Tropical Doctor, January I979

factor in determining the adjustment of a child with a handicap is the manner in which the environment reacts to it. Parents should be encouraged to help the child to grow and develop to its fullest potential in all aspects; physical, mental, psychological and


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social. For all these reasons we have no hesitation in presenting to our readers some of the outstanding achievements of Mr R. C. Hayes whose manufacturing company is at 65a Main Street, Kirby Muxloe, Leicestershire, England LE9 9AN.

Personal Experience

A hidden twin-pregnancy J. W. J. Bijlsma, MD S. F. Makala, MD Hamel, MD

J. L.

District Hospital, Biharamulo, Tanzania TROPICAL DOCTOR,


As stated in Obstetrics and Gynaecology in the Tropics and Developing Countries (Lawson and Stewart 1967), ectopic pregnancies present in very different ways, produce a multiplicity of symptoms and signs, and masquerade as many other conditions. To illustrate this we describe the following case which (nearly) fooled us. In the night of September 19, 1977, a 23-year old woman, a Mhaya from a village 40 miles from our hospital, was admitted. This was her third pregnancy, two children having been born before. She had apparently aborted a two-month-old fetus one week before, at home; she also stated that she saw the fetus. The reason for coming to the hospital now was that she was still losing much blood from the vagina, which had begun to smell in the last few days. On examination the patient was anaemic, febrile and in pain. On vaginal examination the uterus was swollen and tender; there was blood draining from the partially opened cervix. Her blood pressure was 120/80 mmHg, pulse rate 88, regular and full, temperature 38°C. We diagnosed incomplete abortion and gave antibiotics. The following morning we performed an evacuation of the uterus under intravenous pethidine sedation, and with the stump curette we removed some necrotic placenta tissue. The post-operative progress was quite normal: we treated the anaemia by blood transfusion and oral ferrous sulphate; the infection responded to a combination of penicillin and streptomycin. The fever went down, the blood loss had stopped, but we didn't discharge her because she complained of persistent abdominal discomfort. During the next

week her condition remained the same. On October 3 we repeated our vaginal examination and found a slightly enlarged uterus with some tenderness over the fornices. We checked her haemoglobin level again which proved to be only 30%. We asked the family to arrange for another donor and on October 6 she received a second blood transfusion. That evening the patient complained of sudden abdominal pain and her abdomen became distended. On examination we found: blood pressure 95150 mmHg, pulse 96/min and feeble, slightly distended lower part of the abdomen. On auscultation the bowel-sounds were normal, on percussion there was fluid in the abdomen and the hypogastric area was tender. Her temperature was 38°C and there was once again some vaginal bleeding. Although we considered the possibility of an ectopic pregnancy, we decided, in view of the past medical history, to postpone a laparotomy (!); after inserting an indwelling catheter we treated her with intravenous dextrose, alternating with normal saline, under half-hourly control of pulse rate and blood pressure. The following morning her condition was not better and on abdominal aspiration we obtained clear blood. We performed a laparotomy and found her abdomen full of fresh blood, the left tube was ruptured and there was a fetus of nearly 9 em (approximately three months old). We removed the tube and inspected the other tube and both ovaries, which were normal; the uterus was of a normal size but still soft. We were able to auto-transfuse six pints of blood from the abdomen and her postoperative condition improved. On October 17 she was able to leave our hospital and on check-up three weeks later she was well. Although this unusual kind of twin-pregnancy has been described before, we thought it worthwhile to bring it to attention again because of its remarkable features and the danger to the patient. REFERENCE

Lawson, J. B., and Stewart, D. B. (1967). Obstetrics and Gynaecology in the Tropics and Developing Countries. London: Arnold.

A hidden twin-pregnancy.

Tropical Doctor, January I979 factor in determining the adjustment of a child with a handicap is the manner in which the environment reacts to it. Pa...
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