Open Access Case Report

Giant Uterine Fibroid: A Case Report of a Young Nulliparous Woman and Literature Review

Michael Tyodoo Maanongun, Andrea Avershima Ornguze, Babarinde Ojo

Asian Research Journal of Gynaecology and Obstetrics, Page 1-6

Uterine leiomyoma, which arises from uterine smooth muscle, is the most common benign gynaecologic tumour of the female pelvis, however, giant fibroids are very rare in current practice, posing a management challenge. A 28-year-old nulliparous woman presented in a private clinic in Makurdi, Benue State, Nigeria with severe pain and slow growing abdominal mass with pressure symptoms due to a giant uterine fibroid. Intraoperatively, the mass was huge, weighed 11.6kg, was continuous with the uterus and tightly occupied the abdominal cavity with restricted mobility. Myomectomy was done after consideration of the patient’s wishes, fertility concerns and intra operative findings. Patient did well without complications and was discharged on day six.

Open Access Original Research Article

The Correlation of the Lipid Profile and Endothelin-1 with Severe Preeclampsia

John Wantania, Yosiana Wijaya, Anastasia Lumentut, Frans Wantania, Bill Harman, Billy Kepel, Fransiskus Limono

Asian Research Journal of Gynaecology and Obstetrics, Page 7-16

Aims: To determine the relationship of lipid profile and Endothelin-1 (ET-1) in a severe preeclamptic pregnancy.

Study Design: An observational analytic study using cross-sectional was conducted in Department of Obstetrics and Gynecology, Sam Ratulangi University, in conjunction with the teaching hospital, Prof. Dr. R. D. Kandou General Hospital and the sister hospitals in Manado Hospital. Sixteen woman with normal pregnancy and sixteen others with severe preeclampsia who met the inclusion and exclusion criteria, were tested for lipid profile and ET-1. The serum was analyzed at Prodia Laboratory, Manado. The ET-1 level was examined using ELISA (R&D Systems, Inc., Minneapolis, MN 55413, USA). The data obtained was analyzed using SPSS software version 20.0.

Main Outcome Measures: The comparison and correlation of lipid profile and endothelin-1 (ET-1) plasma level in normal and severe preeclamptic pregnancy.

Results: Higher cholesterol total, triglyceride, VLDL, ET-1 level were found in severe preeclampsia group. Also, there was a significant correlation between the ET-1 and the triglyceride (r=0589, p=0.016) and VLDL (r=0590, p=0.016) in the normal pregnancy group. In the severe preeclampsia group, there was no significant correlation between the two variables (p>0.05).

Conclusion: There are elevated levels of triglycerides, VLDL and endothelin-1 in the incidence of severe preeclampsia compared with normotensive. This is a small and preliminary observational study, which shows that the older the age and parity the probability of preeclampsia increases and the more ET-1 is produced. But an elevation of the lipid profile is also observed without a proportional relationship with endothelin. This study suggests that lipids are involved in endothelial damage in pre-eclampsia without any relationship between them.

Open Access Original Research Article

Assessment of Compliance with National Guidelines on the Management of Severe Preeclampsia and Eclampsia in Public Health Facilities in Bayelsa State

O. M. Alabintei, I. J. Abasi, P. W. Alabrah

Asian Research Journal of Gynaecology and Obstetrics, Page 17-28

Background: The Federal Ministry of Health in Nigeria developed a national guideline for the management of severe preeclampsia/eclampsia (Severe PE/E). Effective compliance with these guidelines is essential for delivery of quality care to women with these conditions. This study sought to determine the availability of the national guidelines and assess compliance by healthcare workers (HCWs) in public health facilities in Bayelsa State.

Methodology: This is a mixed-method (quantitative and qualitative) descriptive study involving 155 HCWs responding to a self-administered structured questionnaire and  29 in-depth interviews  with health facility managers in 16 randomly selected health facilities in Bayelsa state.  Thirty-six questions and 16 questions assessed knowledge of severe preeclampsia and compliance with guideline respectively among respondents. Respondents were scored and graded as poor, fair and good level of knowledge and compliance. Chi-squared test and logistic regression were used to identify factors influencing level of compliance with the national guideline. The in-depth interviews were analyzed along thematic areas using NVivo 11.0 QSR software. Level of significance was set at p<0.05.

Results: Slightly above half of the respondents (58.1%) had at least a local treatment guideline in their facility. However, only 69 study respondents (44.5%) knew about the existence of a national guideline on the management of Severe PE/E and even less than this (36.1%) reported that the national guideline was available in their centres. Less than a fifth of participants (17.4%) were found to have good level of compliance with the guidelines. The factors that influenced compliance included level of healthcare (OR – 26.13; p – 0.001) and level of knowledge. (OR- 53.90; p<0.001). From the in-depth interviews the main theme affecting compliance is non-availability of the national guideline at the centres.

Conclusion: The level of compliance with the national guideline on the management of severe PE/E is low in Bayelsa state. Level of knowledge among health workers and non-availability of these guidelines are contributory factors. Training of health workers and provision of the guideline at all levels of care are recommended to guarantee quality care for women with severe PE/E.

Open Access Original Research Article

Can Red Cell Distribution Width (RDW) and Platelet Indices Predict the Severity of Pre-eclampsia?

Deepika Kashyap, Reena Yadav, Smita Singh

Asian Research Journal of Gynaecology and Obstetrics, Page 29-33

Objective: The aim was to study the relationship between platelet indices and red cell distribution width (RDW) with pre-eclampsia and its severity.

Methods: A matched case-control hospital-based observational study was performed with 80 pre-eclamptic women and a control group of 80 normotensive women in the gestational age of 28+0 weeks - 40+6 weeks. Blood samples for routine blood count and RDW levels were analyzed.

Results: The RDW levels were significantly higher in pre-eclampsia group compared to the control group. We also confirmed that the RDW levels were significantly higher in women with severe pre-eclampsia as compared to women with non severe pre-eclampsia on subgroup analysis.

Conclusion: There is a statistically significant association between the RDW and risk of pre-eclampsia and also its severity. It is a marker which is easy to use, inexpensive and can be calculated as a part of routine blood count. It has significant prognostic value in patients with pre-eclampsia.

Open Access Review Article

Peripartum Cardiomyopathy: An Enigma

Jayati Nath

Asian Research Journal of Gynaecology and Obstetrics, Page 34-39

Peripartum cardiomyopathy is a rare, potentially life-threatening disorder affecting women in late pregnancy & the postpartum period. In spite of  identification of at-risk demographics, theories on etiology, and new targets of therapy for the entity , it still remains an enigma for obstetricians worldwide. The management of PPCM has been  guideline-based treatment for cardiac failure with reduced ejection fraction. Though many newer studies have reported the efficacy of novel therapies, much more research needs to be done. Here an attempt is being made to review the pathogenesis and diagnosis of  PPCM and discuss some of the newest therapies for this enigmatic entity.