Clinical significance of low serum magnesium in pregnant women attending the University of Benin Teaching Hospital.

OBJECTIVE: Magnesium level is known to decline during pregnancy. A suggested role for magnesium deficiency in conditions like pre-eclampsia and pre-term birth has prompted studies with conflicting evidence. The primary objective of this study was to determine the prevalence of hypomagnesemia in pregnancy, while the secondary objectives attempted to define maternal and fetal outcome due to hypomagnesemia. SUBJECTS AND METHODS: A pilot study was performed to determine the mean serum magnesium level for the population of female patients attending the University of Benin Teaching Hospital. The result of the pregnant population in the pilot study was used as a reference for hypomagnesemia in this study. Thereafter, a prospective cohort study of antenatal women recruited in the second trimester and followed-up till delivery and 1 week post-partum was done. Serum magnesium estimates were done with samples collected at recruitment and delivery. The magnesium levels determined at recruitment were used to divide the subjects into two groups of hypomagnesemic and normomagnesemic patients. Their sociodemographic and clinical characteristics were used to generate a database for analysis. RESULTS: The prevalence of magnesium deficiency was 16.25%. Hypomagnesemia was significantly correlated with the occurrence of pre-eclampsia ( P = 0.011), leg cramps ( P = 0.000) and pre-term birth ( P = 0.030). A logistic regression analysis showed that hypomagnesemia had an Odds ratio of 22 for pre-eclampsia. There was no maternal mortality or early neonatal death. CONCLUSION: Pre-eclampsia and pre-term birth are associated with hypomagnesemia in pregnancy; hence, magnesium supplementation or magnesium-rich diet consisting of green leafy vegetables, soy milk and legumes may improve outcome.

Pattern and risk factors for partner infection with hepatitis B virus in a prevention of mother-to-child transmission programme.

BACKGROUND: Hepatitis B virus (HBV) infection is horizontally and vertically transmitted. It is associated with high morbidity and mortality but is preventable with vaccine. There is paucity of data on pattern and risk factors for partner infection in prevention of mother-to-child transmission (PMTCT) programmes. OBJECTIVE: To determine the pattern and risk factors for partner infection with HBV in a PMTCT Programme. METHODS: This cross-sectional study evaluated the hepatitis B surface antigen (HBsAg) serostatus of partners of HBV-infected pregnant women in a PMTCT programme using rapid, third generation immunochromatographic test. Repeatedly reactive samples were confirmed using enzyme-linked immunosorbent assay. Patients' sociodemographic characteristics and behavioral risk factors were evaluated against their HBsAg-serostatus. The seropositive and seronegative subjects had liver function tests HBV vaccination respectively. RESULTS: Out of 3,907 pregnant women seen, 3,762(96.3%) and 73 (45.3%) partners of 161 HBV-infected women were screened. The HBsAg seroprevalence among the women and partners were 161(4.3%) and 5(6.8%) respectively; p<0.43. The sero-concordance and discordance were 6.8% and 93.2% respectively. Nulliparity (60.9%) associated with non-protective pre-marital sex and induced abortions (58.4%), history of blood transfusion (6.7%) and lack of vaccination (93.6%) were risk factors for HBV-infection. CONCLUSION: This study has revealed high prevalence of HBV infection among the couples and high serodiscordance rate. The risk factors for HBV infection were preventable. We recommend integration of couple counseling and testing backed with vaccination into antennal care services nationwide. Further study is required to assess the serostatus of female partners' of HBV-infected males to determine HBV feminization.

Clinical Significance of Low Serum Magnesium in Pregnant Women Attending the University of Benin Teaching Hospital

Objective: Magnesium level is known to decline during pregnancy. A suggested role for magnesium deficiency in conditions like pre-eclampsia and pre-term birth has prompted studies with conflicting evidence. The primary objective of this study was to determine the prevalence of hypomagnesemia in pregnancy; while the secondary objectives attempted to define maternal and fetal outcome due to hypomagnesemia.Subjects and Methods: A pilot study was performed to determine the mean serum magnesium level for the population of female patients attending the University of Benin Teaching Hospital. The result of the pregnant population in the pilot study was used as a reference for hypomagnesemia in this study. Thereafter; a prospective cohort study of antenatal women recruited in the second trimester and followed-up till delivery and 1 week post-partum was done. Serum magnesium estimates were done with samples collected at recruitment and delivery. The magnesium levels determined at recruitment were used to divide the subjects into two groups of hypomagnesemic and normomagnesemic patients. Their sociodemographic and clinical characteristics were used to generate a database for analysis.Results: The prevalence of magnesium deficiency was 16.25. Hypomagnesemia was significantly correlated with the occurrence of pre-eclampsia (P = 0.011); leg cramps (P = 0.000) and pre-term birth (P = 0.030). A logistic regression analysis showed that hypomagnesemia had an Odds ratio of 22 for pre-eclampsia. There was no maternal mortality or early neonatal death.Conclusion: Pre-eclampsia and pre-term birth are associated with hypomagnesemia in pregnancy; hence; magnesium supplementation or magnesium-rich diet consisting of green leafy vegetables; soy milk and legumes may improve outcome

Delivery rate in Benin City, Nigeria: are there seasonal variations?

OBJECTIVE: To determine if there are monthly variations in the rate of deliveries in Benin City, Nigeria. MATERIALS AND METHODS: A retrospective descriptive study carried out in the three major obstetric centers in Benin City, Nigeria. We extracted the total number of deliveries from the hospitals' records for over a five-year period and analyzed the figures for monthly variation in delivery rates. This was repeated for a standardized 30-day month and the findings noted. RESULTS: There were 28,686 deliveries during the study period with an average monthly delivery of 2,390. The monthly distribution showed a sinusoidal pattern with peak delivery rates in April-May and October and lowest rates in July-August and December. The months of April, May, and October had delivery rates that were significantly higher than the monthly average delivery rate, while the converse was true for July, August, and December at the 99% confidence interval. CONCLUSIONS: There exists a significant monthly variation in delivery rates in Benin City. This finding will prove valuable in health system planning and in the interpretation of seasonal variations in other reproductive parameters.

Plasma vitamin C levels and risk of preterm prelabour rupture of membranes.

PURPOSE: Preterm prelabour rupture of membranes (PPROM) is a leading cause of preterm births. Its attendant contribution to maternal and perinatal morbidity and mortality makes it imperative to identify factors that may help prevent this condition. This study examined the association between plasma vitamin C concentration and the risk of (PPROM) amongst pregnant women in a tertiary hospital setting. METHODS: This was a prospective cross sectional study conducted at the Obstetric and Gynaecology Department of University of Benin Teaching Hospital (UBTH), Benin City. The study was in two phases, first a pilot study to determine baseline plasma vitamin C concentration amongst pregnant women in UBTH was conducted. In the main study 80 pregnant women were recruited into two groups of those with PPROM (40 cases) and those without PPROM (40 controls) matched for gestational age. Plasma vitamin C concentration was determined for all study participants and their sociodemographic characters were used to generate a database for analysis. RESULTS: In the pilot study, plasma vitamin C concentration decreased with increasing gestational age of pregnancy. In the main study plasma vitamin C concentration was significantly lower in women with PPROM than controls without PPROM, 0.53 ± 0.05 vs. 0.58 ± 0.05 mg/dl; P = 0.0001. Both groups (case and control) were comparably matched in age, parity and social class. There was a significant association between low vitamin C levels and the occurrence of PPROM (95% CI 1.53-11.88; P = 0.008). CONCLUSION: Plasma vitamin C was found to be lower in women with PPROM. Low plasma vitamin C concentration may thus be an associated risk factor for PPROM. Hence improved dietary or drug supplements may be a useful adjunctive strategy to reducing the incidence of PPROM and its attendant adverse sequelae. While this intervention is advocated, further multicentre investigation of the effects of vitamin C on risk of preterm PROM is suggested.

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

Plasmodium falciparum malaria in pregnancy: prevalence of peripheral parasitaemia, anaemia and malaria care-seeking behaviour among pregnant women attending two antenatal clinics in Edo State, Nigeria.

SUMMARY: This study evaluated malaria care-seeking behaviour, as well as the prevalence of parasitaemia and anaemia among pregnant women attending antenatal clinics of two tertiary healthcare facilities in Edo State, Nigeria. Malaria was highly prevalent in the study group (20% by microscopy and estimated 25% by PCR), but parasitaemia and incidence decreased with increasing number of pregnancies. Although the level of education of the study participants was relatively high, antimalarial control measures during pregnancy were found to be poorly utilised by the women and malaria care-seeking was often delayed. A minority of the interviewed pregnant women said they had received sulphadoxine/pyrimethamine-based intermittent preventive therapy (IPT) during current pregnancy. Moreover, the use of inferior antimalaria treatment (e.g. chloroquine) was frequent. The majority of the pregnant women, mainly primigravidae, were anaemic. Efforts to improve antimalaria healthcare must be intensified, targeting pregnant women, particularly the primigravidae and secundigravidae and the healthcare providers.

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.

The effect of endometrial thickness on in vitro fertilization (IVF)-embryo transfer/intracytoplasmic sperm injection (ICSI) outcome.

The value of measuring the endometrial thickness and studying the endometrial receptivity in the context of assisted conception remains a contentious issue. A prospective analysis was carried out to determine the effect of endometrial thickness on IVF - embryo transfer/ICSI outcome in dedicated Assisted Reproductive Technology (ART) units in Abuja and Rivers State, Nigeria. Two hundred and fifty one patients who met the inclusion criteria were analysed. They were grouped on the basis of endometrial thickness into 3 groups; <7 mm, 7 - 14 mm and >14 mm. The main outcome measure was clinical pregnancy. There were significantly more pregnancies in the 7 - 14 mm endometrial thickness group compared to the <7 mm and >14 mm groups, p=0.004 and p<0.0001 respectively. The findings suggest that following IVF/ICSI, significantly more pregnancies occurred when the endometrial thickness was between 7 and 14 mm.

Tubal factor infertility in Benin City, Nigeria - sociodemographics of patients and aetiopathogenic factors.

In Africa, infertility constitutes a major gynaecological complaint and causes enormous socio-psychological stress to the patients. This study examined retrospective data at the University of Benin Teaching Hospital, Benin City, Nigeria, over a 5-year period to determine the factors associated with tubal infertility. Tubal infertility was confirmed in 13.5% of the 1181 new cases of infertility over the study period. The mean age of the patients was 33.2+/-9.5 years. Over 65% were nulliparous and all socioeconomic classes were affected. Major associated factors included infections such as post-abortal sepsis, puerperal sepsis and pelvic inflammatory disease (PID). Infertility is largely preventable. Attention should be focused on reducing the incidence of unsafe abortion and its consequences, providing clean and safe delivery as well as reducing the incidence of and ensuring proper treatment of any cases of PID. Infertility is largely preventable. Attention should be focused on reducing the incidence of unsafe abortion and its consequences, providing clean and safe delivery as well as reducing the incidence of and ensuring proper treatment of any cases of PID.

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.

Management of symptomatic cholelithiasis in pregnancy.

BACKGROUND: Symptomatic cholelithiasis occurs in pregnancy in our patient population, some of whom are diabetic. But its management remains controversial. How common is the problem? Is our current policy of management appropriate for our patients? PATIENTS AND METHODS: The management of 162 pregnant patients admitted over a ten-year period with symptomatic cholelithiasis was evaluated in a retrospective study. The patients were divided into two groups: Group A, 58 patients with diabetes mellitus, and Group B, 104 nondiabetic patients. RESULTS: Symptomatic cholelithiasis occurred in only 0.3% of our pregnant patients. Of 162 patients, 148 (91.4%) had successful conservative (nonsurgical) management. There was no fetal loss, premature birth, maternal morbidity or mortality. Fourteen patients who had failure of conservative treatment had surgical management. When the postpartum cholecystectomy hospitalization days were added to the total days of admission for the nonoperative cases, there was a significant difference in the mean total number of days of hospitalizations between the surgical cases, 12.4 days, and the nonsurgical cases, 20.5 days (P<0.001), but not in the mean number of hospitalizations, 2.3 versus 3.3. CONCLUSION: Our current policy of conservative management seems optimal. It has, however, been achieved at the price per patient of 8 extra days of hospitalization. In keeping with recent improvements in surgery and the advent of laparoscopic surgery, a more cost-efficient approach would suggest a more aggressive policy.

Carcinoma of the cervix: aspects of clinical presentation and management in Benin City.

Carcinoma of the cervix is the most common gynecological cancer in Benin City. Late presentation, poverty and grand multiparity featured prominently. Multiplicity of sexual partners was rather uncommon.

Antimicrobial properties of amniotic fluid from some Nigerian women.

Fifty-one amniotic fluids were aspirated via the vaginal route from 51 pregnant Nigerian mothers. Their antimicrobial activity was tested against Staphylococcus aureus, Escherichia coli and Candida albicans. Inhibition rates were 39.2% for Staph. aureus 19.6% for E. coli and 41.2% for C. albicans. The overall inhibitory capacity was 64.7%. Sixteen fluids (31.4%) were active against one organism, three fluids (5.9%) were active against two organisms and one fluid (2%) was active against the three organisms. Age, parity and meconium-staining of liquor had no correlation with antimicrobial properties. The possible explanations for these are given.

Incidence of penicillinase producing Neisseria gonorrhoeae (PPNG) strains and susceptibility of gonococcal isolates to antibiotics in Benin City, Nigeria.

Of 53 strains of Neisseria gonorrhoeae isolated in Benin City, Nigeria, in February 1983 to October 1984, 46 (87%) produced penicillinase. The minimum inhibitory concentrations (MICs) of penicillin G and ampicillin for these isolates were between 1 mg/l and and 50 mg/l. About 48% (22/46) of the penicillinase producing strains were also resistant to streptomycin, cotrimoxazole, and ampicillin and cloxacillin. All 53 isolates were sensitive to tetracycline, erythromycin, amoxycillin and clavulanic acid, nalidixic acid, spectinomycin, and the penicillinase stable cephalosporins. The high incidence of resistance may have been the result of indiscriminate and unsupervised use of antibiotics before patients presented for proper treatment in clinics and hospitals.

Intestinal injuries following induced abortion.

Sixteen cases of intestinal injuries following illegally induced abortion are reviewed. They constituted 2% of all such cases in the study period. Ten were terminal ileal injuries while six were colonic. Colonic injuries were predominantly encountered in the first trimester. The relative fixity of the terminal ileum and pelvic colon may be a factor in the determination of the site of injury. Morbidity and mortality are related to both gestational age and site of injury.

PIP: 16 cases of intestinal injuries following illegally induced abortion are reviewed. The constituted 2% of all such cases in the study period. 10 were terminal ileal injuries while 6 were colonic. Colonic injuries were predominantly encountered during the 1st trimester. The relative fixity of the terminal ileum and pelvic colon may be a factor in the determination of the site of injury. Morbidity and mortality are related to both gestational age and site of injury.

Severe road traffic injuries in the third trimester of pregnancy.

We report 9 women in the third trimester of pregnancy who were severely injured in road traffic accidents. There were 3 accelerated labours and half the babies died. Immediate obstetric interference was often impractical and did not improve fetal survival. Noteworthy injuries of the central nervous system were associated with very high fetal mortality. Fractures of the pelvis were not nearly as disastrous as the literature suggests. The first consideration in management should be the well being of the severely injured mother, since the injuries that would kill the fetus are not likely to be amenable to surgery. The only justification for intervention for the sake of the fetus that survives the moment of impact is to salvage it from its dying mother's body.