Foetal Transcerebellar Diameter (TCD) measurement between 18 and 23 weeks of pregnancy

Background: The measurement of the Transcerebellar Diameter (TCD) is an emerging ultrasound parameter useful for the estimation of gestational age (GA). Objectives: The objectives of the present study included the establishment of baseline TCD values between 18 and 23 weeks of pregnancy, as a basis for predicting gestational age. Other targets included the determination of the correlation between TCD and the actual/predicted gestational ages and the concordance between the actual and predicted gestational ages in the population. Methods: A cross-sectional study was conducted on 488 singleton fetuses during the second-trimester anomaly scan sessions. Transabdominal ultrasound scan measurement of the Transcerebellar Diameter (TCD) was carried out using standard criteria and both TCD, and GA measurements were used to construct nomograms. Chi-square (Goodness-of-fit) was used to evaluate the statistical significance of differences between the observed and expected (predicted) TCD and GA values. The actual gestational age subtracted from predicted gestational age was subjected to Pearson correlation to determine concordance (r). Results: Transcerebellar Diameter ranged between 16.7mm at 18 weeks and 26.7mm at 23 weeks, with a mean value of 18.5+ 0.96mm and 23.1 +1.65mm respectively. There was a positive correlation between TCD and GA (r = 0.85; p<0.0001). Concordance between the actual and predicted gestational age was high (Pearson correlation r = 0.81; p < 0.0001). Conclusion: The TCD is a reliable marker for gestational age estimation between 18 and 23 weeks of gestation

Knowledge and practice of cervical cancer screening among female professional health workers in a sub-urban district of Nigeria

Cervical cancer is the commonest genital tract malignancies in the females and its burden is enormous, to the patient and her community. It is largely preventable or curable when detected at the very early stage through effective screening programme. Very poor clients' attendance has been noticed at the services provided by the state and other health institutions and female health workers are not exemptions. To determine the level of knowledge of female health workers about cervical cancer prevention using Pap smear and cytology, the degree of utilization and factors that may prevent utilization of services. It is a questionnaire based cross-sectional survey of 187 female health workers in Remo district of Ogun State, assessing their knowledge and utilization of cervical cancer screening services. There were 187 respondents, 78.3% were found to have knowledge of Papanicolaou smear (Pap smear) and only 16 (8.7%) had utilized the services. Lack of physicians' referrals and ignorance about location of service centers were the two most frequent reasons for failure of utilization. Socio-demographic factors do not influence utilization. There is a need for a more expanded and community oriented screening programme that will target the male population with regards to their consent and support. Health care providers should improve on opportunistic screening of patients and adopt alternative screening techniques, such as visual inspection with acetic acid (VIA), so as to widen patients coverage. Continuous education of female health workers about cancer of the cervix and its prevention will improve knowledge and increase service utilization. Nigerian Medical Practitioner Vol. 50(1) 2006: 19-2

Chronic Uterine Inversion Presenting as Menorrhagia - A Case Report

Uterine inversion is an uncommon complication of third stage of labour. When it is incomplete it may be difficult to recognize and may then progress to a chronic condition in the patient. Bleeding and pain, which may be severe enough to lead to shock when acute, are invariable with this clinical condition. Mrs.O.S. is presented to highlight a case of incomplete inversion of the uterus due to poor labour supervision by unskilled midwives. The condition was not recognized and had progressed to chronic inversion at the time of presentation. Uterine inversion is a known cause of primary postpartum haemorrhage and should be suspected in cases that are managed poorly as Mrs. O.S., as such may progress to chronic inversion and become complicated with menorrhagia Key Words: Chronic, Inversion, Menorrhagia, Haultain's Operation Nigerian Medical Practitioner Vol.46(3) 2004: 56-5

Should Ultrasonography be Done Routinely for all Pregnant Women?

Context: Although the importance of routine ultrasound screening of the fetus during pregnancy to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders and placental abnormalities, and to assess fetal age is not in doubt, but whether or not routine ultrasound screening is desirable is still a contentious issue. Objective: The objective of this study is to determine whether ultrasonography should be done routinely for all pregnant women or not. Materials and Methods: This is a retrospective study that reviewed 1,000 obstetric ultrasound scans performed at the Olabisi Onabanjo University Teaching Hospital, Sagamu between June 1998 and May 1999. The case notes and ultrasound scan records of all the patients were analyzed Results: The age range and the mean age of the 1,000 pregnant women who had the obstetric scans were 17-42 years and 27.3 ± 2.1 years respectively. Six hundred and eight (60.8%) had routine ultrasonography (control group) while 392 (39.2%) were scanned for specific obstetric indications. In all, positive findings were seen in 328 cases (32.8%). Seventy five percent of those with specific indications for scanning had positive findings of clinical significance while only 5.6% of the control group had incidental findings of clinical significance. Positive findings on ultrasound were significantly greater in the group with specific indications for scanning, P< 0.001. Conclusion: Our suggestion is that ultrasound examination in pregnant women should be performed only when there are clear obstetric reasons, established clinically. Key Words: obstetric ultrasound scan, positive findings, pregnancy. [ Trop J Obstet Gynaecol, 2004;21:11-14

Profile of Prenatally Diagnosed Major Congenital Malformations in A Teaching Hospital in Nigeria

Background: Prenatal diagnosis of major congenital abnormality is one of the main goals of antenatal care, because of its contribution to perinatal morbidity and mortality. Awareness of the profile in terms of rates and spectrum could aid management and prevention strategies. This study aims to determine the profile of congenital malformations, and the relationship between the rates and some maternal socio-demographic and obstetric variables. Methods: A retrospective cross-sectional study of prenatally diagnosed congenital malformations in singleton pregnancies over a four-year period. The ultrasound scan findings and the findings of fetal ultrasonography, together with maternal socio-demographic and obstetric variables, were collected from the ultrasound scan reports or medical records of each pregnancy. Data were analyzed using Microsoft Excel 2010. Results: Among the 968 singleton pregnancies, 78 had major congenital malformation, giving an antenatal rate of 8.04/1000 (0.8%). The first trimester prevalence was comparable with other trimesters. Malformation mostly involved single systems (93.6%), which are mainly central nervous (48.7%) and gastrointestinal/abdominal systems (21.8%). The rate was statistically significant (&lt; 0.0018) in women aged &gt; 35 years. The mean maternal age and parity were 31.4 + 4.7 and 2.8 + 0.4, respectively. The rates of congenital malformation in spontaneously or assisted conceptions were not statistically significant (p = 0.073 and p = 0.085). Conclusion: Maternal age &gt; 35 years and multiparity are important risk factors for congenital malformation. The commonly involved systems are the central nervous and gastrointestinal systems. &nbsp;Keywords: congenital malformations, prevalence, spectrum, antenatal ultrasound scan, Nigeria&nbsp

Uterine Rupture: a Major Contributor to Obstetric Morbidity in Sagamu

Background: The incidence of uterine rupture is high in most developing countries and it is a leading cause of maternal mortality and morbidity. Objectives:To determine the incidence, aetiology and the associated morbidity and mortality in cases of ruptured uterus presenting at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Materials and Methods: A review of all the case notes of patients that were managed for uterine rupture over a 7-year period was conducted. The records were analysed for the patients' mode of presentation, possible predisposing factors, type of uterine rupture, and the associated morbidity and mortality. Results: The incidence of rupture during the period was 1 in 67 deliveries or 14.9 per 1000 deliveries. The mean age [SD] was 30.1 [1.8] and the mean parity was 3.3 [0.93]. Majority (88.5%) of the patients were unbooked. Oxytocin administration was the identified aetiological factor in 41 (67.2%) of the patients. Majority (73.8%) presented with clinical signs of shock. At operation, 56 (91.8%) were found to have complete uterine rupture, with a predominance of anterior wall rupture (83.6%). Uterine repair with or without bilateral tubal ligation was the usual surgical treatment offered while wound sepsis, with or without generalized septicaemia, was the commonest morbidity found. Maternal mortality was 14.8%. Conclusion: Uterine rupture continues to be a major cause of maternal morbidity and mortality in Sagamu and efforts should be geared towards reducing the number of women affected by this problem. Key Words: Uterus Rupture, Genital Injury, Haemorrhage, Shock [Trop J Obstet Gynaecol, 2003, 20: 137-140

Maternal Deaths from Induced Abortions

Context: Unsafe abortion has grave implications for the life of a woman and her future reproductive career. Efforts to find the reasons underlying how a woman gets to the point of having an unsafe abortion, and means of preventing and minimising complications arising thereby are highly desirable. Objective: To find the extent to which unsafe abortion contributes to maternal mortality in our environment. Study Design, Setting and Subjects: A descriptive study of patients who were admitted for complications arising from induced abortions between January 1988 and December 2000 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with the data being obtained from case records. Results: A total of 103 patients presented with complications arising from induced abortions. Twenty-one (20.4%) of these patients died as a result of complications arising thereby. During the same period, there were 71 deaths in the gynaecological ward. Thus, deaths from induced abortion accounted for 29.6% of all gynaecological deaths. There were 105 maternal deaths in the hospital during the period. Hence, induced abortions were responsible for 20% of all maternal deaths. The patients had various complications including 15 (71.4%) with septicaemia, 10 (47.6%) with anaemia, 7 (33.3%) each with jaundice and peritonitis. Conclusion: Abortion-related maternal death is still a major contributor to maternal mortality in this environment. Women empowerment, easy access to good quality and cheap family planning methods and post abortion care and rationalisation of abortion law may help to halt this stream of deaths from unsafe abortions. Key Words: Pregnancy, Unsafe Abortion, Maternal Mortality [Trop J Obstet Gynaecol, 2003, 20: 101-104

Vacuum Assisted Vaginal Deliveries in Sagamu

A retrospective review of all cases of vacuum assisted vaginal deliveries at the Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1990 and December 2001 is presented. During the study period there were 4962 deliveries and assisted vaginal deliveries by vacuum was 223, giving an incidence of 4.53%. Primiparous patients accounted for 57.4% of the cases. The commonest indication was delayed second stage (87%). The mean birth weight of babies was 3.13 Kg + 0.51 SD. One hundred and fifty two (68.2%) babies had Apgar scores of seven and more at the fifth minute of birth. The commonest fetal injury was scalp abrasion and cervical laceration was the commonest maternal complication. Key Words: Vacuum, Delivery, Vagina. Nig. Medical Practitioner Vol. 45(3) 2004: 38-4

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.info:eu-repo/semantics/publishedVersio