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Introduction and Hypothesis: Management of a recurrent urogenital fistula is very challenging and requires experienced surgeons. The aim of this study was to describe the characteristics, success rates, and associated factors related to surgical repairs of patients with recurrent urogenital fistulas by an experienced team at a fistula centre in Nigeria., Methods: This was a retrospective cohort study of 154 patients that had repeat urogenital fistula repairs at the National Obstetric Fistula Centre, Abakaliki, Nigeria, between January 2014 and December 2016. Information was retrieved from their hospital records. Successful repair was defined by continent status at 3 months after repair. Data were analyzed with SPSS version 20 by IBM Inc., and p < 0.05 was taken as statistically significant. Chi-square test was used to determine the association between the factors and successful repair., Results: The mean age was 36.27 ± 12.96 years. Obstetric fistula occurred in 92.2% of the patients. The success rates for the first, second, third, and fourth repeat repairs were 68.8%. 56.2%, 50%, and 0% respectively. Significant factors were the number of previous attempts at repair (χ 2  = 20.44, p = 0.002), age group (χ 2  = 16.95, p = 0.03), Waaldijk's classification (χ 2  = 13.31, p = 0.04), duration of fistula (χ 2  = 19.6, p = 0.03), surgeons' experience (χ 2  = 7.11, p = 0.04), and place of previous attempt at repair (χ 2  = 6.35, p = 0.02). There were no complications in 86.4%., Conclusions: The success rate was good. Patients who had previous failed repairs at the fistula centre had better outcomes after the repeat surgeries. Centralizing fistula care will enhance optimal outcomes. It may also boost training and research in this specialty.

Background: The huge back-log of obstetric fistula and the increasing incidence of the condition in Nigeria is a cause for concern for all stake-holders. This worrisome trend requires concerted effort with innovative strategies to redress the situation., Methods: Hospital-based outreach programs sponsored by a non-governmental organization with volunteer medical and health personnel were used to repair selected cases of obstetric fistula in Nigeria., Results: Fifty-two relatively simple obstetric fistulas were selected out of 68 (selection rate 76.5%) that presented for repair at 12 outreach programs in 5 different states of Nigeria. All the cases were repaired by one trained gynecological surgeon with a cure rate of 100%. The majority (50.0%) of the women were aged between 16 and 20 years with a mean age of 23.8 years ± 3.6. Most (80.9%) of the women in the study population were primiparous. The majority (50.0%) of the women were divorced at the time of their presentation for repair. A vast majority (76.9%) of the women had either primary level of education or no formal education. There was a preponderance (53.8%) of juxtacervical VVF among women in the study population., Conclusion: The use of hospital- based outreach approach to repair simple cases of obstetric fistula if multiplied could help reduce the large number of women living with unrepaired VVF in Nigeria.

Background: Paediatricians are required to attend all Caesarian sections, yet most neonates so delivered do not require complex resuscitations necessitating a paediatrician's presence., Methods: All Caesarean sections in the University of Benin Teaching Hospital from January to December 2009 were prospectively studied. The socio-demographic characteristics, indication and type of surgery, and the type of anaesthesia were recorded. Neonatal outcome was assessed with Apgar scores at 1 and 5 minutes and the need for a paediatrician determined., Results: There were 431 cases of caesarean section within the period and 326 (75.6%) of these had antenatal care. About three-quarters of the patients had emergency caesarean section. Indications for caesarean section were foetal in 19% and maternal in 81%. Subarachnoid block was the main anaesthetic technique 392/431 (91.0%). Apgar score in 1 min was less than 7 in 172/431 (39.9%) and was severe (< 4) in 26/ 431 (6.0%). Lack of ante natal care (p < 0.05, RR = 1.3, 95% CI = 1.0 - 1.7 ), foetal indications (p < 0.05, RR = 1.4, 95% CI = 1.1 - 1.8), emergency caesarean section (p < 0.05, RR = 1.4, 95% C1 =1.0 -1.8), general anaesthesia (p = 0.0056, RR = 1.6, 95% CI = 1.2 -2.2) and active resuscitation (p < 0.05, RR = 2.5, 95% CI = 2.1 =3.1) were associated with Apgar scores less 7 in 1 minute., Conclusion: Unbooked status, foetal indication (foetal distress, prematurity, abnormal lie), emergency sections, and general anaesthesia may lead to poor Apgar scores and the need for active resuscitation. These settings justify the paediatrician's presence at Caesarean section.

Aim: This study was an analysis of women diagnosed with acute appendicitis in pregnancy, to appraise the maternal and fetal outcomes and explore the correlations with negative appendectomy., Material and Methods: A retrospective study was undertaken at the University of Benin Teaching Hospital, Nigeria. The service delivery records of all pregnant women who underwent appendectomy for acute appendicitis from January 2000 to December 2009 were analyzed., Results: Among 16,173 deliveries, 23 pregnant women were diagnosed with acute appendicitis. The age of the women ranged between 15 and 34 years (median = 26 years), while the majority (65.2%) were nulliparous. The mean gestational age at presentation was 21.1 ± 6.9 weeks with up to 15 (65.2%) patients presenting in the second trimester. Eighteen (78.3%) patients had histopathologically proven appendicitis giving a negative appendectomy rate of 21.7%. Postoperative complications were noted in eight (34.8%) patients. Half of these occurred within the negative appendectomy group. The negative appendectomy group also contributed significantly to the adverse obstetric outcome: preterm labor, 8.7% of 21.7%, preterm delivery, 4.5% of 13.6% and a fetal loss rate of 4.3% of 13%. One maternal death occurred in the group with diseased appendix giving a maternal mortality rate of 4.3%., Conclusions: While a higher index of suspicion among clinicians will ensure earlier diagnosis and improve the associated maternal and fetal prognosis, the need to reduce the negative laparotomy rate is highlighted by the high rate of adverse obstetric outcomes amongst the negative appendectomy group., (© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.)

Background: Caesarean delivery carries a higher morbidity and mortality than vaginal delivery. This first audit of caesarean delivery in our centre will be compared with previous studies around the world. Our objective is to document the indications and outcome of caesarean delivery., Method: This was a retrospective study of patients who had caesarean delivery in Federal Medical Centre Gombe, from January 2001 to December 2003. The biosocial characteristics, indication for surgery, booking status, number and type of caesarean deliveries, type of uterine incision, complications, and cadre of surgeon and duration of hospital stay were obtained for each patient., Results: 264 caesarean deliveries were performed, 250 cases made the criteria for inclusion. There were 2,172 total deliveries during the study period giving a caesarean delivery rate of 12.2%. The majority, 181 (72.4%) of the patients had emergency caesarean delivery while 69 (27.6%) had elective caesarean delivery. The commonest indication for caesarean delivery was cephalopelvic disproportion (20.8%), followed by preeclampsia/eclampsia (18.8%) and ante partum haemorrhage (14.4%). Others were fetal distress (8.8%), and previous caesarean delivery (7.2%). Majority of the patients, 104 (41.6%) were booked with the Federal Medical Centre Gombe, 88 (35.2%) booked elsewhere and 58 (23.2%) were unbooked. Twenty one (8.4%) had complications of which wound infection 11 (5.2%) was the commonest morbidity encountered. There were two maternal deaths and twenty one perinatal deaths giving a maternal and perinatal mortality rates of 800/100,000 and 82/1000 respectively., Conclusion: The indications for caesarean delivery in our study are comparable to findings from other parts of the world. The high emergency caesarean delivery rate among those booked elsewhere is a cause for concern. Health education could reduce the number of emergency caesarean deliveries. Consequently this might reduce the high infectious morbidity associated with the procedure in this study.

Thirty-two cases of emergency obstetric hysterectomy performed in a Nigerian Teaching Hospital were reviewed. The incidence was 1 in 575 births. Associated maternal mortality was 12.5%, morbidity was 62.5% and fetal loss was 78.1%. These rates are related to the indications which were spontaneous uterine rupture in 62.5% of the cases. The majority (68.7%) of the patients had poor antenatal care. Good antenatal care and delivery supervision would reduce the need for this operation.

The results of a prospective survey of post-operative wound sepsis following obstetrical and gynaecological laparotomies at the University College Hospital, Ibadan, Nigeria are presented. The overall wound sepsis rate was 20.2 per cent, but the corresponding rates in the gynaecological, primary obstetrical and repeat obstetrical cases were 14.9 per cent, 7.0 per cent and 29.9 per cent respectively. Statistical tests indicate that these rates differ significantly. The rate among the gynaecological cases did not differ significantly from the primary obstetrical cases, but that of the repeat obstetrical cases was significantly higher than those of the other two groups. The poorer wound healing in the repeat obstetrical laparotomies is thought to be due to poor blood supply. The variables that correlated significantly with wound sepsis rate were: pre-operative anaemia, number of medical students in theatre, antibiotic chemoprophylaxis and excision of previous scar in repeat laparotomies. The commonest organism involved in the wound sepsis was staph pyogenes. The wound sepsis rate obtained in this survey was high and various preventive measures are discussed.