Co Ezeama

Clinical presentation of uterine fibroids in Nnewi, Nigeria: A 5-year review

Background: Uterine leiomyomas are the commonest benign tumors in women, with a higher preponderance amongst Africans. Several etiological factors have been suggested, with subtle variations in clinical presentation being reported in different studies. This may constitute a determinant for the management measures undertaken. Aim: To review the clinical presentation and management measures undertaken for uterine leiomyoma. Subjects and Methods: A retrospective study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, from January 2002 to December 2006. A review of case records of patients with a diagnosis of uterine leiomyoma was done. The data were analyzed and presented in tables using comparative percentages. Results: Uterine leiomyoma constituted 117 of the 1094 gynecological admissions during this study period (10.7%, 117/1094). The mean (SD) age of presentation was 35.7 (6.1) years. Most of the patients were nulliparous (76.7%, 79/103) and 51.5% (53/103) were married. The commonest mode of presentation was lower abdominal mass (66.9%, 67/103) and the least was recurrent abortion (1%, 1/103). Surgery was employed in all cases, with myomectomy being the commonest modality used in 90.3% (93/103) of cases. The common postoperative complications were prolonged pain (49.5%, 51/103) and postoperative pyrexia (34.9%, 36/103). Conclusion: The symptom of lower abdominal mass correlates with late presentations in our setting. This makes the application of newer therapies like laparoscopic myomectomy difficult even when they are available. Other therapies which are independent of fibroid size (like uterine artery embolization) are not readily available in our environment. This further emphasizes the importance of myomectomy as the most important treatment modality in our environment.

Accuracy and cost-analysis of placental alpha-microglobulin-1 test in the diagnosis of premature rupture of fetal membranes in resource-limited community settings

To determine accuracy and costs of placental α‐microglobulin‐1 (PAMG‐1) test compared to standard clinical assessment (SCA) for diagnosing rupture of membranes (ROM).

Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource‐limited setting

To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource‐limited settings.

A comparison of prophylactic intramuscular ergometrine and oxytocin for women in the third stage of labor.

To compare the efficacy and adverse effects of ergometrine and oxytocin given intramuscularly for the prevention of postpartum hemorrhage during the third stage of labor.

Accuracy of a combined insulin-like growth factor-binding protein-1/interleukin-6 test (Premaquick) in predicting delivery in women with threatened preterm labor

Abstract Purpose: To determine values of combinations of interleukin-6 (IL-6)/cervical native insulin-like growth factor-binding protein-1 (IGFBP-1)/total IGFBP-1 (Premaquick©) in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in women with threatened preterm labor. Methods: Women with singleton pregnancies between gestation age (GA) of 24 weeks and 36 weeks and 6 days with preterm labor were recruited during a prospective multicenter study. Premaquick© was positive when at least two of three biomarkers were positive. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were estimated for both prediction of spontaneous deliveries and spontaneous exclusive preterm deliveries. Results: Ninety-seven (99.0%) out of 98 women enrolled were analyzed. Based on delivery status 7/14 days post-enrollment of general study population, Premaquick© had a sensitivity of 87.1/85.7%, a specificity of 92.4/96.8%, a PPV of 84.4/93.8% and a NPV of 93.9/92.3% for prediction of spontaneous delivery. Predictive accuracy of Premaquick© test in relation to days of enrollment were: 90.7% (≤7 days) and 92.8% (≤14 days). For women enrolled at GA <35 weeks, Premaquick© had a sensitivity of 100.0/87.5%, a specificity of 94.1/96.9%, a PPV of 70.5/87.5%, a NPV of 100.0/96.9% and an accuracy of 95.0/95.0% for prediction of preterm delivery within 7/14 days of enrollment, respectively. PPV was most significantly different in both groups when outcomes were compared between 2 days and 14 days post-enrollment (P<0.001). Conclusion: This novel triple biomarker model of native and total IGFBP-1 and IL-6 appears to be an accurate test in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in threatened preterm labor in singleton pregnancies.

Comparison of the duo of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) and traditional clinical assessment for diagnosing premature rupture of fetal membranes

Abstract Purpose: To determine the diagnostic accuracy of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) compared with traditional clinical assessment (TCA) of nitrazine, ferning and pooling for the diagnosis of prelabor rupture of membranes (PROM). Methods: A double-blinded, multicenter clinical study was conducted between February 2015 and August 2015 among pregnant women presenting with symptoms or features suggestive of PROM between 24 and 42 weeks gestation. Confirmation of PROM was done after delivery based on the presence of any two of these criteria: delivery within 48 h to 7 days, evidence of chorioamnionitis, membranes explicitly ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Sensitivity, specificity and accuracy were outcome measures assessed. Results: Two hundred and thirty-six women were recruited. Three women were excluded from the final analysis due to lack of follow-up data and failure to meet inclusion criteria. Two hundred and thirty-three women had complete data for analysis. The specificity and sensitivity values for TCA were 76.2% and 85.2%, which were lower than those of Amnioquick duo+, which were 97.6% and 97.9%, respectively. The accuracy of Amnioquick duo+ was statistically higher (97.9% vs. 83.7%; RR=1.17; 95%CI=1.10–1.24; P<0.001). In equivocal cases (pooling=negative), the accuracy of Amnioquick duo+ vs. TCA was 98.4% vs. 69.4% (RR=1.42; 95%CI=1.20–1.68; P<0.001) at ≥34 weeks gestation and 100.0% vs. 71.4% (RR=1.40; 95%CI=1.07–1.83; P=0.021) at <34 weeks gestation. Conclusion: The performance matrix of Amnioquick duo+® was superior to that of TCA for diagnosing PROM even in equivocal cases.

Diagnostic performance of placental alpha-microglobulin-1 test in women with prolonged pre-labour rupture of membranes

Abstract Objectives: To determine diagnostic performance of placental alpha-microglobulin-1 (PAMG-1) test compared to conventional clinical assessment (CCA) in women with prolonged pre-labour rupture of membranes (PROM). Methods: A double-blind study of women with symptoms and signs of PROM in Nnamdi Azikiwe University Teaching Hospital, Nnewi and University of Nigeria Teaching Hospital, Enugu, in south-east Nigeria using CCA for PROM and PAMG-1 test was done. Women were included if their symptoms, signs or complaints suggestive of PROM was more than 24 h duration. PROM was diagnosed if two out of three methods from CCA (pooling, positive nitrazine test or ferning) were present. Confirmation of PROM was done after delivery using any two of these clinical criteria: delivery in 48 h to 7 days, evidence of chorioamnionitis, membranes obviously ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Results: Accuracy, specificity and sensitivity value for CCA were 72.5, 36.8 and 86.0% lower than for PAMG-1 test which were 95.7, 94.1 and 96.2%. In equivocal cases, PAMG-1 was significantly more accurate than CCA (92.3% versus 38.5%; p < 0.001). Conclusions: This study in women with prolonged PROM, confirms that PAMG-1 test has high diagnostic accuracy irrespective of the duration of PROM before clinical evaluation.

Postabortion care counseling practiced by health professionals in southeastern Nigeria

To determine the practice of postabortion care (PAC) counseling among healthcare professionals in southeastern Nigeria.

Perceptions of focused prenatal care among women attending two tertiary centers in Nigeria

To determine womens perceptions and expectations of focused prenatal care visits.

Genital tract microbial isolate in women with preterm pre-labour rupture of membranes in resource-constrained community setting

Abstract This study determined patterns of microbial isolates in genital tract of women with preterm pre-labour rupture of membranes (PPROM) compared with cases without PPROM. Endocervical swabs of women with confirmed diagnosis of PPROM were examined microbiologically and compared in blinded pattern with gestational-age-matched controls. One hundred and five microbiological results each for cases and controls were analysed. Positive microbial cultures were seen in 79.05% of cases versus 6.67% of controls. Streptococcus spp. (31.43%) was the commonest organism isolated in cases (p < 0.001), while Candida albicans was significantly more in controls (p < 0.001). The highest incidence of PPROM (82.86%) occurred in gestational ages of 28–30 and 34–36 weeks. No fewer than 75.24% cases occurred in low parity (0–2). Majority occurred in extremes of viable preterm gestation and in women of low parity.