Emergency peripartum hysterectomy is a challenging but life-saving procedure. In this descriptive study carried out in a rural Nigerian hospital, we found an incidence of emergency peripartum hysterectomy of 5.4 per 1000 deliveries and a significant association with abdominal mode of delivery, unbooked status, previous caesarean section and placenta previa. The most common indications for peripartum hysterectomy were placenta accreta (47.6%) and uterine rupture (28.6%). There were five (23.8%) maternal deaths and other complications included sepsis (five), bladder injury (three) and prolonged hospital stay (11).

Background: The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy.

of gynaecological admissions to their ICU, followed by hypovolaemic shock at 17%. Heinonen et al. 2 , from Finland, reported that the most common diagnoses at admission were postoperative haemorrhage (43%) and infection (39%). Both studies are somewhat similar to this one in that sepsis (23.8%) and hypovolaemia (9.5%) were significant indications for admission to our ICU. An important cause of admission to ICUs is sepsis following termination of pregnancy (induced abortions). 4 None was admitted to the ICU in this study. Most of these patients avoid public hospitals because of the stigma associated with it in our culture. The mortality rate in this study was 28.6%. Heinonen et al. 2 reported no ICU mortality in their study, but the 6 months mortality rate was 26%. Al-jabari et al. 5 also reported no mortality in their study in Saudi Arabia. The paucity of literature on gynaecological admissions to the ICU makes it difficult to analyse reports from other centres around the world. The high mortality in this study may have resulted because most of the patients presented late to the hospital, and so are often admitted late to ICU. It has been suggested that early ICU admission and aggressive management, including surgical intervention, be strongly recommended in these patients. 6,7 Ten patients were admitted for major surgeries with potential for major complications (i.e. for anticipated problems). While poorly equipped wards might have inspired these admissions in order to monitor the patients closely to prevent sudden complications, it is the authors' opinion that at most, a high-dependency unit be provided for such cases. This will also free bed space for more serious patients. It is important because some of these patients were relatives/friends of some staff members. Admission criteria should be based on the severity of sickness, and the use of scoring systems could be important in this regard. The need for organ support, including invasive monitoring, is also useful indications for ICU admissions. This study also agrees with other studies that the number of gynaecological patients requiring ICU care is small. 1,2,5 A study by Okafor and Aniebue 8 in the obstetric population in our centre over the same period showed that 2.2% of ICU admissions were obstetric patients (or 0.3% of all live births). Conclusion Gynaecological patients made up a small percentage of ICU admission (2.6%) in this study, but contribute for a higher percentage of its deaths (4.3%). Sepsis, hypovolaemic shock and respiratory distress were the causes of mortality in this study. Early admission and surgical intervention may help to lower the mortality rate.

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Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6–45). Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/μL than those with counts >500 (95% CI 1.69–13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05–3.36), especially those with CD4 count <200 cells/μL. Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators.