p=0.412). LBC abnormalities were significantly higher in women >37years (median age) than women ≤37 years (18.2% [4/22] vs. 81.2% [18/22], respectively; p=0.002).The LBC/HR-HPV test combination results were as follows: NILM/HPV- (n=418, 77.1%), NILM/HPV+ (n=102, 18.8%), ASCUS/HPV+ (n=9, 1.7%), ASCUS/HPV- (n=5, 0.9%) and >ASCUS/HPV+ (n=8, 1.5%).
Conclusions: The co-testing approach had the clinical value of increasing screening intervals from 3 to 5 years in 77.1%, predicting possible future cervical lesion in 18.8%, instant confirmation of a precancerous lesion from ASCUS lesions in 1.7% and the instant confirmation of a non-neoplastic lesion from ASCUS lesions in 0.9% of all co-tested samples.