Educational

1. SURGICAL MENOPAUSE
In an 18 years old Prime gravid
A case Report from Meatu, Simiyu
Dr Semeni Hosea Nyerere
MD, Muhas, Dar es Salaam

2. Continued…..
J, An 18yrs old primigravida at term, who resided about 110Km from the
District hospital presented at a district hospital with very severe abdominal
pain in a privately rented taxi, under escort from her husband and mother
Initial assessment by the nurse on duty revealed that she was on active stage
labor, however fundus was too big compared to gestational age, , ther cervix
was full dilated and had swollen with caput and meconium, fetal heart rate
were undetectable, however the nurse was worried by pain which were out
of proportion, so she contacted the doctor on duty (An MD or AMO)

3. Continued….
Review by medical officer reviewed Obstructed labor with possibility of uterine rupture, the fetal
parts were easily palpable and there were neither fetal heart rate heard
INTRA –OPERATIVE
A floating baby with zero APGAR score was found in the abdominal cavity, with huge hematoma
mixed with meconium, the uterus was circumferentially torn and ruptured beyond repir, and was
narrowly attached to each other, this prompted total hysterectomy, patient was transfused intra-
operatively and sent back to maternity for observation

4. • ANTENATAL HISTORY
She attended clinic at a Dispensary 4 times, both visits there were no
significant findings
PAST MEDICAL HISTORY- Un remakable

5. On the day of the event
Labor was reported noticed at 1000HRS morning, she had to wait for her mother in inlaw who were
at the shamba, until 1830Hrs, was taken to a nearby dispensary 5hrs later (1030HRS)
A nurse was not around, was asleep at his home , about 3km from the hospital and attempt to call
him failed
Decided to go TBA, a retired dispensary attendant who also used to conduct delivery when skilled
personnel were away or on trip
Given local herbs and injectable drugs (cant be recalled), multiple PV done for almost 4hrs but effort
proved failures, counselled to go back to the dispensary at 0225HRS , this time a nurse woke up and
advised them to go the District hospital, attempt to reach an ambulance from the district hospital
failed so they had to find other source of transport

6. LITERATURE
Hysterectomy performed before 35yrs old even if perfomed for the sake of
patient safety is associated with multiple risk factors
 low parity
17- beta oestradiol an ovarian hormone that acts on adipose tissue to
facilitate lipid metabolism, lacks of it leads to many metabolic conditions
like high BP, Obesity,
Osteoporosis due to reduced calcium resorption
Urogenital atrophy
Loss of womanhood (period)
Mental depression

7. GAPS AND LESSON LEARNT
GAP AREA TO STRENGHTEN RESPONSIBLE
Family level Early preparation and planning for delivery Family Community Health Workers
Dispensary Poor decision making, operating 24/7,
change altitude
CHMT, (Supportive supervision and
feedbacks giving
On job Training
Local Government Staffing the facility ( From 2 to atleast 4) DMOs, OR-TAMISEMI/MOH