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

An Overview of Vulvovaginal Atrophy‑Related Sexual Dysfunction in Postmenopausal Women

Menopause and the climacteric period are associated with adverse risk factors for the development of vulvovaginal atrophyrelated sexual dysfunction. Sexual dysfunction is a common problem in postmenopausal women, often underdiagnosed, inadequately treated, frequently overlooked, and most often impairing the quality of life of these women. To provide clinicians with current information on vulvovaginal atrophy‑related sexual dysfunction in postmenopausal women. This study is a literature review on vulvovaginal atrophy‑related sexual dysfunction in postmenopausal women. Relevant publications were identified through a search of PubMed and Medline, selected references, journals, and textbooks on this topic, and were included in the review. The prevalence of female sexual dysfunction increases with age. It is a common multidimensional problem for postmenopausal women that alter the physiological, biochemical, psychological, and sociocultural environment of a woman. Menopause‑related sexual dysfunction may not be reversible without therapy. Estrogen therapy is the most effective option and is the current standard of care for vulvovaginal atrophy‑related sexual dysfunction in postmenopausal women. Sexual dysfunction is a common multidimensional problem for postmenopausal women and often impairs the quality of life of these women. Estrogen preparations are the most effective treatment. Selective estrogen receptor modulators, vaginal dehydroepiandrostenedione, vaginal testosterone, and tissue‑selective estrogen complexes are promising therapies, but further studies are required to confirm their role, efficacy, and safety.Keywords: Estrogen, postmenopausal women, sexual dysfunction, vulvo‑vagina

Reducing maternal deaths in a low resource setting in Nigeria

Objective: To assess the impact of the adoption of evidence based guidelines on maternal mortality reduction at Enugu State University Teaching Hospital, Nigeria.Materials and Methods: A retrospective review of all maternal deaths between 1st January, 2005 and 31st December, 2010 was carried out. Evidence based management guidelines for eclampsia and post‑partum hemorrhage were adopted. These interventions strategy were carried out from 1st January, 2008‑31st December, 2010 and the result compared with that before the interventions (2005‑2007). Main outcome measure: Maternal mortality ratio (MMR) and case fatality rates.Results: There were 9150 live births and 59 maternal deaths during the study period, giving an MMR of 645/100 000 live births. Pregnant women who had no antenatal care had almost 10 times higher MMR. There was 43.5% reduction in the MMR with the interventions (488 vs. 864/100 000 live births P = 0.039, odds ratio = 1.77). There was also significant reduction in case fatality rate for both eclampsia (15.8% vs. 2.7%; P = 0.024, odds ratio = 5.84 and Post partum hemorrhage (PPH) (13.6% vs. 2.5% P value = 0.023, odds ratio = 5.5. Obstetric hemorrhage was the most common cause of death (23.73%), followed by the eclampsia.Conclusion: Administration of evidence based intervention is possible in low resource settings and could contribute to a significant reduction in the maternal deaths.Key words: Eclampsia, guidelines, hemorrhage, low resource settings, maternal death, Nigeri

Perceptions of malaria and the utilisation of long lasting insecticide treated nets in a rural Niger delta community in Nigeria

Malaria represents a heavy disease burden with high death tolls in sub-Saharan countries, particularly among children less than five years of age and pregnant women. Misconceptions about the disease are reported to still exist in malaria endemic countries. Insecticide-treated nets (ITNs) have since been advocated as effective control measures against malaria, but how well are they utilised? Objectives: To explore and ascertain the perception of malaria and the utilisation of ITNs in a rural community in the swampy areas of Nigeria's Niger Delta region. Method: A cross-sectional, descriptive study was conducted using simple random sampling technique. Data were collected from household heads with the aid of pre-tested, semistructured, interviewer-administered questionnaires and analysed using SPSS version 17.0 Results: A good perception of the cause (86.9%), mode of transmission (92.8) and preventive measures of malaria were demonstrated. Although, the awareness of ITNs was high (75.6%) with health facilities (35.5%) and radios (33.5%) being the major sources of information, the utilisation rate of ITNs was poor (29%). Conclusion: Intensified efforts by government agencies and diverse stakeholders are recommended to increase the availability and access to ITNs, in order to improve their utilisation rate in rural communities, with adequate priority given to groups at higher risk. Such interventions when implemented consistently and comprehensively are likely to contribute to moving the nation further from malaria control and elimination, towards the possibilities of malaria vaccines and ultimate eradication

Accuracy of clinical and ultrasound estimation of fetal weight in predicting actual birth weight in Enugu, Southeastern Nigeria

Background: Estimation of fetal weight is important for antenatal and intrapartum management of pregnant women. Sonographic methods are not readily accessible in under.resourced settings, it is therefore necessary to study the accuracy of a clinical method of estimating fetal weight where this limitation (unavailability of ultrasound) exists.Objective: To compare the accuracy of clinical and ultrasound methods of fetal weight estimation at term.Materials and Methods: Clinical and ultrasound fetal weights were  estimated on 200 consecutive term pregnancies (37 completed weeks of gestation . 41 weeks and 6 days) at the University of Nigeria Teaching  Hospital, Enugu, Nigeria from 1st April to 30th November 2012. Accuracy was determined using percentage error, absolute percentage error, and proportion of estimates within 10% of actual birth weight.Results: Actual birth weight had strong positive correlation with both clinical and ultrasound estimated fetal weights (r = 0.71, P < 0.001 and r = 0.69, P < 0.001, respectively). Overall, both the clinical and ultrasound methods systematically overestimated the actual birth weight. The proportion of the clinical estimated weights that were within 10% of the actual birth weight was significantly lower than that of ultrasound method for babies of all birth weights (35.0 vs. 67.5%; P < 0.001) and for macrosomic babies (76 vs 100%, P = 0.009). For babies with normal birth weights (2.5-3.9 kg), ultrasound method error values were significantly lower than those of  clinical method for both the mean % error (5.4 vs 19.6%; P < 0.001) and the mean absolute % error (9.97 vs 20.6%; P < 0.001).Conclusion: The ultrasound method is generally a better predictor of the actual birth weight than the clinical method, and thus should be used in estimating the actual birth weight when accessible.Key words: Birth weight, clinical estimation, Nigeria, ultrasound estimatio

Parity‑related Changes in Body Weight May Influence the Zinc and Copper Status of Urban Pregnant Women: A Report from South Eastern Nigeria

Background: Micronutrient replacement is done indiscriminately, without recourse to peculiar socioeconomic and sociodemographic variables. Particularly, the relationship between parity, body weight, and some micronutrients has received minimal attention in Nigeria.Aim: To determine the relationship between parity, body weight, and some micronutrients during pregnancy.Subjects and Methods: This is a cross‑sectional study involving 130 pregnant women and 30 nonpregnant control. They were recruited from two health care facilities in Nigeria and grouped into nulliparous and multiparous. After a 24‑h dietary recall, the weight (W) and height (H) were measured. The body mass index (BMI) (W in kg/H in m2) was calculated. Serum copper and zinc were estimated using flame atomic absorption spectrophotometer.Results: Multiparous nonpregnant subjects parity=3.0 (0.58) had higher weight (P=0.037) and BMI (P=0.035) than their nulliparous counterparts (parity=0). In addition, there were no significant difference in Cu and zinc levels between the two groups (P=0.243 and 0.402, respectively). Expectedly, weight and BMI increased as pregnancy progressed. There was no significant difference in Cu levels between the three trimesters in the nulliparous pregnant and multiparous pregnant subjects. In the pregnant nulliparous subjects, the Zn levels of the 2nd and 3rd trimesters were significantly lower than that of the nonpregnant nulliparous subjects (P<0.001 and 0.039, respectively). However, in multiparous pregnant subjects, only the 3rd trimester Zn level was significantly lower than that of the nonpregnant controls (P=0.017). Conclusion: Pregnancy weight gain is more pronounced in multiparous than nulliparous women. This parity‑related pattern only affects the serum zinc levels, a situation that should be taken into consideration when formulating policies for nutritional replacement.  Keywords: Africa, body mass index, copper, parity, pregnancy, zin

An overview of menopause associated Vaso Motor Symptoms and options available in its management

BACKGROUND: Vasomotor Symptoms are the most common and distressing menopausal complaint, for which women seek advice from their physician.OBJECTIVE: To review menopausal associated vasomotor symptoms and options available in its management.METHODS: Pertinent literature on menopause associated vasomotor symptoms, selected references, textbooks, journals and internet services using the PubMed and Medline databases were included in this review.RESULTS: Hot flushes are the most common and distressing symptom, for which women seek advice from their physician. It occurs in more than 75% of postmenopausal women. Management of hot flushes is problematic because the most recognized effective option oestrogen, is often contraindicated. This has resulted in extensive research exploring different therapeutic options for treatment of hot flushes. Currently, various safe and efficacious nonhormonal options exist but further research is still needed to improve on the treatment of hot flushes.CONCLUSION: The management of the most common and distressing vasomotor symptoms associated with menopause (hot flushes) is controversial. Regardless of the management strategy adopted, treatment options should be periodically reassessed as menopause-related vasomotor symptoms will abate with time even without any intervention in majority of postmenopausal women.KEYWORDS: Menopause, Vasomotor symptoms, Hot flushes, oestrogen therapy

Large Vulvar Lipoma Following Episiotomy - A Case Report

Vulvar lipomas are rare and few cases have been reported in the world literature. We document a case of large soft vulvar mass following episiotomy in a 23-year-old primipara. The mass was excised and histologic examination confirmed lipoma.KEYWORDS: vulvar, tumour, lipoma

Spontaneous Rupture of Gravid Horn of Bicornuate Uterus at Mid Trimester - A Case Report

Rupture of gravid uterus in a primigravida is rare and is generally associated with Mullerian duct anomalies. A case of rupture of gravid left horn of bicornuate uterus at 20 weeks gestation is reported in a 25-year old unmarried primigravida. The ruptured left horn was excised and defect closed. The need for high index of suspicion, early diagnosis and prompt intervention is highlighted. Keywords: bicornuate uterus, uterine rupture, laparotom

Patter of Gynaecological Cancers in University of Nigeria Teaching Hospital, Enugu, South Eastern Nigeria

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