Journal of Obstetrics and Gynaecology of Eastern and Central Africa

Umbilical cord structural changes in Kenyan women with anemia diagnosed within the first 20 weeks of pregnancy: A retrospective cohort study.

Felix Njoroge — 2025-09-30

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.

A fatal outcome following uterine perforation and pelvic abscess after hysterosalpingography: A case report

Esther Nyambura — 2025-09-30

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

Peritoneal tuberculosis as a differential diagnosis for ovarian cancer: A case report

RUKIA GANG'OMBE — 2025-09-30

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.

Pregnancy during adjuvant tamoxifen therapy: A case of temporary interruption and postpartum metastatic recurrence

Morris Maganjo — 2025-09-30

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

Rapidly growing primitive neuroectodermal tumor of the uterus causing obstructive uropathy in a 13-year-old African girl: A case report

JOEL OOKO OJWANDO — 2025-09-30

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