Is a chlorhexidine reaction test better than dipsticks to detect asymptomatic bacteriuria in pregnancy?

Detection of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant morbidities. Therefore, we assessed the use of chlorhexidine reaction to detect ASB in pregnancy. This was a prospective study, which compared chlorhexidine reaction with dipstick tests and urine culture in 150 asymptomatic pregnant women. Urine cultures detected bacteriuria in seven women (4.7%). Chlorhexidine detected ASB in 72 women (48%) and had sensitivity, specificity and accuracy of 100%, 54% and 56%, respectively. Leucocyte esterase (LE) and nitrite detected bacteriuria in 31 (20.7%) women and 12 (8.0%) women, respectively. Singly, LE had a sensitivity and specificity of 14.3% and 79%, respectively, while nitrite's sensitivity and specificity was 42.9% and 93.7%, respectively. Combined, LE and nitrite had better sensitivity (97.9%) and accuracy (94%). Since the accuracy of chlorhexidine is low, other than urine culture, combined dipstick urinalysis of leucocyte esterase and nitrite tests is good to detect asymptomatic bacteriuria in pregnancy.

Seroprevalence and clinico-epidemiological correlates of hepatitis C viral antibodies at an antenatal booking clinic of a tertiary hospital in Nigeria.

PURPOSE: This was to determine the sero-prevalence of hepatitis C viral (HCV) antibodies in pregnant women attending the first antenatal clinic and assess the epidemiologic correlates of women anti-HCV positive. METHODS: This was a prospective observational study which used in vitro diagnostic test kits to detect anti-HCV antibodies. Women attending their first antenatal clinic were recruited at the antenatal clinic of Irrua Specialist Teaching Hospital, Edo State, Nigeria. Seropositive women had liver enzymes assessed, and screening for hepatitis B surface antigen and Human Immuno-deficiency Virus (HIV) was done. RESULTS: Eight out of 205 women were anti-HCV positive. The prevalence of hepatitis C infection was 3.9 %. The mean age of the women was 28.9 ± 2.1 years. Most (50 %) anti-HCV positive women had tertiary level education. Though health workers made up 3.5 % of the participants, they constituted 25 % women with anti-HCV antibody. Awareness of HCV infection had no impact on the rate of infection. Multiple sexual partners (P = 0.71), blood transfusion (0.64) and female circumcision (P = 1.00) were not significant risks of infection. 2 (1 %) women had hepatitis B co-infection and 1 (12.5 %) woman had both HCV antibody and HIV co-infection. CONCLUSION: Despite the 3.9 % prevalence, routine screening for hepatitis C virus infection in pregnancy is unjustified. Risk-based screening using locally prevailing risk factors with antenatal monitoring and postpartum treatment of women with hepatitis C antibodies is recommended.

Enhanced urinalysis in the detection of asymptomatic bacteriuria in pregnancy.

BACKGROUND: Detection and treatment of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant maternal and fetal morbidity. Other than urine culture, no other screening test is unequivocal. OBJECTIVE: The use of enhanced urinalysis test to detect ASB in pregnancy was investigated. METHODS: This was a prospective observational study which compared enhanced urinalysis with dipstick tests and urine culture. Clean catch midstream urine specimen was collected from 150 consecutive asymptomatic pregnant women. Tests of validity were used for comparison. RESULTS: Enhanced urinalysis detected bacteriuria as much as urine culture (4% vs. 4.7%). Itwas 57.1% sensitive and 98.6% specific. It had a false negative rate of 42.9% and was 96.7% accurate when compared to urine culture. Enhanced urinalysis took 1-2 hours to be done and required skills to use the microscope and was more expensive than dipstick urinalysis. CONCLUSION: The accuracy of enhanced urinalysis and its ability to detect ASB as much as urine culture connotes that it can be used to detect asymptomatic bacteriuria in pregnancy albeit only in secondary and tertiary health centres because of the cost and technicality involved.

Retained Placenta: Still a Cause of Maternal Morbidity and Mortality in a Nigerian Semi- Urban Population

Background: Retained placenta is associated with morbidity and mortality when left untreated. This study was done to determine the occurrence of retained placenta in our setting as well as to ascertain the possible risk factors; morbidities and mortality. Method of study: This was a retrospective review of all cases of retained placenta over a three year period (March 2005 to March 2007). There were 3542 deliveries; and of which 64 cases were of retained placenta. Results: The incidence of retained placenta was 1.8of all deliveries with a higher incidence in unbooked patients and a case fatality of 3.12.The commonest complication was postpartum haemorrhage in 51(79.68) of cases with blood transfusion rate of 47. onclusion: Complications associated with retained placenta could be reduced by adequate utilisation of health care facilities manned by skilled attendants; availability of blood transfusion services as well as effective and safe anaesthesia

Eclampsia in Irrua Specialist Teaching Hospital: a five-year review.

OBJECTIVE: The contribution of Eclampsia to maternal mortality in Nigeria is well documented. In Irrua it accounts for over 25% of maternal deaths. Addressing Eclampsia is therefore a priority programme of the Irrua Safe motherhood Initiative. AIM: The aim of this study is to determine the incidence of eclampsia, its clinical correlates and outcome. Finally strategies will formulate programme implementation. MATERIALS AND METHODS: This is a retrospective study of cases of eclampsia in Irrua Specialist Teaching Hospital, Edo state; over a five-year period. Information was retrieved using a structured proforma. Statistical analysis was done using the excel statistical package and the Epi info 2002 statistical software. RESULTS: Seventy eight (78) were admitted in the 5 year study. This accounted for 2.52% of total labour ward admission. However only 74 case notes were available for analysis. 70/74 of the patients were unbooked emergencies. Among the unbooked patients. 38/70 (54.29%) of the unbooked had not received any antenatal care whatsoever. The incidence was disproportionately higher in younger women and teenagers as well as in primigravida. 55/74 (74.32%) had preceding headache while 21.62% had a prior history of blurred vision, 14.86% had epigastric pain.16.22% had restlessness while 10.81% had nausea and vomiting each. The perinatal mortality rate was 28.38% while the maternal mortality ratio was 22.97%. Maternal mortality was associated with poor urinary output (0.0003), history of native medication (0.0199), number of fits (0.00209). Platelet count below 50,000/ml, highest systolic blood pressure above 200 mmhg (0.000018) and pulmonary oedema (0.000558). CONCLUSION: Addressing Eclampsia in Irrua will include community campaigns, capacity building, retraining of staffs within the hospital and improved facilities for the management of cases.

Comparative study of intradermal smear microscopy in the diagnosis of malaria in symptomatic pregnant women.

OBJECTIVES: A comparative study of intradermal smear in the diagnosis of malaria in symptomatic pregnant women. Venous blood served as the control. PATIENTS AND METHODS: Fifty consecutive symptomatic pregnant women were recruited. Thick films of both venous and intradermal blood were examined. Questionnaires were used to determine patients' preference for the two techniques. Tests of statistical significance were done with Fisher exact and Yates correlation coefficient at 95% confidence interval. Sensitivity specificity and accuracy rates were used to assess the validity of intradermal smear. RESULTS: Intradermal smear more frequently diagnosed malaria parasitaemia than peripheral venous blood (66% vs 56%). This was statistically significant (P value: 0.0065). The sensitivity of intradermal smear was 85.7% while the positive predictive value was 77.4%. The accuracy rate was 76.7%. The technique of intradermal blood collection was preferred by 28% of women. CONCLUSION: Intradermal smear is useful in malaria diagnosis in pregnancy and may be an additional evaluation tool for persistent fever in pregnancy.

Comparative Study of Intradermal Smear Microscopy in the Diagnosis of Malaria in Symptomatic Pregnant Women

Objectives: A comparative study of intradermal smear in the diagnosis of malaria in symptomatic pregnant women. Venous blood served as the control. Patients and methods : Fifty consecutive symptomatic pregnant women were recruited. Thick films of both venous and intradermal blood were examined. Questionnaires were used to determine patients' preference for the two techniques. Tests of statistical significance were done with Fisher exact and Yates correlation coefficient at 95confidence interval. Sensitivity specificity and accuracy rates were used to assess the validity of intradermal smear. Results: Intradermal smear more frequently diagnosed malaria parasitaemia than peripheral venous blood (66vs 56). This was statistically significant (P value: 0.0065). The sensitivity of intradermal smear was 85.7while the positive predictive value was 77.4. The accuracy rate was 76.7. The technique of intradermal blood collection was preferred by 28of women. Conclusion: Intradermal smear is useful in malaria diagnosis in pregnancy and may be an additional evaluation tool for persistent fever in pregnancy

Utility of intradermal blood smear in the detection of asymptomatic malaria parasitaemia in pregnancy.

OBJECTIVES: We evaluated the usefulness of intradermal smear microscopy (IDS) in the detection of asymptomatic malaria parasitaemia in pregnancy. Peripheral venous blood (PVB) served as control. The preference for the collection technique of dermal blood was also assessed. PATIENTS AND METHODS: One hundred and fifty (150) asymptomatic women were recruited. They had both intradermal smear and peripheral venous blood smear were made for all patients. Measures of test validity included sensitivity, specificity and accuracy rate. Test of statistical significance was with Yates correlation at 95% confidence limit. RESULTS: The prevalence of asymptomatic malaria parasitaemia was higher using intradermal smear (35.3% vs 33.3%) though this was not statistically significant. Intradermal smear had a sensitivity of 40% and specificity of 67%. The positive predictive value was 37.8% with accuracy rate of 58%. 41% of participants preferred the technique of collection of intradermal blood. CONCLUSION: Intradermal smear appears to have no usefulness in the detection of asymptomatic malaria parasitaemia in pregnancy. However, we recommend more studies on its value in pregnancy, especially amongst symptomatic pregnant women.

Chronic uterine inversion secondary to submucous fibroid: a case report.

A rare case of non-puerperal chronic uterine inversion secondary to sub mucous fibroid in a 38-year-old woman is presented. There was complete uterine inversion with the incarcerated inverted uterus protruding through the vvgina beyond the vulva. The sub mucous fibroid was attached to the fundus. At laparotomy, a dimple with a constriction ring was found in the position of the uterus. The distal ends of the fallopian tubes and part of the ovary were visible through the constriction ring. Histological examination of the uterus and fibroid following hysterectomy confirmed their benign nature.

The diagnostic accuracy of the rapid dipstick test to predict asymptomatic urinary tract infection of pregnancy.

Untreated urinary tract infection can have devastating maternal and neonatal effects. Thus, routine screening for bacteriuria is advocated. This study was designed to evaluate the diagnostic accuracy of the rapid dipstick test to predict urinary tract infection in pregnancy with the gold standard of urine microscopy, culture and sensitivity acting as the control. The urine dipstick test uses the leucocyte esterase, nitrite and test for protein singly and in combination. The result of the dipstick was compared with the gold standard, urine microscopy, culture and sensitivity using confidence interval for proportions. The reliability and validity of the urine dipstick was also evaluated. Overall, the urine dipstick test has a poor correlation with urine culture (p = 0.125, CI 95%). The same holds true for individual components of the dipstick test. The overall sensitivity of the urine dipstick test was poor at 2.3%. Individual sensitivity of the various components varied between 9.1% for leucocyte esterase and the nitrite test to 56.8% for leucocyte esterase alone. The other components of the dipstick test, the test of nitrite, test for protein and combination of the test (leucocyte esterase, nitrite and proteinuria) appear to decrease the sensitivity of the leucocyte esterase test alone. The ability of the urine dipstick test to correctly rule out urinary tract infection (specificity) was high. The positive predictive value for the dipstick test was high, with the leucocyte esterase test having the highest positive predictive value compared with the other components of the dipstick test. The negative predictive value (NPV) was expectedly highest for the leucocyte esterase test alone with values higher than the other components of the urine dipstick test singly and in various combinations. Compared with the other parameters of the urine dipstick test, singly and in combination, leucocyte esterase appears to be the most accurate (90.25%). The dipstick test has a limited use in screening for asymptomatic bacteriuria. The leucocyte esterase test component of the dipstick test appears to have the highest reliability and validity. The other parameters of the dipstick test decreases the reliability and validity of the leucocyte esterase test. A positive test merits empirical antibiotics, while a negative test is an indication for urine culture. The urine dipstick test if positive will also be useful in follow-up of patient after treatment of urinary tract infection. This is useful in poor resource setting especially in the third world where there is a dearth of trained personnel and equipment for urine culture.

Heterotropic pregnancy: a report of two cases.

Heterotropic pregnancy is reported infrequently in Nigeria. Two cases were managed within the span of five years with the successful delivery of a live term baby in one of the patients. A high clinical index of suspicion is required because an intra uterine gestation does not rule out a co-existing ectopic gestation especially in this region with high twinning rate and tubal disease

How useful is the Helen Keller food frequency chart in the determination of the vitamin A status in pregnancy?

Vitamin A deficiency sub clinical or overt, is associated with adverse maternal, fetal and neonatal outcome. This is also true for an excess of vitamin A. The challenge in pregnancy is to detect sub clinical vitamin A deficiency in patients for whom supplements or dietary manipulation will be of benefit. This was a cross sectional case controlled study at the University of Benin Teaching Hospital to compare the Helen Keller Food Frequency Chart with biochemical methods in the determination of vitamin A status in pregnancy. Data was collected from Antenatal patients (142). Using serum Biochemistry three categories of patient were recognized. Patients with normal vitamin A levels (N=100 women with blood vitamin A within two standard deviation of the mean) Twenty-four women (24) had low vitamin A levels (N=24, patients with blood vitamin A level at less than 2 standard deviation below the mean). Eighteen patients (18) had high vitamin A levels (patients with blood vitamin A levels at greater than two standard deviation above the mean). All recruited patients had a dietary assessment using the Helen Keller Food Frequency Chart. The Helen Keller Food Frequency Chart (HKFFC) was found to have a high degree of sensitivity (74.5%) and a high specificity (75%) in detection of patients with vitamin A deficiency. The positive predictive value was 93.62%. The low negative predictive rate of 37.5% however implies that a positive test is more important than a negative test. The HKFFC was unable to differentiate patients with normal or high vitamin A levels. Dietary assessment with the HKFFC is a cheap effective method to detect sub clinical vitamin A deficiency in pregnancy. It is an easy cost effective screening tool to select patients for whom dietary manipulation and or vitamin A supplementation may be beneficial.