The prevalence of polycystic ovary morphology among women attending a new teaching hospital in southern Nigeria.

The aim of this study was to determine the prevalence of polycystic ovary morphology (PCO) among Nigerian women attending for pelvic ultrasound. This was a retrospective study of the ultrasound scan findings of all women who attended for pelvic ultrasound scan at a new teaching hospital in southern Nigeria from the commencement of ultrasound services on 1 March to 31 July 2010. The main indication for the scans was infertility (52.7%), and the commonest finding was fibroid (44.6%). Polycystic ovary morphology was present in 12.2% of the women. On average women with PCO were younger (30.3 v 35.0 years) and more likely to present with amenorrhea (33.3 v 7.6%) than women without PCO, but there was no other statistically significant differences between the two groups. This study suggests that Nigerian women have a low incidence of PCO morphology.

Evaluation of the use of a Whatsapp Forum for the Daily Clinical Case Review in Obstetrics and Gynaecology at a Teaching Hospital during the COVID-19 Pandemic.

Background: This study aimed to evaluate the use of a Whatsapp forum for a daily clinical case review in Obstetrics and Gynaecology. Methodology: We used a Qualitative Action Research methodology, as the study involved an intervention; the introduction of a WhatsApp platform for daily morning case review; and exploration of what happened following the intervention using a feedback questionnaire. The 21 resident doctors and consultants who completed and returned the feedback questionnaire were the subjects of the study. Results: Twenty-one out of the 29 doctors in the department (72.4%) participated in the study. Of the participants, 66.7% agreed or strongly agreed that the Whatsapp forum was an appropriate way of conducting the daily morning case review. Also, 76.2% of participants said that the learning via WhatsApp platform was different and created a forum for everyone to be in attendance and participate at their convenience. Hence, the vast majority of participants (81%) said that they would recommend Whatsapp morning review to other departments. Eighty-one per cent agreed or strongly agreed that the WhatsApp morning review motivated them to learn but what the Registrars liked the least about the WhatsApp review was 'the stress of typing and responding to long questions'. However, the Registrars felt safe and relaxed and said the Whatsapp approach 'reduced harassment and abuse of the junior doctors'. Conclusion: The WhatsApp forum is an appropriate and safe method of conducting the obstetrics and gynaecology daily medical case review especially during a Pandemic. It may be worth looking at using the WhatsApp forum as an additional learning tool in the department even after the COVID-19 pandemic.

The CircumVent Project: a CPAP/O2 helmet solution for non-invasive ventilation using an implementation research framework.

BACKGROUND: Acute respiratory failure, a major cause of death in COVID-19, is managed with high-flow oxygen therapy via invasive mechanical ventilation. In resource-limited settings like Nigeria, the shortage of ventilators and oxygen supply makes this option challenging. Evidence-based non-invasive alternatives to mechanical ventilation such as the use of continuous positive airway pressure (CPAP) devices exist, but there have been concerns that non-invasive ventilation may expose healthcare workers to infection from aerosolized dispersion of SARS-CoV-2. We propose to evaluate the feasibility, adaptability and acceptability of a CPAP/O2 helmet solution for non-invasive ventilation among patients with COVID-19 and health workers in eight COVID-19 treatment and isolation centers in Nigeria. METHODS: The study will occur in 4 stages: (1) convene a Steering Committee of key stakeholders and recruit implementation sites; (2) use the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework to guide a needs assessment of treatment centers' capacity to use high-flow oxygen therapy to treat COVID-19 patients and utilize the findings to develop an implementation strategy for the use of a CPAP/O2 helmet solution; (3) build infrastructure to support training and data monitoring processes and to develop implementation protocols to evaluate the adaptability of the strategy for the use of the CPAP/O2 helmet; and (4) train health workers, distribute a CPAP/O2 helmet solution for non-invasive ventilation, pilot test the implementation strategy, and assess feasibility of its use and acceptability that includes monitoring altered risk of SARS-CoV-2 infection among healthcare workers. DISCUSSION: The CPAP/O2 helmet solution for non-invasive ventilation in Nigeria can serve as a scalable model for resource-poor countries, and beyond the COVID-19 pandemic, has the potential to be deployed for the treatment of pneumonia and other respiratory diseases. TRIAL REGISTRATION: NCT04929691. Registered June 18, 2021-retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04929691.

In What Ways Might Stories and Anecdotes Impact upon the Quality of Small Group Teaching in Obstetrics and Gynecology?

OBJECTIVES: The aim of this study was to find out how stories and anecdotes might improve the quality of the daily morning obstetrics and gynecology (O and G) teaching and determine if the emotions generated by the stories and anecdote deepened the understanding of medical topics. MATERIALS AND METHODS: The overarching approach to this study was action research. On two occasions, I told stories using PowerPoint presentation during the morning teaching in the O and G seminar room to 10 and 11 learners instead of the traditional factual presentation of a medical topic. The learners ranged from the 3rd-year medical students to 4th-year specialist trainees in O and G and a consultant anesthetist. Each learner completed a feedback questionnaire at the end of the teaching session. I noted the learners' comments and analyzed written feedback. RESULTS: More than 90% of the learners agreed or strongly agreed that the stories were appropriate for their level of training, and on both occasions, every single learner agreed or strongly agreed that the stories improved the quality of the morning teaching. On both days all but one learner agreed or strongly agreed that the stories improved their understanding of the medical topics, and a senior O and G trainee wrote that the story was: "useful - improved my understanding of situation involved." The stories generated a lot of emotion in the learners, emotions that deepened their understanding of the topic covered. CONCLUSION: Stories and anecdotes appear to improve the quality of teaching, and this was the case regardless of level of training and experience of the learner. Hence, stories and anecdotes may be an excellent teaching tool in a setting like the morning teaching where the learners are quite varied.

Spontaneous monochorionic triplet pregnancy with no fetal anomaly or feto-fetal transfusion.

We present a case of spontaneously conceived monochorionic triamniotic triplet pregnancy with no fetal anomaly or feto-fetal transfusion. The mother developed gestational diabetes at 20 weeks gestation, and at 20 weeks and 4 days gestation triplet 2 was found to have selective growth restriction and absent end diastolic flow. Although laser treatment and clamping of the umbilical cord of the growth-restricted baby was considered, the management was conservative with regular ultrasound scans and antenatal corticosteroids at 24 weeks gestation, and the umbilical artery Doppler reverted to normal at 26 weeks and 4 days and growth velocity was maintained. An elective caesarean section was performed at 33 weeks gestation to deliver three boys in excellent condition who only required feeding support.

A longitudinal study of the control of renal and uterine hemodynamic changes of pregnancy.

We have determined the sequence and extent of maternal renal and uterine adaptation to pregnancy and examined the role of hormonal factors in their regulation. Renal bipolar diameter (RBD), renal artery resistance index (RARI), uterine artery pulsatility index (UAPI), and plasma relaxin, human chorionic gonadotropin (hCG), progesterone, estradiol, urea, and creatinine were measured longitudinally in women with normal spontaneous singleton pregnancies, in vitro fertilization (IVF) singleton pregnancies, ovum donation (OD) singleton pregnancies, and multiple pregnancies from prepregnancy to postpartum. There was a progressive increase in the RBD and the RARI and a decrease in the UAPI during pregnancy. These changes reversed toward prepregnancy levels by 6 weeks post delivery. There was no difference in the rate of change of RBD, RARI, and UAPI between spontaneous singleton, IVF singleton, OD singleton, and multiple pregnancies (p < 0.05), but relaxin was directly correlated to the RARI (r = 0.654, p = 0.015), and progesterone was inversely correlated to uterine artery PI (r = 0.554, p = 0.049). These data show that renal size and resistance to blood flow increase with advancing gestation, whereas the uterine artery resistance declined with gestation. These changes may be influenced by relaxin and progesterone.

A longitudinal study of the maternal cardiovascular adaptation to spontaneous and assisted conception pregnancies.

OBJECTIVE: To determine the sequence and extent of maternal cardiovascular adaptation in an integrated way in spontaneous and assisted conception pregnancies. METHODS: Cardiovascular assessments were performed pre-pregnancy, during pregnancy and 6 weeks post delivery in women with normal spontaneously conceived singleton pregnancies (n = 13); singleton IVF pregnancies (n = 5); singleton OD pregnancies (n = 4); and multiple pregnancies (n = 6). RESULTS: The OD singleton pregnancies had a significantly higher diastolic and mean blood pressure (BP) than the normal singleton pregnancies at 10 weeks gestation (p = 0.010 and 0.008, respectively), and the multiple pregnancy group had a higher systolic and mean BP at 16 weeks gestation than the IVF singleton pregnancy group (p = 0.045 and 0.033, respectively). The multiple pregnancy group had higher heart rate (HR) at 16 weeks gestation (p = 0.010), higher fractional shortening (FS) at 16 weeks gestation (p = 0.006), and higher left ventricular (LV) mass at 26 weeks gestation (p = 0.049) than the IVF singleton pregnancy group. The rate of change of LV mass was correlated to the rate of change of the blood pressure (r = 0.725, p = 0.005 for mean BP) and inversely correlated to the rate of change of fractional shortening (r = 0.767, and p = 0.002). CONCLUSION: Ovum donation pregnancies are associated with higher BP in early pregnancy, whilst multiple pregnancies are associated with higher BP, FS and LV mass in later pregnancy.

Obstetrical factors related to nuchal cord.

BACKGROUND: To investigate the intrapartum factors related to umbilical cord nuchal loops (nuchal cord) with particular reference to shoulder dystocia. METHODS: We studied all singleton pregnancies with a vertex presentation and a birth weight of at least 2500 g from 1 January 1978 to 31 March 1997 and the 13,717 pregnancies with nuchal cord were compared to the 44,136 without nuchal cord. RESULTS: When compared to pregnant women without nuchal cord, a greater proportion of pregnant women with nuchal cord underwent induction of labor (adjusted OR 1.09, 95% CI 1.04-1.15) and augmentation with oxytocin (adjusted OR 1.06, 95% CI 1.01-1.11). They had a longer second stage of labor (p=0.0013) and a greater proportion of primiparous women with tight nuchal cord had second stage of labor that lasted longer than two hours (adjusted OR 1.21, 95% CI 1.03-1.41). The proportion of abnormal fetal heart rate patterns was higher in the presence of nuchal cord (adjusted OR 1.61, 95% CI 1.55-1.68). Shoulder dystocia occurred more commonly in association with nuchal cord, especially when the nuchal cord was tight (adjusted OR 1.50, 95% CI 1.30-1.72 for all nuchal cord; adjusted OR 1.82, 95% CI 1.42-2.34 for tight nuchal cord). CONCLUSIONS: Umbilical cord nuchal loops are associated with induction of labor, slow progress of labor, and shoulder dystocia.