Obstetric and gynaecologic case records and conmentaries

This book of case records and conmentaries presented as part of fulfillment of the requirements for the degree of master of medicine in obstetrics and gynaecology, University of Dar es Salaam. The review is mainly on patients managed by the author at the Muhimbili Medical Centre. Muhimbili Medicine, University of Dar es Salaam, is one of the 4 main referral hospitals in the country. It is the only hospitals in the country. It is the only hospital in the country with radiotherapy facilities. The Centre has three main activities, namely, Service, Teaching and Research. It is a zonal Consultant Hospital for the eastern, southern and central zones of the country and acts a regional and referral hospital in the country. It is the only hospital in the country with radio therapy facilities. The Centre has three main activities, namely, Service, Teaching and Research. It is a zonal Consultant Hospital for the eastern, sourthrn and central zones of the country and acts a regional and referral hospital for Dar es Salaam and Coast regions. There are 4 main clinical departments in the Centre, namely, Surgery, Medicine, Paediatrics and Child Health and Obstetrics and Gynaecology. Obstetrical and Gynaecological Services: The department of Obstetrics and Gynaecology functions as an independent unit. It is organized into 4 firms –A, B, C, and D, each with at least two Consultants/Specialists. Each firm works independently with its own out-patient clinics operation schedules and emergency duties. Service activities:

1. Out-patient clinics: these are primarily for refered patients and follow ups. They include the following: a) Antenatal clinics. b) Gynaeological clinics. c) Specialized clinics: i) Infertility ii) Family planning
2. In-patient services: these form extensions of the out-patient services. Admissions come as emergencies or referred cases. Emergency admissions pass via the Casuality department to the admissions Firm. Gynaecological Services: These comprise of out-patient, in-patient and operative services. Out-patient Services: there are 4gynaecological out-patient clinics in a week, one day foreach firm. There is also an infertility clinic and a family planning clinic, each once a week. All these clinics are run by Consultants/Specialists, Residents and Registrars. Patients reach the gynaecological out-patient clinics by appointments. Referred patients from the peripheral health units in Dar es Salaam report to the Records Office with their referral notes. The records clerk gives the respective appointment. Patients reffered from up-country.