The case is that of a 40 year old nulliparous who presented with progressive abdominal swelling, bilateral leg swelling, easy fullness and weight loss. She was married but husband had abandoned her because of this problem. Abdomen was massively distended without clinical signs of ascites. Ultrasound scan revealed abdominopelvic mass with features of uterine fibroid with pressure effects on the urinary tract. She had myomectomy done at which an unusually massive uterine fibroid in adhesions with anterior abdominal wall and the liver was found. She had prolonged daily peritoneal fluid effluent in excess of 300 mls for about 2 weeks which was managed. Histology of specimen revealed uterine leiomyoma. Late presentation for uterine fibroid is common in this part of the world, however this incident case that weighted 15 kg and involved in adhesion with the liver is not common. It is adviseable for patients with uterine fibroid to present early for treatment to achieve better outcome. It is also suggested for the gynecologist to counsel and peruse such cases at initial stages so to prevent adverse outcomes.
Caesarean Section on maternal request is a planned surgery performed without medical indication, where the wish of the woman compensates for the lack of medical reasons. Preferences for caesarean section are often associated with some factors that may be cultural, economic, religious or social. Some women are said to suffer from tocophobia which is the fear of childbirth and may be a major psychological cause for caesarean section due to maternal request (CSMR). This study explored the popularity of maternally requested caesarean section amongst pregnant women in the Antenatal clinic of University of Medical Sciences Teaching Hospital, Akure. Method: It was a cross-sectional descriptive study. Results: Willingness to request for caesarean section if not indicated is found to be low with only about 10% indicating that they can do so. Rather, refusal to undergo caesarean section when medically indicated is found to be relatively high with 43 % of respondents indicating their unwillingness to have caesarean section even if indicated. Fear of adverse occurrence to mother or baby is the major reason for avoiding caesarean section Conclusion: Maternally requested caesarean section is not popular amongst pregnant women while aversion to indicated caesarean section is high in the study area. There is need for massive education and enlightenment on caesarean section in order to improve its acceptability.
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