Case Report; Heterotopic Pregnancy Following Induction of Ovulation

Heterotopic pregnancies are occurring more commonly with the increasing use of assisted reproductive methods. No single investigation can predict the presence of heterotopic pregnancy. Heterotopic pregnancy should be suspected in any patient who presents with lower abdominal pain in the early phase of an obvious intrauterine pregnancy following fertility treatment. Transvaginal ultrasonography is a useful diagnostic adjunct. Early intervention is essential to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality. Key Words: Pregnancy, Ectopic, Heterotopic, Ovulation Induction .[Trop J Obstet Gynaecol, 2002, 19: 115-116

Bacterial Flora of the Vagina and Cervix in Non-pregnant Nigerian Women

A qualitative comparative study of the bacterial flora of the vagina and cervix of 90 non-pregnant women of reproductive age (18 35 years) Calabar was undertaken. The study revealed that both aerobic and microaerophili organism as well as the strictly anaerobic bacteria constitute the microflora of the lower genital of this group of women. Of the 90 women sample, Lactobacili were the most frequent isolated organism in both the cervix and vagina , occurring in 62.2% and 75.6% of the sample respectively. Proteus species were the least in incidence, occurring in only 4% of either the cervical or vaginal specimens. The following pathogenic organisms were isolated in both the vagina and cervix. Escherichia coil, Staphylococcus aureus, Candida albicans, Clostridium species and Beta-haemolytic streptococci. In general, the same types of organism were isolated in both the cervical and vaginal sample, although the incidence in the two sources varied. Key Words: Bacterial flora, vagina, cervix, non-pregnant women, reproductive age. [Trop J Obstet Gynaecol, 2004;21:49-51

The role of a parenteral multivitamin preparation (Eldervit-12® in the prevention of anaemia in pregnancy

Context: Over half of all women in developing countries develop anaemia during pregnancy. It is a significant contributory factor to maternal morbidity and mortality.Objective: To determine if the administration of a parenteral multivitamin preparation (Eldervit 12 R) in pregnancy is effective in reducing the prevalence of anaemia in pregnancy.Materials and Methods: A prospective, randomized controlled trial using patients pooled into study and control groups receiving Eldervit-12 injections and oral multivitamin preparations respectively. One hundred patients were recruited into each group. Baseline Haemoglobin concentration and reticulocyte count were done at the time of recruitment and repeated at 36 weeks gestation. Results: The changes from baseline to final value in the Haemoglobin concentration (9.7-11.7g/dl) and reticulocyte count (2.1-3 %) were higher in the study than in the control group (9.8-10g/dl and 2.2-3 % respectively). The final Haemoglobin concentration and reticulocyte count of the study group (11.7 g/dl and 5.3 % respectively) were significantly higher than in the control group (10.0 g/dl and 3.0 % respectively). In the study group 9.7% of patients were anaemic (WHO Definition) while in the control group 75% remained anaemic at 36 weeks gestation. Overall the drug was well tolerated.Conclusion: This study suggests that the use of Eldervit-12 in pregnancy can significantly reduce the prevalence of anaemia in the later stages of pregnancy. Keywords: anaemia, pregnancy, Eldervit-12 injection, haemoglobin, reticulocytesTropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 159-16

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways