Comparative diagnosis of premature rupture of membrane by nitrazine test, urea, and creatinine estimation.

OBJECTIVE: The study compared the reliability of nitrazine, urea, and creatinine in the diagnosis of premature rupture of membrane (PROM). Nitrazine strip measures pH levels while urea and creatinine are produced mainly in amniotic fluid and not in the maternal vagina. METHODS: Sixty-four pregnant women with demonstrable passage or pooling of liquor par vaginum on speculum examination and 64 with no liquor drainage at 28-42 weeks gestation were studied. Vaginal fluid aspirates from both groups of patient were tested for urea, creatinine, and pH levels using nitrazine strip. Receiver Operating Characteristic (ROC) curves were plotted to determine cutoff values for urea and creatinine. Statistical analysis was done using SPSS version 23.0 and setting statistical significance at P ≤ 0.05. RESULTS: Nitrazine test showed high level of specificity (100%) but a sensitivity of 87.5%. Predictive ability of urea at >12.7 mg/dl obtained as cutoff value from the ROC curve showed a sensitivity of 19.64% and specificity of 94.44% while for creatinine the cutoff value was at >0.8 mg/dl with sensitivity of 48.21% and specificity of 65.28%. CONCLUSION: Nitrazine strip was the most reliable of the three in the diagnosis of PROM. This was followed by creatinine and then urea. In view of the gaps in sensitivity and accuracy and the importance of precise diagnosis to prevent maternal and fetal complications, there is still the need to find other affordable, more sensitive and more accurate biochemical marker/s that will help in diagnosing PROM especially in difficult cases.

Adjunctive use of tranexamic acid to tourniquet in reducing haemorrhage during abdominal myomectomy - A randomized controlled trial.

BACKGROUND: Uterine fibroids are the commonest tumour of the female genital tract; about one third are symptomatic and require management. The treatment of uterine fibroids may be medical, surgical, conservative or expectant. Myomectomy is the common surgical treatment option for women failing medical management and desiring to preserve fertility and/or their uterus. The tourniquet is shown to be effective in reducing blood loss during myomectomy and tranexamic to a less extent. However, the adjunctive use of tranexamic acid with tourniquet to further reduce blood loss has not been studied. AIM: The aim of the study was to determine the efficacy of perioperative intravenous tranexamic acid in further reducing blood loss at abdominal myomectomy when used as an adjunct to tourniquet. METHODS: The study was a randomized double-blind controlled study involving women who underwent abdominal myomectomy. Participants were randomized to either tourniquet plus intravenous tranexamic acid or tourniquet plus placebo groups using simple random sampling. The primary outcomes were the intra-operative blood loss, post-operative haematocrit values and need for intra-operative blood transfusion. The data was analyzed using the SPSS software version 23.0 and p value < 0.05 was significant. RESULTS: The mean intra-operative blood loss (998.72 ±â€¯607.21 ml vs 907.25 ±â€¯529.85 ml, p = 0.475), intra-operative blood transfusion rate (45% vs. 30%; p = 0.166) and mean unit of blood transfused (1.13 ±â€¯1.64 vs. 0.75 ±â€¯1.28; p = 0.256) were higher for tourniquet plus placebo group compared to tourniquet plus tranexamic acid group. The estimated blood loss per 100 g of fibroid removed was reduced significantly in the tranexamic acid plus tourniquet group (139.80 ±â€¯2.28 ml vs 104.09 ±â€¯1.97 ml; p = 0.001). STRENGTH AND LIMITATIONS: The strength of the study include randomization and blinding. The limitations included non-uniformity of sizes and locations of fibroids, as well as the different surgeons with possibly different skills, techniques and experiences, though they were statistically not significant. CONCLUSION: The adjunctive use of tranexamic acid to tourniquet significantly further reduces intraoperative blood loss during abdominal myomectomy when compared to tourniquet alone. RECOMMENDATIONS: Adjunctive use of tranexamic acid is recommended for further reducing intra-operative blood loss during abdominal myomectomy.

Non-fistulous urinary leakage among women attending a Nigerian family planning clinic.

Urinary leakage is an important gynecological challenge, which has a substantial impact on quality of life. The aim of this study was to determine the prevalence and types of non-fistulous urinary leakage among women attending the family planning clinic of the University of Ilorin teaching hospital, Ilorin, Nigeria. The study was a cross-sectional study carried out between January 3 and April 25 2009. One hundred and two women experienced urinary leakage out of 333 women interviewed, giving a prevalence rate of 30.6%. Stress incontinence was the most common urinary leakage (prevalence rate 12.0%). This is followed by urge incontinence (10.8%), urinary incontinence (4.8%), and overflow incontinence (3.0%). None of the women afflicted sought medical help. Conclusively, this study has demonstrated that non-fistulous urinary leakage is a common problem among women of reproductive age in this environment.

Duration of labor with spontaneous onset at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

BACKGROUND/OBJECTIVE: Duration of labor varies from one pregnancy to another and a period of less than 12 hours is regarded as normal. Modern obstetric practice involves active management of labor with the aim of preventing prolonged labor and its sequelae. The main objective of this study was to determine and compare the average duration of labor of spontaneous onset between nulliparas (Po) and multiparas (P ≥ 1) and to determine factors affecting duration of labor. MATERIALS AND METHODS: This study was a prospective study carried out between 15 May and 14 June 2004 at the Labor Ward of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Two hundred and thirty-eight women who satisfied the inclusion criteria were studied. The inclusion criteria were term pregnancy with vertex presentation, labor with spontaneous onset, live fetus at presentation and spontaneous vertex delivery. RESULTS: The mean ± SD admission-delivery interval in labor ward was shorter (3.77 ± 2.88 hours) among multiparas than that of nulliparas (5.00 ± 3.17 hours) (P = 0.235). The mean ± SD duration of labor (from the onset of labor to delivery) was shorter among multiparas (8.73 ± 4.17 hours) than that of nulliparas (11.23 ± 4.29 hours) (P = 0.426). The differences were not significant (t-test, P > 0.05). Maternal age and individual parity had significant correlation with the duration of labor in this study (Pearson correlation = -0.019, -0.027, respectively, P < 0.05). CONCLUSION: Interestingly, duration of labor was not significantly different among multiparas and nulliparas although it was shorter. Correlation existed between duration of labor and maternal age and individual parity.