Accuracy of mid-trimester ultrasound scan in foetal gender determination at the University College Hospital, Ibadan Nigeria

Objectives: This study aimed to determine the accuracy of prenatal sonographic gender determination during foetal anomaly ultrasound and the overall sensitivity pattern in our institution.Materials and Methods: A cross-sectional study of 520 consenting pregnant women who presented for foetal anomaly scans within a one-year period in our institution. The diagnostic accuracy of gender determination during the anomaly and delayed scans were determined by comparing the sonographic gender with the birth gender and calculating sensitivity, specificity, positive predictive value and negative predictive value. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, frequencies, Mc-Nemar chi-square test were used at 5% level of significance. Results: The mean maternal age was 31.51 ±5.02years. Of the 520 consenting pregnant women studied, 16(6.0%) women were having twin gestation. Four hundred and ninety-seven (92.7%) genders were determined during foetal anomaly scan. The accuracy of the ultrasonography (US) examination performed by the resident doctors was 98.02% while the accuracy of the scan performed by the consultant radiologists was 100%. Overall, the accuracy of the gender determination on ultrasound was 98.69%. The general specificity and sensitivity of the US were 98.71 % and 98.68% respectively while the positive and negative predictive value were 99.01 % and 98.29% respectively. Conclusion: The accuracy of ultrasound examination in detecting foetal gender during foetal anomaly ultrasound is high with equally high predictive values and therefore it is recommended as a mandatory variable during anomaly scans. There is need for continuous training of resident doctors or operators in lower cadre to improve their competency in foetal gender determination.

Prevalence of bacterial vaginosis in pregnant women attending Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria using the complete Amsel's diagnostic criteria

Background: Bacterial vaginosis (BV) in pregnant women remains a cause for clinical concern among clinicians and health care professionals. BV has been linked to prenatal, antenatal and postnatal challenges in pregnant women. Information on prevalence of BV across trimesters of pregnancy is expected to give better clinical insight into the pathophysiology of this polymicrobial disorder. This study was conducted to determine the prevalence of BV in pregnant women attending the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Methodology: This was a cross-sectional study of 120 pregnant women (40 in each trimester of pregnancy) who had symptoms suggestive of BV, selected by systematic random sampling from among the women attending the Obstetrics and Gynaecology (O & G) clinic of NAUTH, Nnewi. Each subject participant was examined by the attending clinician, and high vaginal swab (HVS) sample was collected for diagnostic analysis of BV using with complete Amsel's clinical criteria, which consists of three of the four criteria; (i) adherent and homogenous vaginal discharge, (ii) vaginal pH > 4.5, (iii) detection of clue cells on saline wet mount, and (iv) amine odor after the addition of potassium hydroxide (positive Whiff test). Results: The mean age of the 120 selected participants was 27.25±6.09 years. The age groups 25-29 (36.7%) and 20-24 years (33.3%) constituted the largest proportion, while age groups <20 (5.0%) and 40-45 years (5.0%) constituted the least. Of the 120 participants, 26 (21.7%) were positive for BV by the Amsel's criteria. Pregnant women in age group <20 years had the highest prevalence of BV (100%, 6/6), followed by those in the age groups 20-24 (27.5%), 40-45 (16.7%), 25-29 (15.9%), 30-34 (9.1%) and 35-39 years (0%) (X 2=28.063, p=0.0001). Prevalence of BV was significantly higher in single (unmarried) pregnant women (45.5%, X 2=4.038, p=0.045), women with primary school education level (66.7%, X 2=14.530, p=0.001), unemployed women (36.1%, X 2=13.278, p=0.0013), and nulliparous women [36.4%, X 2 (for trend) = 4.805, p=0.0274), while there was no significant difference in the prevalence of BV with relation to trimester of pregnancy (X 2=2.750, p=0.253). Conclusion: This study reveals a relatively high prevalence of BV and significant association with factors such as age group, education and occupational status among pregnant women attending NAUTH Nnewi. Regular screening of women for BV prenatally may enable appropriate interventions to prevent adverse pregnancy outcomes

Nuchal Translucency Thickness at 11-14 Weeks of Gestation in Cameroon

Objectives: To determine the prevalence of nuchal translucency at 11-14 weeks of pregnancy in the Cameroonian population. Compare our values of the nuchal translucency thickness to international reference valuesMaterial and Methods: Descriptive cross-sectional study including 332 Cameroonian women who received obstetric ultrasound between 11 and 14 weeks in four hospitals in Cameroon; from 1st January to 31 December 2012. Measurement of nuchal translucency was performed according to the recommendations of the Fetal Medicine Foundation. Results: 340 fetuses were examined. The median nuchal thickness was 1.5 mm (range: 0 - 9.7 mm). Abnormal nuchal thickness (? 3 mm) was 1.5(5/340) and was significantly predominant in the range of maternal age over 36 years. In 8.8(30/340) of cases; nuchal translucency was absent among which 46.7(14/30) were examined before 13 weeks.CONCLUSION: The prevalence of abnormal nuchal translucency thickness is 1.5 in our setting and is significantly higher in the range of maternal age over 36 years. There exists an early 'filling' of nuchal translucency (before 13 weeks) in some Cameroonian fetus

Urea and Creatinine Clearances in the Three Trimesters of Pregnancy

The aim of this study was to determine the creatinine and urea clearances; as indices of glomerular filtration rate (GFR) during the three trimesters of pregnancy. A total of 108 healthy subjects between the ages of 18 and 37years were divided into non-pregnant women (28+5years; n=30); 1st trimester of pregnancy (28+5years; n=18); 2nd trimester of pregnancy (28+4years; n=30). Serum and urine samples were collected at mid-trimester period. Creatinine and urea concentrations in serum and urine were determined using Jaffe's method for creatinine and the urease (Ccr) and urea clearance (Uurea) in the three trimesters when compared with the non-pregnancy value. The increase in creatinine clearance peaked in the second trimester (64.76+1.37 (non-pregnancy vs. 2nd trimester); while the increases of 34.50+3.68ml/min (non-pregnancy vs. 1st trimester); and 38.63+1.56 (nonpregnancy vs. 3rd trimester) were similar. These increases in Ccr were associated with a significant fall (p0.01) in all trimesters of pregnancy. Il is conclued that GFR increases in pregnancy until term; with a peak at the seond trimester

Effectiveness of Manual Vacuum Aspiration (MVA) in the Management of First Trimester Miscarriage: Experience in a Specialist Centre in North-Eastern Nigeria

Background: Safe management of abortion with an easy; simple and effective procedure is mandatory to minimise abortion related morbidities and mortalities. Aim: To assess the pattern of presentation of cases of first trimester miscarriage and the value of manual vacuum aspiration (MVA) in the management of abortion. Methods: Clinical records of 251 cases of miscarriage managed over a 3-year period 2005 - 2007 using MVA ipas aspirator were retrieved and information pertaining to age parity; gestational age at presentation; indication for MVA use; duration of hospital stay and complications encountered were retrieved for analysis and interpretation. Results: A total of 1899 gynaecological procedures were carried out over the 3-year period; out of which 251 were MVA procedures performed for various first trimester miscarriages; accounting for 13.2of the total gynaecological admissions. Sixty one (24.3) of the patients who benefited from MVA were in the 25-29 years age group; while those in the age 20-24 and 30-34 years group constituted 21.5and 20.7respectively. Grandmultiparas (53.7) constituted the majority. The procedure was performed for 50.2of the patients at 9-11 wks of gestation. Most (88.0) of the patients had the procedure performed for incomplete abortion and while the remaining 12.0were for check MVA after complete abortion and missed abortion. Most (67) of the cases were perform as outpatient procedures. There were three maternal deaths which were not related to the procedure. Conclusions: First trimester miscarriage appeared to be most common among grandmultipara and during the 9-11weeks of gestation. Most of the patients fell into the 25-29 years age group. It appears MVA is being effectively utilized in our centre

The Value of Routine Mid-Trimester Ultrasound in Low-Risk Pregnancies at Primary Care Level

This study investigated the effect of routine second-trimester ultrasound scanning on obstetric management and pregnancy outcomes. This was an open cluster; randomised; controlled trial. Clusters of women with low-risk pregnancies presenting in the second trimester were randomised to receive an ultrasound scan followed by usual antenatal care; or to an unscanned control group undergoing conventional antenatal care only. Out of the 962 women randomised; follow-up was successful for 804 (83.6); with 416 allocated to the ultrasound scan group and 388 controls. There were no significant differences between the ultrasound scan group and the control group in terms of prenatal hospitalisa- tion; mode of delivery; miscarriage; perinatal mortality rate and low birthweight rate. Ultrasound dating was associated with a lower rate of induction of labour for post-term pregnancy (1.4vs. 3.6; P=0.049). However; ultrasound scanning in low-risk pregnancies was not associated with improvements in pregnancy outcome

Nuchal Translucency as a Method of First-Trimester Screening for Aneuploidy

Objective. To determine the effectiveness of nuchal translucency (NT) screening in predicting aneuploidy and structural abnormalities in a South African population. Study design. Descriptive study. Setting. Chris Hani Baragwanath Hospital fetal medicine unit. Outcome measures. An adjusted risk was derived from the combination of maternal age-related risk and the risk derived from NT screening. A positive screen was denoted by an adjusted risk of more than 1/300 and a negative screen by an adjusted risk of less than 1/300. In order to determine the number of undiagnosed abnormalities in the group; all babies were examined by a paediatrician at birth to detect and describe dysmorphic features. Results. A total of 428 patients underwent first-trimester screening between July 2003 and July 2005. Three per cent were lost to follow-up. Of the 415 patients analysed; 59 screened positive and 356 screened negative. The mean age for both groups of patients was 30.1 years. Of the 57 patients who screened positive; 24 elected to have chorionic villus sampling (CVS). This resulted in the detection of 6 chromosomal abnormalities and 2 structural abnormalities. Among the remaining 356 patients; who had screened negative; 2 had an increase in the adjusted risk when the risk was compared with the background risk; and 1 chromosomal abnormality was detected in this group; 8 elected to have CVS because of a previous history of a chromosomal abnormality; and there were no abnormalities among them. Conclusions. The use of these screening methods has enabled prenatal karyotyping to become cost effective; and allows concentration on pregnancies at highest risk for chromosomal abnormalities; regardless of age

Nuchal Translucency (NT) as a Method of First Trimester Screening for Aneuploidy

Objective : To determine the effectiveness of nuchal translucency screening in predicting aneuploidy and structural abnormalities in a South African population Study design Descriptive Study Setting Chris Hani Baragwanath Hospital Fetal Medicine Unit Outcome measures An adjusted risk was derived from the combination of maternal age-related risk and the risk derived from nuchal translucency screening. A positive screen was denoted by an adjusted risk of more than 1/300 and a negative screen by an adjusted risk of less than 1/300. In order to determine the number of undiagnosed abnormalities in the group; all babies were examined by a paediatrician at birth to detect and describe dysmorphic features. Results : A total of 428 patients underwent first trimester screening between July 2003 and July 2005. Three percent were lost to follow up. Of the 415 cases analyzed; 57 patients screened positive and 356 patients screened negative. The mean age for both groups of patients was 30.1 years. Of the 57 patients that screened positive 24 elected to have chorionic villus sampling (CVS). This resulted in the detection of 6 chromosomal abnormalities and 2 structural abnormalities. Among the remaining 356 patients; who had screened negative; 2 had an increase in the adjusted risk when the risk was compared to the background risk; and one chromosomal abnormality was detected in this group; 8 elected to have CVS because of a previous history of a chromosomal abnormality and there were no abnormalities among them. Conclusions : The use of these screening methods has enabled prenatal karyotyping to become cost effective; and to allow concentration on pregnancies at highest risk for chromosomal abnormalities; regardless of age

Health Care Attendance Patterns by Pregnant Women In Durban; South Africa

"Background: High rates of perinatal mortality and morbidity and maternal mortality in South Africa remain a major problem. The Saving Mothers and Saving Babies Reports identified patient-related factors as possible causes. Among the patient-related factors was non-attendance; or attendance late in pregnancy; for antenatal care in public hospitals. It would appear that pregnant women confirm their pregnancies by visiting general practitioners; but do not attend antenatal care in the public sector.Aim: The aim of this study was to determine healthcare attendance patterns among pregnant women in Durban; South Africa.Method: This was a descriptive study. Participants were recruited and categorised into ""early booker""; ""late booker"" and ""unbooked in labour"" groups. All the participants were interviewed individually using a structured questionnaire.Results: The majority of participants presented for formal ""booking"" late in pregnancy; 47.9 ""booked"" at a gestational age of six months after the last menstrual period. Among the ""early bookers""; the majority (94.4) had confirmed their pregnancy by four months of amenorrhoea; and 60.6 of these confirmed their pregnancies within the public health sector. All the ""early bookers"" began antenatal care prior to the 20th week of gestation. A total of 66.9 of the ""late bookers"" and 66.7 of the ""unbooked"" women also had their pregnancies confirmed at four months amenorrhoea; but 49.0 of the ""late bookers"" and 59.8of the ""unbooked"" women confirmed their pregnancies in the private health sector. The ""late bookers"" also showed a delay of two to three months between confirming the pregnancy and booking visits. Of the women in this study; 49 visited a general practitioner (GP) to confirm the pregnancy after two to four months of amenorrhoea. This figure rose to 53.0 if only the ""late bookers"" and the ""unbooked"" were analysed. Further; 35.3 visited a GP more than once; either for antenatal care or because of ill health.Conclusion: It is imperative for GPs to understand the role of antenatal care and to refer pregnant women appropriately."