Gerald Okanandu Udigwe

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).

The evaluation of accuracy of serial rapid HIV test algorithm in the diagnosis of HIV antibodies among pregnant women in south east Nigeria

BackgroundAccurate HIV testing in pregnancy is critical to the prevention of mother to child transmission of HIV infection and linkages to other preventive strategies.Aims and objectivesThis study determined the sensitivity, specificity negative and positive predictive value of serial rapid testing of HIV among pregnant women in Nnewi, south east Nigeria.MethodologyThis was a comparative descriptive study conducted over a 4-month period. Serial rapid testing algorithm was compared with conventional ELISA testing after obtaining informed consents from the pregnant women. All positive and discordant results were confirmed with western blot HIV test. Participants also completed a questionnaire. Data analysis was done using SPSS version 20.ResultA total of 166 pregnant women participated in this study. The mean age of the participants was 29xa0±xa04.3xa0years. The HIV prevalence was highest in the 25–29xa0years category. This was also the modal age category. Majority of the women were multiparous. The prevalence of HIV infection was 12xa0%. The sensitivity, specificity, negative and positive predictive value of serial rapid HIV testing was 95, 100, 99.3 and 100xa0% respectively.ConclusionThe sensitivity of the serial rapid test algorithm was high but still lower than the WHO recommended 99xa0% and above. The 100xa0% specificity and positive predictive value makes it a good diagnostic test strategy. There is need for regular review of HIV test kits and policy.

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 24u2009h 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 48u2009h 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%; pu2009<u20090.001). 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.

The prevalence of HIV sero-positivity in late pregnancy among antenatal attendees with seronegative status in first half of pregnancy in Nnewi, South East Nigeria

Background: In sub-Saharan Africa, women and children are vulnerable to HIV/AIDS with about 61% of the infections occurring in women and about 90% of the pediatrics infection through Mother-to-child transmission (MTCT). Antenatal attendees in Nigeria are offered routine HIV testing and counselling on the first visit with opt-out option irrespective of the gestational age at contact. This appears commendable but, considering the national HIV prevalence of 4.6%, our large population of >140 million, the long period of seroconversion of the virus and the fact that pregnant women continue to indulge in activities like: unprotected sexual intercourse with single or multiple partners or men with multiple sexual partners or legal polygamy, cross generational sex, intercourse with sero-discordant partners that put them at risk of new infections; a single screening test on contact may not be sufficient to detect all maternal infections. Aim and Objectives: This is to perform a second HIV testing in antenatal women late in pregnancy and determined the sero-prevalence of HIV amongst those who tested negative in the first half of pregnancy. Materials and Methods: This is a prospective cross sectional study conducted among previously HIV negative pregnant women in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi between November 2010 and February 2011. The rapid test kits: Determine, Stat Pak and Unigold were used for detection/diagnosis of HIV antibody. Semi structured questionnaire was used to collect socio-demographic data of the subjects. Descriptive analysis of the result was done using the SPSS version 16. Results: The HIV prevalence following repeat testing in late pregnancy was 3.91% (9/230). The mean HIV prevalence at antenatal booking during the study period was 20.64% (116/562). Conclusion: The study highlights the high prevalence of HIV among previously negative attendees in late pregnancy. It brings to the fore the enormity of missed opportunity associated with a single routine antibody rapid test for pregnant women on contact/early pregnancy. Therefore, routine repeat antenatal HIV testing and counselling in late pregnancy is strongly advocated.

Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome.

Background. Acute intestinal obstruction during pregnancy is a very challenging and unusual nonobstetric surgical entity often linked with considerable fetomaternal morbidity and mortality. When it is synchronous with abdominal pregnancy, it is even rarer. Case Presentation. A 28-year-old lady in her second pregnancy was referred to Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, at 27 weeks of gestation due to vomiting, constipation, and abdominal pain. Examination and ultrasound scan revealed a single live intra-abdominal extrauterine fetus. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was successful till the 34-week gestational age when she had exploratory laparotomy. At surgery, the amniotic sac was intact and the placenta was found to be adherent to the gut. There was also a live female baby with birth weight of 2.3u2009kg and Apgar scores of 9 and 10 in the 1st and 5th minutes, respectively, with the baby having right clubbed foot. Adhesiolysis and right adnexectomy were done. The mother and her baby were well and were discharged home nine days postoperatively. Conclusion. To the best of our knowledge, this is the first report of abdominal pregnancy as the cause of acute intestinal obstruction in the published literature. Management approach is multidisciplinary.

Placental Peripartum Pathologies in Women with Preeclampsia and Eclampsia

Objective To determine the pattern of pathological changes in placentas of preeclamptic/eclamptic parturients and its correlation with the clinical severity as well as the perinatal outcome. Methods A cross-sectional analytical study of placental pathologies in preeclamptic/eclamptic patients was performed in a blinded pattern and compared with matched normal controls. Data were analyzed using Epi-Info 2008 version 3.5.1. Results Placental pathologies were evaluated in 61 preeclamptic/eclamptic patients and in 122 controls. Of the 61 placentas, 53 (4.7%) were of preeclampsia while 8 (0.71%) were of eclampsia. Of the preeclamptic group, 14 (23%) had mild preeclampsia while 39 (63.9%) had severe preeclampsia. Infarction, haematoma, and some histological changes increased with the severity of preeclampsia (p < 0.001). When comparing placentas in eclampsia, severe preeclampsia, mild preeclampsia, and normal controls, there was respective increase in the presence of any infarction (75%, 66.7%, 35.7% vs. 12.3%) or any haematoma (100%, 100%, 71.4% vs. 35.2%), decidual arteriopathy (87.5%, 76.9%, 64.3% vs. 35.2%), cytotrophoblastic proliferation (75%, 71.8%, 42.9% vs. 25.4%), and accelerated villous maturation (75%, 69.2%, 57.1% vs. 31.1%). There was no statistically significant difference in placental calcifications, stromal oedema, stromal fibrosis, and syncytial knots. Degree of placental infarction was correlated with the fetal birth weight. The fetal birth weight with placental involvement of >10% was significant (p=0.01). Conclusion In mild or severe preeclampsia/eclampsia, placentas had significant histological signs of ischaemia and degree of placental involvement by infarction is inversely proportional to fetal birth weight. While feto-placental ratio was higher with increased severity of the disease, the mean weight was less. This trial is registered with researchregistry3503.

Accuracy and response time of dual biomarker model of insulin‐like growth factor binding protein‐1/ alpha fetoprotein (Amnioquick duo+) in comparison to placental alpha‐microglobulin‐1 test in diagnosis of premature rupture of membranes

The aim of this study was to determine accuracy and response time of duo of insulin‐like growth factor binding protein‐1 (IGFBP‐1)/alpha‐fetoprotein (Amnioquick duo+) versus placental alpha‐microglobulin‐1 (PAMG‐1) in diagnosing premature rupture of membranes (PROM).

Effect of on‐site training on the accuracy of blood loss estimation in a simulated obstetrics environment

To determine the effect of on‐site training on the accuracy of blood loss estimation in a simulated obstetrics environment.