Sonographic prediction of successful embryonic implantation in in-vitro fertilization and embryo transfer cycle procedures, using a multi-parameter approach.

INTRODUCTION: The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depend on maternal age, embryo quality and uterine receptivity. Prediction of embryonic implantation prior to IVF has become crucial in counseling patients due to the cost of failed procedure, in terms of huge financial expenditure, time taken for the procedure, associated health risks and psychological effects following unfulfilled expectation. The objective of this study was therefore to develop a scoring protocol and consequently, a predictive model for a successful embryonic implantation in IVF-ET cycles using maternal demographic, endometrial, ovarian, and hormonal parameters as tools for clinical decision and patient counseling. MATERIAL AND METHODS: The body mass index (BMI), age, endometrial pattern and thickness, antral follicle count, (AFC) and anti-Mullerian hormone (AMH) concentration of 295 women between the ages of 18-45 years were evaluated prior to IVF- ET at a fertility clinic in Lagos, Nigeria. The AFC, endometrial pattern and thickness were determined sonographically and the AMH assayed, using ELISA test kits. Multiple regression analysis was used to determine the contribution of each parameter to the likelihood of a successful implantation, and a 4 point rating scale was developed based on the relative contribution of each parameter. Scores were then assigned based on the strength of each predictor variable to implantation rates. RESULTS: Eighteen women that conceived had a full score of 20, while five that failed to conceive scored below 9. Chi square test indicated that endometrial pattern, thickness, age, AFC and AMH are highly significant in predicting embryonic implantation at IVF, while BMI was insignificant (r = -1.831, p = 0.094). CONCLUSION: The prediction model demonstrated a positive correlation between the cumulative score and implantation rate. The use of the scoring system could provide a guide to clinicians to predict the success rate of each IVF-ET procedure prior to commencement of treatment. IMPLICATIONS FOR PRACTICE: The availability of this prediction model provides a counselling tool for physicians to IVF clients which ensures improved confidences level and reduced disappointments from failures in successful implantation and embryonic transfer including its associated financial costs and health risks.

Sonographic Biometry of Fetal Interorbital Distance as a Predictor of Gestational Age in Enugu, Southeast Nigeria.

OBJECTIVE: The objective of this study was to develop a sonographic technique for the measurement of fetal interorbital distance (IOD) for gestational age (GA) determination and to establish a normogram of IOD for the local population. METHODS: The fronto-transverse sonographic technique was established as a feasible and reproducible technique for IOD measurement. Two independent and experienced sonographers tested the technique and had a coefficient of variation of 17.64% and 19.72%, respectively, which is statistically insignificant. The established technique was used to measure the IOD of 320 fetuses from the 13th week to 40th week GA, while standard technique was used to measure biparietal diameter (BPD), head circumference (HC) and femur length (FL) of the fetuses. The data obtained were used to determine the regression equation GA = 6.24 + 4.89 IOD for the prediction of the gestational age. RESULTS: There was good correlation between IOD, BPD, HC and FL. The predicted normogram of IOD was compared with normogram of the Caucasian population. The result showed that there was no statistical difference between them (p < 0.05). CONCLUSION: Results from the study suggest that the fronto-transverse technique is a feasible and reproducible technique for IOD measurement and the established normogram of IOD can be a veritable statistic for GA prediction in our locality.

REFERENCE VALUES OF FETAL PEAK SYSTOLIC BLOOD FLOW VELOCITY IN THE MIDDLE CEREBRAL ARTERY AT 12-41 WEEKS OF GESTATION IN JOS, NORTH CENTRAL NIGERIA.

OBJECTIVES: The objectives of this prospective cross sectional study are (i) to establish new reference values of peak systolic blood flow velocity measurement in the fetal middle cerebral artery (MCA-PSV) following validated methodological guidelines (ii) to correlat peak systolic velocity with gestational age and (iii) to establish regression prediction model of MCA-PSV for our population. PATIENTS AND METHODS: Cross-sectional data were obtained from 480 low risk pregnant women and cross validated by 120 high risk pregnant women between 12 and 41 weeks' gestation. Reference ranges for MCA-PSV were constructed and for each measurement linear regression models were fitted separately to the mean and standard deviations (SD) as a function of gestational age. A comparison was made between the reference ranges produced in our study and those of Caucasians. RESULTS: Tables of mean values of peak systolic velocity and percentile with regression equations of MCA-PSV are resented, with suggested limits of 2.5th as lower borderline and 97.5th values representing the upper borderline of normal. Foetal middle cerebral artery peak systolic velocity demonstrated simple continues increase and strong positive correlation with gestational age. Calculated values of z were higher than critical values for PSV of subjects and Caucasian values; p < 0.05 CONCLUSIONS: We have constructed reference ranges for MCA-PSV of gestation 1,241 week period and because the methodological flaws of published study have been eliminated, cross validated by a control group including larger sample size drawn from our population we therefore consider this to be useful for clinical practice.

Sonographic Biometry of Normal Kidney Dimensions among School-age Children in Nsukka, Southeast Nigeria.

BACKGROUND: Some kidney diseases are usually associated with changes in kidney size. OBJECTIVE: To determine sonographically the normal limits and percentile curves of the kidney dimensions according to age, gender and somatometric parameters among school-age children. METHODS: A prospective cross-sectional research design and convenience sampling method were utilized. Participants included 947 normal subjects (496 boys and 451 girls) aged 6-17 years old. The sonographic examination was performed on a Shenzhen DP-1100 machine with 3.5 MHz convex transducer. Longitudinal and transverse dimensions of the kidneys were obtained in coronal plane with the subject in the supine or left lateral decubitus position. RESULTS: The means of right and left kidney lengths in mm were 79.6 ± 8.1 and 81.6 ± 8.3, respectively while that of the right and left kidney widths in mm were 35.03 ± 3.6 and 35.09 ± 3.6, respectively. Dimensions of the kidneys were not statistically different in boys and girls (p > 0.05). There was a statistically significant difference between right and left kidney length (p < 0.05). Height correlated best with both kidney lengths. Thus the normal limits, prediction models and percentile curves of kidney lengths were established with respect to height. CONCLUSION: Sonographic determination of pathologic changes in the size of the kidneys necessitates knowing the normal ranges of its lengths especially with respect to height in school-age children.

Sonographic determination of spleen to left kidney ratio among Igbo school age children of south east Nigeria.

BACKGROUND: Clinical determination of mild splenomegaly is notoriously inaccurate. OBJECTIVES: To determine sonographically the spleen to left kidney ratio according to age and somatometric parameters among school age children in a tropical environment. METHODS: A cross sectional study and convenience sampling were done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6-17 years at the University of Nigeria Medical Centre, Nsukka. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen and left kidney lengths were obtained using appropriate techniques. The weight and height of the subjects were obtained with the participants wearing light weight street clothes without shoes. RESULTS: Measurement of spleen and left kidney lengths were reliable within and between sonographers. The spleen and left kidney lengths were not statistically different in boys and girls (p > 0.05). The spleen to left kidney ratio according to age and somatometric parameters is constant at about 1.13 with 1.3 as the upper limit of normal in the studied population. CONCLUSION: Sonography can be used to detect mild splenomegaly if the spleen to left kidney ratio is greater than 1.3 in the absence of renal disease among school age children.

Sonographic biometry of spleen among school age children in Nsukka, Southeast, Nigeria.

BACKGROUND: Normative value of spleen size among school age children is important for objective assessment of the spleen. OBJECTIVES: This study was aimed at determining sonographically the normal limits of the spleen size according to age, sex, and somatometric parameters among school age children. METHODS: A cross sectional study was done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6 - 17 years. The subjects were recruited from some primary and secondary schools within Nsukka metropolis and also from out patients in the study centre. A pilot study was done to determine the intra- and inter rater reliability of sonographic measurements of the spleen. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen sizes were obtained with the subject in a right lateral decubitus position. RESULTS: Measurement of spleen length was reliable while measurement of spleen width was less reliable within and between sonographers. Dimensions of the spleen were not statistically different in boys and girls (p > 0.05). Height correlated best with spleen dimensions. CONCLUSIONS: Normogram of the spleen size with respect to height is important in the determination of some pathology associated with changes in its size.

Sonographic characterization of renal pathologies in HIV/AIDS in Plateau State, Nigeria.

BACKGROUND: The prevalence of HIV/AIDS in Jos is about 7% according to Idoko et al. Many deaths from infection occur from the complications involving vital organs. The effects of this complication on the kidneys being one of the vital organs are yet to be determined in the locality. The kidneys are prone to impairment due to direct viral attack, opportunistic infections and nephrotoxic drugs. Though renal sonographic features are well characterized in literature, there is no documentation of correlation between renal sonographic features in HIV/AIDS and healthy population in Nigeria. The objectives of the study are to determine the commonly occurring renal sonographic features in HIV/AIDS in terms of echogenicity and size, and correlate these features with measured CD4 cell count. METHODS: 302 subjects were studied prospectively over a period of twenty two months. In order to determine renal sizes, several bilateral longitudinal and transverse scans of the subjects' kidneys in a supine position were done. In order to clarify renal echogenicity, a-four point scoring method was devised to measure the severity of sonographic changes in the kidneys. Subjects' CD4 cell counts were collected from the APIN laboratory and Faith Alive Foundation both in Jos. Pearson's correlation and regression were used for correlation between CD4 cell count and renal length, and between renal length and age, and Z-test was used to compare mean renal dimension of male and female of subjects and HIV sero negative subjects. RESULTS: The subjects consisted of 123 males and 179 females with a mean age of 34.4 years, between the ages of 4 and 80 years. Results indicated that 77.7% of subjects had increased renal echogenicity reflecting the prevalence of renal disease in HIV/AIDS in the locality, 76.7% of the subjects were in their reproductive and sexually active ages (21-40 years). There was significant negative correlation between renal length and measured CD4 cell count (p < 0.01) and also between renal length and age of subjects (p < 0.05). No significant correlation between renal echogenicity and CD4 cell count was noted. Result also indicate that renal length is related to CD4 cell count by the equation = 0.0029CD4+11.1423. CONCLUSION: It is concluded that sonographic features of the kidneys in HIV infection in this locality is characterized by increased renal length with decreasing CD4 cell count amongst sexually active age group. And also a generally high incidence of renal involvement (disease) in HIV/AIDS is seen, similar to those reported in literatures.

The effect of in-vivo intravenous administration of sodium meglumine diatrizoate on some haematological parameters.

BACKGROUND: To investigate the in-vivo effects of intravenous administration of sodium meglumine diatrizoate on some haematological parameters in a Nigerian population. METHODS: Blood samples were collected before and one hour after intravenous injection of sodium-meglumine diatrizoate from 50 subjects undergoing intravenous urography examinations who had no history of and laboratory confirmed diseases that may affect haematological parameters. Standard laboratory methods were used to assay the haemoglobin concentration (Hb), packed cell volume (PCV), total white blood cell (WBC) count and differentials and blood film for any morphological changes in the red blood cells (RBC). Comparisons were made between the mean values of these haematological parameters before and one hour post injection using paired t-test for any statistically significant differences. RESULTS: There were statistically significant reductions in the mean values of Hb concentration and the neutrophil count one hour post injection compared with their pretest values (p < 0.05). The lymphocytes were also significantly increased post injection compared to the pretest values whereas 70% of the erythrocytes were morphologically altered from their approximately 100% normocytic shape at pre-test. CONCLUSION: Intravenous administration of sodium-meglumine diatrizoate causes in-vivo reduction in Hb concentration and neutrophil count in humans as well as poikilocytosis of the erythrocytes. Some of these effects have the potential of triggering or exacerbating crisis in a sickle cell anaemia subject which is endemic in our locality. Caution should therefore be exercised in the choice and administration of radiological contrast agents to sickle cell subjects. Preparations that are iso-osmolar with plasma and have less probability in precipitating crises should be preferred instead.

Relationship between sonographic renal length and renal parenchymal thickness in normal adult southeast Nigerians.

AIM: To determine the relationship between sonographic renal parenchymal thickness (RPT) and renal length (RL) in normal adult Nigerian. STUDY DESIGN: The RL and RPT of 309 normal subjects within the age range of 18-80 years were measured sonographically and prospectively. Correlation was performed between RL values and RPT usingPearson Linear 'r' test RESULTS: The range of RL value were 8.5-12.9 cm and the corresponding mean were 10.33 +/- 0.7 cm and 10.45 +/- 0.63 cm for the right and left kidneys respectively. The range of values for the RPT was 1.40-2.4 and the corresponding mean values were 1.91 +/- 0.20 cm and 1.95 +/- 0.19 cm for the right and left kidneys respectively. There was a strong positive correlation between RPT and RL (r = 0.72 and 0.77 for the right and left kidney respectively. However for RL values above 11.0 cm the RPT values fluctuated. CONCLUSION: From this study, for RL above 11.0 cm there was no relationship with RPT. The study suggests that for our population groups, kidneys with RL lower than 8.5 cm and RPT of 1.40 cm or less should not be biopsied in contrast to webb's criteria.

Relationship between sonographic renal length and renal parenchymal thickness in normal adult southeast Nigerians

Aim: To determine the relationship between sonographic renal parenchymal thickness (RPT) and renal length (RL) in normal adult Nigerian. Study design: The RL and RPT of 309 normal subjects within the age range of 18 - 80years were measured sonographically and prospectively. Correlation was performed between RL values and RPT using Pearson Linear `r' test Results: The range of RL value were 8.5-12.9cm and the corresponding mean were 10.33+ 0.7cm and 10.45+ 0.63cm for the right and left kidneys respectively. The range of values for the RPT was 1.40 - 2.4 and the corresponding mean values were 1.91+ 0.20cm and 1.95+ 0.19cm for the right and left kidneys respectively. There was a strong positive correlation between RPT and RL (r = 0.72 and 0.77 for the right and left kidney respectively. However for RL values above 11.0cm the RPT values fluctuated. Conclusion: From this study; for RL above 11.0cm there was no relationship with RPT. The study suggests that for our population groups; kidneys with RL lower than 8.5cm and RPT of 1.40cm or less should not be biopsied in contrast to webb's criteria

Normal sonographic renal length in adult southeast Nigerians.

The renal lengths of 200 adults with normal renal and cardiac status were measured sonographically in the supine position to establish normative values of renal length for the locality and to correlate them with some anthropometric parameters. The ranges of normal kidney length obtained were 8.3 -12.8 cm and 8.0- 12.5 cm for the left and right kidneys respectively. The mean renal lengths of males were slightly higher than those of females. Renal length correlated positively with subject weight and not with the height or age of patients. This study was able to establish a normogram of renal length for the locality, with mean renal length of 10.6 cm and 10.3 cm for the left and right kidneys respectively. The renal lengths obtained showed no racial dependence. The positive correlation with body weight seems to substantiate the longer lengths of male kidneys versus female kidneys. The study also established a confidence interval of difference between right and left kidneys for the different age groups that could prove invaluable in making critical decisions on size differences in unilateral renal disease.

Sonographic splenic sizes in normal adult nigerian population

This study aimed to establish ultrasonic splenic dimensions which can be used as normogram for adult Nigerians. 250 adult subjects were scanned prospectively using a 3.5MHZ ultrasound sector probe. The splenic length; width and thickness were btained in the supine position and the weight calculated using Downey's formula. Differences in splenic dimensions were determined using Z test; while the relationship between the splenic dimension and the subjects age; BMI; and height were analysed using Pearson Moment Correlation. The normal splenic sizes obtained ranged from 9.9 -11.5cm (length - L); 6.0-7.5cm (Width W) and 4.0- 4.5cm (thickness -T). The splenic dimensions for males were 11.1 + 0.7cm (L); 7.3 + 0.2cm (w) and 4.2+ 0.2cm (T). The corresponding values for females were 10.6 + 0.7cm; 6.8 + 0.5cm and 4.2 + 0.2cm respectively; thus showing a statistically significant difference between the males and females (P 0.05). A poor correlation was shown to exist between splenic dimensions and age but splenic weight increased with body weight (r0.05); the maximum splenic weights t occurred in the 4 decade in Nigerians nd and in the 2 decade in Caucasians. This finding appears to bear credence to existing opinion by Chauhan et al that splenic recession rather than splenomegaly is prevalent in adults living in endemic falciparum zones. Statistically significant differences between splenic length and weights of the sexes have been established by the study. The good correlation between subject height and splenic length portends profound options of predicating subjects splenic size and matching his ultrasound values with this predicted splenic length (SPL = 1.2 + 0.063)

Relationship between umbilical vein diameter (UVD) and growth parameters in Nigerian foetuses

The intrahepatic diameter of the umbilical vein of 350 normal and singleton fetuses were measured sonographically to establish the relationship between umbilical vein diameter (UVD) and fetal growth parameters. Foetuses from 17 weeks to 40 weeks were evaluated sonographically in mothers who had no history of chronic illness or abnormal liquor volumes. The least squares method was used to fit mean UVD values against G.A. Pearson Moment Correlation analysis was also performed between the mean UVD and the other established growth parameters (BPD and AC) obtained concurrently. There was a steady increase in the foetal UVD with gestational age which is expressed by the equation. GA = 2.36 + 4.84 UVD. The fastest growth rate of the UVD occurred in the last 10 weeks of gestation with a maximum mean value of 9.85 + 0.71mm. The UVD correlated strongly and positively with both BPD and AC

Clinicians opinion on errors in ultrasound reports in South Eastern Nigeria

This study investigated clinicians opinion on common errors in ultrasound reports in South Eastern Nigerian. 238 clinicians from speicialities of internal medicine, surgery, general practice and obstetric/gynaecology selected through stratified random sampling were invloved in ths survey. A questionnaire with four response options ranging from 'very often' to 'never' were used to obtain respondents opinion on the frequency of their observation of common errors in ultrasound reports. The commonest errors identified by respondents were conflicting report (3.73 + 0.62) and missed diagnosis (3.66 + 0.69). On a 4 point scale clinicians indicated that irrespective of the common errors, the ultrasound report was still helpful. The overall mean rating of the clinicians on the extent of common errors in ultrasound report is 2.77 + 0.29. The response indicates that ultrasound reports in the locality are associated with significant errors