Sonographic evaluation of maternal uterine artery from 11 - 30 weeks 6 days of gestational age in a Nigerian population: A predictive index for pre-eclampsia and intrauterine growth restriction

INTRODUCTION

Uterine artery (UtA) Doppler sonography is a potential screening tool for pregnancy complications in placental insufficiency. Evaluation of the maternal and fetal vessels in pregnancy ensures accurate identification and prediction of pregnancy complications, such as preeclampsia (PE) and intrauterine growth restrictions (IUGR). The study aims to establish local reference values for UtA in a Nigerian population.

METHODS

This prospective longitudinal study was conducted among 230 pregnant women. All participants had their left (Lt) and right (RT) UtAs evaluated with a Doppler ultrasound from 11 to 30 weeks 6 days of gestational age. Peak systolic velocity (PSV), End diastolic Velocity (EDV), Systolic/Diastolic ratio (S/D), Pulsatility Index (PI), and Resistivity Index (RI) were measured and documented.

RESULTS

The mean values of UtA at 11-30 weeks 6 days of GA ranged as follows: 0.79-0.53 (RI), 1.83-0.79 (PI), 5.16-2.23 (S/D), 96.37-98.00 (PSV) & 26.07-44.14 (EDV). While the mean values of the Rt. & Lt. UtA 's ranged as follows: 0.79-0.50 (RI. Rt), 0.78-0.56 (RI. Lt), 2.05-0.80 (PI. Rt), 1.61-0.78 (PI. Lt), 6.03-2.13 (S/D. Rt), 4.29-2.33 (S/D. Lt), 89.79-99.23 (PSV. Rt), 102.76-96.71 (PSV. Lt) & 23.31-45.25 (EDV. Rt), 28.83-43.02 (EDV. Lt) respectively.

CONCLUSION

UtA Doppler reference range was established in the study population. These reference ranges will be of clinical value in daily obstetric practice.

IMPLICATION FOR PRACTICE

Obstetricians and sonographers will apply these values for early prediction of pregnancies at risk of complications in the locality.

Pregnancy options counselling in Ghana: a case study of women with unintended pregnancies in Kumasi metropolis, Ghana

Background

Pregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana due to absence/inadequate pregnancy options counselling for clients to make informed decisions. This study examines options counselling for abortion seekers in health facilities in Ghana.

Methods

Analytical cross-sectional study design was done in selected specialised public and NGO health facilities within Kumasi Metropolis of Ghana, using self-administered structured questionnaires for data collection from 1st January to 30th April, 2014. Participants were 442 women with unintended pregnancies seeking abortion services. Data was analysed using Epi-Info (7.1.1.14) and STATA 12 to generate descriptive statistics, Pearson chi-square and multivariable logistic regressions. The Kwame Nkrumah University of Science and Technology approved the study.

Results

Respondents had divergent reproductive and socio-demographic profiles. Majority (about 58%) of them had been pregnant more than twice, but about 53% of this population had no biological children. (Although about 90% of respondents held perceptions that the index and previous pregnancies were mistimed/unintended, the majority (72%) had no induced abortion history. Induced abortion (208, 49%) and parenting (216, 51%) were mentioned as the only available options to unintended pregnancy in hospitals. Exposure to options counselling was observed to be significantly associated with parity (P = < 0.001), gestational age (P = < 0.001), previous induced abortions (P = < 0.001), perception of pregnancy at conception (P = < 0.001) and level of education (P = 0.002). The logistic regression analysis also shows that higher education has statistically significant effect on being exposed to options counselling (P = < 0.001). Majority of respondents (95%) were not aware that giving a child up for adoption is an option to abortion in Ghana.

Conclusions

Pregnancy options counselling remains a major challenge in comprehensive abortion care in Ghana. Although higher educational attainments significantly exposes women to options counselling for informed decisions, the less educated are disadvantaged in this regard. Further research on type and depth of counselling services provided to pregnant women in health facilities is required to inform health policy and program decisions.

Attitudes of doctors toward establishing safe abortion units in Ghana

OBJECTIVES

To assess physician knowledge of the current legal status of abortion in Ghana and determine the proportion physicians in favor of establishing units where safe abortion would be provided, and the proportion of those willing to offer such services.

METHODS

A survey conducted at Komfo Anokye Teaching Hospital, Ghana, in August 2003. Using a self-administered questionnaire, 74 randomly selected physicians expressed their views on whether abortion units should be established within national health facilities in Ghana, and what role they would play in them.

RESULTS

Of the 59 physicians (80%) who favored the establishment of safe abortion units within national health facilities, 27 (36%) indicated a willingness to take part in counseling only, 33 (45%) were prepared to carry out abortions, and 14 (19%) said they would play no role in these units.

CONCLUSION

Most physicians participating in this study conducted in Ghana were willing to play some role in the provision of safe abortion services.