Sonographic estimation of foetal weight versus actual birth weight at term

Background: Estimated foetal weight is very critical to decision making in the management of pregnant women. It is therefore important to evaluate the accuracy of ultrasound estimated foetal weight (USEFW) at term in our environment. We compared ultrasound estimated foetal weight at term with the actual foetal birth weight at delivery.Methods: This was a prospective, comparative cross-sectional study at the Lagos State University Teaching Hospital over a 6-month period. Four hundred and five pregnant women with normal singleton pregnancy, who had sonographic estimation of foetal weight at term, using the Hadlock IV formula, were followed up and had their actual birth weight (ABW) determined at delivery. Accuracy was determined by proportion of estimates within 10% of actual birth weight and mean absolute percentage error (MAPE). The p<0.05 was considered significant at 95% confidence interval.Results: The prevalence of macrosomia was 10.3%. At 10% margin of error, ultrasound accurately estimated the weights of 73.3% of babies. The mean USEFW was 3559.89±316.9g and mean ABW was 3477.42±422.9g with a mean difference of 82.44g (p<0.001) and MAPE of 7.11. There was positive correlation (r=0.669) between the EFW and ABW (p<0.001). The USEFW had a sensitivity of 66.7%, specificity of 91.5%, positive predictive value of 47.5% and negative predictive value of 96.0% in predicting macrosomia.Conclusions: Ultrasound estimation of foetal weight at term is reliably accurate in predicting actual birth weight in south-western Nigeria.

Clinical and sonographic features in infertile women with and without polycystic ovarian syndrome

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine cause of infertility affecting about 1 in 10 women of reproductive age. This study determined the proportion of infertile women with PCOS and compared clinical and sonographic features in infertile women with PCOS and without PCOS.Methods: This was a prospective comparative cross-sectional study at the Lagos State University Teaching Hospital over a 6 month period. One hundred and fifty two infertile women were recruited and had trans-vaginal ultrasonography for the presence and absence of polycystic ovaries. The diagnosis of PCOS was made using the Rotterdam criteria with other relevant socio-demographic and clinical data noted in the study proforma. Student t and chi-square tests were used as appropriate.Results: The prevalence of PCOS among infertile women was 32.9%. The mean age of infertile women diagnosed with PCOS and without PCOS was 33±4.90 and 32.71±5.00 years, respectively. Women with PCOS had significantly higher BMI than women without PCOS. Increased ovarian volume, peripheral follicular distribution and increased stromal echogenicity were observed in 60%, 74% and 94% of women with PCOS on trans-vaginal ultrasound compared to 11.8%, 2% and 2% of women without PCOS, respectively.Conclusions: The prevalence of PCOS among infertile women is high. Clinical characteristics of women with PCOS and women without PCOS are similar except in their BMI and features that constitute the diagnostic criteria for PCOS

Pattern of primary caesarean deliveries in a Nigerian tertiary hospital

Background: Primary caesarean section (CS) has become a major driver of the steadily rising total caesarean rate. This study determined the primary CS rate, pattern and associated factors.Methods: It was a retrospective, hospital-based cross-sectional study of 645 pregnant women who had primary caesarean section over a 3-year period in Lagos state university teaching hospital, Lagos, Nigeria. Data obtained were expressed in frequency and percentages.Results: Primary CS accounted for more than 50% of all the CS done during the study period with a primary CS rate of 16.7% and total CS rate was 30.6%. Primary CS was commonest among women of age group 30-39years (50.1%) and women with no prior parous experience (58.6%). The commonest indication for primary CS was poor progress in labour due to cephalopelvic disproportion, which occurred in 170 women (26.4%), followed by suspected foetal distress in 94 women (14.6%) and hypertensive disease in pregnancy in 91 women (14.1%). Post-operative wound infection and/or dehiscence was the most prevalent post-operative complication occurring in 12.1% of women who had primary CS.Conclusions: Primary CS rate is increasing and relatively more common among primiparous women. Cephalopelvic disproportion, suspected foetal distress and hypertensive disorders of pregnancy are the leading indications for primary CS.

Misoprostol and oxytocin versus oxytocin alone in the active management of the third stage of labour: a randomised, double-blind, placebo-controlled trial

We investigated whether the use of misoprostol plus oxytocin in the active management of the third of stage of labour (AMTSL) would reduce the rate of primary postpartum haemorrhage (PPH) compared with intramuscular oxytocin alone. This was a multicentre, double-blind, placebo-controlled, randomised trial where 1036 pregnant women, in addition to intramuscular oxytocin (10 IU) in the third stage of labour, randomly received either 400 µg sublingual misoprostol (519 women) or a placebo (517 women). The primary outcome measure was the mean blood loss (MBL) within 1 h of delivery. The trial was registered with ClinicalTrials.gov (NCT02424201). The MBL in the oxytocin plus misoprostol group was 229.73 ± 108.12 compared to 274.58 ± 121.09 in the oxytocin plus placebo group (t = 6.289, p < .001). Twenty-eight (5.4%) women in the misoprostol group had a blood loss ≥500 ml versus 39 (7.5%) women in the placebo group (risk-ratio [RR] − 0·72, 95%CI 0.45–1.14; p = .1616). The combination of misoprostol with oxytocin in the AMTSL reduces MBL post-delivery but is not superior to oxytocin alone in the reduction of the rate of PPH.IMPACT STATEMENT What is already known on this subject? The routine use of 10IU of intramuscular oxytocin in the active management of the third stage of labour reduces the rates of postpartum haemorrhage. What do the results of this study add? The addition of 400ug of sublingual misoprostol to the routine use of 10IU of intramuscular oxytocin in the active management of the third stage of labour reduces mean blood loss when compared with intramuscular oxytocin alone, but is not better in reducing the rates of postpartum haemorrhage. What are the implications of these findings for clinical practice and/or further research? Routine use of misoprostol as adjuncts to the active management of the third stage of labour does not reduce the rate of PPH