Volume regulatory hormones and plasma volume in pregnant women with sickle cell disorder.

BACKGROUND: Sickle cell disease (haemoglobin SS (HbSS)) mainly affects those of West African origin and is associated with hypervolaemia. Plasma volume rises by up to 50% in normal pregnancy but was previously found to be paradoxically contracted in late sickle cell pregnancy. The renin-angiotensin-aldosterone system is activated very early in human pregnancy to support the plasma volume expansion. We hypothesised that activation of the renin-angiotensin-aldosterone system would be blunted in pregnant women with sickle cell disease. MATERIALS AND METHODS: We measured plasma volume and concentrations of plasma renin, angiotensinogen, aldosterone and other volume-related hormones in a cross-sectional study of pregnant and non-pregnant Nigerian women with HbSS or HbAA. RESULTS: Plasma volume was higher in non-pregnant HbSS than HbAA women, but had not risen by 16 weeks, unlike plasma volume in HbAA women. The concentration of plasma renin also rose significantly less by 16 weeks in HbSS; angiotensinogen and aldosterone concentrations increased. CONCLUSIONS: The lower plasma renin concentration at 16 weeks with HbSS could be either primary or secondary to vasoconstriction related to inadequate vasodilator activity. The contracted plasma volume might then stimulate aldosterone synthesis by non-angiotensin II dependent stimulation. Studies of vasodilators such as nitric oxide, vasodilator eicosanoids or the PlGF/VEGF/sFlT-1 axis in pregnant HbSS and HbAA women will test this hypothesis.

Risk factors for ectopic pregnancy in Lagos, Nigeria.

BACKGROUND: Ectopic pregnancy is an important cause of maternal deaths in Nigeria and in other developing countries. In Lagos, Nigeria, it is responsible for 8.6% of maternal deaths, and has a case fatality rate of 3.7%. The purpose of this study was to determine the risk factors for ectopic pregnancy in Lagos. METHODS: A case-control study of 100 patients and 280 controls was performed in the three hospitals--Lagos University Teaching Hospital, Ayinke House Maternity Hospital, and Lagos Island Maternity Hospital--in Lagos from June 1999 to December 1999. Data were analyzed by using logistic regression. RESULTS: The incidence was 23.1/1000 (1 : 43) deliveries and was responsible for 48.5% of gynecologic emergencies. Age, marital status, socioeconomic status, and parity were not the significant risk factors for ectopic pregnancy. An early age of sexual debut increased the risk of ectopic pregnancy almost two-fold (adjusted OR = 1.93; 95% CI = 1.71-2.93), whereas a late age of sexual debut was protective (adjusted OR = 0.37; 95% CI = 0.19-0.59). History of multiple lifetime sexual partners, induced abortions, pelvic inflammatory disease, sexually transmitted disease (STD), miscarriage, and pelvic surgery independently and significantly increased the risk of ectopic pregnancy. Induced abortion and STD increased the risk 14-fold and nine-fold, respectively. Previous use of intrauterine contraceptive device increased the risk almost four-fold (adjusted OR = 3.76; 95% CI = 2.12-6.69), whereas the use of condoms was protective (adjusted OR = 0.35; 95% CI = 0.17-0.71). CONCLUSIONS: Proper sex education, prevention of unwanted pregnancy, and prevention and proper treatment of sexually transmitted infections will reduce the incidence of ectopic pregnancy.

Prevalence of HIV among women with vaginal discharge in a gynecological clinic.

OBJECTIVE: Vaginal discharge is a common complaint among women with sexually transmitted diseases (STDs) in Nigeria. Given the association between STDs and HIV and the alarming rise in the prevalence of HIV in Nigeria, we performed this study to determine the prevalence of HIV in patients with vaginal discharge. STUDY DESIGN: Between April 2000 and August 2000, women who attended the Lagos University Teaching Hospital and complained of vaginal discharge were adequately counseled for HIV serotest. High vaginal/endocervical swabs and venous blood were taken for microbiological studies and HIV serotest, respectively. RESULTS: Out of the 230 women counseled for HIV serotest 140 (60.9%) consented. The mean age of the 140 was 31.1+/-6.9 years (range 18-50 years). In 31 (22.1%), Candida albicans was isolated, in 26 Gardnerella vaginalis (18.8%), in 17 Staphylococcal spp. (12.1%); and E. coli, Trichomonas vaginalis, and Neisseria gonococcus in 7.9%, 4.3%, and 1.4%, respectively. Four (2.9%) of the 140 patients were HIV seropositive, and all had Candida albicans isolated. The prevalence of HIV among patients with Candida albicans was 12.9%. Association between HIV seropositivity and Candida albicans infection is significant (X2=14.48; p=0.002). CONCLUSION: Candida albicans is a common cause of vaginal discharge among HIV-seropositive women in Lagos.

Cervical cytology in an urban population in Lagos, Nigeria.

Eight hundred and eighty-four consecutive women had cervical smears in a clinic in Lagos, Nigeria between September 1998 and 31 August 1999. Mean age was 36.6 - 11.6 years (range 16-81 years); 93.7% were first-time screening. Three hundred and twenty-five (36.5%) smears were normal, inflammatory smears 52.7%, mild dyskaryosis 2.4%, moderate dyskaryosis 1.5%, severe dyskaryosis 0.3% and probable malignancy (malignant cells) 0.8%. Abnormal smears were higher in symptomatic cases compared with asymptomatic cases (chi2=15.3, P< 0.01); 6.1% and 2.1% of symptomatic cases had dyskaryosis and carcinoma, respectively, compared with 3.4% and 0.1% for asymptomatic cases. In postcoital bleeding 9.3% and 1.9% had dyskaryosis and carcinoma, respectively. Fifty-six of 62 cases of cervical erosion had abnormal smears. In postmenopausal bleeding 13.0% and 4.3% had dyskaryosis and carcinoma, respectively. Prevalence of abnormal cervical smears is high in women who have genital tract disease. In places with no national screening programmes every effort should be made to screen such women.