Prevalence of gall stones in a group of antenatal women in Ibadan, Nigeria.

The prevalence of gall stones in Africa is low even though this varies from one part of the continent to another. The few studies were hospital based and excluded majority of silent stones. Abdominal ultrasounds were carried out prospectively on 4,214 consecutive patients referred to an ultrasound centre which cares primarily for pregnant women--a well known vulnerable group for gall stones. An overall prevalence rate of 2.1% was found. This represents a 300-fold increase over previous figures in Ibadan albeit from a different study group. A further study of the disease in the general population is necessary, though it is suggested that the figure in the general population may be less. When this figure is compared with the 10 to 20% in Europe and North America, it confirms the low incidence of the disease in our environment. Majority of the stones were asymptomatic (95%). This needs to be confirmed in the general population. The average stone former in our environment as in previous study does not conform to the classical caucassian description.

Diagnosis of ocular disease in Ibadan by ultrasound.

15 patients with ocular disease, in whom views of posterior segment of the eyes could not be obtained underwent ultrasonography of the eyes to aid in the diagnosis and further management of the patients. In some cases the ultrasound was then compared with the histological diagnosis when the eye was removed and in other cases to the ophthalmoscopic examination when a better view of the posterior segment could be obtained. This was done as a pilot study to ascertain the level of accuracy of our ultrasonic diagnosis and how much it could be depended upon for the very important decision of removal of the eye when indicated.

Maternity care monitoring: a contrast at two levels of health care delivery in Ibadan, Nigeria.

The obstetric performance of women delivering at two hospitals in Ibadan is compared in this study. The prevalence of high-risk pregnancies at the tertiary level hospital (University College Hospital) was higher than that of the secondary level hospital (Oluyoro Catholic Hospital). Consequently, the cesarean section rate of the UCH (21.8%) was higher than that at the OCH (2.3%). Similarly, the maternal mortality (3.5 per 1000) and perinatal mortality (60.2 per 1000) at the UCH were significantly higher than at the OCH, 2.0 per 1000 and 9.8 per 1000, respectively. The need for a national birth survey based on a representative sample of all the different types of health establishments in Nigeria was stressed.

PIP: The obstetric performance of women delivering at 2 hospitals in Ibadan, Nigeria, is compared in this study. The prevalence of high-risk pregnancies at the tertiary level hospital (University College Hospital) was higher than that of the 2ndary level hospital (Oluyoro Catholic Hospital). Consequently, the cesarean section rate of the UCH (21.8%) was higher than that at the OCH (2.3%). Similarly, the maternal mortality 3.5/1000) and perinatal mortality (60.2/1000) at the UCH were significantly higher than at the OCH, 2.0/1000 and 9.8/1000, respectively. The need for a national birth survey based on a representative sample of all the different types of health establishments in Nigeria was stressed.

Assessment of foetal femur length by ultrasound in a normal Nigerian obstetric population.

In a group of Nigerian pregnant women at different gestational ages, 1097 foetal femur length measurements were taken using ultrasound. The measurement increased from a mean femur length of 15.9 mm at 14 weeks' gestation to 75.0 mm at 40 weeks' gestation. The growth pattern showed an asymptotic curve with faster growth in the early part of pregnancy. The standard deviation widened towards 40 weeks of gestation. There was a statistically significant correlation (r = 0.9887; P less than 0.001) between gestational age and femur length. In the first half of pregnancy the femur length was significantly smaller than in studies reported for Caucasians. The finding may be related to the habit of late booking for antenatal care in our patients.

A fall in the rate of multiple births in Ibadan and Igbo Ora, Nigeria.

The twinning, triplet and quadruplet rates were found to be 23.8, 0.3 and 0.04 per thousand maternities, respectively in a survey of 71,773 maternities carried out in Ibadan and Igbo Ora, Nigeria. This represents a dramatic fall from the rates found in previous studies. The findings are discussed in the light of changing dietary habits.

Real time pelvic ultrasonography during the periovulatory period of patients attending an artificial insemination clinic.

Real time ultrasonography was used to examine the ovaries of 50 patients at the calculated time for artificial insemination with donor semen (AID). Forty-two (84%) had one or more follicles greater than 13 mm in diameter. Both ovaries were monitored daily until the main follicle had ruptured (mean number of examinations, 2.4 per patient; range, 1 to 5). Seven women became pregnant (mean follicular diameter, 21.6 mm; range, 18 to 25 mm). The fecundability rate was 12%, compared with 6% for a corresponding group of 50 patients who were not examined with ultrasound. Seven patients experienced mittelschmerz, and in 39 the leading follicle had ruptured before the rise in basal body temperature (BBT). Ultrasonography may be used to confirm the presence or absence of preovulatory follicle prior to treatment.

Monitoring gonadotrophin therapy by real-time ultrasonic scanning of ovarian follicles.

Real-time ultrasound scanning of ovarian follicles was performed during 61 cycles in 22 infertile patients being treated with sequential injections of human menopausal gonadotrophin (hMG) and human chorionic gonadotrophin (hCG). Total 24-h urinary oestrogens were estimated (and in 13 cycles plasma oestradiol) but the amount of gonadotrophin given was based mainly on the ultrasound findings. A retrospective analysis of the results showed that there was a poor statistical correlation between the diameter of the largest follicle and the total urinary oestrogens (r=0.39) and with the level of plasma oestradiol (r=0.56), although similar clinical information was obtained by all methods. Ovulation was induced in 58 cycles when the leading follicle had a mean diameter of 20-25 mm (mean 21.3 mm); follicular rupture was observed in 57 cycles and in these cases there was biochemical evidence of luteinization (plasma progesterone greater than 15 nmol/1; total urinary pregnanediol greater than 8 nmol/24h). Three patients (three cycles) were not given hCG; one developed micropolycystic ovaries and two showed evidence of hyperstimulation (one follicle greater than 25 mm diameter, three or more follicles 20-25 mm diameter). Twelve patients became pregnant, all with single fetuses. Subsequently one aborted, one had an ectopic pregnancy, three gave birth to normal babies at term and seven pregnancies are continuing. Real-time ultrasound scanning of ovarian follicles is a simple, practical method for monitoring follicular growth during the administration of hMG and predicting the response to hCG.