Reliability of Sonographic Estimation of Fetal Weight: A Study of Three Tertiary Hospitals in Nigeria

Context:

There is a dearth of sonologists in Nigeria, yet sonographic estimation of actual birth weight (ABW) is important in antenatal care.

Aim:

To determine the reliability of estimated fetal weight (EFW) by sonographers and sonologists in Lagos Nigeria.

Settings and Design:

In the cross-sectional study, a convenience sample of 663 healthy women with singleton pregnancy at term was selected. Ethical approval for the study design and consent of participants were obtained.

Subjects and Methods:

Three sonographers and three sonologists used a single ultrasound scanner with Hadlock-3 algorithm to measure biparietal diameter, abdominal circumference, and femur length in three centers while three midwives used a single neonatal weighing scale to measure ABW.

Statistical Analysis Used:

Medical^® statistical software version 12.5 was used to analyze data. Descriptive and inferential statistics, as well as Bland/Altman plots were used to determine reliability of EFWs. Results were tested for statistical significance at P ≤ 0.05.

Results:

Majority (76.2%) of babies had normal weight while mean EFW and ABW were 3.50 ± 0.10 kg and 3.45 ± 0.12 kg, respectively and the difference between them is not statistically significant (P > 0.05). For sonographers and sonologists in each center, mean error and coefficient of variation were very small while Pearson's correlation coefficient as well as intra- and interclass correlation coefficients was very high.

Conclusion:

Independent estimation of ABW by sonographers in Lagos metropolis was very reliable. Sonography was also highly reliable in predicting macrosomia.

Correlation of ultrasonographic estimated fetal weight with actual birth weight in a tertiary hospital in Lagos, Nigeria

BACKGROUND

Sonographic fetal weight estimation is an important component of antenatal care.

AIM

To sonographically estimate fetal weight at term and to compare estimated with actual birth weights to determine the validity of estimated fetal weights.

SUBJECTS AND METHODS

In the prospective study, a convenience sample of 282 women was recruited. Ethical approval and informed consent of patients were obtained. An experienced sonographer estimated fetal weights by measuring BPD, HC, AC and FL using a scanner with Hadlock 3 weight estimation model. Actual birth weights were measured with a Crown weighing scale by a midwife. Data was analyzed with SPSS software version 17.0 while descriptive and inferential statistics were used to interpret results. Results were tested at error level set at p≤ 0.05.

RESULTS

Mean estimated and actual birth weights were 3378±40g and 3393±60g respectively. Difference between the two means was not significant. Eleven percent of fetuses were sonographically estimated to be microsomic while 14.5% were microsomic at birth; 12.1% were sonographically estimated to be macrosomic but 15.2% were macrosomic at birth. Most macrosomic fetuses were delivered through cesarean section(CS) and fetal weights increased with maternal age and parity.

CONCLUSION

Sonographically estimated fetal weight using Hadlock 3 weight estimation model without validation correlated positively with actual birth weight in a Nigerian population.

Assessment of radiation protection practices among radiographers in Lagos, Nigeria

BACKGROUND

Use of ionising radiation in diagnostic radiography could lead to hazards such as somatic and genetic damages. Compliance to safe work and radiation protection practices could mitigate such risks. The aim of the study was to assess the knowledge and radiation protection practices among radiographers in Lagos, Nigeria.

MATERIALS AND METHODS

The study was a prospective cross sectional survey. Convenience sampling technique was used to select four x-ray diagnostic centres in four tertiary hospitals in Lagos metropolis. Data were analysed with Epi- info software, version 3.5.1.

RESULTS

Average score on assessment of knowledge was 73%. Most modern radiation protection instruments were lacking in all the centres studied. Application of shielding devices such as gonad shield for protection was neglected mostly in government hospitals. Most x-ray machines were quite old and evidence of quality assurance tests performed on such machines were lacking.

CONCLUSION

Radiographers within Lagos metropolis showed an excellent knowledge of radiation protection within the study period. Adherence to radiation protection practices among radiographers in Lagos metropolis during the period studied was, however, poor. Radiographers in Lagos, Nigeria should embrace current trends in radiation protection and make more concerted efforts to apply their knowledge in protecting themselves and patients from harmful effects of ionising radiation.

CT-detected intracranial hemorrhage among patients with head injury in Lagos, Nigeria

PURPOSE

To evaluate the computed tomography (CT) findings of intracranial hemorrhage among patients with head trauma in Lagos, Nigeria.

METHODS

In this retrospective, cross-sectional study, a convenience sample of 500 patients with head trauma who had diagnostic cranial CT scans was selected. All the radiological reports and CT scans of patients with head trauma were retrieved in the hospitals selected as study sites. The reports were sorted into 2 groups - normal findings and intracranial bleeding. The reports of intracranial bleeding were sorted again into different classes of intracranial bleeding as identified by the radiologist who reported it. All data were analyzed using the Epi Info public domain software package. The chi-square test was used to measure the statistical significance of study results at P < .05.

RESULTS

Most of the study subjects (68%) were men. Traffic accidents accounted for 44% of all the head traumas found in the study, and 58% of the head traumas resulted in intracranial bleeding. Among the hemorrhages found, 37% were intracerebral, 25% were subdural, 16% were intraventricular, 15% were subarachnoid, and 7% were epidural.

DISCUSSION

Intracranial hemorrhage was a common consequence of acute head trauma sustained from traffic accidents in the population studied, with intracerebral hemorrhage being the most prevalent type.

CONCLUSION

Traffic accidents are the main cause of acute head trauma in Lagos, Nigeria. The use of CT for early diagnosis of intracranial hemorrhage appears justifiable.

Analysis of film reject rate in the diagnostic x-ray facility of a tertiary health institution in Benin, Nigeria

BACKGROUND

Film rejects analysis (FRA) as part of quality assurance tests in radiography services, is carried out periodically to identify causes of film rejection and to proffer solutions to ameliorate such problems.

OBJECTIVE

The study was carried out to estimate film rejection rate in a tertiary health facility in Benin, Nigeria and also to identify causes of film rejection in the centre.

METHODS

This prospective study was carried out within 6 months. Ethical approval was obtained from the local committee on research and ethics before the study commenced. Only routine x-ray procedures were included in the study. Four x-ray rooms and four radiographers with equal training and job experience were selected for the study. Different boxes labeled for each room were used to daily collect rejected films.

RESULTS

Overall rejection rate was 6.7%. Improper exposure caused the highest rate of repeats (> 12% in the old x-ray rooms). Highest rejection rates (31%) were found in the old x-ray rooms. Paranasal sinuses examination accounted for highest rejection rate (25%) among all routine x-ray investigations considered.

CONCLUSION

Rejection rate found was within recommended limits.Obsolete but poorly maintained x-machines layed major roles in overall film rejection rate in the centre. X ray of paranasal sinuses was challenging to radiographers observed. Radiographers should embrace CPD while obsolete x-ray equipments found in the centre should be scrapped to further reduce film reject rate in the centre.

Achalasia of the oesophagus in infancy: a case report

BACKGROUND

Achalasia characteristically causes dismotility of the lower oesophageal sphincter and defective peristalsis of the body of the oesophagus, in response to the act of swallowing, as a result of ganglionic cells degeneration. The resultant oesophageal dilatation leads to food stasis and may cause oesophagitis and tracheobronchial aspiration. Achalasia is a rare occurrence in the paediatric age group and even more extremely rare in the neonate and young infant. Urgent radiologic evaluation of the underlying cause of persistent on-going vomiting in an infant is mandatory.

OBJECTIVE

To emphasize the role of upper gastrointestinal imaging in infants with persistent on-going vomiting, severe dehydration and malnutrition through case illustration of a 9-month-old infant seen in a private medical outfit in Lagos.

METHODS

Dilute barium oesophagogram, pre- and postoperatively, was performed in a 9-month-old infant and illustrative images were presented. Literature materials on achalasia of the oesophagus were reviewed and juxtaposed with findings in the illustrated case for discussion.

RESULTS

Only 3 to 4 percent of achalasia is reported to occur in the paediatric age group with average duration of 28 months from onset of symptoms to diagnosis. Persistent vomiting and failure to thrive are common. Pneumatic dilatations and surgical myotomy are recommended treatment methods.

CONCLUSION

Urgent upper gastrointestinal contrast study is appropriate in infants with suspected achalasia for successful management.