Comparison of clinical and ultrasonographic estimation of foetal weight at term and their correlation with birth weight.

The study compares the accuracy of clinical and ultrasonographic estimation of foetal weight at term in predicting birth weight. It was a prospective comparative study conducted in a tertiary hospital in Abuja, Nigeria between May and August 2018. Three hundred pregnant women planned for delivery were recruited. In-utero clinical estimation of foetal weight was carried out using Dare's clinical method and sonographic estimation using Hadlock 3 formula. The newborn babies were weighed within 30 minutes of delivery. The difference in the accuracy of the clinical method (75.3%) and the ultrasonographic method (82.3%) was statistically significant (p-value=0.023). The accuracy of the clinical method among parturients whose BMI were <30kg/m2 and ≥30.0kg/m2 were 83.5% and 68.5% respectively while that of the ultrasonographic method were 85.2% and 80% respectively. We conclude that ultrasonographic estimation of foetal weight is more accurate than the clinical method. However clinical method may be used when an ultrasound scan is not accessible.

The Prevalence of Human Immunodeficiency Virus Infection among Pregnant Women in Labour with Unknown Status and those with Negative Status Early in the Index Pregnancy in a Tertiary Hospital in Nigeria.

Rapid HIV test in labour provide an opportunity for the identification of HIV positive pregnant women who should benefit from interventions to reduce the risk of mother-to-child transmission (MTCT) of HIV. Between November 2013 and June 2014 we conducted rapid HIV testing of pregnant women in labour at the National Hospital Abuja to determine the HIV seroconversion rate in pregnancy and the prevalence of HIV in pregnant women in labour with previously unknown status. HIV testing and counseling (HTC) was acceptable to 224 (99.6%) of the pregnant women who met the study criteria. The mean 'turnaround' time for test result was 288 minutes and 16.2 minutes for tests performed in the hospital laboratory and those performed at the point-of-care (labour ward) respectively. HIV seroconversion was detected in 2(1.2%) of the 165 parturients with initial HIV negative result early in the index pregnancy. HIV infection was detected in four (2.7%) of the 59 parturients with unknown HIV status. Secondary school level education was significantly associated with HIV seroconversion in pregnancy P < 0.001. HTC in labour using rapid testing strategy is feasible and acceptable in our setting. The introduction of HCT will lead to the diagnosis of HIV positive women in labour, appropriate interventions and prevention of MTCT of HIV.

Management of infertility in HIV infected couples: a review.

The HIV epidemic has continued to grow and remains a major challenge to mankind. In the past, ethical considerations about the resulting child and risks of sexual, vertical and nosocomial transmission of HIV prevented practitioners from offering fertility services to people living with HIV. In recent times however, the use of highly active antiretroviral therapy (HAART), has not only improved the life expectancy and quality of life of those infected but also reduced the risk of HIV transmission. The need for fertility services in the HIV-positive population has thus increased and may be employed for management of infertility and protection from transmission or acquisition of HIV infection. As such, preconception counseling, sexual health and fertility screening have become routine in the management of HIV-positive couples. The option of care include adoption, self insemination with husband sperm, embryo donation from couples who have been verified to be HIV negative, insemination with donor sperm, timed unprotected intercourse (TUI) and sperm washing combined with intrauterine insemination (IUI) and assisted reproductive technology (ART) including in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Access to these fertility services by HIV-positive clients should be facilitated as part of efforts to promote their reproductive health and rights.

Contraception in the context of HIV/AIDS: a review.

Over 50% of the 33.3 million HIV-positive persons are women within the reproductive age group. With increasing availability and use of highly active antiretroviral therapy (HAART), the prognosis, life expectancy and quality of life of infected persons has improved. HIV-positive women, like their uninfected counterparts, may desire to plan pregnancies, limit their families, or avoid pregnancy. The effective use of contraception by HIV-positive clients can contribute significantly to reduction in both sexual and vertical transmission of the virus. HIV-positive clients can use most of the available contraception methods including barrier, hormonal, intrauterine devices and sterilization. However, some antiretroviral drugs interact with hormonal contraceptives with potentials for reduction in efficacy. Dual protection with concomitant use of a more effective contraceptive method and male or female condom to prevent HIV and Sexually transmitted infections (STIs) is the standard. It is necessary to make provision for contraceptive service as part of comprehensive care for the HIV-positive client.

Review of Medically Indicated Preterm Births Due to Hypertensive Disorders in Pregnancy at a Tertiary Hospital in Abuja: Maternal Characteristics and Neonatal Outcome.

Background: Preterm birth is the delivery of a baby before 37 weeks of gestation. Hypertension in pregnancy has been found to be the most common cause of medically indicated preterm birth leading to significant neonatal mortality and morbidity. Objective: To evaluate the prevalence of medically indicated preterm births due to hypertension in pregnancy, the pattern of maternal characteristics and the immediate neonatal outcome. Study Design: A descriptive cross-sectional study of all medically indicated preterm births due to hypertensive disorders in pregnancy at National Hospital Abuja from 1st January 2008 to 31st December 2012. Results: The total number of births over the five-year period was 9055 with preterm births contributing 1075(11.9%), 523(48.7%) were spontaneous while 552(51.3%) were medically indicated. Hypertension in pregnancy was the indication for 254(23.6%) of the overall preterm births and 46% of medically indicated preterm births. Preeclampsia was the diagnosis in 77.1% of the cases of hypertensive disorders, 33.5% deliveries were between 34-36 weeks gestational age and the mean birth weight was 1.82kg. Conclusion: Hypertensive disorder was a major contributor to medically indicated preterm birth in this study with Preeclampsia as the predominant form. Proper preconception and antenatal care with institution of preventive measures for preeclampsia will help prolong gestation in at risk mothers to ensure better survival for neonates.

The efficacy of intermittent preventive therapy in the eradication of peripheral and placental parasitemia in a malaria-endemic environment, as seen in a tertiary hospital in Abuja, Nigeria.

OBJECTIVE: To determine whether intermittent preventive therapy in pregnancy (IPTp) eradicates peripheral and placental malaria and improves birth weight. METHOD: A cross-sectional study was conducted of 426 pregnant mothers on IPTp with sulphadoxine-pyrimethamine against malaria who presented in labor, at National Hospital Abuja, Nigeria between January and June 2017. The hospital is within the malaria-endemic zone of West Africa. Consenting pregnant women with uncomplicated singleton term pregnancy who had antenatal care in the hospital and lived in the study area for at least 6 months were consecutively recruited. Peripheral and placental blood were collected and examined for malaria parasite by microscopy. Babies were weighed at birth. RESULTS: The prevalence of peripheral malaria parasitemia and placental parasitization were 12.9% (95% confidence interval [CI] 10.0-16.6) and 9.4% (95% CI 7.0-12.7), respectively. Parasite density in both peripheral parasitemia and placental parasitization was low among the women that took IPTp, decreasing with increasing doses, with no parasitemia or parasitization in women that took up to three doses. Birth weight was lower in babies of mothers with plasmodium infestation than in those without infestation (P<0.001, P=0.024). CONCLUSION: IPTp reduces both peripheral parasitemia and placental parasitization, with the capacity to eliminate or prevent them. IPTp also reduces low birth weight.

Multiple origins and regional dispersal of resistant dhps in African Plasmodium falciparum malaria.

BACKGROUND: Although the molecular basis of resistance to a number of common antimalarial drugs is well known, a geographic description of the emergence and dispersal of resistance mutations across Africa has not been attempted. To that end we have characterised the evolutionary origins of antifolate resistance mutations in the dihydropteroate synthase (dhps) gene and mapped their contemporary distribution. METHODS AND FINDINGS: We used microsatellite polymorphism flanking the dhps gene to determine which resistance alleles shared common ancestry and found five major lineages each of which had a unique geographical distribution. The extent to which allelic lineages were shared among 20 African Plasmodium falciparum populations revealed five major geographical groupings. Resistance lineages were common to all sites within these regions. The most marked differentiation was between east and west African P. falciparum, in which resistance alleles were not only of different ancestry but also carried different resistance mutations. CONCLUSIONS: Resistant dhps has emerged independently in multiple sites in Africa during the past 10-20 years. Our data show the molecular basis of resistance differs between east and west Africa, which is likely to translate into differing antifolate sensitivity. We have also demonstrated that the dispersal patterns of resistance lineages give unique insights into recent parasite migration patterns.

Coverage and distribution of obstetricians and gynecologists in Nigeria.

OBJECTIVE: To determine the number, regional spread, and population ratio of obstetricians and gynecologists (OB/GYNs) in Nigeria. METHODS: Data for the present descriptive study were collected between July 1, 2012, and December 31, 2013, as part of a national survey of OB/GYNs. Information was obtained about characteristics, qualifications, place of work, primary employer, subspecialty interest, and type of practice. RESULTS: In total, 968 OB/GYNs were identified, of whom 846 (87.4%) were male. The estimated national population in 2013 was 175651197, which meant that there was one OB/GYN for every 181 458 individuals. Lagos State had the highest number of OB/GYNs (179 [18.5%]), whereas Yobe State had only 2 (0.2%) and Jigawa State 1 (0.1%). The geopolitical region with the highest number of OB/GYNs was the South West (315 [32.5%]), whereas the North East had the lowest number (45 [4.6%]). CONCLUSION: The number of OB/GYNs in Nigeria is inadequate in view of the population size, and coverage varies greatly in different states. Efforts to improve maternal health and reduce the maternal mortality ratio should include more investment in training, engagement, and equitable distribution of OB/GYNs in all parts of the country.

The role of advocacy in the national strategy for maternal death review in Nigeria.

Strategic advocacy has played a substantial role in the development and implementation of maternal death review (MDR) in Nigeria. Stakeholders that include the Society of Gynaecology and Obstetrics of Nigeria have partnered with the Federal Ministry of Health to ensure a robust arrangement that will guarantee the success of MDR in this country. Consequently, it is envisaged that the program will both contribute to a sustainable reduction in the maternal mortality ratio and promote improvements in maternal health care. The Nigerian experience indicates that the influence of stakeholders, such as professional organizations, is essential to drive the development of MDR programs through provision of advocacy and technical support. The current convergence of factors-including global support, political will, technical innovations, and increased financial resources-provides an ideal opportunity to make MDR a reality for all countries.