Pattern of Presentation and Associated Morbidities of Women Presenting with Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is caused mainly by benign disorders;however it is sometimes caused by endometrial cancer. Aim: We here attempted to determine what conditions account for PMB in an outpatient clinic of a University hospital in London. Methodology: Study subjects consisted of 179 patients with PMB who were referred to us from July to December 2019. Sociodemographic data including patient’s age, risk factors, diagnosis and management were reviewed. Underlying conditions where determined. Results: Of 179 subjects, the following findings were made: 1) Age 59.63 ± 8.3 (mean and standard deviation). 2) Parity;multiparity, 57.0% (mean ± 1.67). 3) First episode of PMB, 77.1%. 4) The most frequently observed risk factor;obesity 34.6%. 5) The following accounted for PMB (diagnosis in order of incidence rate);genital atrophy 37.4%, submucosal fibroid 28.5%, endometrial polyp 20.7%, endometrial hyperplasia 6.7%, and endometrial cancer 5.6%. All patients were treated appropriately. We did not determine the prognosis of patients with endometrial cancer. Conclusion: Although the incidence of rate among women with PMB has already been reported, its reconfirmation in a single facility is important for making policies in the treatment of PMB.

A Six-Year Review of Caesarean Sections at the Federal Teaching Hospital Abakaliki, Ebonyi State, South East Nigeria

Background: Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). Subjects and Methods: This was a six-year retrospective study covering January 1st 2012 to December 31st 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed by means of Epi Info version 7. Results are presented in tables, means and simple percentages. Results: During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. The most common indication for an emergency caesarean section was failure to progress in labour with 20.0% contribution and the most common indication for elective caesarean section was previous caesarean section with 13.5%. Majority of the babies were delivered at term (77.0%) with an average gestational age of 38 ± 2.6 weeks. Almost two-thirds of the subjects (62.5%) had emergency caesarean section. The average birthweight was 3.03 ± 0.71 kg. Maternal anaemia was the most common complication recorded 38.0%. There was direct maternal death in 2.0% of the study population. Severe birth asphyxia was recorded in 12.3% of the babies while there was 3.2% perinatal death. Conclusion: There is a high rate of caesarean section from this study. The World Health Organization has stated that there is no additional maternal or fetal benefit with caesarean section rate of greater than 10% - 15%. Stakeholders and policy makers need to do more to mitigate this rising trend.