The influence of parity on the gestational age at booking among pregnant women in Enugu, South East Nigeria

Ultrasound measurement of placental thickness: A reliable estimation of gestational age in normal singleton pregnancies in Nigerian women

Purpose:

The aim of this article is to evaluate the accuracy of placental thickness (PT) in determination of gestational age (GA) in normal singleton foetuses.

Materials and Methods:

The study was a cross-sectional descriptive study which recruited consecutively a total of 406 pregnant women with singleton pregnancies (at 15–40 weeks of gestation), referred for routine obstetric ultrasound (US) scan at the National Hospital, Abuja from October to December 2019. Biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), and PT were measured using standard protocols. All measurements were calculated by taking three best measurements, and the mean of the measurements was taken and recorded for each participant. Pearson’s correlation analysis was computed to determine linear relationships between variables. A significant statistical level was determined at a critical value of P < 0.05.

Results:

The mean age was 31.8 ± 4.8 years. The mean PTs in the second and third trimesters were 23.2 ± 3.1 and 34.1 ± 3.7 mm, respectively. PT had a linear relationship and a statistically significant positive correlation (r=0.99, P = 0.00) with GA. There was also a statistically significant positive correlation between PT on the one hand, and BPD, AC, HC, FL, PT, and GA, on the other hand.

Conclusion:

There was a significant and strong positive correlation between PT and GA. The study shows that US measurement of PT is a reliable method of estimating GA in singleton pregnancies in Nigeria.

PMTCT Service Uptake Among Adolescents and Adult Women Attending Antenatal Care in Selected Health Facilities in Zimbabwe

Background:

Age-disaggregated analyses of prevention of mother-to-child transmission (PMTCT) program data to assess the uptake of HIV services by pregnant adolescent women are limited but are critical to understanding the unique needs of this vulnerable high-risk population.

Methods:

We conducted a retrospective analysis of patient-level PMTCT data collected from 2011 to 2013 in 36 health facilities in 5 districts of Zimbabwe using an electronic database. We compared uptake proportions for PMTCT services between adolescent (≤19 years) and adult (>19 years) women. Multivariable binomial regression analysis was used to estimate the association of the women's age group with each PMTCT service indicator.

Results:

The study analyzed data from 22,215 women aged 12–50 years (22.5% adolescents). Adolescents were more likely to present to antenatal care (ANC) before 14 weeks of gestational age compared with older women [adjusted relative risk (aRR) = 1.34; 95% confidence interval: 1.22 to 1.47] with equally low rates of completion of 4 ANC visits. Adolescents were less likely to present with known HIV status (aRR = 0.34; 95% confidence interval: 0.29 to 0.41) but equally likely to be HIV tested in ANC. HIV prevalence was 5.5% in adolescents vs 20.1% in adults. While >84% of both HIV-positive groups received antiretroviral drugs for PMTCT, 44% of eligible adolescents were initiated on antiretroviral therapy vs 51.3% of eligible adults, though not statistically significant.

Conclusions:

Pregnant adolescents must be a priority for primary HIV prevention services and expanded HIV treatment services among pregnant women to achieve an AIDS-free generation in Zimbabwe and similar high HIV burden countries.

Women's perception of accuracy of ultrasound dating in late pregnancy: a challenge to prevention of prolonged pregnancy in a resource-poor Nigerian setting

Background

Expected date of delivery (EDD) is estimated from the last menstrual period (LMP) or ultrasound scan. Conflicts between these estimates especially on the part of the physician and his/her patient could pose a challenge to prevention of prolonged pregnancy. The objective of this study was to determine the perception and acceptability of menstrual dating (EDD derived from LMP) with regard to timing of labor induction for postdatism by pregnant women who have a late pregnancy (≥23 weeks’ gestation) ultrasound scan.

Methods

This cross-sectional study included 443 consecutive pregnant women receiving antenatal care at two tertiary health institutions in Enugu, Nigeria, from January 1, 2013 to March 31, 2013.

Results

The mean age of the women was 27.9±2.41 (range 17–45) years. Most ultrasound scans (90.8%, 357/389) were carried out in late pregnancy, and 41.9% (167/389) were self-referred. The majority of the respondents (51.7%, 229/443) did not accept induction of labor for postdatism at a certain menstrual dating-derived gestational age of 40 weeks plus 10 days if the late pregnancy ultrasound scan dating was less. Predictors of this poor attitude to timing of induction of labor for postdatism included low educational level, low social class, and poor knowledge of the limitations of ultrasound scan dating in late pregnancy (P<0.05).

Conclusion

The worrisome confidence in ultrasound scan dating is a challenge to the prevention of prolonged pregnancy and its complications in our environment. Antenatal health education should discourage self-referral for ultrasound scan dating and emphasize its limitations in late pregnancy as well as the perinatal effects of prolonged pregnancy.

A comparison of capillary and venous blood haematocrits of pregnant women in Nigeria: the impact on diagnosis and prevalence of anaemia in pregnancy

Background. Volume of red cells in capillary blood varies from that of venous blood. The magnitude of this variation as well as its impact on the diagnosis of anaemia in pregnancy needs to be studied. This study demonstrates the disparity between capillary and venous PCV in pregnancy. Objectives. To determine whether capillary blood PCV (cPCV) differed from venous blood PCV (vPCV) of normal pregnant women in Enugu, Nigeria, and its effect on diagnosis and prevalence of anaemia. Methods. PCV was estimated using pairs of venous and capillary blood samples from 200 consecutive pregnant women at the Antenatal Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Results. Participants' cPCV (median = 34.0%, IQR = 31.0–35.8) was significantly lower than their vPCV (median = 34.0%, IQR = 32.0–37.0) (Z = −6.85, P < 0.001). However, women's cPCV had strong positive correlation with their vPCV (r = 0.883, P < 0.001). The prevalence of anaemia among participants using capillary and venous blood was 33.5% (67/200) and 28.0% (56/200), respectively (O.R = 1.3 (CI 95%: 0.85, 1.98),  P = 0.233). Conclusions. Capillary blood PCV was lower than vPCV among pregnant women in Enugu, Nigeria. Nevertheless, the prevalence of anaemia derived from cPCV did not differ significantly from that of vPCV.

Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: a cross-sectional study

BACKGROUND

Obesity in pregnancy is a global health problem which is associated with poor pregnancy outcomes. The use of weight and height, measured at about ten weeks of gestation, to produce pre-gestational body mass index is recommended for the diagnoses of the condition but limitations abound in under resourced settings.

OBJECTIVES

To measure anthropometric indices such as mid upper arm circumference, calf circumference, waist circumference and waist to hip ratio, for identification of obesity in pregnancy.

METHODS

Anthropometric measurements were carried out on cohorts of pregnant women from 4 hospitals in Enugu, South-eastern Nigeria.

RESULTS

There were no significant difference in the mean mid upper arm circumference (MUAC) and calf circumference (CC) across the trimester groups. The mean values of waist circumferences, hip circumference and waist to hip ratios changed significantly across the trimesters. The 75(th) percentile of MUAC (33 cm) and CC (39 cm) in all trimesters, had sensitivity and specificity of more than 70% for identifying obesity in pregnancy.

CONCLUSION

MUAC and CC values of 33cm and 39cm respectively might be reliable cut off points for diagnoses of obesity throughout pregnancy in Enugu, Nigeria.

Pattern and determinants of antenatal booking at abakaliki southeast Nigeria

Background:

Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit.

Aim:

The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants.

Subjects and Methods:

A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6, 2011 to August 5, 2011 was undertaken. Epi info 2008 version was used for analysis.

Results:

The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1% (286/344) of the pregnant women booked after the first trimester while the remaining 16.9% (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy, personal wishes, and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2% (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3% (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1% (279/344) knew the benefits of early antenatal care even though they booked late 83.1% (286/344).

Conclusion:

Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking.

Low levels of some nutritional parameters of pregnant women in a rural community of South East Nigeria: implications for the attainment of the millennium developmental goal

Background:

In developing countries, under nutrition is common, and this plays a crucial role in the pathogenesis of malaria and anemia. Indeed it has been associated with adverse pregnancy outcomes. Unfortunately, published evidence concerning the situation is lacking.

Objectives:

To evaluate some nutritional function indices of pregnant women in a rural Nigerian community.

Subjects and Methods:

This is a cross sectional study involving of 171 pregnant women from a rural area in South-eastern Nigeria. They included 72 and 99 women in their second and third trimesters respectively. The control group was of 60 women, matched in age, parity and socioeconomic conditions, non-pregnant, non-menstruating and non lactating apparently healthy women. The parameters measured by standard methods included serum iron, total proteins, albumin, globulin, packed cell volume and hemoglobin.

Results:

The results obtained from control group, second and third trimesters, recorded as Mean (SEM) were 134.60(3.12) μg/L, 101.20(4.48) μg/L and 91.87(3.42) μg/L respectively for iron; 69.12(0.80) g/L, 63.60(0.71) g/L and 57.74(0.75) g/L for total proteins; 42.95(0.92) g/L, 35.74(1.00) g/L and 35.26(0.64) g/L for albumin; 26.77(1.00) g/L, 27.78(1.07) g/L and 22.93(0.88) g/L for globulin; 32.80(0.36%), 27.92(0.37%) and 27.73(0.34%) for packed cell volume, and 11.25(0.11) g/L, 9.59(0.13) g/L and 9.57(0.14) g/L for hemoglobin respectively. These results showed that all the parameters decreased significantly in pregnancy (P<0.001) except globulin that did not show immediate, significant decrease.

Conclusion:

There is a general decrease in the nutrition parameters studied among the pregnant women from our study area, indicating under-nutrition. Urgent measures should be taken to improve the nutritional status of rural dwellers especially the antioxidant micronutrients.

Two logistic models for the prediction of hypothyroidism in pregnancy

BACKGROUND

The mounting evidence linking hypothyroidism during pregnancy with poor pregnancy outcome underscores the need for screening and, therefore, a search for more reliable and cheaper screening methods.

METHODS

The study was conducted in two phases. The phase one study comprised of healthy women in different stages of pregnancy who attended routine antenatal clinic at St Theresa's Maternity Hospital, Enugu, Nigeria from September 6 to October 18 1994. In this study the variables compared between the hypothyroid and non-hypothyroid pregnant women were maternal age, the number of the pregnancy or gravidity, gestational age, social class, body weight, height, the clinically assessed size of the thyroid gland, serum free thyroxin (FT4) and serum thyrotrophin (TSH). Based on the parameter differences between the two comparison groups of pregnant women two Logistic models, Model I and Model 11, were derived to differentiate the hypothyroid group from their non-hypothyroid counterparts. The two logistic models were then applied in a prospective validation study involving 197 pregnant women seen at presentation in Mother of Christ Specialist Hospital and Maternity, Ogui Road, Enugu from March 2002 to November 2007

FINDINGS

The findings were that 82 (50.3%) of the 163 pregnant women had thyroid gland enlargement while 60 (36.8%) had hypothyroidism as defined by FT4 values below and/or TSH above their laboratory reference ranges. The pregnant subjects with hypothyroidism, compared with their non-hypothyroid counterparts, were characterized by a higher gravidity (p < 0.01), a higher body weight (p < 0.01), a higher goiter prevalence rate (p < 0.01) and a more advanced gestational age (p < 0.0001). A significant, positive correlation was also found between body weight and gestational age (r = 0.5; p < 0.01) At the cut-off point for Model l (fitted with gravidity, thyroid size and gestational age) it had a sensitivity of 100%, a specificity of 72.8% and an overall predictive accuracy of 82.9%; whereas for Model II (fitted with gravidity, thyroid size and body weight) the sensitivity was 100%, the specificity was 59.2% and the overall accuracy of discrimination was 74.8%. In the prospective validation study both models showed a sensitivity of 100% each with specificities of 85.5% for Model I and 76.2% for Model II.

CONCLUSION

It is concluded that logistic models fitting gravidity, thyroid gland size and gestational age or body weight are useful alternatives in screening for hypothyroidism during pregnancy. There is, however, a need for further independent confirmation of these findings.