SummaryBackgroundPost-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.FindingsBetween March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus ...

The broad ligament is the commonest extra uterine site for the occurrence of leiomyoma but with a very low incidence rate. Because of its overall low incidence rate, it poses both clinical and radiological difficulty in differentiating with an ovarian tumour. We report a case of a 31-year-old unmarried nullipara (para 0 + 0) who presented with 12-month history of progressive abdominal swelling, three-month history of pelvic pain and one-month history of prolonged heavy menstrual flow. Examination of the abdomen showed a 36-week-size mass which was multi-lobulated, firm, non tender and slightly mobile extending to the xyphisternum. On abdominal ultrasonography scan, the uterus was deviated to the contra lateral side with a huge, irregular mass measuring 24 × 18 cm posterior to the uterus. She had laparotomy and four fibroid seedlings were removed. The largest was a broad ligament myoma which measured 24 × 17 × 12 cm and weighed 3883 g.

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Abstract:Introduction: About 90% of menstruating women get advanced warning of an approaching period because of the physical and/or psychological changes in the days before the period begins. Many women have mild symptoms and in a few it may be severe. This study intends to find the commonest symptoms among students in health institutions in Zaria, Northern Nigeria. Objective: To determine the commonest premenstrual symptoms among students in health institutions in Zaria. Methods: A cross sectional study was carried out in some health institution in Zaria Northern Nigeria over a three month period. A total of 300 students were interviewed using semi structured open ended questionnaires. Information about premenstrual symptoms were sought. The criteria for the diagnosis of (Premenstrual Syndrome) PMS was based on the Diagnostic and Statistical Manual of Mental Disorder (DSM IV Manual). Data was analyzed using computer software SPSS version 20. Results: Medical students constituted 42.7%, Nursing 28.6%, Medical Laboratory 27.8% and Medical Records 0.9%.Their age range was 18 to 29 years with a mean age of 20 + 3 years. The mean age of menarche was 13.7 years (SD 2.1).The prevalence of PMS was 40.7%. The major tribes (Hausa/ Fulani, Igbo and Yoruba) were more likely to have the above symptoms than both the Northern and Southern minorities. The commonest symptoms was abdominal pain/discomfort as seen in 180 (70.6%) of the respondents. Tiredness 158 (61.0%) and painful/tender breasts 149 (57.1%) were also common. Fifty seven percent (57.3%) 141 of them had severe symptoms warranting drug use while 8 (3.7%) had to be admitted in the hospital. The use of drugs for the above symptoms as well as the hospitalization rate was not statistically significant. Conclusions: Both physical and psychological premenstrual symptoms were found among these students which affected their quality of life. To what extent these symptoms affect studies and family life in our environment requires further research.

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