Estimation of fetal weight: a comparison of clinical and sonographic methods.

Fetal weight estimation is important in the management of labour and delivery. This study aimed to compare the accuracy of the clinical and ultrasound methods of fetal weight estimation. This was a prospective study involving 110 term cephalic singleton pregnancies delivered within 24 hours of clinical fetal weight estimation using Johnson's and Dare's formulae and ultrasound estimation at a Tertiary hospital in Abakaliki, Nigeria. The data were analysed with Stata 11 software. The sonographic estimation within 10% of the actual birth weight (ABW) of 68.2% was significantly greater than the accuracy of Johnson's (23.6%), Dare's (26.4%), and the combined clinical formulae (27.1%). The clinical methods overestimated the fetal weight. Both methods showed a positive correlation with the ABW. In conclusion, the sonographic method had a better accuracy than the clinical methods. However, fetal weight overestimation by clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude fear of complications from macrosomia. Impact statement What is already known on this subject? An accurate estimation of fetal weight is important in the management of labour and delivery. However, there is limited evidence that any of the available methods of fetal weight estimation is more accurate than the others. What do the results of this study add? This study showed that the clinical methods using Johnson's and Dare's formulae had a significantly higher mean percentage and absolute mean percentage error compared to the sonographic estimation of fetal weight. The sonographic estimation within 10% of actual birth weight (ABW) of 68.2% was significantly greater than that of Johnson's and Dare's formulae with 23.6% and 26.4%, respectively. All of the methods showed a positive correlation with the ABW. What are the implications of these findings for clinical practice and/or further research? This implies that the sonographic method has a better accuracy than the clinical methods in estimating the fetal weight. However, the overestimation of fetal weight by the clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude the fear of complications from macrosomia.

Uterine rupture at a secondary hospital in Afikpo, Southeast Nigeria.

INTRODUCTION: Uterine rupture is an obstetric catastrophe that is associated with high maternal and perinatal mortality rates. Its incidence is high in developing countries. In Nigeria, the incidence of uterine rupture continues to increase due to poverty, illiteracy, ignorance, the lack of quality obstetric care and bad governance. METHODS: A retrospective review was conducted of all cases of ruptured uterus seen at the Mater Misericordiae Hospital in Afikpo, Nigeria between January 2001 and December 2007. RESULTS: There were a total of 51 ruptured uteri out of 4,361 deliveries, yielding a ratio of one in 86. A total of 19 (37.3 percent) patients had a scarred uterus, while 32 (62.7 percent) had an intact uterus, yielding a scarred to unscarred uterus ratio of one in 1.7. The mean maternal age was 32.0 years, and the mean parity was 3.4. Patients with a scarred uterus had a lower mean age and parity. 29 (56.9 percent) cases were unbooked, out of which seven (24.1 percent) had a scarred uterus. Obstructed labour (88.2 percent), grandmultiparity (27.5 percent) and abnormal lie (9.8 percent) were the main causes of rupture. 39 (76.5 percent) patients had their labour managed at home or by traditional birth attendants before presentation. 45 (88.2 percent) patients underwent uterine repair alone, five (9.8 percent) had uterine repair with bilateral tubal ligation and one (two percent) had a hysterectomy. Three maternal deaths occurred, yielding a case fatality rate of 5.9 percent. The perinatal mortality rate was 84.6 percent. CONCLUSION: Health education, the provision of quality obstetric care, improved governance and monitoring of the activities of traditional birth attendants may help to reduce the menace of uterine rupture.

Hysterosalpingographic findings in patients with infertility in South eastern Nigeria.

BACKGROUND: Hysterosalpingography (HSG) is still an integral part of gynecological evaluation of infertile couple and its value has not been underestimated in modern gynecological practice, especially in developing countries. The study aims to evaluate the findings at HSG in patients presenting with infertility at the Ebonyi State University Teaching Hospital, Abakaliki, Southeastern Nigeria. METHODOLOGY: A retrospective analysis of 100 consecutive HSG results of patients presenting with infertility was done between January 2005-April 2008. Their clinical records and radiological findings were analyzed for demographic data, and cervical, uterine and tubal, pathology. RESULTS: The commonest age group was between 25 -34 years. Sixty-five percent presented with secondary infertility while 35% presented with secondary infertility. Hysterosalpingographic findings were abnormal in 80% of patients (primary infertility 20% and secondary infertility 60%). Bilateral tubal blockage and bilateral fimbrial adhesion were the commonest tubal factor abnormalities while intracavitary mass impression and cervical synechia were the commonest findings for uterine and cervical factor abnormalities respectively. CONCLUSION: Tubal blockage and tubal factor infertility are still common among infertile couples. This may probably be due to chronic pelvic inflammatory disease or pelvic infection following sexually transmitted infections, mismanaged pregnancies and septic abortions, as most of the patients presented with secondary infertility. Measures to prevent the occurrence of these infections are highlighted.

Hysterosalpingographic Findings in Patients with Infertility in South Eastern Nigeria

Background:Hysterosalpingography (HSG) is still an integral part of gynecological evaluation of infertile couple and its value has not been underestimated in moderngynecological practice; especially in developing countries. The study aims to evaluate the findings at HSG in patients presenting with infertility at the Ebonyi State University Teaching Hospital;Abakaliki; Southeastern Nigeria. A retrospective analysis of 100 consecutive HSG results of patients presenting with infertility was done between January 2005-April 2008. Their clinical records and radiological findings were analyzed for demographic data; and cervical; uterine and tubal; pathology. Results: The commonest age group was between 25 -34 years. Sixty-five percent presented with secondary infertility while 35presented with secondary infertility. Hysterosalpingographic findings were abnormal in 80of patients (primary infertility 20and secondary infertility 60). Bilateral tubal blockage and bilateral fimbrial adhesion were the commonest tubal factor abnormalities while intracavitary mass impression and cervical synechia were the commonest findings for uterine and cervical factor abnormalities respectively. Conclusion:Tubal blockage and tubal factor infertility are still common among infertile couples. This may probably be due to chronic pelvic inflammatory disease or pelvic infection following sexually transmitted infections; mismanaged pregnancies and septic abortions; as most of the patients presented with secondary infertility. Measures to prevent the occurrence of these infections are highlighted

Hysterosalpingographic Findings in Patients with Infertility in South Eastern Nigeria

Hysterosalpingography (HSG) is still an integral part of gynecological evaluation of infertile couple and its value has not been underestimated in modern gynecological practice; especially in developing countries.The study aims to evaluate the findings at HSG in patients presenting with infertility at the Ebonyi State University Teaching Hospital;Abakaliki; Southeastern Nigeria. A retrospective analysis of 100 consecutive HSG results of patients presenting with infertility was done between January 2005-April 2008. Their clinical records and radiological findings were analyzed for demographic data; and cervical; uterine and tubal; pathology.The commonest age group was between 25 -34 years. Sixty-five percent presented with secondary infertility while 35presented with secondary infertility. Hysterosalpingographic findings were abnormal in 80of patients(primary infertility 20and secondary infertility 60). Bilateral tubal blockage and bilateral fimbrial adhesion were the commonest tubal factor abnormalities while intracavitary mass impression and cervical synechia were the commonest findings for uterine and cervical factor abnormalities respectively. Tubal blockage and tubal factor infertility are still common among infertile couples. This may probably be due to chronic pelvic inflammatory disease or pelvic infection following sexually transmitted infections; mismanaged pregnancies and septic abortions; as most of the patients presented with secondary infertility. Measures to prevent the occurrence of these infections are highlighted

Prevalence of malaria parasitaemia and malaria related anaemia among pregnant women in Abakaliki, South East Nigeria.

BACKGROUND: Malaria currently is regarded as the most common and potentially the most serious infection occurring in pregnancy in many sub Saharan African countries. This study was undertaken to evaluate the prevalence of malaria parasitaemia and malaria related anaemia among pregnant women in Abakaliki, South East, Nigeria. MATERIALS AND METHODS: This is a cross sectional, descriptive study conducted in two tertiary health institutions in Abakaliki, South East, Nigeria (Ebonyi State University Teaching Hospital And Federal Medical Centre). Using systematic sampling method, 193 pregnant women were selected from the health institutions for the study. Their blood were analysed for haemoglobin status and malaria parasite. Data were also collected using an interviewer administered questionnaire. All the data were analysed using Epi info version 6 statistical software. RESULTS: Response rate was 100%. Twenty nine percent prevalence of malaria parasitaemia was detected, more common among primigravidae. Women with higher parity had higher frequency of anaemia in pregnancy. More than half of the pregnant women (51%) were in their second trimester at the time of booking. There was no case of severe anaemia requiring blood transfusion. CONCLUSION: Our pregnant women register late for antenatal care. Prevalence of malaria parasitaemia is high in our environment as well as anaemia in pregnancy, using the standard WHO definition. It is suggested that effort should be intensified to make our women register early for antenatal care in order to identify complications early. Intermittent preventive treatment for malaria should be incorporated into routine drugs for antenatal women.

Obstetric indices at the Ebonyi State University Teaching Hospital, Abakaliki, South East Nigeria.

BACKGROUND: Some vital health statistics are usually necessary in planning and execution of certain health policies and programmes. This is especially important in an obstetric unit where reduction of maternal and perinatal mortality have become yardstick for achieving some aspects of the Millennium Development Goal. Nigeria. METHOD: A review of Obstetric records in the Department of Obstetrics and Gynaecology EBSUTH, Abakaliki, over a three-year period (January 2001-December 2003 was done. RESULTS: A total 1660 deliveries were conducted during the review period. Of these, 82.2% were registered for antenatal care. Caesarean section rate was, 17.8%, instrumental deliveries 2.1% while 0.5% had destructive operations. Teenage pregnancy and grandmultiparity accounted for 6.0% and 15% respectively. Sixteen Percent of the babies were of low birth weight while 4.5% were macrosomic. Maternal mortality ratio and perinatal mortally rate were 3,392 per 100,000 and 86.3 per 1,000 respectively CONCLUSION: Some of the vital obstetric indices were still within the range comparable to other centers. Grandmultiparity contributed a significant proportion of the cases and this calls for aggressive family planning campaigns. Maternal and perinatal mortality rates were outrageous. It is suggested that periodic review of some vital obstetric indices will pinpoint priority areas and help health policy makers and implementers provide the basic rudiments of safe motherhood initiative to our women.

Obstetric Indices at The Ebonyi State University Teaching Hospital; Abakaliki; South East

Background: Some vital health statistics are usually necessary in planning and execution of certain health policies and programmes. This is especially important in an obstetric unit where reduction of maternal and perinatal mortality have become yardstick for achieving some aspects of the Millennium Development Goal. Nigeria. Method: A review of Obstetric records in the Department of Obstetrics and Gynaecology; EBSUTH; Abakaliki; over a three-year period (January 2001-December 2003 was done. Results: A total 1660 deliveries were conducted during the review period. Of these; 82.2were registered for antenatal care. Caesarean section rate was; 17.8; instrumental deliveries 2.1while 0.5had destructive operations.. Teenage pregnancy and grandmultiparity accounted for 6.0and 15respectively. Sixteen. Percent of the babies were of low birth weight while 4.5were macrosomic. Maternal mortality ratio and perinatal mortally rate were 3;392 per 100;000 and 86.3 per 1;000 respectively. Conclusion: Some of the vital obstetric indices were still within the range comparable to other centers. Grandmultiparity contributed a significant proportion of the cases and this calls for aggressive family planning campaigns. Maternal and perinatal mortality rates were outrageous. It is suggested that periodic review of some vital obstetric indices will pinpoint priority areas and help health policy makers and implementers provide the basic rudiments of safe motherhood initiative to our women

Physical and psychological sequelae of female genital mutilation: a case report.

BACKGROUND: One harmful traditional practice that has resisted change in many African countries is female genital mutilation (FGM), otherwise known as female circumcision. This is usually associated with many complications. This report highlights a combination of physical and psychological sequelae associated with female circumcision. METHOD: Case-note of a patient managed for complications of female genital mutilation was used with a review of the relevant literature. RESULT: A 17-year old, married, illiterate farmer who had complete labial fusion following circumcision is presented. She had a total of six failed repairs, with psychological trauma, prior to her presentation in this hospital. A successful vulval reconstructive surgery was preformed and she was able to start a normal life with her husband. CONCLUSION: FGM carries very high morbidity. All supporters [corrected] of reproductive health should initiate programmes to stop this harmful and dehumanizing practice.

Rising trends in caesarean section rates: an issue of major concern in Nigeria.

BACKGROUND: Caesarean section rates have been on the increase for the past decades. Reasons for this increase and the danger it portends, especially in developing countries, are evaluated. METHOD: Literature on caesarean sections performed in various centres in Nigeria and Western countries were retrieved through manual library search. RESULTS: There has been a progressive rise in caesarean section rates from the 1970s up to 2002, from 9.4% to 34.6%. Measures to reduce this rising rates were discussed. CONCLUSION: There is great need to reduce the caesarean section rate in Nigeria. There should be a clear and unquestionable indication for caesarean section in any patient.

Ruptured advanced tubal ectopic pregnancy simulating uterine rupture: a case report.

BACKGROUND: Ectopic pregnancy is one of the most critical and life-threatening emergencies in gynaecological practice and poses a diagnostic dilemma in advanced cases. This report highlights a case of ruptured advanced tubal ectopic pregnancy simulating uterine rupture. METHOD: Case-note of a patient managed for ruptured advanced tubal ectopic pregnancy was used with a review of the relevant literature. RESULT: A 24-year old primigravida who presented at 23 weeks gestation with signs and symptoms suggestive of ectopic pregnancy is presented. The advanced nature of the pregnancy posed a diagnostic dilemma as ruptured uterus shares the same characteristic dramatic presentation, especially in this patient with previous myomectomy. Prompt resuscitation and immediate laparotomy produced a good outcome. CONCLUSION: High index of suspicion is important in the diagnosis of ectopic pregnancy. Even when diagnosis is in doubt, exploratory laparotomy may be life saving.

Contraceptive use at the family planning clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria.

During the five year review period (January 1993-December 1997), 19,470 clients visited the family planning clinic of the University of Nigeria Teaching Hospital, Enugu. Of these, 2402 clients (12%) were new patients and 17,068 (88%) were old patients. Among the new clients, 2262 (94%) eventually accepted a contraceptive method. The majority of the women (60%) chose the intrauterine contraceptive device (IUCD), 20% chose the injectables, while bilateral tubal ligation and norplant were chosen by 8% and 7%, respectively, of the clients. The oral contraceptive pill was the least popular (1%). Variations in the pattern of contraceptive use among clients at the family planning clinic were discussed. Measures to increase the contraceptive prevalence, and particularly strategies to meet the specific contraceptive needs of clients at the clinic, were also examined.