Ovarian torsion-detorsion in a 10-year premenarchial female with chronic recurrent abdominal pain misdiagnosed as 'ama-afo' in a suburb: A case report

This case involved a 10‐year‐old female with recurrent abdominal pain misdiagnosed as ‘ama‐afo’. Intraoperative findings showed a left‐sided strangulated/gangrenous tubo‐ovarian mass twisted four times on its pedicle.

The efficacy of magnesium sulphate as an adjunct to local anaesthetics for perineal pain relief after episiotomy

Background

Episiotomy is a deliberate surgical incision of the perineum with the aim of increasing the vulval outlet to facilitate childbirth. However, it could be associated with some complications, such as pain, hemorrhage, and wound infection. It is a surgical procedure that requires adherence to basic surgical principles of providing adequate analgesia.

Aim

To determine the efficacy of magnesium sulphate (MgSO₄) as an adjunct to local anesthetics for analgesia during episiotomy repair among women that had vaginal delivery at Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria.

Subject and Methods

This was a single-blind randomized clinical trial. Pregnant women who had episiotomy during the study period were randomized into two groups. Those in Group A had xylocaine administered alone, whereas those in Group B had xylocaine + MgSO₄ administered for repair of episiotomy. Pain was assessed by numeric rating scale at commencement of the repair, at 2 and 6 h after the repair. Patient's level of satisfaction, request for additional analgesia, and side effects were also assessed.

Results

The pain score in the xylocaine + MgSO₄ group was lower throughout the period of assessment. There was no significant difference in the pain scores between the two groups at 0 and 6 h. However, there was significant difference in the mean pain scores between the two groups at 2 h (P < 0.001). There was no significant difference in the level of satisfaction, request for additional analgesia, and side effects between the two groups.

Conclusion

Both xylocaine alone and xylocaine with MgSO₄ provide adequate perineal pain relief during episiotomy repair. MgSO₄ improves the analgesic effect of xylocaine at 2 h after episiotomy repair without any significant side effect.

Peculiarities and management challenges of advanced renal cell carcinoma incidentally discovered in pregnancy

Our aim is that urologists, gynecologists, nephrologists, and general practitioners will be reminded that diagnosis of renal malignancies sometimes require a high index of suspicion as they may remain asymptomatic in advanced stages; even as they can also rarely co‐exist with and cause peculiar challenges in pregnancy.

OSCE: DESIGN, DEVELOPMENT AND DEPLOYMENT

BACKGROUND

OSCE - Objective Structured Clinical Examination - as an examination format was developed by Harden and colleagues in 1975 as an answer to the oft-criticised traditional long case clinical examination which was judged to have low psychometric properties. Since then it has received wide acceptance globally as an objective form of assessing clinical competences both at the undergraduate and post graduate levels. Despite this wide acceptability and usage, many medical institutions in the West African sub region are yet to embrace this reality. However there has been a renaissance of interest in the past decade within the sub region such that medical assessments at both undergraduate and postgraduate levels are increasingly adopting the OSCE system. A lot of training and capacity building need to be done. It is in the light of this that a comprehensible and moderately comprehensive document has been developed for the benefit of medical teachers and examiners in the West African sub region.

AIM

This document aims to provide the medical teachers and examiners in the West African sub region a valuable, easily understood OSCE document that will facilitate their understanding and use of OSCE as an assessment tool, based on wide experience of use, capacity building and establishment of the format in medical schools and postgraduate institutions in the sub region.

METHODOLOGY

A widespread relevant literature search using different search platforms was conducted to identify published works, monograms and workshop manuals that met the aim and objectives targeted.

RESULTS

Out of numerous publications, most of which highlighted the works of the original authors of OSCE, others qualitatively comparing the OSCE and traditional examinations, a few others quantitatively comparing OSCE and the traditional examination and yet others examining aspects of cost and security, this document is a distillate of all the above, such that the reader is well engaged to obtain a balanced coverage of the subject.

CONCLUSION

An OSCE document comprehensively but compactly presented is made available for trainers and examiners in West African sub region and which easily serves as a reference document to facilitate and improve the quality of OSCE assessments in the sub region.

Accuracy of intra-partum prediction of birth weight using maternal anthropometric parameters

AIMS AND OBJECTIVES

This study aimed at predicting foetal birth weight using various clinical methods and to determine which of the methods is the most accurate in this population.

SUBJECTS AND METHODS

Parturients of all parities admitted into the labour ward of OAUTHC, Ile-Ife at term for delivery were recruited for this study. They had their symphysiofundal height, abdominal circumference at the umbilical level, height and weight measured. The body mass index was then calculated. The birth weight was calculated from these measurements using four clinical formulae. The weights of the babies were measured after delivery and compared with the individual estimated birth weights.

RESULTS

There were 400 women who met the inclusion criteria during the time of this study. Three of the methods [Johnson's Rule, Ojwang's Rule and 5% maternal weight] overestimated the birth weight while 10% BMI underestimated the birth weight significantly.

CONCLUSION

There is a strong correlation between the birth weights predicted by the various clinical methods and the actual birth weight. The accuracy of the methods can be improved by using the derived modified formulae.

Sociodemographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: a four-year review

BACKGROUND

Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70 000 women die globally as a result, with the majority occurring in the developing world. This study aims to determine the sociodemographic factors involved in complicated unsafe abortions.

SUBJECTS AND METHODS

The study is a four-year retrospective evaluation of all cases of complicated unsafe abortions managed at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria between January 1, 2007 and December 31, 2010.

RESULTS

The incidence of unsafe complicated abortions over the study period was 4.10% of total deliveries and contributed 14.0% of gynaecological admissions: 34.92% occurred in adolescents less than 20 years of age, of which the majority (55.55%) were secondary school students. There were 55.45% of patients who were nulliparae, 60.32% were unemployed and 69.80% were unmarried. A total of 87.30% had never used any form of contraceptive. Abortion mortality rate was 256/100 000 deliveries and the case fatality was 4.76%. It constituted 30.0% of all gynaecological deaths and 17.64% of maternal deaths during the study period. The commonest cause of death was septicaemia (66.66%).

CONCLUSION

Unfavourable sociodemographic factors are major determinants of the high incidence of unsafe abortion in the Niger Delta despite strict abortion laws. Concrete measures must be put in place to address these, as unsafe abortion and its complications are a major cause of maternal morbidity and mortality in the environment.

The effect of a depressed economy on the utilisation of maternal health services: the Nigerian experience II

This study follows an earlier one on the effect of the depressed Nigerian economy on the utilisation of maternal health services. Since then, there has been an observed and continued deterioration in maternal health service utilisation. The present study compares service utilisation within three time periods: pre-Structural Adjustment Programme (SAP) period of 1980-84; 1985-89 and 1990-94, revealing a continued decline in antenatal bookings, obstetric admissions and hospital deliveries with figures well below the pre-SAP levels. Maternal and perinatal morbidity have maintained a disproportionate upward trend. Specifically, perinatal mortality, obstructed labour and anaemia increased by two-, three- and six-fold respectively in the decade between the pre-SAP period and 1990-94 time period. Maternal mortality ratio of 9.3 per 1000 births is a 1.5 increase over pre-SAP level. The findings indicate a continuation over unsafe reproductive life among Nigerian women with bleak prospects into the 21st century and call for urgent change in government policy.

Changes in sexual practices and responses among ante-natal clinic attendees in a Nigerian teaching hospital

A cross-sectional study was carried out among 134 antenatal clinic attendees in a Nigerian tertiary hospital to assess pregnancy-related sexual beliefs and changes in sexual frequency and response. Information was collected through a semi-structured questionnaire, and analysed by SPSS. Only 15% of women believed that religious, social or cultural reasons prevented sexual intercourse in pregnancy. Frequency of sexual intercourse decreased in pregnancy in 37.4% of the respondents, remained unaltered in 46.1% and increased in 16.5%. Age, marriage duration and gestational age were not associated with change in the pattern of coital frequency in pregnancy, but education was significantly associated. Sexual responsiveness diminished in approximately half of our respondents in terms of arousal (54.5%), orgasm (48.5%), pleasure (43.7%) and satisfaction (51.4%). The changes were not associated with pregnancy duration. We concluded that sex in pregnancy is well accepted in our environment, and health workers should promote sexual health and well-being in pregnancy.

Retained placenta: a cause of reproductive morbidity in Nigeria

This study analysed the reproductive morbidity associated with 91 cases of retained placenta at the Obafemi Awolowo University Hospital in Nigeria. The incidence of retained placenta in the hospital was 1.4% of all deliveries. Over 42% of the patients were admitted in haemorrhagic shock; 56.5% were anaemic, 10.6% severely; 17% had puerperal sepsis while 67% of the women received blood transfusions. There was one maternal death (1%). Unbooked patients (74%) constituted the largest proportion of cases while inappropriate management of the third stage of labour featured in many of the patients. Retained placenta was treated with manual removal in 90% of cases. Properly supervised delivery is an important component in efforts to reduce the incidence of morbidity associated with retained placenta in Nigeria.

Cervical cancer-a neglected health tragedy

This is a review of the problems of cervical cancer in Nigeria, typified by data from a tertiary hospital over a 9-year period. Of 146 cases of cervical cancer studied, 79% presented in advanced stages, peak age incidence was between 40 and 70 years, mean 54.5 +/- 12.4 (SD) years. Squamous cell carcinoma was predominant (97% of cases). Presentation was typical: mainly abnormal vaginal bleeding, vaginal discharge and postmenopausal bleeding. Low socioeconomic status (90%) and high parity (83%) were prominent features. Treatment and outcome were poor because of late presentation, lack of radiotherapy facilities and inadequate surgical procedures. Comparison with previous Nigerian studies reveal a continued lack of improvement over the years as regards preventative strategies and adequate treatment facilities. Suggestions on cervical cancer control measures for developing countries like Nigeria are given.

Evaluation of health workers' training in use of the partogram

OBJECTIVE

To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers.

METHODS

Fifty-six health workers offering delivery services in primary health care facilities were trained to use the partogram and were evaluated after 7 months.

RESULTS

A total of 242 partograms of women in labor were plotted over a 1-year period; 76.9% of them were correctly plotted. Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram occurred in 6.6%. No statistically significant difference was recorded in the rate of correct plotting and consequent decision-making between nurse/midwives and the CHEWs.

CONCLUSION

Lower cadres of primary health care workers can be effectively trained to use the partogram with satisfactory results, and thus contribute towards improved maternal outcomes in developing countries with scarcity of skilled attendants.

Contraceptive practice among married market men in Nigeria

BACKGROUND

Until recently, family planning researchers and service providers had focused almost exclusively on women. Men are often seen as uncooperative and uninterested in family planning or reproductive health.

OBJECTIVE

To investigate the contraceptive knowledge, attitude and practice among married market men.

DESIGN

A cross-sectional survey.

SETTING

llesa Main Market, Osun State, Nigeria.

SUBJECTS

Four hundred and fifty married market men were interviewed between November 2000 and January 2001.

MAIN OUTCOME MEASURES

Level of awareness and utilisation, reasons for non-use, influence of socio-demographic variables.

RESULTS

All the men were aware of family planning and 60.9% are currently using a form of contraception with their spouse. Reasons for non-contraceptive use by 39.1% of the respondents include: family size not yet complete, religious opposition, afraid of contraceptive failure, still searching for a male sex. Christianity and education were significantly associated with contraceptive use and knowledge (p < 0.05).

CONCLUSION

Men favour contraceptive use in Nigeria. Involving men by family planning providers is a winning strategy with benefits to both men and women.

Decision-caesarean delivery interval in a Nigerian university hospital: implications for maternal morbidity and mortality

This is a 5-month prospective study to determine the decision emergency caesarean delivery interval in a Nigerian tertiary hospital, the factors responsible for the delays and the consequent maternal and perinatal complications. One hundred and thirty-four emergency caesarean deliveries were analysed and the main indications were failure to progress/ prolonged labour (35.4%), previous caesarean-section/failed trial of scar (27.9%), cephalopelvic disproportion (26.8%), fetal distress (19.5%), pre-eclampsia/eclampsia (15.3%) and obstructed labour/ruptured uterus (14.7%). The mean decision-caesarean delivery interval was 4.4 +/- 4.2 (SD) hours (range 0.5-26 hours), median 3.2 hours and mode 2 hours. Bottlenecks within the maternity unit were responsible for delays in 31.7% of cases. Unavailability of paediatrician (19.6%), non-availability of anaesthetic coverage (13.6%), unreadiness of the operation theatre (11.9%) and seeking second opinion (6.4%) were other major causes of delay. There were 15 perinatal deaths, five of whom were directly linked to the delays i.e. a perinatal mortality rate of 3.7%. Four maternal deaths were directly attributable to delay, a maternal mortality rate of 3%. Other direct consequences of the delays were severe haemorrhage (10.3%), uterine rupture (2.3%) and disseminated intravascular coagulopathy (1.5%). Suggestions on how to minimise delays in emergency services and overall improvement in quality assurance control are discussed.

Autotransfusion for ruptured ectopic pregnancy

OBJECTIVES

Clinical outcomes following the exclusive use of autotransfusion in the management of ruptured ectopic pregnancy are reviewed.

METHODS

A MEDLINE search (1966-2002) for relevant articles documenting the exclusive use of autotransfusion, and data collection and analysis was made.

RESULTS

There were 21 studies, 16 from developing and five from developed countries, involving 632 cases of ruptured ectopic pregnancies. Hypovolemic shock with significant hemoperitoneum (>500 ml) was the most common complication. The procedure was performed completely manually in developing countries and with the help of a device in developed countries. The mean volume of autotransfused blood was over 1000 ml, with mean hemoglobin levels ranging from 6 to 12.5 g/dl. Mean posttransfusion hemoglobin levels were higher than pretransfusion levels. There was one death, thought to be due to pulmonary embolism, and nine major and minor complications.

CONCLUSIONS

Autotransfusion is useful in the management of ruptured ectopic pregnancy.

Prevalence and determinants of contraceptive practice in a defined Nigerian population

This study investigates the prevalence and determinants of contraceptive practice in Ile-Ife, Nigeria. A prospective study of 500 rural women in the reproductive age group was conducted between April to June 1999 in the Igboya health district of Ife central local government area of Osun State. A comprehensive contraceptive promotion and distribution had been carried out in this area by the University Teaching Hospital, the State Ministry of Health and many non-governmental organisations in the past 10 years. It is therefore expected that the contraceptive awareness and use in this environment would be high. Unfortunately, although all the respondents (100%) were aware of contraception and 78% were sexually active, only 18.8% used contraception. A majority of the non-users gave no reasons for failure to use contraception. Among reasons given by others include fear of side effects, no need for contraception, not married, religion, need for more children and student status. The most common contraceptive method among users was intrauterine contraceptive device followed by pills, condoms and injectable contraceptives. Factors which were significantly associated with utilisation of contraception were availability of family planning services, parity, knowledge of contraception and child spacing (P < 0.05). Religion, literacy level, attitudes of family planning providers and distance to family planning services were not found to be significant (P > 0.05). Recommendations that will improve wide contraceptive usage are preferred.

Decision-intervention interval in ruptured uteri in Ile-Ife, Nigeria

OBJECTIVE

To determine the decision-intervention interval in ruptured uterus with a view of overhauling the management strategy thereby improving the maternal and perinatal outcome.

DESIGN

Cross-sectional survey based on secondary data done between 1990-1999.

SETTING

Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.

SUBJECTS

One hundred and two consecutive women who had uterine rupture.

RESULTS

The decision-surgical intervention interval ranged from 30 minutes to 4.5 hours. The major reason for delay was unavailability of compatible blood (88.2%), followed by lack of electricity (4.9%), unsterile instruments (3.9%), waiting for ambulance to get senior obstetricians (2.9%), delay in arrival of anaesthetist (1.9%) and neonatologists (1.9%). The peri-natal mortality rate (PNMR) was 843 per 1000 total births and maternal mortality rate (MMR) 4902 per 100,000 births.

CONCLUSION

The maternal and perinatal outcome in uterine rupture would be improved by early diagnosis and avoidance of preoperative delay through availability of essential obstetric services.

Brought-in maternal deaths in south-west Nigeria

Not all pregnant women who decide to seek care at a medical facility in Nigeria arrive in time to be treated. Some die while trying to get there. Data on such deaths are, however, scarce. In this study, conducted over a 5-year period (1995-99), when any pregnant woman was brought in dead into the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, the relatives were interviewed immediately to discover the immediate and remote causes. Reasons given for late presentation include: inability to obtain transportation in time (41.7%), inability of the health-care staff to detect an obstetric emergency early enough and refer to an appropriate centre (33.3%), inability of the referring hospital to perform an emergency caesarean section (33.3%), fear of caesarean section (25%), unwillingness of drivers to travel by night (25%) and no money to pay for hospital costs (16.7%). Causes of death include eclampsia, ruptured uterus, severe postpartum haemorrhage, severe antepartum haemorrhage, sickle cell anaemia with crises and road traffic accidents. Prevention of 'brought-in' maternal deaths requires social transformation, overhauling the health-care delivery services and improving the socio-economic status of the population.

Emergency obstetric admissions: late referrals, misdiagnoses and consequences

This is a prospective study that examined the nature of emergency obstetric admissions in a Nigerian university hospital in association with such factors as late referrals and misdiagnoses and their contribution to maternal and perinatal morbidity/mortality. The study comprised 144 consecutive emergency obstetric admissions to the hospital over a 6.5-month period. An incidence of 13.6% emergency admissions was recorded. Despite the proximity of the hospital to the parturients, most of them laboured in substandard facilities within the community. Referrals to the university hospital were made only after prolonged delay and onset of complications. Obstetric haemorrhage (24.6%) was the most common cause for referral followed by labour disorders (19%) and hypertensive disorders (8.4%). Thirteen maternal deaths occurred, giving a maternal mortality ratio of 6.2%, while perinatal mortality rate was 461 per 1000 births. Twelve of the maternal deaths were in women living within 5 km of the hospital. There was a caesarean section rate of 50.9%, a 4.8% incidence of diagnostic laparotomy, a 9% incidence of emergency hysterectomy and 44% of emergency blood transfusions. Misdiagnoses of clinical conditions were made by the referring centres in 68% of cases, which contributed to the high maternal morbidity and mortality. Patient attitude was the main cause of non-use of teaching hospital facilities (fear of operation in 32% of cases, dissuasive advice from friends in 27.4% and negative staff attitude in 7%). A need for and type of programme that will promote increased utilisation of modern maternal health services in the community are discussed.

Emergency autologous blood transfusion in the management of ruptured ectopic pregnancy

Thirty-three cases of ruptured ectopic pregnancies treated by emergency autologous blood transfusion were compared with 85 cases treated by homologous blood. The postoperative outcome was satisfactory and the duration of hospital stay was similar in both groups. However, the quantity of blood transfused in those who received autologous blood was significantly higher than in those transfused with homologous blood ( P 0.02). Because of this experience we advocate greater use of intra-operative blood salvage and autotransfusion, even when banked homologous blood is available, in the management of ruptured ectopic pregnancy.

An evaluation of the WHO criteria for abnormal glucose tolerance test during pregnancy in Nigerian women

A 75 g oral glucose tolerance test was performed in 127 normal Nigerian women between 24 and 28 weeks of pregnancy. The glucose response at fasting, 1, 2 and 3 h were studied. At 2 h, the glucose level at 2-SD and 4-SD above the mean were less than the criteria of abnormality recommended by the World Health Organisation: 6.5 mmol/l vs. 8 mmol/l for impaired glucose tolerance and 8.0 mmol/l vs. 11.0 mmol/l for gestational diabetes mellitus. The area under the glucose response curve correlated best with the glucose levels at 2 h during the OGTT (y = 4.3 + 1.8x, r = 0.862). The 75-g OGTT interpreted with the WHO criteria appear not to be appropriate for use in pregnant women in Nigeria.

Pregnancy outcome after illegal induced abortion in Nigeria: a retrospective controlled historical study

The effect of illegal abortion on subsequent reproduction was studied in 46 Nigerian women who gave a history of illegal termination of pregnancy. There was a statistically significant increase in the incidences of premature rupture of membranes, premature labour and low birth weight when compared to 53 primigravida who gave no such history of abortion. The perinatal mortality was also significantly higher in the abortion group. In contrast, pre-eclampsia was less common in the abortion group. These findings indicate that illegal abortion has adverse effects on pregnancy outcome in Nigerian women.

Correlation of ultrasound assessment of endometrial growth and plasma steroid concentrations during superovulation for in vitro fertilization

Endometrial and follicular development were investigated by ultrasound in 25 normally cycling women who received clomiphene citrate and human menopausal gonadotrophin to induce multiple follicular development for in vitro fertilization. Ultrasonic determination of endometrial thickness and reflectivity grading and follicular number were correlated with daily concentrations of estradiol (E2) and progesterone (p) in peripheral serum. Serum E2 showed a better positive correlation with endometrial thickness than with total number of developing follicles. There was a significant inverse correlation between endometrial thickness and plasma p concentration. The E2 value per follicle and E2/p ratio were both weakly correlated respectively with endometrial thickness. These data indicate that ultrasound determination of endometrial thickness is a useful ultrasonic parameter for monitoring ovarian function for in vitro fertilization. However, endometrial thickness should always be combined with total number of developing follicles, in order to reach decisions concerning timing of oocyte recovery.

Illegal induced abortion: a study of 74 cases in Ile-Ife, Nigeria

Seventy-four women with complications of induced abortion were studied prospectively at the Obafemi Awolowo University, Nigeria. Twenty of the women were interviewed privately to elicit confidential information and also to determine their attitudes to contraception and to the Nigerian national abortion law. The results showed that abortion is prevalent in all classes of women and in married as well as unmarried women. There were 13 maternal deaths, accounting for 35% of the maternal mortality in the hospital during the period. Sepsis was the most common cause of death, and most of the abortions complicated by sepsis had been performed by medical practitioners. Interviews with the women revealed that most of them had knowledge of contraception but were unwilling to use it because of wrong information. Most women did not know that abortion is illegal in Nigeria, but felt that it should be. Measures that could be of value in reducing abortion-associated maternal mortality in Nigeria include training and retraining of physicians in the management of abortion and of abortion complications, family planning education of all fertile women, provision of confidential family planning services and liberalization of the abortion law.

Ureteric injuries associated with gynecologic surgery

We conducted a review of eight ureteric injuries associated with major gynecologic surgery in seven patients over an 11-year period. Our low incidence of 0.36% is comparable with other reports. Diagnosis was made either intra-operatively or postoperatively. Immediate ureteric repair is advocated for all injuries discovered intra-operatively. Attention to preventive measures both before and during gynecological operations will reduce the incidence of ureteric injuries.

Adenomyosis uteri in Ile-Ife, Nigeria. A prospective clinicopathologic study

A 12-month prospective study of 120 consecutive hysterectomy and 12 myomectomy specimens received at the histopathology laboratory of the Obafemi Awolowo University Teaching Hospitals was undertaken to determine the occurrence of adenomyosis. The observed incidence was 9.8%. Adenomyosis was commonest in multiparous women in the fifth decade of life. The principal presenting complaint was abnormal uterine bleeding. The average dimension of a typical affected uterus was 10 x 7 x 6 cm weighing an average of 175 g. Diagnosis was mostly post-operative. This study shows that adenomyosis uteri is not uncommon in Nigerians.

Preterm premature rupture of fetal membranes in a low socioeconomic population: results of conservative management

A retrospective review of pregnancies complicated by preterm premature rupture of membranes (PPROM) in 149 women of low socioeconomic status in Nigeria was undertaken. Delivery occurred within 24 h of onset of symptoms in 51 of these women (immediate delivery group), whereas 98 patients were managed conservatively. The mean length of gestation was higher in the conservatively managed group and the perinatal mortality was correspondingly lower. In contrast, there was a slightly increased incidence of puerperal febrile morbidity in the conservative group. These data suggest that conservative management can be selectively employed in PPROM occurring in women of low socioeconomic status.

Rupture of the gravid uterus following a road traffic accident

A case of rupture of the uterus at 34 weeks of pregnancy due to a road traffic accident is presented. Emergency laparotomy and total abdominal hysterectomy were done with good maternal outcome. This is a rare cause of rupture of the uterus in this population.

Does standing up improve the predictive value of the supine pressor test for gestational hypertension?

Fifty-six primigravid women at 28-32 weeks' gestation were studied prospectively to compare the roll-over test with the stand-up pressor test in the prediction of gestational hypertension. Blood pressures were measured in the different positions continuously using an automated machine. Twenty patients developed gestational hypertension; two of these were accurately predicted by roll-over test and six by stand-up pressor test (P less than .001). However, there was no significant difference between the tests in the rates of false negatives, specificity, and negative and positive predictive values. Concomitant measurement of blood pressures in the standing position may increase the sensitivity of the roll-over test for the prediction of gestational hypertension.

Maternal sickle cell trait is not a cause of low birthweight in Nigerian neonates

As a result of reports of reduced birthweight in neonates of mothers with hemoglobin AS (Hb-AS) in other populations, we compared birthweights in 57 Hb-AS primigravidas in Nigeria with 60 controls who were sickle negative. There was no statistically significant difference in mean birthweight or placental weight between the groups. This finding may be due to development of resistance against malaria infection by Hb-AS women in this population.

Plasma zinc and copper in pregnant Nigerian women at term and their newborn babies

The concentration of copper and zinc was determined by atomic absorption spectrophotometry in 26 normal Nigerian women at term and their newborn babies. Cord zinc was significantly greater than maternal zinc. In contrast, cord copper was lower than maternal copper. There was only a weak correlation between cord copper and maternal copper but none between cord zinc and maternal zinc. There was no correlation between maternal and cord zinc and neonatal birthweight. However, an inverse correlation was found between maternal and cord copper and neonatal birthweight. These results indicate that: (1) zinc has no effect on fetal growth in Nigerian women but (2) copper may have a negative effect on fetal growth.

A Randomized Clinical Trial of Misoprostol and Oxytocin for Induction of Labour

DOI: http://dx.doi.org/10.3126/njog.v5i1.5061 NJOG 2010 Jul-Aug; 5(1): 44-48