Fetal Gestational Age Estimation Using Ultrasonic Transverse Cerebellar Diameter in a Sub-Saharan African Population.

Background: To explore the relationship between fetal Transverse Cerebellar Diameter (TCD) and menstrual gestational age (GA) and to generate normative references (nomogram) of the fetal TCD in some pregnant women in Southwest Nigeria. Methods: Four hundred pregnant women with a singleton fetus between 14 and 38 weeks GA were enrolled. The TCD and other biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) as well as the cerebellar appearance were analyzed and correlated with the GA. Results: The mean TCD increased from 13.3 ± 0.3 mm at 14 weeks to 52.3 ± 3.3 mm at 38 weeks of pregnancy. A strong positive correlation was observed between TCD and GA, which was best represented by a linear regression equation: Predicted GA = 0.557 × TCD + 8.840. The regression analysis indicated a statistically significant strong positive relationship between TCD and GA (r = 0.972 and P < 0.001). The cerebellar appearance based on shape and echogenicity was graded into Grade I: 230 fetuses (57.5%); Grade II: 74 fetuses (18.5%) and Grade III: 96 fetuses (24.0%). Median GA and TCD were 21 weeks and 21.2 mm for Grade I; 29 weeks and 35.5 mm for Grade II; and 35 weeks and 48.1 mm for Grade III, respectively. Conclusion: The TCD increased in a linear fashion with advancing GA in the evaluated fetuses. The TCD is, therefore, a good marker for GA estimation. There is a gradual ultrasonographic change in fetal cerebellar appearance with advancing gestation.

The efficacy of oral naproxen and cervical lidocaine spray on perceived pain during hysterosalpingography.

OBJECTIVE: This study was carried out to evaluate the efficacy of the combined use of oral naproxen and cervical lidocaine spray during hysterosalpingography (HSG) compared to the use of oral naproxen or cervical lidocaine spray alone. Materials and Methods: This prospective randomised controlled study was carried out using a total of 240 patients who were randomly assigned to four groups. Group 1 received cervical lidocaine spray only, Group 2 received oral naproxen only, Group 3 received cervical lidocaine spray and naproxen tablet, whereas Group 4 was the control group. A visual analogue scale was used for subjective pain assessment at three pre-defined steps. RESULTS: The mean pain scores of the patients in each of the four groups are Group 1 (3.6 ± 2.0, 5.1 ± 1.8, 5.8 ± 2.2); Group 2 (2.7 ± 1.4, 3.6 ± 2.0 and 3.9 ± 1.9); Group 3 (2.8 ± 1.5, 3.4 ± 2.0 and 4.2 ± 2.3); Group 4 (4.7 ± 1.7, 5.9 ± 1.7 and 5.3 ± 1.7) at T1, T2 and T3, respectively. Pain perception was statistically significantly reduced by naproxen and combined naproxen plus lidocaine spray at all the stages of HSG while cervical lidocaine spray had a statistically significant reduction in pain perception only during cervical instrumentation. CONCLUSION: Oral naproxen and combined naproxen plus cervical lidocaine spray were effective in reducing HSG-associated pain during all the stages of HSG. However, combined oral naproxen and lidocaine spray did not show superior efficacy over oral naproxen alone. Cervical lidocaine spray was not an effective method.

Ultrasonographic characterisation of obstructive uropathy in Nigerian women with uterine fibroids.

OBJECTIVES: The objective of this study was to determine the prevalence of upper renal tract obstructive changes in women with uterine fibroids using ultrasonography (USG). METHODS: We enrolled 140 women with uterine fibroids and performed USG of the uterus and upper renal tract with full and empty urinary bladders, respectively. The number of fibroid nodules and the uterine volume were determined. The presence of hydronephrosis was graded and documented. Uterine volumes >200 cm3 were denoted as large and vice versa. Statistical analysis was done using Chi-square and non-parametric tests. RESULTS: The median uterine volume was 556 cm3. Application of a 200 cm3 cut-off value yielded 126 (90%) large uterine volumes and 14 (10%) small uterine volumes. Of the 140 women enrolled, 52 (37.1%) had renal backpressure changes. Of these 52 patients, 51 (98.1%) had uterine volumes >200 cm3. Both kidneys were affected in the vast majority (36 out of 52 = 69.2%) of those with renal backpressure changes, and 23 (44.2%) of the 52 women with renal backpressure changes had mild (Grade 1) hydronephrosis, while 25 (48.1%) had moderate (Grade 2) hydronephrosis. When unilateral, however, backpressure changes were significantly more common on the right side. CONCLUSION: Approximately one in three women with fibroids had renal backpressure changes in this study. Large uterine volume is a key predisposing factor. Routine sonographic assessment of fibroids should include a focused/targeted evaluation of the kidneys.