Iron status of some pregnant women in Orlu town--eastern Nigeria.

BACKGROUND: High prevalence of anaemia has been reported among pregnant women especially in developing nations. This paper considers maternal haemoglobin (Hb) level, serum total iron, iron binding capacity, and serum ferritn iin antenatal women in Orlu-Imo State Nigeria. PATIENTS AND METHODS: Haemoglobin level, serum iron, serum ferritin, and total iron binding capacity (TIBC) were measured in different trimesters among 90 pregnant women aged 20-45 years, on iron supplements attending antenatal clinic of Imo State University Teaching Hospital Orlu. First trimester comprised of 16.7% (n = 15), second trimester comprised of 50% (n = 45) while as third trimester comprised of 33.3% (n = 30). 30 non-pregnant women aged 26-40 years were used as controls. RESULT: The mean Hb level was 11.28 +/- 1.4 g/dl in first trimester, 9.51 +/- 1.9 g/dl in second trimester, 10.4 +/- 1.2 g/dl in third trimester, and 10.9 +/- 1.5 g/dl in controls. Mean serum iron level was 142 +/- 23 microg/ml in first trimester, 235 +/- 118 microg/ml in second trimester, 251 +/- 118 microg/ml in third trimester, and 99.7 +/- 19.4 microg/ml in controls. Mean serum ferritin was 57.7 +/- 30 ng/ml in first trimester, 37.6 +/- 17 ng/ml in second trimester, 37.3 +/- 20 ng/ml in third trimester, and 86.7 +/- 16.9 ng/ml in controls TIBC was 337 +/- 90 microg/dl in first trimester, 441 +/- 19 microg/dl in second trimester, 482 +/- 149 microg/dl in third trimester and 271.8 +/- 89.0 microg/ml in controls. Hb level was relatively stable in pregnancy, but was significantly (p < 0.05) lowest in the second trimester compared with controls Serum iron and TIBC progressively increased from first trimester to third trimester. Conversely, serum ferritin declined progressively from first trimester to third trimester. The increments in serum iron was statistically significant (p < 0.05) between first and second trimester, but not significant between second and third trimester. TIBC was significantly higher in third trimester compared with first trimester. Serum ferritin was significantly lower in second and third trimesters compared with controls. This implies a progressive mineral transfer from mother to fetus. TIBC and serum iron were significantly (p 0.05) lowest in non-pregnant controls compared with the three trimesters of pregnancy. Conversely ferritin was significantly (p < 0.05) higher among the non-pregnant controls compared with the three trimesters of pregnancy. This implies that the nonpregnant women had more iron store and had less iron need than their pregnant counterpart. The higher iron need in pregnancy necessitated its mobilization from its stores. CONCLUSION: This study encourages more critical antenatal care especially at second trimester of pregnancy with much emphasis on dietary supplementation of iron and minerals through adequate consumption of local vegetables and other food diets rich in iron. There was poorest antenatal attendance in the first trimester. Pregnant women in this environment should be encouraged to register early for antenatal care.

Relevance of clinical pelvimetry to obstetric practice in developing countries.

The outcome of labour in 177 Nigerian primigravidae in whom clinical pelvic assessment was performed before delivery, is studied. No significant difference occurred in the mode of delivery for the rank of the pelvic assessors (consultants or resident doctors) at x = 0.05. No significant difference also occurred in the incidence of caesarean section between the pelvic assessed and the unassessed patients, and between those whose pelves were assessed adequate and those assessed inadequate. One-minute Apgar scores were significantly higher for fetuses delivered of women with adequate pelves compared to those with (i) borderline pelves (Z = 3.46, p < 0.001), (ii) unassessed pelves (Z = 2.84, p < 0.005) and (iii) the not adequate pelves-borderline and inadequate (Z = 3.04, p < 0.005), thereby conferring a predictive role on Apgar scores to clinical pelvimetry. The procedure is cost-free and requires minimal guidance to perfect. Its continued practice in routine ante-natal care in developing countries is therefore advocated.

PIP: Clinical pelvimetry has been used in obstetrics practice in developing countries to prevent cephalopelvic disproportion. Questions have been raised, however, about the accuracy of this technique. This issue was addressed in a retrospective study of all 177 primigravidae who delivered at Nigeria's Nnamdi Azikiwe University Teaching Hospital in 1990-93. Of the 132 of these women who underwent pelvic assessment, the pelvis was deemed adequate in 119 (90.16%), borderline in 10, and inadequate in 3. Pelvic assessment performance or findings were not significantly associated with the assessor (consultant or resident doctor) or cesarean delivery rate; however, 1-minute Apgar scores were significantly higher among infants of mothers assessed to have an adequate pelvis than those with a borderline pelvis (p 0.001), an inadequate pelvis (p 0.005), or not assessed (p 0.005). It is recommended that developing countries without sophisticated monitoring equipment continue the practice of clinical pelvimetry and perform radiological pelvimetry in women with a borderline or inadequate pelvis.