Cervicovaginal fluid beta human chorionic gonadotropin assay as an early predictor of spontaneous preterm delivery among antenatal patients

BACKGROUND: The aim of this study was to assess the usefulness of the beta subunit of hCG in cervicovaginal secretions as a biochemical predictor of spontaneous preterm delivery among pregnant women with and without preterm delivery risk.DESIGN: This was an eight-month prospective case control study of pregnant women with or without risk factors for preterm delivery. SETTING: Ifako- Ijaye General Hospital Lagos/ Lagos State University Teaching Hospital, Ikeja Lagos Nigeria. PARTICIPANTS: 150 pregnant women which consisted of 50 cases with preterm delivery risk and 100 controls without preterm delivery risk. INTERVENTIONS: A structured interviewer administered questionnaire which had been pretested, was used to collect data. Two cervicovaginal fluid samples at 26 weeks and 32 weeks were collected from each of the participants and it was quantitatively assayed using ELISA for presence of beta hCG. The participants were followed up till delivery. RESULTS: 15 participants out of the 50 cases delivered their babies preterm, while only 2 participants out of the 100 controls had preterm delivery. The 15 cases who delivered preterm had significant increase in their mean beta HCG value from 7.44±1.74 at 26 weeks to 32.6±1.32 at 32 weeks with p value<0.001. There was however no statistical difference in the mean beta HCG at 26 weeks and at 32 weeks for the control group. CONCLUSION: The concentration of beta HCG in the cervicovaginal fluid is a useful early predictor of preterm delivery especially among patients with risk factors.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Delays in presentation and management of ovarian cancer in Lagos, Nigeria.

This study highlights the extent of delays in the presentation and management of ovarian cancer at the Lagos State University Teaching Hospital. A total of 37 histologically confirmed epithelial ovarian cancer cases managed from January 2004 to December 2008 were analysed. The time interval between onset of symptoms and seeking healthcare, was 36.1 ± 40.8 weeks; between seeking healthcare and referral to tertiary hospital, was 22.7 ± 30.4 weeks; and the overall time interval from onset of symptoms to presentation for definitive care, was 52.0 ± 51.8 weeks. Private hospitals (35.1%) and herbal homes (21.6%) were the commonest facilities first visited. A total of 32 (86.5%) of the patients presented in stages III and IV. The overall compliance rate for recommended chemotherapy was 11.1%. Ovarian cancer in Lagos, Nigeria is characterised by patient-related delays in presentation, provider-related delays in referrals and poor compliance with recommended chemotherapy.

The understanding and acceptability of assisted reproductive technology (ART) among infertile women in urban Lagos, Nigeria.

This descriptive study was carried out to assess the awareness and acceptability of Assisted Reproductive Technology (ART) among infertile women in Lagos, Nigeria. Self-administered questionnaires on the knowledge of ART in the women were used. After a brief exposé on ART, questions relating to their attitude were answered. A total of 166 women were studied. Only 51.8% had any knowledge of ART and most of these had poor knowledge. A total of 137 women would embrace ART if offered but 29 would not, for reasons such as religion, fear of side-effects, failure and unaffordable costs. There is a paucity of good knowledge of ART. A significant number of the women would consider ART if offered. There is thus a need to create more awareness about the possibilities offered by ART, as well as instituting low cost ART strategies in developing world countries.

Pattern of genital tract abnormalities on hysterosalpingography in infertile patients in ikeja, Nigeria.

Structural abnormalities of the female genital tract, whether congenital or acquired could result in infertility or reproductive failure. This study retrospectively analysed the structural abnormalities found in patients who had hysterosalpingography in the Lagos State University Teaching Hospital (LASUTH), Ikeja. A descriptive analysis of structural abnormality of the uterine cavity, fallopian tube and the cervical canal in two hundred and fifty patients, who were referred from the gynaecology clinic to the Radiology Department of LASUTH, from January to December 2005, is presented. The commonest abnormality seen was tubal blockage (56.8%) whether unilateral or bilateral. Filling defects (16%) were seen within or outside the uterus, causing irregularity of its wall. These could be due to fibroids, endometrial polyps or fibrous tissue causing adhesions. Cervical canal (19.8%) abnormalities were also noted. Only two cases of congenital anomalies were seen. We found that hysterosalpingography is a relatively cheap and easy mode of diagnosing structural anomalies of the genital tract such as fibroids and tubal pathologies.

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria.

This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15 +/- 2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p = 0.00043). Majorities' first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks.

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria

This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15±2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p=0.00043). Majorities' first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks. (Afr J Reprod Health 2008; 12[2]:89-97)

Efficacy of visual inspection of the cervix using acetic acid in cervical cancer screening: a comparison with cervical cytology.

Screening programmes for the early detection of premalignant lesions of the cervix are expensive and technically difficult, especially in resource-challenged settings. There is a need for cheaper and equally effective alternative screening methods. This study compared the efficacy of visual inspection of the cervix using acetic acid (VIA) with the Pap smear method. A total of 186 subjects had a Pap smear followed by visual inspection of the cervix using 3 - 5% acetic acid with biopsies taken from suspicious acetowhite positive lesions. Cases of abnormal cytology were recalled for biopsies. A total of 150 subjects were negative for both tests; 30 (16.2%) were positive for VIA, while six were positive for both VIA and Pap smear. VIA detected one lesion missed by Pap smear on biopsy. The sensitivity of VIA was 100%, while that of Pap smear was 85.7%. The negative predictive value of VIA was 100%, while the positive predictive value was 20%. The sensitivity of VIA equals the reported rates for Pap smear. VIA is proposed as a credible alternative to Pap smear in resource-challenged settings.

Uterine artery ligation for management of uterine fibroids.

OBJECTIVE: To determine the efficacy of uterine artery ligation by the vaginal route for the management of symptomatic uterine fibroids. A pilot study had suggested that the procedure was effective. METHODS: After bilateral uterine artery ligation, ultrasonic measurements of uterine and fibroid volumes were determined at 6 and 12 months in 21 women (age, 31-49 years) with symptomatic fibroids. The severity of symptoms was assessed preoperatively and postoperatively. RESULTS: Mean uterine and fibroid volumes were significantly reduced at 6 and 12 months. A consistent pattern of decreased duration of menstrual blood flow was recorded. All participants who completed follow-up expressed satisfaction with treatment outcome. CONCLUSION: The procedure was found to be a safe, inexpensive, and effective therapeutic option for the treatment of symptomatic uterine fibroids.