The relationship of ethnicity, maternal height and shoe size, and method of delivery.

In a bid to determine the relationship of ethnicity, maternal height and shoe size as predictors of cephalopelvic disproportion, we conducted a prospective comparative study of primigravidas at term with singleton pregnancies, who had undergone spontaneous labour. A total of 208 primigravidas were studied; 151 (62.9%) achieved vaginal delivery and 57 (37.1%) had emergency caesarean section for failure-to-progress. We found a statistically significant positive correlation between maternal height and vaginal delivery (p = 0.04), but no correlation with maternal shoe size was found (p = 0.24). This study also showed that Caucasian women were significantly more than twice as likely to achieve vaginal delivery compared with Africans (p = 0.02). Maternal height of at least 162.5 cm, has a sensitivity of 74% and a specificity of 43% for predicting vaginal delivery. We concluded that the most predictive anthropometric measurement for vaginal delivery is maternal height.

Vaginal bleeding following the use of a single dose of 1.5mg levonorgestrel (LNG) for emergency contraception.

INTRODUCTION: Recent studies have shown that a single dose of 1.5 mg levonorgestrel is an effective and safe emergency contraceptive but detailed information on its menstrual side effects is lacking. This study assessed the vaginal bleeding patterns in healthy women who used the medication for emergency contraception. STUDY DESIGN: A prospective observational study of 544 women who sought emergency contraception and volunteered to use a single dose of 1.5mg. levonorgestrel. They were assessed for bleeding patterns, pregnancies and side effects. RESULTS: The pregnancy rate was 0.7% (95%CI, 0.0-1.4). Early or timely return of menses occurred in 69% of the women while in 21% menses was late by more than a week. Normal vaginal bleeding occurred in 57% of the women while others had intermenstrual bleeding/spotting, premenstrual bleeding/spotting or menorrhagia. Non-menstrual side effects include nausea, vomiting, dizziness, headache, breast tenderness and low abdominal pain. All side effects were well tolerated by the women. CONCLUSION: A single dose of 1.5mg LNG when used for emergency contraception is safe and reliable but is associated with menstrual disturbances that may be of concern to a small number of users.

Does screening for cervical intra-epithelial neoplasm in developing countries prevent invasive cervical cancer?

In a bid to evaluate the practical relevance of screening for cervical intraepithelial neoplasia (CIN) in reducing the incidence of invasive cancer in Nigeria, we performed a comparative study of CIN and invasive carcinoma in Ibadan, Nigeria over a period of 8 and 16 years respectively. 4.5% of patients with invasive cervical cancer were under the age of 30 years. It peaked at 28% in the age group 41-50 years. In comparison, <3% of patients with CIN were below 20 years of age while it had the highest incidence of 37%, 34% and 36% respectively in age 40 years and below. The mean age for CIN was 39.6 +/- 9.6 (SD) years compared to 51.3 +/- 11.1 (SD) years for invasive cervical cancer (p < 0.01). There was a 10 year interval between the onset and peak age incidence of invasive cancer and CIN respectively, even though there was an overlap of cases from the third decade. We therefore suggest a combined approach of public education to encourage early presentation and provision of health service outlets for cervical cancer screening in Nigeria to reduce the burden of cervical cancer.

Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians.

Emergency contraception was introduced in Nigeria over two decades ago, but few women have used this method even in emergency situations because of the side effects. To find an acceptable levonorgestrel regimen for emergency contraception in our community, the two-dose regimen 0.75-mg levonorgestrel 12 h apart (group A) and the single dose 1.5-mg levonorgestrel (group B) were studied in 1118 volunteers. Mild side effects such as nausea, vomiting, lower abdominal pains, menorrhagia, dizziness, headache, and breast tenderness were reported. Significantly more women in the high-dose group reported headache, breast tenderness, and heavy menstrual flow. Eleven pregnancies (1.0%) were reported (7 in group A and 4 in group B). The crude relative risk of pregnancies was similar in the two groups (RR = 0.71, 95% CI = 0.32-1.55; p > 0.05) [corrected]. On the other hand, the estimated effectiveness rate of 86.80% in group A was significantly lower than the 92.99% for group B (p < 0.05). The pregnancy rates increased with delay in starting treatment and if further acts of unprotected sexual intercourse took place after treatment. It was concluded that both regimens were effective and safe.