Primary vaginal leiomyosarcoma: case report of a rare gynaecological malignancy and diagnostic challenge in a resource-constraint setting.

Primary vaginal leiomyosarcoma (VLMS) is an extremely rare variant of primary vaginal cancers with very poor prognosis irrespective of the stage at presentation and the type of treatment received. It is easily recurrent and has a high propensity for haematogenous spread especially to the lungs. We present the case of a 34-year-old Para 1 + 1 (1 alive) woman with recurrent vaginal mass of 8 years duration after two surgical excisions without histological evaluation. She had examination under anaesthesia and a wide local excision of the vaginal mass. Histological examination of the mass revealed poorly differentiated VLMS with positive surgical margins and she was commenced on adjuvant chemo-radiation. Histological evaluation remains the hallmark for diagnosing rare malignancies like VLMS, which unfortunately is not a standard practice in some resource-constraint settings.

Good clinical practice advice for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria.

The impact on healthcare services in settings with under-resourced health systems, such as Nigeria, is likely to be substantial in the coming months due to the COVID-19 pandemic, and maternity services still need to be prioritized as an essential core health service. The healthcare system should ensure the provision of safe and quality care to women during pregnancy, labor, and childbirth, and at the same time, maternity care providers including obstetricians and midwives must be protected and prioritized to continue providing care to childbearing women and their babies during the pandemic. This practical guideline was developed for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria and other low-resource countries.

Foeto-placental parameters in normal pregnancy and factors affecting them.

OBJECTIVE: The aim of this study was to evaluate foeto-placental (F/P) parameters, namely foetal birth weight, placental weight (PW) and F/P weight ratio, in normal pregnancy and factors affecting them. METHODOLOGY: A retrospective study was conducted on labour ward data obtained over a period of 3 years (2015-2017). Only deliveries above 28-week gestational age which met other selection criteria were included in the study. Their sociodemographic parameters, PW, foetal birth weight, foetal outcome and Apgar scores were extracted from the delivery registers. The F/P weight ratio was calculated from the values obtained. All data collected were subjected to statistical analysis using SPSS version 20. RESULTS: The mean age ± standard error of mean of parturient was 31.84 ± 0.18 years. A larger proportion, 1455 (80.7%) of the women were booked. The mean gestational age ± standard deviation at delivery was 37.81 ± 2.72 weeks. Foetal weight (FW), PW and F/P weight ratio rise progressively with advancing gestational age in normal pregnancy, the FW rising faster than the placenta which gains weight slowly. The F/P ratio rises steadily initially and then abruptly from 42-week gestational age as the foetus outgrows the placenta, after which there is a sharp decline from 43-week gestational age. FW, PW and F/P ratio are significantly affected by gestational age and booking status (P = 0.000). Parity and foetal sex were found to have significant influence on FW alone (P = 0.026 and P = 0.000, respectively). CONCLUSION: This study clarifies the need to avoid undue prolongation of pregnancy beyond 42 weeks to avert adverse consequences which may be related to the differential growth in the foetus and placenta.

Vitamin D deficiency in pregnant women and newborns in Lagos, Nigeria.

We aimed to determine the prevalence of Vitamin D deficiency among pregnant women and their newborns in order to make recommendations for Vitamin D supplementation, if necessary. It was a cross-sectional study carried out over a period of 12 months. Information such as use of Vitamin D supplements, number of daytime hours spent outdoors and dressing style was obtained from 166 pregnant women in Lagos, Nigeria; maternal and cord blood 25(OH)D concentration was determined using ELISA. The prevalence of Vitamin D deficiency (<20 ng/mL) in the mothers and newborns was 4.8% and 29.5%, respectively, while insufficiency (21-29 ng/mL) was 28.3% and 46.1%, respectively. Vitamin D supplement use during pregnancy, daytime outdoor exposure and mothers' dressing style were significantly associated with maternal serum 25(OH)D concentration (p < .05). Our study showed that despite a sunny environment like ours, inadequate serum 25(OH)D concentration is still considerable among pregnant women and their newborns and suggests a need for Vitamin D supplementation in pregnant women. Impact Statement What is already known on this subject? Vitamin D is an essential vitamin that plays a major role in maintaining pregnancy and ensuring adequate skeletal formation in the foetus. Studies have shown that there is high Vitamin D deficiency in pregnant women in the temperate regions of the world and thus Vitamin D supplements are being offered to these pregnant women. Studies have also shown that the foetal/neonatal serum Vitamin D level is a reflection of the maternal level. What the results of this study add? The results of this study adds that there may be some factors preventing adequate delivery of Vitamin D from the maternal circulation to the foetal circulation, because despite a low prevalence of Vitamin D deficiency in the mothers, their neonates had a high deficiency rate. What the implications are of these findings for clinical practice and/or further research? The implications of these findings are; further research is warranted in order to find what could be causing a reduced delivery of Vitamin D from the mothers to their foetuses, so as to prevent it if possible. Second, these findings suggest that our pregnant women should still receive a form of Vitamin D supplements, so as to raise their serum Vitamin D to a level which would guarantee optimal foetal concentration.