Atherogenic Index, Cardiovascular Risk Ratio, and Atherogenic Coefficient as Risk Factors for Cardiovascular Disease in Pre-eclampsia in Southeast Nigeria: A Cross-Sectional Study.

BACKGROUND: Pre-eclampsia is a key trigger for maternal and perinatal morbidity and mortality. Current evidence suggests an association between dyslipidemia and atherosclerosis. Thus, the importance of evaluating some indices of atherosclerosis during pregnancy cannot be over-emphasized. AIM: To evaluate the effect of some lipid profile indices as risk factors for developing cardiovascular disease (CVD) among women with pre-eclampsia in Enugu, Southeast Nigeria. MATERIALS AND METHODS: A cross-sectional study of two groups of eligible pregnant women between 20 and 40 weeks of gestation selected at three healthcare facilities in Enugu, Nigeria was carried out. The case group consisted of 160 women with pre-eclampsia, while the control group consisted of 160 normotensive pregnant women. Participants' fasting blood samples were analyzed for different fractions of lipids and their atherogenic indices were calculated. RESULTS: There were significantly higher mean levels of total cholesterol (TC), low-density lipoprotein (LDL), and triglyceride (TG) [P < 0.001] in pre-eclampsia than in normal pregnancy. The atherogenic index of plasma (AIP), cardiovascular risk ratio (CRR), and atherogenic coefficient (AC) were significantly higher in pre-eclampsia than in normal pregnancy (P < 0.001) and there was a significant positive correlation between mean arterial pressure (MAP) and AIP (r = 0.421), CRR (r = 0.416) and AC (r = 0.634) for women with pre-eclampsia. CONCLUSION: Pre-eclampsia is associated with an increased risk of CVDs. Determining the atherogenic indices and assessing the AIP level in pre-eclamptic women may predict disease risk and help in early management and measures for its prevention.

Analysis of cost burden of obstetric care among human immune-deficiency virus (HIV) positive women in Enugu metropolis, South-East Nigeria.

The cost of obstetric care could hinder the capacity of human immune-deficiency virus (HIV) positive women to receive adequate care during pregnancy and delivery. This study was aimed at determining the relationship between antenatal/delivery care cost and delivery place choice among HIV positive women in Enugu metropolis. This was a cross-sectional study of 232 post-partum HIV-positive women who came for 6-weeks post-natal visit. Data were analysed using SPSS version 20. The ethical clearance number obtained at UNTH on 18/11/2015 was NHREC/05/01/2008BFWA00002458-1RB00002323. The average obstetric care cost among the respondents was N55,405.67 (US$346.28). The delivery cost (p-value-0.043) had positive relationship with delivery place choice. The women's proportion delivered by skilled birth attendants (SBA) was 93.1%. In conclusion, obstetric care cost among HIV positive women in Enugu was high. The high obstetric care cost influenced the delivery place of one-third of them. The choice of ill-equipped health facilities may result in higher risk of HIV transmission.IMPACT STATEMENTWhat is already known on this subject? The high HIV/AIDs burden in Nigeria could be attributed to poverty, ignorance, corruption and poor implementation of policies targeted at halting the spread of the infection. The cost of obstetric care could hinder the capacity of HIV positive women to receive adequate care during pregnancy and delivery.What do the results of this study add? The cost of antenatal care (p-value = .02) and delivery (p-value = .001) had a significant positive relationship with the choice of place of delivery by the respondents. The proportion of the women delivered by SBA was 93.1%. Approximately 31.9% of the women delivered at the health facilities different from where they had antenatal care.What are the implications of these findings for clinical practice and/or further research? This implies that the obstetric care cost among HIV positive women in Enugu metropolis was catastrophic. Though 93.1% of the respondents were delivered by SBA, the high cost of obstetric care influenced the delivery of one-third of them at centres different from where they had antenatal care. This may lead to women delivering in poorly equipped health facilities, which, in turn, may result in a higher risk of mother-to-child HIV transmission.

Estimation of fetal weight: a comparison of clinical and sonographic methods.

Fetal weight estimation is important in the management of labour and delivery. This study aimed to compare the accuracy of the clinical and ultrasound methods of fetal weight estimation. This was a prospective study involving 110 term cephalic singleton pregnancies delivered within 24 hours of clinical fetal weight estimation using Johnson's and Dare's formulae and ultrasound estimation at a Tertiary hospital in Abakaliki, Nigeria. The data were analysed with Stata 11 software. The sonographic estimation within 10% of the actual birth weight (ABW) of 68.2% was significantly greater than the accuracy of Johnson's (23.6%), Dare's (26.4%), and the combined clinical formulae (27.1%). The clinical methods overestimated the fetal weight. Both methods showed a positive correlation with the ABW. In conclusion, the sonographic method had a better accuracy than the clinical methods. However, fetal weight overestimation by clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude fear of complications from macrosomia. Impact statement What is already known on this subject? An accurate estimation of fetal weight is important in the management of labour and delivery. However, there is limited evidence that any of the available methods of fetal weight estimation is more accurate than the others. What do the results of this study add? This study showed that the clinical methods using Johnson's and Dare's formulae had a significantly higher mean percentage and absolute mean percentage error compared to the sonographic estimation of fetal weight. The sonographic estimation within 10% of actual birth weight (ABW) of 68.2% was significantly greater than that of Johnson's and Dare's formulae with 23.6% and 26.4%, respectively. All of the methods showed a positive correlation with the ABW. What are the implications of these findings for clinical practice and/or further research? This implies that the sonographic method has a better accuracy than the clinical methods in estimating the fetal weight. However, the overestimation of fetal weight by the clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude the fear of complications from macrosomia.

The prevalence of osteoporosis among antenatal clinic attendees in a rural mission hospital in South-East Nigeria.

INTRODUCTION: Osteoporosis is a global public health problem characterized by reduction of bone mineral density (BMD). This study aimed to assess the prevalence of osteoporosis among antenatal clinic attendees in a rural Southeastern hospital. MATERIAL AND METHODS: This was a cross-sectional study of booking Antenatal Clinic Attendees at Mile 4 Catholic Hospital, Abakaliki, between October 2014 and February 2015. The study participants were selected through systematic random sampling. The BMD of the right calcaneal bone of the participants was measured using the OsteoPro, a Quantitative ultrasound scan. RESULTS: A total of 327 eligible women participated in the study. The average age of the participants was 29 ± 4.5 years. The average parity was 2 ± 1.6 childbirths. The mean T-score was -1.19 ± 4.9. Osteoporosis and osteopenia were recorded in 119 women (36.4%) and 56 women (17.1%), respectively, whereas 152 (46.5%) were within normal range. History of regular exercise by the respondents is statistically significant on the reduction of osteopenia and osteoporosis (P ≤ 0.05). The history of ever use of calcium supplementation by the study participants in the index pregnancy did not have any significant effect on the reduction of osteoporosis. CONCLUSION: There is a high prevalence of osteoporosis among pregnant women in Southeast Nigeria. This may be due to the predominant poor adherence and low dose of calcium supplementation among pregnant women in this environment. Therefore, there is an urgent need for sensitization on this public health problem.

Male partner involvement in female contraceptive choices in Nigeria.

Opposition by male partners is one of the barriers to contraceptive use in sub-Saharan Africa. The study aimed at determining the extent of male partner involvement in female contraceptive (FP) choices in Enugu, south-east Nigeria. Questionnaires were administered to 243 consecutive women attendee of family planning clinic, University of Nigeria Teaching Hospital (UNTH), Enugu from January to June, 2012. A total of 137 women made contraceptive decisions jointly with their partners, which gave a male involvement rate of 56.4%. Only respondents' higher age (≥ 35 years) had significant association with male partner involvement in FP choices (odds ratio (OR) = 2.1; 95% confidence interval: 1.22, 3.51; p = 0.008). Covert contraceptive use rate was 4.9% (12/243). A majority of women attending the FP clinic of UNTH, Enugu involved their partners when making contraceptive choices. Male-partner-targeted family planning programme has the potential to increase uptake of contraception in our environment.

The role of ultrasonography in in-vitro fertilization and embryo transfer (IVF-ET).

BACKGROUND: Although ultrasonography was introduced into Obstetrics and Gynaecology by a British Gynaecologist over five decades ago, the requirements for formal training in its use by gynecologists in Nigeria is just beginning to catch on, despite its indispensible role in various aspects of our clinical practice. OBJECTIVE: To describe the role of ultrasonography in in-vitro fertilization and the indispensability of the instrument to reproductive medicine. METHOD: A review of literature written in English language on the use and application ofultrasonography. in in-vitro fertilization was done. The review covered articles published between 1980-2012. RESULTS: Ultrasound is the most versatile method for pre-treatment assessment in IVF being the dominant instrument for assessing ovarian reserve, pelvic pathologies and for assessing the uterine cavity. The ability of ultrasonography to measure endometrial thickness in addition to detecting uterine masses gives it an edge over laparoscopy/hysteroscopy as a diagnostic procedure in uterine cavity assessment, although hysteroscopy has the advantage of therapeutic potential. Similarly, ultrasonography is superior to biochemical methods for follicular monitoring because of its ability to demonstrate the number and sizes of follicles, and guide preparations for oocyte retrieval. The relative ease of ultrasound guided oocyte retrieval; its less technical demands and the possibility of conducting the procedure under local anaesthesia have made ultrasound guided oocyte retrieval more popular across the world. Randomized controlled trials show that ultrasound-guided transfer techniques have better outcomes than the clinical touch technique in terms of on-going pregnancies and Clinical pregnancies. Ultrasonography is now the key instrument for diagnosing and monitoring pregnancy following embryo transfer, biochemical methods being complimentary. CONCLUSION: Ultrasonography is now the single most important instrument in in-vitro fertilization .programmes and gynaecologists with interest in reproductive medicine need necessarily to obtain a formal training in its use.

Presence of chaperones during pelvic examinations in southeast Nigeria: women's opinions, attitude, and preferences.

OBJECTIVES: To assess the opinions, attitude, and preferences of Nigerian women to the presence of chaperones during pelvic examinations. MATERIALS AND METHODS: A cross-sectional survey of first time gynecology clinic attendees on their opinions, attitudes, and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi-structured, researcher-administered questionnaires. RESULTS: One hundred and nineteen (51.7%) of the respondents preferred female physicians for pelvic examination, 23 (10%) preferred male physicians and 88 (38.3%) had no gender preference. When the examining physician is a male, 124 (53.9%) respondents would like to have chaperones during pelvic examinations while 106 (46.1%) would not. Eighty-three percent of respondents preferred nurse chaperones. Age, level of education, and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones ( P = 0.503, 0.525, and 0.605 respectively). CONCLUSIONS: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients' right to refuse the offer.

Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in a low resource setting.

Retained placenta membranes and tissue are responsible for 5% to 10% of postpartum hemorrhage. Placenta accreta occurs in approximately 1 in 2500 pregnancies of which placenta percreta constitutes about 5% of placenta accreta. This portends the rarity of placenta percreta especially in a 32 year old woman with minimal risk factors. Our patient was a G4P3(+0) woman with 2 living male children who presented at 39 weeks plus 2 days gestation in latent phase of labour and transverse lie. She had emergency caesarean hysterectomy due to primary postpartum haemorrhage secondary to placenta percreta. There should be a high index of suspicion of placenta percreta in women with the risk factors and whoever does caesarean section should have the skills for hysterectomy in case of any encounter with placenta percreta not amenable to conservative management.