Sonographic determination of fetal gender in the second and third trimesters in a private hospital in Enugu,southeast Nigeria

BackgroundPregnant Nigeria women are usually anxious about the gender of their fetuses for social reasons.ObjectiveThe purpose of this study was to determine the accuracy of ultrasound in the determination of fetal gender in women who wished to know the gender of their fetuses and in those whom the gender of their fetuses were requested for on clinical grounds in the second and third trimesters.MethodsA prospective longitudinal study was performed on 1480 singleton pregnancies who met the inclusion criteria between February 2004 and January 2008. Ultrasound examination was performed on GE ALOKA 500 machine, transabdominally between 14 and 40 weeks gestational age (GA). Both transverse and mid-sagittal planes of a section of the fetal genital tubercle were performed to identify the gender. The subsequent gender at birth was obtained from the hospital birth records.ResultsDuring the study, 1211 (81.8%) women requested gender information while the gender information from 269 (18.2%) women was requested for on clinical grounds. The mean GA at which the fetuses were scanned was 29⁺² ± 3⁺⁶ weeks (range 14–40 weeks). Fetal gender assignment was possible in 1350 (91.2%) out of 1480 fetuses; 680 assigned male and 670 female. Of these, the fetal gender corroborated birth sex in 1325 (89.5%) and disagreed in 25 (1.7%) cases. The overall estimated sensitivity of the scan is 98.1%, while the estimated specificity for identification of the male sex (100%) was higher than the female (78.3%). Of the 130 cases where no identification of gender was possible, 50 were in the second trimester and 80 were in the third trimester.ConclusionThis study demonstrated that the accuracy of fetal gender determination increased with gestational age, from 97.1% in the second trimester to 98.5% in the third trimester. The overall fetal gender accuracy rate for male fetus was better than female and was statistically significant (P < 0.05).     

Microvesicles in haemoglobinopathies offer insights into mechanisms of hypercoagulability, haemolysis and the effects of therapy

Levels of circulating red blood cell (RBC)-derived vesicles are increased in sickle cell anaemia (SCA) and thalassaemia intermedia (TI) but the mechanisms, effects and controlling factors may differ. This study found that levels of vesicles and intravascular haemolysis were linked as shown by the correlation between levels of vesicles and plasma Hb. Vesicle levels were 6-fold greater in SCA and 4-fold greater in TI than in controls. The proportion of plasma Hb within vesicles was increased in SCA and TI with a significantly higher proportion in TI. We examined whether subpopulations of RBC expressing phosphatidylserine (PS) were a source of PS(+) vesicles and observed a significant association. Thrombin generation was promoted by the vesicles in which 40–50% expressed PS. In TI, markers of thrombin generation were significantly related to PS(+) RBC. Splenectomy in TI had significant effects including greater increases in vesicle levels, plasma Hb, PS(+) RBCs and thrombin generation markers than in unsplenectomised patients. In hydroxycarbamide (HC)-treated SCA patients these measures were decreased compared with untreated controls. The relationship between vesicle levels and plasma Hb suggests a mechanism linking vesiculation to haemolysis and consequently nitric oxide (NO) bioavailability and suggests a means by which HC treatment improves NO bioavailability.     

Socio-economic differences in preferences and willingness to pay for different providers of malaria treatment in southeast Nigeria

This article determined whether there are links between socio-economic status (SES) and preferences of consumers for different strategies for improving timely and appropriate management of malaria. Ranking of preferences and willingness to pay (WTP) for 5 different strategies for improving the management of malaria in Enugu State, southeast Nigeria were elicited from randomly selected respondents. The results showed that the people were also willing to pay for improved management of malaria, though the levels of WTP was dependent on the SES of the respondents, with the poorest SES group willing to pay the least amount of money. Also, the respondents generally mostly preferred timely and appropriate management of malaria through formal public healthcare system. Hence, to decrease the inequity in malaria management and ensure the ready availability of appropriate treatment to the poorest households, the government should increase the availability and accessibility of publicly owned healthcare services, complemented by community-based health services.     

Factors associated with the use of maternity services in Enugu, southeastern Nigeria

The maternal mortality ratio and other maternal health indicators are worse for developing countries than for the developed world due to improved access to quality care during pregnancy and especially at delivery in the industrialized world. This study was carried out to identify the factors which influenced choice of place of delivery by pregnant women in Enugu, southeastern Nigeria, and to recommend ways to improve women's access to skilled attendants at delivery. A pre-tested questionnaire was administered by interviewers to women who had delivered within 3 months prior to date of data collection. The response rate was 75.5% (n=1098). Of the respondents, 52.9% delivered outside health institutions and 47.1% in health institutions. The major factors influencing choice of place of delivery included promptness of care, competence of midwife/doctor, affordability, health education, 24 h presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non-institutional deliveries and socio-demographic/economic factors such as place of residence (urban/rural), religion, educational status, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p<0.05). We conclude that factors which will positively influence women to deliver in health institutions in Enugu, Nigeria include a variety of interacting social, economic and health system factors, which operate at various levels-the household, community, the health institutions and the larger social and political environment. Attention to these factors will not only improve maternity utilization but, hopefully, also will reduce the high maternal mortality and improve other maternal health indicators in the study area.     

Solitary infantile myofibroma compromising the airway

Infantile myofibromatosis is an uncommon and benign condition presenting in the neonatal period. It is self-limiting disease that may present as a localised or generalised process. Various examples of this entity have been reported in the literature. This report describes a neonate with a rapidly growing oropharyngeal lesion obstructing the airway that had the typical histological features of an infantile myofibroma. This case report highlights that a solitary myofibroma may be incredibly extensive making complete excision impossible and can be particularly challenging to manage in terms of airway stabilisation.