Correlation Between the Clinical Diagnosis and Sonographic Diagnosis in Women with First-Trimester Vaginal Bleeding

BACKGROUND

Vaginal bleeding is the most common cause of presentation at the emergency department in the first trimester. Clinical presentation helps determine the likely cause of first-trimester vaginal bleeding. However, ultrasound imaging is required to reach a definitive diagnosis.

OBJECTIVE

To determine the relationship between clinical diagnosis and ultrasonographic findings in women with first-trimester vaginal bleeding.

METHODS

A prospective longitudinal study was conducted on 94 pregnant patients with a history of bleeding per vagina (PV) in the first trimester by using transvaginal ultrasound.

RESULTS

PV spotting was noted in 64.9% and heavy bleeding in 35.1%. The most common clinically associated symptom was abdominal pain (68, 72.3%), and the least common clinically associated symptom was vesicle expulsion (2.1%). The most common predisposing factor was fever (31, 33.0%). The most frequent clinical diagnosis was threatened abortion (48, 51.1%), and the least common clinical diagnosis was gestational trophoblastic disease (GTD) and inevitable abortion (1, 1.1%). The most common ultrasound diagnosis at the initial scan was incomplete abortion (19.2%), while at follow-up scans, it was threatened abortion (48, 51.1%). The overall concordance between clinical diagnosis and ultrasound was 38.8%, with both complete abortion and GTD showing a concordance of 100%. The least concordance was seen in missed abortions (25%).

CONCLUSION

Clinical assessment is insufficient in the identification of the cause of vaginal bleeding due to the overall low concordance rate. A combination of clinical assessment and ultrasonography is required for decision-making in every case.

Large supralevator puerperal haematoma following a normal delivery

BACKGROUND

Puerperal Haematomas are not very common and supralevator haematomas following normal vaginal deliveries are quite rare.

METHOD

We report a case of supralevator haematoma following a normal spontaneous vertex delivery, necessitating laparotomy.

RESULTS

A 29 year old multiparous woman who had a normal pregnancy and normal labour, developed a large supralevetor haematoma. She had a laparotomy and her recovery was uneventful.

CONCLUSION

Supralevator haematomas should be considered in patients presenting with lower abdominal pains and absence of vaginal bleeding following normal delivery. Ultrasound scan is helpful, but not conclusive in the diagnosis of supralevator haematomas.

The pattern of hysterosalpingographic findings in women being investigated for infertility in Nnewi, Nigeria

BACKGROUND

Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours.

OBJECTIVE

To review the pattern of hysterosalpingographic findings among women being investigated for infertility in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a period of five years (2001-2005).

METHOD

The data obtained from the request forms and radiologists' reports were analyzed using SPSS version 11. The level of statistical significance was set at p < 0.05.

RESULTS

Of the 320 studied, 230 were found suitable for analysis. Their ages ranged from 20 to 44 years (mean 32.8 +/- 5.8 years). The indications were primary infertility in 103 (44.8%), secondary infertility in 88(38.3%), while in 39 (16.9%) patients the type of infertility was not specified. The reports revealed that 67 (29.1%) had normal HSG Cervical abnormalities were found in 34 (14.8%), uterine cavity abnormalities in 108 (47.0%). Tubal pathologies were seen in 100 (43.5%) with bilateral tubal occlusion in 43 (18.7%) and bilateral hydrosalpinges in 6 (2.6%) patients.

CONCLUSION

Tubal pathology remains a major contributor to female infertility in this part of the world.

Spectrum of childhood malignancies in Enugu, Nigeria (1999-2004)

A retrospective analysis of childhood malignancies in Enugu, Nigeria was carried out using data obtained from the Cancer Registry of the University of Nigeria Teaching Hospital (UNTH), Enugu between 1st January 1999 and 30th June 2004. A total of 79 childhood cancers were recorded during the period. There were 48 males (60.8%) and 31 females (39.2%) with a male female ratio of 1.5:1. The three commonest malignancies were lymphomas 33 (41.2%), sarcomas 12 (15.2%) and nephroblastomas 12 (15.2%). The less common tumours included the leukaemias 6(7.6%), retinoblastomas 6 (7.6%), neuroblastomas 4 (5.1%), and carcinomas 2 (2.5%). Burkitt's lymphoma remains the commonest specific childhood malignancy in this environment constituting 19 (57.6%) of all the lymphomas and 24.1% of all the cancers seen.

Prevalence and clinical picture of IDDM in Nigerian Igbo schoolchildren

OBJECTIVE

To evaluate the prevalence and clinical picture of IDDM in Nigerian Igbo schoolchildren born and living in continental Africa.

RESEARCH DESIGN AND METHODS

In three school districts (Ezza, Ishielu, Ohaukwu), 77,862 schoolchildren aged 5-17 yr answered our questionnaires on age, sex, known disease, drugs being taken, family history, and diabetic symptoms like polyuria, polydipsia, polyphagia, and weight loss. Positive respondents were given glucosuric tests, and glucosuric subjects had hyperglycemic tests. Diagnosis of IDDM was established in hyperglycemic patients by referred hospital clinicians based on insulin requirements.

RESULTS

Twelve new cases of IDDM were found in addition to 14 previously diagnosed cases, giving a CPR of 0.33/1000. Ishielu had a CPR of 0.46/1000 compared with 0.25 (P less than 0.01) for Ohaukwu. Boys had a CPR of 0.38/1000 compared with 0.25/1000 (P less than 0.06) for girls. Boy-to-girl prevalence ratio was approximately 3:1.

CONCLUSIONS

The relatively high prevalence of IDDM in this poor African population, despite potential deaths caused by minimal medical attention, may be because of long-term protein malnutrition and endemic childhood infections, which have been implicated in the etiology of IDDM in similar malnourished populations.