Background: The obstructed hemivagina with ipsilateral renal agenesis (OHVIRA) syndrome is a type of Müllerian duct anomaly (MDA) resulting from abnormal development of Müllerian ducts. Its features typically become apparent at puberty when girls present with menstrual abnormalities. The varied presentation of MDAs presents diagnostic and management challenges. Case presentation: A 16-year-old diabetic African girl presented to Savannah Healthcare with cyclical lower abdominal pain and foul-smelling per vagina discharge. Magnetic resonance imaging (MRI) showed complete duplication of the uterus, cervix, and vagina (uterine didelphys) with an obstructed left hemivagina with hematocolpos. The septum obstructing the hemivagina was resected with drainage of the hematocolpos. A follow-up abdominal renal ultrasound showed the absence of the left kidney. Conclusion: Careful clinical examination and MRI are essential for diagnosing OHVIRA syndrome. Prompt surgical intervention improves outcomes.
Background: Laparoscopic management is the gold standard for treating ectopic pregnancies (EP), but its cost limits its widespread use in developing nations. A 10-year period audit was conducted evaluating laparoscopically treated EPs at a tertiary referral hospital, focusing on admission cost and contributing factors. Methods: This was a retrospective observational study conducted at the Aga Khan University Hospital. All women admitted with surgically managed Eps were included. Analysis of data was done against a preset checklist. Descriptive statistics for continuous variables were computed and presented in tables and figures. Results: The adjusted admission cost for patients with surgically managed EP ranged from US $2 017 (KES 220 252) to US $ 6,326 (KES 690 828). The mean cost of admission was US $ 3 254 (KES 355 384; n=259). The following factors were significantly associated with an increased admission cost: increasing patient age (p=0.000), volume of hemoperitoneum(p=0.000) duration of surgery (p=0.003) and duration of hospital stay (p=0.000). Conclusion: The mean admission cost for surgically managed EP was similar to that in high-income countries. However, when adjusted for per capita gross domestic product, the cost was disproportionately high. No consistent decline in the mean annual cost was observed over the study period. Increasing patient age, hemoperitoneum volume, surgery duration, and duration of hospital stay all significantly impacted on the admission cost.
Background: Diagnosis and management of cesarean scar ectopic pregnancy (CSP) remain challenging. We describe ultrasound diagnosis followed by hysteroscopic resection and methotrexate administration. Case presentation: A 42-year-old woman, para 2+1, presented with 8 weeks of amenorrhea and vaginal bleeding. She had two previous cesarean deliveries. Initial ultrasound suggested an incomplete miscarriage and beta human chorionic gonadotropin (β-HCG) was 46,129 mIU/ml. After failed medical management, repeat ultrasound diagnosed CSP. Hysteroscopic resection was performed, and she received methotrexate, resulting ß-HCG resolution. Conclusion: Though rare, CSP should be entertained in any woman presenting with vaginal bleeding with a history of cesarean delivery. Hysteroscopic resection with methotrexate provides good fertility-preserving modality for management. Keywords: cesarean scar ectopic pregnancy; hysteroscopic resection; methotrexate
Background: Intrauterine contraceptive devices (IUCDs) are widely used for long-term contraception and are generally safe. However, misplacement can occur, often presenting as a missing thread and typically remaining asymptomatic. A misplaced IUCD can lead to complications like uterine perforation, migration to adjacent organs, pelvic abscess, or ectopic pregnancy. Various diagnostic and treatment modalities are available for management. Case series: We present 10 cases of misplaced IUCDs encountered at Kenyatta National Hospital, highlighting their clinical presentations, diagnostic approaches, and treatment strategies. Conclusion: This case series highlights the importance of vigilant monitoring for nonspecific symptoms indicative of IUCD displacement or migration. Timely evaluation and intervention are essential, with imaging and minimally invasive surgery playing a central role in achieving favorable outcomes. Keywords: hysteroscopy, intrauterine contraceptive device, laparoscopy, misplaced IUCD
Background: Peritoneal tuberculosis can closely mimic ovarian cancer in its clinical and radiologic presentation, particularly in high-tuberculosis-burden regions, including Kenya. Early recognition is key to avoid misdiagnosis and inappropriate management. Case presentation: A 17-year-old presented with abdominal distension, pain, and unintentional weight loss. Imaging demonstrated bilateral complex ovarian masses, ascites, and peritoneal nodularity, with an elevated cancer antigen 125 (CA-125) level of 221 U/mL. Diagnostic laparoscopy revealed diffuse peritoneal tubercles, and biopsy confirmed granulomatous inflammation of peritoneal tissue with acid-fast bacilli consistent with peritoneal tuberculosis. The patient showed marked clinical and radiological improvement after six months of standard antituberculosis therapy. Conclusion: Peritoneal tuberculosis is an important differential diagnosis for ovarian cancer. In high-prevalence settings such as Kenya, clinicians must maintain a high index of suspicion when evaluating patients with features suggestive of ovarian cancer to facilitate timely diagnosis and appropriate referral. Keywords: CA-125, ovarian cancer, peritoneal tuberculosis.
Background: Gestational anemia is a global health concern. The initial 20 weeks of pregnancy are critical for the development and prevention of negative pregnancy outcomes related to low hemoglobin levels. Objective: To compare the structural characteristics of the umbilical cord (UC) in women diagnosed with anemia in the first 20 weeks of pregnancy with those without anemia. Methods: This was a retrospective cohort study conducted at the Kenyatta National Hospital. Thirty-six umbilical cords were collected and examined for differences in gross and histological features. Comparisons were also made between the fetal and placental ends of the UC for these features. Results: Significant differences were observed in the diameter of the umbilical cord, the volume of Wharton’s jelly, and the intima-media thickness of the umbilical vein (all p<.05) between the anemic and nonanemic group. Disruption of the internal elastic lamina and intimal thickening of the umbilical vein were more prominent toward the fetal end of the UC in the anemia group. However, the increased risk of low birth weight in this group was not statistically significant, with a relative risk (RR) of 4.0 (95% CI: 0.49-32.39). Conclusion: Anemia within the first 20 weeks is associated with structural changes in the UC that may contribute to adverse outcomes. Improving hemoglobin levels before conception and during early pregnancy is therefore critical. Keywords: adverse pregnancy outcomes, anemia, gestational anemia, low birth weight, umbilical cord.
Background: Uterine primitive neuroectodermal tumors (PNETs) are a rare group of embryonal tumors, with less than 100 cases reported, mostly in postmenopausal women. Their rarity poses diagnostic and management challenges, contributing to high mortality. Case presentation: A 13-year-old presented with a 2-month history of abdominal pain, swelling, and heavy menstruation. Physical examination revealed a firm, fixed, nontender pelvic mass. She underwent a panhysterectomy and nodal resection. Histopathology confirmed PNET. The tumor recurred within a month, and intraoperative spillage occurred during repeat surgery. She developed obstructive uropathy and succumbed approximately 11 months after initial presentation. Conclusion: Uterine PNETs are aggressive tumors that rapidly infiltrate and obstruct pelvic structures. Owing to their rarity, diagnosis and management remain challenging, with high mortality. Keywords: embryonal tumors, obstructive uropathy, primitive neuroectodermal tumor, uterus
Background: Limited data exist regarding recurrence risk in pregnant women with hormone receptor-positive breast cancer who temporarily discontinue endocrine therapy. Case presentation: A 37-year-old gravida 4, para 3, presented for antenatal care at 13 weeks’ gestation while on adjuvant tamoxifen, which she had taken for two months before conception. Examination revealed a fundal height of 18 weeks and a healed mastectomy scar. Ultrasonography confirmed a dichorionic diamniotic twin pregnancy. Tamoxifen was discontinued, and pregnancy proceeded uneventfully until spontaneous preterm delivery at 34 weeks. Both neonates were clinically normal. Tamoxifen was resumed postpartum; however, 5 months after delivery, the patient developed metastatic recurrence and subsequently succumbed. Conclusion: Pregnancy during breast cancer is not uncommon and poses complex clinical challenges. A multidisciplinary team is key to optimize maternal and neonatal outcomes. Keywords: breast cancer, endocrine therapy, metastasis, pregnancy, tamoxifen
Background: Hysterosalpingography (HSG) is a widely used diagnostic tool in infertility evaluation. Although generally safe, it carries a rare risk of severe complications, including infections. Case presentation: A 43-year-old gravida 1 para 1, with secondary infertility for 15 years, presented with generalized body malaise, dyspnea, easy fatiguability, progressive abdominal pain, and noticeable abdominal swelling. The patient developed a pelvic abscess secondary to uterine perforation, two weeks after HSG. Despite antibiotic therapy and surgical drainage, her condition progressively deteriorated, culminating in septicemia and death. Conclusion: Although rare, severe complications of HSG, such as uterine perforation and pelvic abscess, can be fatal. Early recognition and multidisciplinary management are essential to improve outcomes. Keywords: Acinetobacter baumannii, media, hysterosalpingography, infertility, pelvic abscess, postoperative complications
Substance abuse during pregnancy has predominantly afflicted younger echelons and has routinely been associated with multiple obstetric complications. These adverse outcomes have routinely been attributed to impaired access to care (1). This has been recognized as a problem in multiple settings and is acknowledged as having the potential for far-reaching long-term impact of the maternal-fetal dyad (2). In this issue, Obwaya et alia undertook a retrospective cohort study to evaluate adverse pregnancy outcomes amongst gravidae who chewed Khat (Catha edulis) in Meru County, Kenya (3). The majority of their Khat-consuming study participants (90%) were under 35 years of age, with no differences observed in their mode of delivery. On analysis, they found that the use of Khat resulted in a duodecuple, quadrupled, and tripled increase in the risks of postpartum hemorrhage, preterm birth, and low birth weight, respectively. They also inferred increased associations with admission to the neonatal intensive care unit and premature rupture of membranes, although the latter lacked statistical significance. This evidence corroborates the inference of a previous meta-analysis which concluded that: substance abuse is a risk factor for adverse pregnancy outcomes; and that one in five substance users are engaged in polysubstance use (4). Despite the limitations incurred, this study generated objective evidence that associates Khat use with significant adverse pregnancy outcomes in the Kenyan setting. Overall, there is a considerable association between adverse pregnancy outcomes and substance use during gestation. Additionally, there may be considerable value in following up on such study populations to determine if maternal substance abuse during pregnancy would be associated with conduct problems in the offspring (5) in our setting.
Background: The third trimester represents a critical window in pregnancy when these hematologic changes could have the greatest impact. Therefore, understanding how coronavirus disease 2019 (COVID-19) infection influences blood profiles during this period is vital for clinical management and risk stratification. In Kenya, while national guidelines recommend laboratory evaluation, including complete blood count, c-reactive protein (CRP), lactate dehydrogenase (LDH), and coagulation profiles for pregnant women with suspected or confirmed COVID-19, there is a paucity of local data documenting these hematologic trends. Objective: To investigate hematologic profile differences between pregnant women in the third trimester with and without COVID-19 infection. Methods: A cross-sectional comparative study was employed to compare hematological parameters in pregnant women with and without COVID-19 between May 1st and August 31st, 2021. We recruited 60 eligible patients from the Nairobi hospital using purposive sampling. We assessed the complete blood count, coagulation profile, lactate dehydrogenase, and C-reactive protein. Results: Pregnant women with COVID-19 had significantly higher levels of neutrophils, prothrombin time, CRP, and LDH compared to those without, with respective AORs of 9.50 (p<0.01), 11.52 (p=0.001), and 3.06 (p=0.078). No significant differences were observed in white blood cells, basophils, and international normalized ratio after adjusting for age, parity, COVID-19 vaccination, and fetus number. Conclusion: This study reported significant associations between neutrophil count, prothrombin time, CRP, LDH levels, and COVID-19 infection status in pregnant women. These indices may aid in distinguishing healthy pregnant women from those with COVID-19 infection. Keywords: COVID-19 infection, pregnant women, third trimester, blood profile
Background: Khat (Catha edulis) is a green leafy plant containing psychoactive alkaloids, such as cathine and cathinone. Khat use in pregnancy affects maternal and fetal well-being. Objective: This study aimed to determine the risk of adverse pregnancy outcomes among pregnant women who chew khat compared with pregnant women who do not chew khat in Meru County in 2023. Methods: A retrospective cohort study was employed at the Meru Teaching and Referral Hospital and Nyambene Level 4 Hospital that compared immediate postpartum mothers who chewed khat during pregnancy (exposed, n=150) and those who did not chew khat during pregnancy (unexposed, n=300). Data on khat chewing during pregnancy and various maternal, fetal, and early neonatal outcomes were collected using a questionnaire. Data were summarized as means, frequency, and percentages and com pared using the Students t-test, Pearson’s Chi-square, and Fischer’s exact test. All statistical tests were considered significant if the p<0.05. Results: There was a statistically significant increased risk of preterm birth (AOR 4.44, 3.31-10.92, p 0.001), low birth weight (AOR 2.95, 1.19-7.57, p 0.02), admission to neonatal intensive care unit or newborn unit (AOR 1.13, 1.03-4.10, p 0.01), and postpartum hemorrhage (AOR 12.85, 2.17 – 244.02, p 0.02). An increased risk of premature rupture of membranes was observed, but this was not statistically significant (OR 1.61, 0.9-2.85, p 0.11). Conclusion: Women who used khat during pregnancy had an increased risk of adverse pregnancy outcomes, including preterm birth, low birth weight, admission to neonatal intensive unit, and postpartum hemorrhage. Keywords: adverse pregnancy outcomes, khat, Meru
Background: Rectovaginal space hematoma following vaginoplasty is a rare complication that canlead to serious morbidity and disability. In the literature, reported cases remain few, especially inlow-income countries where cosmetic gynecology consultations are increasing.Case presentation: We present a case of extensive rectovaginal space hematoma presenting withurine retention following vaginoplasty. The patient had anemia, hypotension, tachycardia, vulvalswelling, and a suprapubic mass from the overdistend bladder. She was surgically managed and didwell postoperatively.Conclusion: Rectovaginal space hematomas are rare and associated with significant morbidity ifinappropriately managed. Cosmetic gynecological surgeons should be aware of this complication.
Background: Globally, in 2017, 810 women died daily from pregnancy- or childbirth-related preventable complications. Of these deaths, 94% occurred in resource-poor countries, with the highest maternal and perinatal mortality occurring in sub-Saharan Africa (SSA). We conducted a systematic review and meta-analysis of studies on the decision-to-delivery interval (DDI) from the SSA to determine the mean DDI, establish the maternal and neonatal outcomes reported, and evaluate the obstacles to achieving the gold standard DDI of ≤30 minutes. Methods: We performed a systematic literature review and meta-analysis of eligible studies between January 1995 and December 2022, in seven databases and grey literature. Studies of any design were included if they reported obstetric emergencies delivered by cesarean birth and had information on the DDI. Three independent reviewers applied eligibility criteria, assessed the risk of bias, and extracted data. The authors performed meta-analysis of mean DDI on studies with adequate data. Results: Thirty-nine studies with 41 datasets (12,835 participants), qualified for inclusion. In these studies, only 6.34% of cesarean deliveries were performed in under 30 minutes. A meta-analysis of 27 datasets found an overall DDI mean of 2.81 hours (168.8 minutes, 95%CI 151.5 to 186.2)). The pooled perinatal and maternal case fatality rates for the included studies were 61.2 in 1000 and 444.1 in 100,000 CDs, respectively. Conclusion: This review and meta-analysis found unacceptably high mean DDI, and perinatal and maternal mortality following cesarean delivery in SSA.
Background: Maternal ‘near-miss’ and deaths, together termed severe maternal outcome(SMO) follow a pattern of deterioration that can be predicted and prevented. To prevent SMO, a Modified Early Obstetric Warning System (MOEWS) for tracking significant changes (‘triggers’) in vital signs among obstetric patients and initiating corrective measures is suggested. Objective: To determine predictors of SMO and the validity of the MEOWS for predicting SMO at Moi Teaching and Referral Hospital (MTRH), Eldoret-Kenya Methods: A retrospective cohort study was conducted at MTRH among 3200 mothers admitted from 1st January 2019. Maternal mortality and ‘near miss’ were determined by WHO criteria. Mothers were grouped into two outcome groups; either experiencing or not experiencing SMO. Their vital signs 24 hours prior to either outcome were then tabulated on a MOEWS chart and determined whether they met a vital sign trigger threshold. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) were determined. Relationship between sociodemographic and obstetric characteristic and SMO was determined by multivariate analysis Results: The sociodemographic and obstetric predictors of SMO were age over 35 years(aOR=1.56), having a previous caesarean delivery(aOR=2.19), caesarean delivery in the index pregnancy(aOR=2.09), being a referral(aOR=3.43), not attending antenatal care (aOR=2.53) and admission in the preterm period(aOR=2.81) and in the postpartum period(aOR 51.3). The sensitivity of MOEWS was 77%, specificity 98%, PPV 61% and NPV 98%. Conclusion: The MOEWS chart has a high specificity, sensitivity and NPV but low PPV. The MOEWS chart is a valuable tool for predicting SMO
Background: Sigmoid during in pregnancy is the most common cause of intestinal obstruction. Despitethis, diagnosis remains the largest challenge. The diagnosis of sigmoid volvulus in pregnancy is oftendelayed because the symptoms mimic typical pregnancy-associated complaints. Clinical examination isusually limited because of the gravid uterus, and radiological evaluation presents another challengebecause of the risks of teratogenicity to the fetus, especially in the first trimester. Delays in diagnosisinvariably lead to ischemia, necrosis, and colon perforation, and prompt surgical intervention isnecessary to minimize maternal morbidity and fetal mortality.Case presentation: A 36-year-old para 4+0 gravida 5 presented initially at 29+1 weeks of gestation withabdominal symptoms. A diagnosis of acute gastritis and pyelonephritis was made, and the patient wasallowed home. She later presented with severe abdominal pain and vomiting, after which a diagnosis ofsigmoid volvulus was made at 30+5 weeks of gestation. The patient underwent laparotomy where thevolvulus was detorted. However, she experienced fetal demise in utero two days after the laparotomy.She was induced into labor and expelled the fetus.Conclusion: Sigmoid volvulus complicating pregnancy is rare. However, when it occurs, it may lead toconsiderable maternal and fetal morbidity and mortality. In patients who present with abdominal pain,distension, and absolute constipation, a high index of clinical suspicion is required for prompt diagnosis.Early diagnosis and appropriate surgical intervention are crucial to improve maternal and fetal outcomes,as shown in this case.
Background: Sexual dysfunctions are associated with comorbidities, which can be the cause or theresult of the dysfunctions. Little research has been done to document comorbidities in Kenya. This studydocumented comorbidities associated with sexual dysfunctions in patients treated at the Sexology Clinicin Nairobi.Objective: To provide health service providers with evidence on what to investigate when patientspresent with sexual dysfunctions so that treatment is directed to the root causes.Methods: Quantitative retrospective analysis of records of patients presenting with sexual dysfunctionswas performed at the Sexology Clinic in Nairobi. Records analysis of patients’ files seen at the clinic for12 months were analyzed. A total of 396 files were reviewed (362 males and 34 females) using astandard tool. Biopsychosocial factors and treatment correlations were performed.Results: The commonest comorbidities in male sexual dysfunctions were metabolic diseases comprisinghypertension (19%), hyperlipidemia (17%), diabetes (14%), and obesity (9%). Hormonal disorders werealso common, with testosterone deficiency being the leading factor at 16% followed byhyperprolactinemia and thyroid hormone disorders each at 2% of all male dysfunctions. Medicines usedin treating metabolic disorders also adversely affect sexual function in males. Conversely, the mostcommon comorbidities in female sexual dysfunction were menopause and female genital cutting. In bothmales and females, comorbidities included infertility, cancer and its treatment, and psychological orpsychiatric problems. Sleep deprivation, alcohol and drug abuse, stressful lifestyles, and relationshipdisharmony were associated with sexual dysfunction in both sexes.Conclusions: Lifestyle diseases are commonly associated with sexual dysfunctions, which could beindicators for lifestyle diseases.Recommendations: Service providers should use sexual dysfunctions as an entry point for full patientassessment for commonly associated disease conditions.
Background: Juvenile granulosa cell tumors (JGCTs) are rare sex cord stromal tumors diagnosedmainly in premenarchal girls and women younger than 30 years. Case presentation: A 19-year-old primigravida at 36 weeks of gestation presented to the labor ward withcomplaints of generalized abdominal pain, headaches, and reduced fetal movements for two days.Ultrasound revealed a left-sided 15.7 by 15 cm large cyst and a solid mass of increased vascularity withmaternal ascites. The biophysical profile of the fetus was 4/8 (no movement or tone but the presence ofrespiration and amniotic fluid). An emergency exploratory laparotomy was performed, and intraoperativefindings revealed a massive torsed right ovary with a ruptured ovarian mass with grossly edematous and necrosed fallopian tubes. Following a safe cesarean section delivery of the fetus, a right salpingo-oophorectomy with cystectomy was performed. The histopathological results confirmed the diagnosis of JGCT FIGO stage IC2. Postoperatively, the patient was treated with six sessions of chemotherapy(cisplatin and paclitaxel). Post-chemotherapy magnetic resonance imaging showed normal abdominalviscera with minimal free fluid in the posterior cul de sac and a normal left ovary. Inhibin B levels droppedto 3.17, and the patient is on follow-up for the next 5 years with repeated tumor marker testing andcomputed tomography scans.Conclusion: JGCT is a very uncommon pregnancy tumor, and aggressive treatment is necessary foradvanced-stage tumors such as the one in this case to prevent recurrence or even death.
Background: The health system is least prepared to manage sexual dysfunctions and lacks trainedprofessionals who can adequately assess and manage individuals with sexual dysfunctions because theneed for the service has not been documented. This is because routine data are not collected on sexualdysfunctions. This study aimed to outline the distribution of sexual dysfunctions among patients seekinghealth services in a specialized sexual medicine clinic in Nairobi (Sexology Clinic).Methods: Records of all patients seen at the clinic for 12 months were analyzed. A total of 396 patientfiles were reviewed (362 males and 34 females) using a standard tool. The sociodemographic andmedical details of the patients were analyzed. Data were entered in SPSS and summarized using tablesand figures. Disease associations with sociodemographic characteristics were analyzed. Classification ofsexual disorders was performed using the International Classification of Diseases (ICD)-11.Results: The most prevalent sexual disorders in both genders were sexual arousal disorders (76.4%),sexual desire problems (16.42%), and orgasmic disorders (3.6%). Disease distribution was found to bedependent on patient age and sex. Ethnicity, religion, and profession did not affect disease distribution.Conclusion: The distribution of sexual dysfunctions observed in Nairobi was found to be similar to thoseobserved in other populations.Recommendation: Health promotion and treatment programs for sexual dysfunction should bedeveloped to mirror those in more liberal countries because sexual medicine needs are the same. Thehealth system should collect routine sexual health data to help with future planning.
