Preconception Care and Sickle Cell Anemia in Pregnancy

Background: Pregnancy in women with sickle cell anemia is associated with adverse outcome for mother and child, but with improvements in medical care, the outcome has greatly improved in developed countries. Despite being the most prevalent genetic disease in Africa, sickle‑cell disease, along with its serious health problems in pregnancy, is largely neglected.Objective: To determine the effects of preconceptual care on pregnancy outcome among booked patients with homozygous sickle cell disease at Aminu Kano Teaching Hospital, Kano, Nigeria.Materials and Methods: A cohort study of the pregnancy outcome, among booked 39 pregnant women with homozygous sickle cell disease (Hbss), who had preconception care, and an equal number of booked pregnant women with homozygous sickle cell disease (Hbss), who did not have preconception care (controls), at Aminu Kano Teaching Hospital, between January 2000 and December 2006.Results: There was no statistically significant difference in the occurrence of complications between the two groups, but complications occurred with less frequency among the cases compared to the controls.Conclusion: This study suggest that preconception care and effective prenatal care by a multidisciplinary team, and delivery in a hospital which is accustomed to management of sickle cell disease and its complications, is associated with good pregnancy outcome in women with sickle cell anemia in pregnancy. Keywords: Multidisciplinary team management, preconception care, pregnancy outcome, sickle cell anemi

Diagnostic laparoscopy in chronic pelvic pain: What are the issues in a resource poor country?

Background: In resource poor countries, the underlying diagnosis of the cause of chronic pelvic pain are unclear in many of the cases, because of the poor sophistication of the non-invasive investigation tools that are employed in making the diagnosis, and laparoscope is not available in many health facilities that manage gynaecological emergencies. A study of the role of diagnostic laparoscopy is necessary.Aim: To determine the role of diagnostic laparoscopy in management of chronic pelvic pain in a resource poor country.Method: A two year prospective, comparative study of 44 patients with chronic pelvic pain, who had initial diagnosis following non-invasive investigations (clinical/laboratory/ultrasound evaluation) and final diagnosis following laparoscopy, at Aminu Kano Teaching Hospital, Kano, Nigeria. The correlation of the initial diagnosis with final diagnosis (accuracy of initial diagnosis) was done using tests of validity.Results: The period incidence was 27.9% of all gynaecological diagnostic laparoscopy. The sensitivity of initial diagnosis for ectopic pregnancy was 60.0%, specificity 89.5%, positive predictive value (PPV) 81.8%, negativepredictive value (NPV) 51.5%, and accuracy 59.1%. For chronic pelvic inflammatory disease, the sensitivity was 23.3%, specificity 70.3%, PPV 21.4%, NPV 86.7%, and accuracy 61.4%. For pelvic adhesions, sensitivity was 0.0%, specificity 100.0%, PPV 0.0%, NPV 84.1% and accuracy 84.1%, and for uterine fibroids, the sensitivity was 100%, specificity 100%, PPV 100%, NPV 100% and accuracy 100%.Conclusion: Diagnostic laparoscopy should be strongly considered as a primary evaluation tool in the management of chronic pelvic pain in resource poor countries.Keywords: Chronic pelvic pain, resource poor countries, initial diagnosis, final diagnosis, tests of validit

Use of hernal medicines in pregnancy in Aminu Kano teaching Hospital - Mythor reality

Background: There is increasing reports of use of herbal medicines worldwide. Among the patients who are likely to be at risk from adverse effects of herbal medicines are pregnant and lactating women. A study of the use of herbal medicines in pregnancy is necessary.Objective: To determining the period incidence, socio-demographic pattern, knowledge, attitude and use of herbal medicines in pregnancy.Method: A cohort study of 440 women, who attended the antenatal clinic and delivered in Aminu Kano Teaching Hospital, Kano Nigeria, between June and December, 2011.Results: The period incidence for use of herbal medicines in pregnancy in this study was 25%. There was no significant association between the use of herbal medicines and age or parity groups (P > 0.05), but there was significant association with no formal education (OR = 2.97, CI = 1.49 – 5.91, P = 0.001), and low socioeconomic class (OR = 1.90, CI = 1.17 – 3.08, P = 0.008). Majority of the respondents used herbal medicines in the first (58.2%) and second trimesters (56.4%) trimesters of pregnancy, were not sure of its safety and efficacy, but hope to use it in future pregnancies, because it is their traditional medicine. Their mothers were the commonest source of procurement and information.Conclusion: The use of herbal medicines among a cohort of pregnant women in Aminu Kano Teaching Hospital is high. Use of herbal medicines in pregnancy should be made prominent in our training curriculum, health talks and history taking during antenatal clinic visits.Keywords: Herbal medicine, pregnant women, socio-demographic pattern, Knowledge, attitude, useTrop J Obstet Gynaecol, 30 (1), April 201

Normal flora and bacterial vaginosis in pregnancy: an overview

The female genital tract is an intricate, yet balanced ecosystem that hosts a variety of different residential microflora. The physiological changes that occur during pregnancy may disrupt this balanced ecosystem and predispose women to a potentially pathogenic microbiota. Bacteria that are associated with bacterial vaginosis (BV) are opportunistic pathogens that frequently form part of this microbiota. The overgrowth of and infections with these bacteria are linked to poor obstetric outcomes and increased transmission of other reproductive tract infections (RTIs). These infections increase women’s susceptibility of acquiring HIV, the rates of HIV shedding and the development of Acquired Immune Deficiency Syndrome (AIDS) in HIV infected patients. It is unknown how the plethora of bacterial species associated with BV contributes to the dynamics of this condition. The use of high-throughput methods have led to the in-depth investigation of different BV-related bacterial species and the functional capabilities of these species. However, the pathogenesis of BV is still poorly defined and the role of individual BV-related bacterial species in specific pregnancy complications is unclear and controversial. The majority of BV infections are asymptomatic and successful diagnosis is complicated by the lack of reliable and standardized diagnostic tests.University of Pretoria, the Medical Research Council (South Africa) and the National Health Laboratory Service (NHLS).http://www.tandfonline.com/loi/imby202017-05-31hb2016Medical Microbiolog