Browsing by Author "Kwawukume, E.Y."
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Item Caesarean section in developing countries(Best Practice and Research: Clinical Obstetrics and Gynaecology, 2001-02) Kwawukume, E.Y.In developing countries, obstetric practice, including the performance of caesarean section, is complicated by problems that are no longer seen in developed countries. The various indications for caesarean section might be the same but the operation is often technically more difficult to perform in developing areas. Developing countries lack resources. This chapter highlights the problems encountered in the developing world. Because cephalopelvic disproportion is one of the main indications for performing caesarean section in our subregion, the technique of delivery of the impacted fetal head is discussed and alternatives to caesarean section are also suggested. The current view on myomectomy at caesarean section is described; including the technique of bloodless myomectomy at caesarean section. It is hoped that, with the training of postgraduate doctors in anaesthesia and obstetrics, the delivery of obstetric care will be accessible to rural areas in the developing world.Item Changing policies and guidelines can make a difference(International Journal of Gynecology and Obstetrics, 2010-11) Kwawukume, E.Y.Item Complete hydatidiform moles in Ghana(Ghana Medical Journal, 2001-06) Kwawukume, E.Y.Hydatidiform moles belong to the spectrum of diseases known as gestational trophoblastic diseases. Gestational trophoblastic diseases have been known since antiquity. Hippocrates, four centuries before the birth of Christ, described the hydatidiform mole as dropsy of the uterus and attributed it to unhealthy water. It was not until 1700 that William Smellie first used the term hydatidid and mole l. In 1895, the pathological description of proliferation of the syncytium and the cytotrophoblast of the villi in molar pregnancies was established. Since then, a considerable amount of knowledge and experience has been obtained. Workers in Africa continue to find the scope of the disease in our subregion despite our limited resources.Item Delivery of Impacted Fetal Head at Caesarean Section - Surgical Technique(Ghana Medical Journal, 1992) Ghosh, T.S.; Kwawukume, E.Y.A type of U-shaped incision with a broad base to deliver the impacted fetal head or the neglected shoulder at cesarean Section is presented. This incision combined with an assistant dislodging the wedged fetal head upwards before incising the lower segment of the uterus prevented lateral extension into the uterine arteries in 56 patients at the Korle Bu Teaching Hospital. The surgical technique is described.Item Eosinophilic enteritis--a diagnostic dilemma(West African journal of medicine, 2002-07) Clegg-Lamptey, J.N.; Tettey, Y.; Wiredu, E.K.; Kwawukume, E.Y.Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. The diagnosis is often difficult to make and most cases are only diagnosed after laparotomy/ laparoscopy and biopsy. It can be successfully treated with corticosteroids. We report a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone.Item Ghana postgraduate obstetrics/gynecology collaborative residency training program: Success story and model for Africa(American Journal of Obstetrics and Gynecology, 2003-09) Klufio, C.A.; Kwawukume, E.Y.; Danso, K.A.; Sciarra, J.J.; Johnson, T.OBJECTIVE: We describe a residency program in Ghana that was developed to train obstetrics/gynecologist specialists for Ghana and the subregion to promote and manage the reproductive health of women and to reduce a high maternal mortality rate. STUDY DESIGN: The Carnegie-supported program, begun in 1989, is a 5-year residency in the two medical schools in Ghana, but with one central coordinating office. It has features that equip the graduate resident to practice in his/her environment. The fourth year of the program is unique: the resident attends a hospital management course for 3 months, goes for a clinical rotation in the United States or United Kingdom for 3 months, and moves to live and work in a rural district hospital for 6 months. RESULTS: The success rate of the Ghanaian residents in the examination of the West African College of Surgeons has been three to four times higher than the overall pass rate. As of October 2002, the program had produced 26 specialists, all of whom are practicing in Ghana. In contrast, of 30 specialists who were trained abroad between 1960 and 1980, only 3 specialist had returned home by the end of the 1980s. The current chairpersons of the two medical schools are graduates of the program. Carnegie financial support for the program came to an end in January 2000, but the Ghana Ministry of Health has increased its support enthusiastically. The program is being sustained. Maternal mortality and morbidity rates are falling slowly in the two teaching hospitals; case fatality rates have been reduced markedly. New residents are entering the program and are progressing to completion. CONCLUSION: The program has been an unqualified success and merits replication.Item Myomectomy during cesarean section(International Journal of Gynecology and Obstetrics, 2002-02) Kwawukume, E.Y.Obstetricians are often confronted with large fibroids while performing cesarean sections. Pedunculated fibroids can easily be removed and hemostasis secured at that time without endangering the life of the mother. Yet, myomectomy during cesarean section was practically absent from the obstetric literature until the last decade and the current teaching still is to deliver the baby and perform myomectomy later, perhaps before the next pregnancy. When the fibroids are located in the lower segment of the uterus, many obstetricians prefer to choose this classical route. To deliver the baby, however, they are sometimes faced with the emergency decision of either removing fibroids, or incising through them and leaving them behind for a later myomectomy. In a prospective clinical trial conducted between April 2000 and January 2001 at the Korle Bu Teaching Hospital and Family Health Hospital in Accra, Ghana, a myomectomy performed during a cesarean section was compared with a cesarean section without myomectomy. Twelve patients with uterine fibroids who had a cesarean section for various indications formed the case group. Women who had a cesarean section immediately after one of the 12 selected patients served as a control group. In all, 24 women were enrolled in the study. The average age of the case group was 34.5 years and the average age of the control group was 30.2 years. The average hemoglobin rates were 11.73 g/dl pre‐operatively and 9.90 g/dl post‐operatively for the case group, and 12.07 g/dl pre‐operatively and 10.34 g/dl post‐operatively for the control group. The average duration of the operation was 62.08 min for women who had cesarean section and myomectomy. Although it was longer than for the control group, for which it was 50.83 min, it was not significantly longer. The removed fibroids, which were mainly intramural and located in the body of the uterus, were composed of 1–6 nodules. In one patient, they weighed a total of approximately 500 g. Uterine involution was normal in all women and there were no significant complications during the puerperium.Item Oral nifedipine therapy in the management of severe preeclampsia.(International Journal of Gynecology and Obstetrics, 1995) Kwawukume, E.Y.; Ghosh, T.S.OBJECTIVE: The purpose of this study was to compare the efficacy of nifedipine (Cordipin) and hydralazine in lowering blood pressure in severe preeclampsia. METHOD: A randomized, prospective study of 104 patients with severe preeclampsia in the Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana, was conducted between January 1992 and June 1994. RESULTS: Of the 104 patients recruited into the study, six did not deliver at our hospital and were thus excluded from the study. Nifedipine and hydralazine as first-line drugs controlled the blood pressure in 44 and 35 patients, respectively, but failed in 5 and 14, respectively. This was statistically significant (P < 0.05). The mean birth weight was higher in the nifedipine group (2500+/-800 g vs. 2400+/-800 g). There were 11 admissions to the neonatal intensive care unit in the nifedipine group and 13 in the hydralazine group but the difference was not statistically significant. CONCLUSION: Nifedipine and hydralazine could both be used effectively to control blood pressure in severe preeclampsia in our subregion. While hydralazine is administered intravenously and needs strict monitoring, nifedipine is more effective, is easy to administer orally, less demanding on hospital staff, convenient and more predictable.Item Quality of life, optimism/pessimism, and knowledge and attitudes toward HIV Screening among pregnant women in Ghana.(Women's Health Issues, 2008) Moyer, C.A.; Ekpo, G.; Kwawukume, E.Y.; Greene, J.; Naik, S.; Sippola, E.; Stern, D.T.; Adanu, R.M.K.; Koranteng, I.O.; Anderson, F.J.OBJECTIVE: We sought to explore optimism/pessimism, knowledge of HIV, and attitudes toward HIV screening and treatment among Ghanaian pregnant women. METHOD: Pregnant women in Accra, Ghana, completed a self-administered questionnaire including the Life Orientation Test-Revised (LOT-R, an optimism/pessimism measure), an HIV knowledge and screening attitudes questionnaire, the Short Form 12 (SF-12, a measure of health-related quality of life [HRQOL]), and a demographic questionnaire. Data were analyzed using t-tests, ANOVA, correlations, and the chi2 test. RESULTS: There were 101 participants; 28% were nulliparous. Mean age was 29.7 years, and mean week of gestation was 31.8. All women had heard of AIDS, 27.7% had been tested for HIV before this pregnancy, 46.5% had been tested during this pregnancy, and 59.4% of the sample had ever been tested for HIV. Of those not tested during this pregnancy, 64.2% were willing to be tested. Of all respondents, 89% said they would get tested if antiretroviral drugs (ARVs) were readily available and might prevent maternal-to-child transmission. Neither optimism/pessimism nor HRQOL was associated with attitudes toward HIV screening. Optimism was negatively correlated with HIV knowledge (p = .001) and was positively correlated with having never been tested before this pregnancy (p = .007). CONCLUSION: The relationship between optimism/pessimism and HIV knowledge and screening behavior is worthy of further study using larger samples and objective measures of testing beyond self-report.Item Technique of Delivery of the After Coming Head in Breech Presentation.(Ghana Medical Journal, 1992) Ghosh, T.S.; Kwawukume, E.Y.Between January 1989 and December 1992. fifteen cases of difficult breech deliveries were done with the bead arrested at the pelvic brim in anterior-posterior position. There was one perinatal mortality. Ten premature dead babies were also delivered with an average time of 6.2 ± 2 hours. Cervical dilatation at the time of the procedure ranged between 4 to 6cm. All the deliveries were done in Karle-Bu Teaching Hospital, Accra. Ghana. The technique of delivery is described.