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Case Records and Commentaries in Obstetrics and Gynaecology n CASE REPORTS AND COMMENTARIES IN OBSTETRICS AND GYNAECOLOGY if SUBMITTED BY DR. AMON K.K.CI CHIRCIIIR IN PART FULFILMENT FOR THE 1)1 GRI I Ol MASTER OF MEDICINE IN OBSTETRICS AND GYNAIX ()L()(,\ OF THE UNIVERSITY OF NAIROBI FEBRUARY 2005 TABI.K OF CONTENTS Page Dedication I Acknowledgement Declaration m Certification Introduction v OBSTETRIC SHORT CASES Case No 1. Severe pre-eclampsia at 34weeks - emergency cesarean section, live babs I 2. Successful vaginal birth after primary cesarean section. 14 3. Ruptured uterus and urinary bladder avulsion. 21 4. Cephalopelvic disproportion in labor- emergency cesarean section: live baby ; > 5. Antepartum haemorrhage due to placenta praevia. ts 6. Postpartum haemorrhage due to retained placenta and cervical laceration t 7. Shoulder dystocia - successful vaginal delivery 8. Malaria in pregnancy - remission with chemotherapy. 62 9. Unsensitized Rhesus negative mother - vaginal delivery: live baby. 10. Prolapsed cord in labour - emergency cesarean section: live baby 11. Grade IV cardiac disease at 14 weeks- preterm labor at 34 weeks: live baby * t 12. 1 win gestation in a primigravida in labor- emergency cesarean section: live balm-'. 13. Delayed second stage o f labour - vacuum extraction: live baby. I * 14. Breech presentation in second stage- assisted breech delivery: live baby 11 * 15. Acute foetal distress in labour - emergency cesarean section: live baby. 1.1 OBSTETRIC LONG COMMENTARY J^PDfCAr TIPpa* WVERSITY OP Na, ^ Acceptability of HIV testing and nevirapine administration to HIV sero-posili%r women in early labour at the Punmani Maternity Hospital, Nairobi. 131 GVNACOEOCY SHORT CASES t»ai,c 1. Ambiquous external genitalia - congenital adrenal hyperplasia. 170 2. Cervical carcinoma in situ - extended hysterectomy. 178 3. Ovarian cancer stage 111 - debulking and chemotherapy. IK'J 4. Gestational trophoblastic disease - subtotal hysterectomy and chemotherapy 5. Long-term reversible contraception - Jadelle insertion after Norplant renun al 6. Secondary infertility due to tubal blockage - laparoscopic tuboplasty. 7. Desired family size - postpartum bilateral tubal ligation (BTL). ' - 8. Symptomatic uterine leiomyomata - total abdominal hysterectomy. ' ' 9. Transverse vaginal septum with haematocolpos and hacmatomctra 10. Acute ruptured tubal pregnancy - partial left salpingectomy. '< • 11. Pelvic inflammatory disease- Laparotomy and drainage of pyosalpinx 12. Uterine prolapse, cystocoele and rectocoele - total vaginal hysterectomy and anterior and posterior colporrhaphy. 2<>S 13. Vesico-uterine fistula and ligated left ureter - fistula repair and ureteric re-implantation. 14. Bartholin’s abscess - marsupialization. 15. Septic incomplete abortion - manual vacuum aspiration. GYNAECOLOGY LONG COMMENTARY The prevalence of endometriosis among women undergoing laparoscopic sur get > at the Aga Khan Hospital, Nairobi. Appendix I - Obstetric long commentary information and consent form C Appendix II -Obstetric data collection questionnaire (English & Kiswahili versions) '■ • 1 Appendix III - Procedure for rapid HIV testing. Appendix IV - Revised American fertility society classification of endometriosis Appendix V - Gynaecology data collection consent form. • Appendix VI - Gynaecology data collection questionnaire. Appendix VII - Research approvals. DEDICATION This book is dedicated to my lovely wife, Rebecca, our two precious sons. Shorn and Samim .uni brother and mentor, Andrew. ACKNOWLEDGEMENT It is with solemn and humble submission that I thank God the Almighty for directly or m.lu. > 1. - : me to reach this far and to complete this book. I am sincerely grateful to my sponsor, the Moi Teaching and Referral Hospital, for enabling ■■ ; this postgraduate course. Special thanks and heartfelt appreciation go to my supervisors. Dr. Oinondi Ogutu ami hi i Gichuhi, for their invaluable and readily accessible guidance in writing the loin; comim-nt.im-'. and t| short cases in this book. I wish to thank Professor Shadrack B. Ojwang and Dr Evan s. , u wise counsel during my Elective Term at the Aga Khan Hospital where some short cases in tins b.s.k a c management and the gynaecology long commentary study w as carried out My gratitude goes to the management and particularly the nurses of Pumwam Mali nut . II unreservedly facilitated my obstetrics long commentary study in the hospital. While wishing them happiness, I am highly indebted and grateful to the Records Dcpatiim-ni m - staff of the Aga Khan Hospital, Nairobi, who despite their busy work retrieved lot me tin t l the gynaecology long commentary without pay. My sincere gratitude also goes to Alex Wambua who, not only analyzed the data «>i tl also facilitated the production of most manuscripts in this book. Tegla C hemalm a: : I K k ! acknowledged for their tireless efforts in typing the proposals and most of this bm>k respi. ■;. I am most grateful to all the Consultants and Senior Registrars for their dcdicatnm ami seeing that I acquired the necessary knowledge and skills during my training I a. km w ai symbiotic relationship I had with my fellow students from whom I learnt most alniml.u I■. Equally well appreciated are the nurses, laboratory technicians/technologists. clciks. librarian* an.I .» I Mh people who in one way or another helped me to realize the objectives of m> cntin p ■ • ' mi Most importantly, I thank all the patients without whose cooperation my trnimm; > impossible. I thank my mother who not only took me to school against all odds but continued t.< date t<- succeed. To my big brother Andrew, thanks for being my mentor and close to rcpla. mi: nr. at Lastily but not least, I must thank my w-ife, Rebecca, and our sons Shcm and San . • al tolerating the long duration I was unable to be with them while under training an i : u in me bad and good times. n DECLARATION I declare and certify that the short commentaries in this book were managed by me umk-i 1 i supervision and guidance of the senior members of staff in the Department of Obstctru ■ ami (Am»cv«-I.> of the University of Nairobi. I further declare that the two long commentaries in this book arc my original work ami luu- >1 !> presented for a degree in any other university. i Signed: I)R. AMON K. CHIRCH1R FEBRUARY 2005 CERTIFICATION OF SUPERF1S1QN I his is to certify that Dr. Anion K. Chirchir researched upon the long commentaries presented m th book under our guidance and supervision and that this book is submitted with our approval Date: DU. OMONDI OGUTU, M.B.Ch.B., M.MED. (OBS/GYN) Hon. l.ectuer (University of Nairobi) and Chief Medical Specialist 0 Kenyatta National Hospital NAIROBI. Signed: Date: A DR. WANYOIKE GICHUHI, M.B.Ch.B., M.MED. (OBS/GYN) Consultant and Lecturer Department of Obstetrics and Gynaecology University of Nairobi tv CERTIFICATION This is to certify that Dr. Anion K. Cliircliir managed obstetric cases number 7.10. and 13 and gynaecology case number 4 under my supervision and guidance at the Aga Khan Hospital. \ i Date: ( ' 1 PROF. S.B.O. OJWAING’. M.D. M.MED. (OBS/GYN) DIP. GYN. ONCOI (HA Professor and Consultant Department of Obstetrics and Gynaecology University of Nairobi v CERTIFICATION This is to certify that obstetric cases number 4 and 5 and gynaecology cases number 3, 7, 10 and II um - managed by Dr. Anion K. Ciiirchir under my supervision and guidance at the Kcnyatta National 11 , i Nairobi. Signed: PROF. J.G. KARANJA M.B.ChB. M.MED. (OBS/GYN) Associate Professor and Consultant Department of Obstetrics and Gynaecology University of Nairobi vi CERTIFICATION I liis is to certify that obstetric cases number number 2, 3, 6, 14, and 15 and gynaecology cases numbci 5 and 15 were managed by Dr. Amon K. Cliirchir under my supervision and guidance at tin Ken . :.i National Hospital, Nairobi. DR. OMONDI OGUTU, M.B.CIi.B. M.MED. (OBS/GYN) lion. Lecturer (University of Nairobi) and Chief Medical Specialist Kenyatta National Hospital Nairobi. vn CERTIFICATION This is to certify that Dr. Amon K. Chirchir managed obstetric cases number 2 and 11 under mv supervision and guidance at the Kenyatta National Hospital. DR. KOIGI KAMAU M.B.Ch.B. M.1MED. (OBS/GYN) Consultant and Senior Lecturer Department of Obstetrics and Gynaecology University of Nairobi CERTIFICATION I liis is to certi ly that Dr. Anion K. Cliirchir managed obstetric eases number 8, 9and I . u ul y \ m.h i > • i(> cases number 6, 8, 9, 12, 13 and 14 under my supervision and guidance at the Kcnyatla National Hospital Signed: Date: DR. SAMSON H. INI. WANJALA M.B.Ch.B., M.MED. (OBS/GYN) Senior Lecturer and Consultant Department of Obstetrics and Gynaecology University of Nairobi IX INTRODUCTION Kenyatta National Hospital (KNH) is currently the only institution in Kenya in which posty.railu.it degn courses in Obstetrics and Gynaecology are taught by a team of dedicated members of staff from both KM I and the Obstetrics and Gynaecology department of the college of Health Sciences of the l nivcisiiy oi Nairobi. It is in KNH that most of the short cases were managed between January 2(><0 and S pt< min • 2004. The obstetrics long commentary was undertaken in Pumwani Maternity Hospital while some •.». • cases and the Gynaecology long commentary study took place at the Aga Khan Hospital. Nairobi KENYATTA NATIONAL HOSPITAL Established in 1901 as the then Native Civil Hospital, Kenyatta National Hospital (KNIIl ha <>. • die . »n grown to be the largest teaching and referral hospital in Kenya with approximately a .......bed ; is situated in the heart of Nairobi about three kilometers from the city center. It is built on appnn 304 acres of land. It was called King George’s Hospital in the 1950s but acquired its current name m 1 •><.-» The hospital serves as a national referral hospital and is also the teaching hospital for both midi . • I all and postgraduate students from the University of Nairobi Medical School and the Kenya M ' 11 i College, both situated within its compound.
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