Caesarean myomectomy in Aba, south-eastern Nigeria

Abstract

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.

FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders,

“…9 Recent variants of the classical clinical description of PAS often include criteria such as a "difficult manual, piecemeal removal of the placenta"; "absence of spontaneous placental separation 20-30 minutes after birth despite active management, including bimanual massage of the uterus, use of oxytocin and controlled traction of the umbilical cord"; "retained placental fragment requiring curettage after vaginal birth"; and "heavy bleeding from the placentation site after removal of the placenta during cesarean delivery". [10][11][12][13] This has resulted in a multitude of different clinical criteria, which can be easily confused with non-accreta placental retention and secondary uterine atony. With so many different criteria all purporting to represent PAS, but without any attempt to differentiate between adherent and invasive forms, it is unsurprising that there is a wide variation in the reported prevalence over the last 30 years.…”

Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis

“…19, [47][48][49][50][51][52] Twenty-eight (28/29) were published after the year 2000 (Table 1). There were 18 studies from a single institution 14,[26][27][28][29][30][31]33,[36][37][38][39][40]42,44 , three involving two affiliated institutions 32,34,51 , two studies from the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network 48,50 , two regional studies 43,46 , three national studies 41,45,49 and two international studies involving four 19 and two 52 countries, respectively.…”

Antenatal topographical assessment of placenta accreta with ultrasound

“…The major risk of placenta accreta (term used here collectively for placenta accreta vera, increta and percreta) occurs at the time of at delivery when placental separation often results in profuse haemorrhage, need for massive transfusion, damage to neighbouring organs and even maternal death 1,2 . If the extent of involvement and the vascularity of the myometrium might be mapped antenatally, operability could be assessed and the management strategies be planned, including conservative management of the placenta when there is extensive and vascular myometrial involvement, or possible separation of the placenta when the myometrial involvement is partial/focal 3 and less vascular.…”