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

Seroprevalence of Human Immunodeficiency Virus, Hepatitis B, Hepatitis C, syphilis, and co infections among antenatal women in a tertiary institution in south east, Nigeria

Background: Sexually transmitted infections and human immunodeficiency virus (HIV)/AIDS are a major public health concern owing to both their prevalence and propensity to affect offspring through vertical transmission. Aim: The aim was to determine the seroprevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and co‑infections among antenatal women in Enugu, South‑East Nigeria. Materials and Methods: A retrospective study of antenatal women at the University of Nigeria Teaching Hospital, Enugu, South‑East Nigeria from 1st May 2006 to 30th April 2008. A pretested data extraction form was used to obtain data on sociodemographic variables and screening test results from the antenatal records. The analysis was done with SPSS version 17 (Chicago, IL, USA). Results: A total of 1239 antenatal records was used for the study. The seroprevalence of HIV, HBV, HCV, and syphilis among the antenatal women were 12.4% (154/1239), 3.4% (42/1239) 2.6 (32/1239) 0.08% (1/1239), respectively. The HIV/HBV and HIV/HCV co‑infection prevalence rates were 0.24% (3/1239), 0.16% (2/1239), respectively. There was no HBC and HCV co‑infection among both HIV positive and negative antenatal women. There was no statistically significant difference in HBV and HCV infection between the HIV positive and negative antenatal women. The only woman that was seropositive for syphilis was also positive to HIV. Conclusion: The seroprevalence of HIV, HBV, HCV, and syphilis is still a challenge in Enugu. Community health education is necessary to reduce the prevalence of this infection among the most productive and economically viable age bracket.Keywords: Antenatal women, Co‑infection, Human immunodeficiency virus, Hepatitis C virus, Hepatitis B virus, Seroprevalence, Syphili

Utilization of insecticide treated nets among pregnant women in Enugu, South Eastern Nigeria

Background: The goal of roll back malaria partnership is to achieve universal coverage for all populations at risk using appropriate interventions for prevention and case management.Objective: The objective of this study is to determine the use of insecticide treated nets (ITNs) and other anti-vector measures among pregnant women in an area hyper-endemic for malaria.Materials and Methods: Questionnaires were administered to a cross-section of 832 consecutive pregnant women attending antenatal care in three hospitals in Enugu, Nigeria that have high client flow for maternity services. Data collected were analyzed using descriptive and inferential statistics by means of the Statistical Package for Social Sciences (SPSS) version 16. P-value of less than 0.05 was considered statistically significant.Results: The mean age of the women was 33.2 ± 2.9 (range: 15-45) years. Three hundred and fifty nine (43.1%) women owned insecticide treated nets (ITNs), however 325(90.5%) slept under the nets during the index pregnancies; equivalent to 39.1% utilization rate among the 832 women studied. Out of the 325 (39.1%) women that used ITNs; 236 (28.4%) used it singly, while 89 (10.7%) used it in combination with other anti-vector measures. Educational status and social class of the women had strong association with the use of ITNs (P < 0.0001). Women who used ITNs were significantly less likely to have acute malaria, anaemia and babies with low birth weight than women who did not use ITNs (P < 0.05).Conclusion: The use of ITNs is poor among pregnant women in Enugu, but associated with favorable maternal and feto-neonatal outcome. Future measures to increase its use should consider improvement in educational level and social class of our women.Key words: Insecticide treated nets, Malaria, Nigeria, pregnanc

Falls among pregnant women in Enugu, Southeast Nigeria

Background: Falls during pregnancy are major public health issues and a common cause of maternal injury during pregnancy. There is paucity of data on prevalence and risk factors of falls during pregnancy in African population including Nigeria.Objective: To determine the prevalence and risk factors associated with falls during pregnancy in Enugu, Nigeria.Materials and Methods: This was a cross.sectional study of 332 consecutive pregnant women presenting in labor for delivery at the University of Nigeria Teaching Hospital Enugu, Nigeria between 1st May and 31st December, 2012.Results: The mean age of the women was 32.2 } 2.7 (range: 20.42) years. One hundred and eight women (32.5%) reported falling at least once during the index pregnancy. Women aged . 30 years had twofold risk of falling during pregnancy than women aged > 30 years [41.1% (69/168) vs. 23.8% (39/164); odds ratio (OR): 2.23; 95% confidence interval (CI): 1.39.3.58; P < 0.001)]. Similarly, women . 160 cm in height had significantly higher risk of falling during pregnancy than women < 160 cm in height [43.5% (70/161) vs. 22.2% (38/171); OR: 0.37; 95% CI: 0.23.0.60; P < 0.0001)]. Furthermore, primigravidae had almost threefold risk of falling during pregnancy than multigravidae [45.3% (63/139) vs. 23.3% (45/193); OR: 2.73; 95% CI: 1.70.4.37; P < 0.0001)].Conclusion: Falls during pregnancy is common in Enugu, Nigeria. It is, therefore, recommended that women should be counseled during pregnancy on this public health problem and the above.identified risk factors emphasized in order to reduce the prevalence and morbidity.Key words: Enugu, falls, Nigeria, pregnant women, prevalence, risk factor

An Audit of Uterovaginal Prolapse in Enugu, Southeast Nigeria

Abstract A retrospective study of utero-vaginal prolapse to determine the frequency and determinants of uterovaginal prolapse, degrees and its complications at the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria between January 1, 2005 and December 31, 2009. The prevalence of uterovaginal prolapse was 3.4%. Thirty three (66%) of them were postmenopausal. Multiparity was a significant determinant as 74% of them were grandmultiparous. The commonest symptom was "something coming down the vagina" in 96% of the study subjects. Second degree prolapse was the commonest type of presentation (48%) and the definitive treatment modality was vaginal hysterectomy with pelvic floor repair (44%). Multiparity, prolonged labour and unsupervised deliveries are significant determinants. Uterovaginal prolapse is primarily a common gynaecological condition of the parous and elderly postmenopausal women associated with a decreased body image and quality of life. Education of women, women empowerment, effective antenatal care, supervised hospital deliveries, and limiting the family size by efficient contraception deserve priority attention to prevent this social malady

Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.

INTRODUCTION: In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. METHODS: We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. RESULTS: From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. CONCLUSION: Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution

Improving access to health care for malaria in Africa: a review of literature on what attracts patients

BACKGROUND: Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services. METHODS: This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings. RESULTS: A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers. CONCLUSION: This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly