The Application of First‑Trimester Volumetry in Predicting Pregnancy Complications

The application of first trimester volumetry in predicting pregnancy complications is a promising and interesting field in Obstetrics and Radiology. This was a descriptive review of first trimester volumetry in predicting pregnancy complications over a period of 6 months (January 1st, 2013 to June 30th, 2013). A search of literature on first trimester volumetry published in English was conducted. Relevant materials on first trimester volumetry were selected. Placenta volumes (PV) and embryo volume/fetal volume ratios in the first trimester are correlated with crown rump length (CRL) or gestational age (GA). Measurement of PV or placental quotient (PV/CRL ratio) is an early assessment to identify impaired trophoblast invasion and predict subsequent development of intrauterine growth restriction (IUGR) or pre‑eclampsia (PE). In early onset IUGR due to triploidy, or trisomy 13 or 18, a larger deficit in fetal volume is observed compared to CRL. In obstetric sonography, standardization of the 3D volumetric methodology is needed to improve reproducibility of measurement. The accuracy of these measurements is uncertain and current applicability to practice is not fully accepted, therefore, the current methods are yet to be standardized and general applicability is uncertain. Volumetry holds a good promise as an extra method for predicting IUGR, PE, aneuploidy, miscarriages, or stillbirth but lack of standardization currently limits its applicability.Keywords: 3D ultrasound, first trimester, pregnancy complications, volumetr

Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri, Nigeria

Background: Uterine myomas co-existing with pregnancy could cause obstetric complications.Objectives: To assess sonographically the frequency of occurrence and effect of uterine myomas co-existing with pregnancy.Methods: A longitudinal study was conducted during a period of 23 months. A convenience sample of 816 consecutive consenting pregnant women who met the inclusion criteria was evaluated during routine prenatal ultrasound scan. The women were referred for prenatal sonography. One hundred of the subjects who had myoma co-existing with pregnancy and another 100 subjects without myoma were selected for follow-up. These groups were followed up till delivery and obstetric complications and outcomes were documented. Any changes in size and growth rate of myoma were documented.Results: Subjects with myoma co-existing with pregnancy were 12.3%. This was commoner with increasing maternal age. An increase was observed in myoma mean size from 60mm to 63mm from the 1st scan sequence to the 2nd scan sequence and a reduction from 63mm to 59mm in the 3rd scan sequence. Myoma growth rate was 0.667mm per week. Myomas inpregnancy especially large ones caused more complications during delivery when compared to pregnancies without myomas.Conclusion: Routine sonography is important in pregnancy management of uterine myomas co-existing with pregnancy.Keywords: Routine sonography; uterine myoma, pregnancy, obstetric complications

Sonographic evaluation of the spleen among sickle cell disease patients in a teaching hospital in Nigeria

Background: Regional variations in size and parenchyma echo-texture of the spleen among sickle cell disease (SCD) patients have been documented in various publications. The objectives of this study were to assess the size and parenchyma echo-texture of the spleen of SCD patients and ascertain the relationship of age, height and weight with the spleen sizes.Methods: This was a cross sectional study involving 103 each of SCD and age matched control subjects. Aloka ST- 550 -3500 ultrasound machine with 3.5 and 5 MHz convex transducers was used to scan the subjects over a 15 months period (September, 2012 to November, 2013). The age, height and weight of each subject were recorded.Results: The spleen sizes of SCD patients were generally larger than those of the controls (p < 0.05). Abnormal spleen parenchyma of varied appearances was found among the SCD subjects. There were negative correlations between mean spleen sizes and height, weight and age in SCD patients but positive correlations were found between them in the controls.Conclusion: Routine sonographic assessment of spleen size and echo-texture is useful in the management of SCD patients.Key words: sickle cell disease, sonography, spleen morphology, patient management, Nigerian population

Validity of common ultrasound methods of fetal weight estimation in late pregnancy among women in Kwale, Niger Delta region, Nigeria.

Background: Accuracy of some ultrasound equations used in our locality for fetal weight estimation is doubtful.Objective: To assess the accuracy of common ultrasound equations used for fetal weight estimation.Subjects and Methods: A longitudinal study was conducted on selected Nigerian obstetric population at Central Hospital, Kwale between March, 2009 and January, 2011. Sonography was performed on 412 women with advanced singleton cyesis and measurements of BPD, HC, AC, and FL were obtained and figured into 12 common ultrasound equations for the estimation of fetal weight. The actual birth weight at delivery was recorded.Results: The highest intraclass correlation coefficient was generated by the Hadlock 5 and Hsieh 2 equations. The least mean absolute percent error was obtained with Hsieh 2 equation, followed by Woo 3, and Hadlock 5. These equations also had the least percentage error and the least range of limits of agreement in the same order with no significant difference between their mean fetal weight estimates and that of the actual birth weight (p > 0.05). All twelve equations had strong positive correlation with the actual birth weight with Nzeh 2 equation the least.Conclusion: Hsieh 2 equation has the best accuracy in fetal weight estimation studied.Key Words: Validation; Fetal Weight; Sonography; Advanced Cyesis; Nigerian Populatio

Relationship between sonographic umbilical cord size and gestational age among pregnant women in Enugu, Nigeria

Background: Common fetal parameters for gestational age (GA) estimation have pitfalls especially in advanced pregnancy and pregnancy complicated by fetal structural anomaly.Objective: To assess the relationship between umbilical cord size and gestational age of the fetus.Subjects and Methods: A sonographic cross sectional study involving 300 pregnant women with GA between 14 weeks to 40 weeks was done in Enugu, Nigeria. Gestational ages were first estimated by use of Naegele’s formula for GA estimation based on the date of onset of each subject’s last menstrual period. Fetal parameters such as biparietal diameter, femur length, head circumference and abdominal circumference were measured and also used to estimate GA. Umbilical cord diameters were measured and used to compute the umbilical cord cross-sectional area.Results: The mean umbilical cord diameter and cross-sectional area were 14.5mm + 7.2mm and 201.6mm + 139.5mm2 respectively. Umbilical cord growth rate of 1.0mm/week was noted between the 14th and 35th week of pregnancy. There were significant correlations (p < 0.001) between umbilical cord size and other fetal parameters for GA estimation.Conclusion: Umbilical cord size had strong linear relationship with common fetal GA estimation parameters and could be used to compliment these parameters for GA estimation.Key words: Sonography, umbilical cord size, gestational age, Nigeria

Use of fetal biometry in the assessment of gestational age in South East Nigeria: Femur length and biparietal diameter

Background: Fetal growth is influenced by many factors such as race, socioeconomic status, genetics, geographical location, maternal diseases, and number of babies. Consequent upon these, fetal growth charts may vary from one location to another even within the same geographical entity.Objective: This study was designed to establish the fetal growth chart in antenatal women who had ultrasound scanning at the University of Nigeria Teaching Hospital, Enugu, South East Nigeria.Patients and Methods: This is a descriptive analysis of fetal biometric measurement of antenatal women. Four hundred and seventy pregnant women were studied.Results: The nomogram for the femur length (FL) and biparietal diameter (BPD) for the different weeks of gestation (from 13th to the 40th week) were established. Correlation coefficients between gestational age and the various fetal parameters were also reported. Growth charts using both FL and BPD were plotted. A regression model for prediction of fetal age using the fetal biometry was also deduced for the studied population.Conclusion: The fetal parameters used in this study were consistently smaller than reported values from European studies up to the 34th week of gestation after which a catch‑up growth till the 40 weeks was observed. Fetal parameters observed in this study were larger than most of the reported Asian values.Keywords: Fetal biometry, gestational age, intrauterine growth curve, South East Nigeria, ultrasoun

Sex Dimorphism of the Heart Diameters and Cardiothoracic Ratios in a Normal Nigerian Population.

Objective: To determine gender associated differences in the cardiothoracic ratio (CTR) and heart diameters in a normal Nigerian population. Subject and Method: The normal heart diameters and cardiothoracic ratios were measured from posteroanterior (PA) chest radiographs of healthy 510 male and 508 female Nigerians of age range 4 - 80 years. Results: Mean heart diameter of 13.0+ 1.5cm, 12.3+1.3cm and 12.6+1.5cm for males, females and both respectively and mean CTR values of 46.2 + 4.1, 47.2 + 4.4 and 46.7 + 4.3 of males, females and both respectively were noted in the studied population. . The study reports a consistent sex difference in heart diameter of 0.5 to 1.2cm and 1.0 to 3.1cm in chest diameter. It apportions a difference of up to 37% in heart size ratio to gender difference. Discussion/Conclusion: The study established statistically significant differences in the heart diameter and CTR of the studied population, which is based on gender. Keywords: Sex dimorphism, cardiothoracic ratio, heart diameter.Nigerian Medical Journal Vol. 48 (1) 2007: pp. 24-2

Osteochondritis Dissecans Of The Knee Joint (Osgood-Schlatters Disease)

An 18-year-old male professional footballer presented in the surgical outpatient department (SOP) of University of Nigeria Teaching Hospital Enugu complaining of bilateral knee-joint pains and tenderness severe enough to prevent him from participating in training sessions and professional league matches. Both knee joint were X-rayed and the radiographs revealed bilateral Osteochondritis dissecans of the knee joints (Osgood schlatters disease). This case is being reported to highlight on the epidemiology, etiology clinical appearance, possibilities for radiological diagnoses, classification of osteochondritis dissecans, the various treatment modalities available complications of osteochondritis dissecans and above all emphasizes on the benignity of the disease.Key words: Osteochondritis dissecans, Knee joints, Osgood Schlatters diseas

Relationship between Sonographic Placental Thickness and Gestational Age in Normal Singleton Fetuses in Enugu, Southeast Nigeria

Background: The accuracy of common ultrasound parameters for the estimation of gestational age (GA) decreases as pregnancy advances in age. Hence, there is need to explore other parameters that may complement the established fetal biometric parameters in predicting GA in late pregnancy. Aim: The aim of this study is to determine the relationship between the sonographic placental thickness (PT) and GA in the second and third trimesters.Subjects and Methods: A cross‑sectional study of 627 normal pregnant women with GA between 14 and 40 weeks was conducted at the University of Nigeria Teaching Hospital Ituku‑Ozalla, Enugu from May 2013 to February 2014 by sonography. Anteroposterior diameter of the placenta was measured at the level of the umbilical cord insertion. The last menstrual period of the women, femur length, biparietal diameter, head circumference, and abdominal circumference of the fetus were measured for GA estimation. Descriptive statistics, regression analysis, and independent sample t‑test were used in statistical analysis.Results: Mean PT was 23.2 (2.8) mm in the second trimester and 36.1 (3.6) mm in the third trimester. There was a significant difference between the values in the present study and values from similar studies in other populations (P < 0.04). There was a strong relationship between GA and PT and the following mathematical relationships for the second and third trimesters were obtained in the GA = 0.982 (PT) + 3.614 and GA = 0.977 (PT) + 3.354, respectively.<Conclusion: Population‑specific charts for PT may be used to estimate GA inthe second and third trimesters.Keywords: Gestational age, Placental thickness, Second and third trimesters, Sonograph

Traumatic Ruptured Diaphragm: A Clinical Diagnostic Dilemma

Sequel to a car crash, Chief A, a 52-year old bankerpresented in the Orthopaedic Unit of University of Nigeria Teaching Hospital Enugu with fracture right forearm bones and minor bruises in the abdomen and buttocks. His fractured right forearm was treated surgically and patient was dischharged. A month later, Chief A developed breathlessness and was therefore re-admitted in same hospital where radiological survey including plain chest radiography and tailored barium meal revealed a hitherto clinically Occult rupture left hemi-diaphragm with mediastimal shift to the contra-lateral side. We present this case to highlight the pleomophism of traumatic rupture of diaphragm with emphasis on the causes, clinical presentation, complications and model of progression and different treatment options.Key words: Traumatic, Rupture, DiaphragmJournal of Experimental and Clinical Anatomy Vol. 4 (1) 2005: 25-2