Background:Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality.Objectives:This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto.Materials and Methods:This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the χ2 test was used to analyze some of the results with the confidence limit set at 95%.Results:During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively.Conclusion:The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.

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Background:Palliative care is the proactive care which seeks to maximize quality of life for people and families facing life-threatening illnesses.Objectives:To ascertain the existing knowledge of palliative care among medical interns and determine the effect of a structured educational intervention on improvement of their knowledge levels.Subjects and Methods:This is a quasi-experimental, interventional study with a one group pre- and post-test design involving medical interns rotating through the various departments of the Usmanu Danfodiyo University Teaching Hospital, Sokoto. The study population was chosen by convenience sampling method. The interns completed a pre- and a post-test assessment following a structured educational intervention for the evaluation of knowledge of palliative care. Knowledge was evaluated by a self-administered structured questionnaire.Results:A total number of 49 medical interns were recruited, among whom were 41 males and 8 females. Their ages ranged from 21 to 36 years with a mean of 27.7 (standard deviation 2.14) years. In the pretest, 11/49 (22.5%) of the respondents had poor knowledge level of palliative care; however, in the postintervention, only 2/49 (4.1%) of the respondents had poor knowledge. Similarly, good knowledge levels appreciated from 9/49 (18.4%) to 14/49 (28.6%) while very good knowledge increased from 10/49 (20.4%) to 19/49 (38.8%). This effect was statistically significant (Chi-square test 11.655 df = 3, P = 0.009).Conclusion:There is poor knowledge of palliative care among the interns due to ignorance. Following an educational intervention, the knowledge levels appreciated significantly. Palliative care should be part of the medical curriculum.

Postpartum haemorrhage (PPH) is the most common cause of maternal mortality globally. In about 50% of cases PPH is due to uterine atony. When conservative and medical methods of treating PPH due to uterine atony fail, surgical intervention is required to save the woman's life. As an alternative in such cases, intrauterine tamponade has been used successfully to stop bleeding, thus avoiding surgery. We report four cases of PPH due to uterine atony in which intrauterine tamponade with an inflated condom was effective in arresting haemorrhage. We advocate the use of a similar device in carefully selected cases, especially in low-resource settings.