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Routine prenatal ultrasound anomaly screening program in a Nigerian university hospital: Redefining obstetrics practice in a developing African country.

Akinmoladun JA, Ogbole GI, Lawal TA, Adesina OA - Niger Med J (2015 Jul-Aug)

Bottom Line: The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country.The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%).Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University College Hospital, Ibadan, Nigeria.

ABSTRACT

Background: Congenital anomalies are among the leading causes of fetal and infant morbidity and mortality worldwide. Prenatal ultrasound (US) screening has become an essential part of antenatal care in the developed world. Such practice is just evolving in the developing countries such as Nigeria. The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country.

Materials and methods: This was a prospective evaluation of the prenatal US screenings conducted at a major referral hospital in Southwestern Nigeria. All pregnant women referred to the antenatal clinic for mid-trimester screening during the period of study were assessed.

Results: Two hundred and eighty-seven pregnant women (5 with twin gestations) were presented for fetal anomaly scan during the study period. Twenty-nine anomalies (9.9%) were detected among the scanned population. Sixteen of the anomalies were followed to delivery/termination with a specificity of 93.5%. The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%). Six (20.6%) of the anomalies were lethal. Five of the anomalies were surgically correctable.

Conclusion: Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.

No MeSH data available.


Related in: MedlinePlus

A transabdominal ultrasound scan of a 22-week-old fetus showing a fetus with left sided pleural fluid collection, which has displaced the heart to the right
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Figure 2: A transabdominal ultrasound scan of a 22-week-old fetus showing a fetus with left sided pleural fluid collection, which has displaced the heart to the right

Mentions: The sensitivity of US in the detection of fetal anomalies is largely dependent on the expertise of the examiner, the gestational age at the time of scanning, the definition of anomaly as major and minor, and the postnatal ascertainment of anomalies.2021 The 93.8% sensitivity of our initial prenatal screening program appears to be greater than what was reported by similar scan studies that reported values of 22-41%82021 to as high as 74-85%.222324 These may be due largely to the level and experience of the people performing the examination. The performing Radiologist in this study had received extensive training from a renowned center in the UK before initiation of the program. Levi et al.20 found a lower sensitivity in the earlier part of their study that improved later as the examiners/sonographers mastered the techniques, gained more experience, and training was enhanced. There were three fetuses in this study that had severe anomalies and were followed to term. Due to early prenatal diagnosis, these patients had appropriate specialists present at the delivery and appropriate interventions were instituted as soon as it was possible. The mode of delivery was changed in two of the cases with gastroschisis [Figure 1] and pleural effusion [Figure 2]; an earlier delivery date was recommended for the fetus with unilateral megaureter [Figure 3] to prevent further damage to the contralateral kidney. All three cases underwent surgical interventions.


Routine prenatal ultrasound anomaly screening program in a Nigerian university hospital: Redefining obstetrics practice in a developing African country.

Akinmoladun JA, Ogbole GI, Lawal TA, Adesina OA - Niger Med J (2015 Jul-Aug)

A transabdominal ultrasound scan of a 22-week-old fetus showing a fetus with left sided pleural fluid collection, which has displaced the heart to the right
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697214&req=5

Figure 2: A transabdominal ultrasound scan of a 22-week-old fetus showing a fetus with left sided pleural fluid collection, which has displaced the heart to the right
Mentions: The sensitivity of US in the detection of fetal anomalies is largely dependent on the expertise of the examiner, the gestational age at the time of scanning, the definition of anomaly as major and minor, and the postnatal ascertainment of anomalies.2021 The 93.8% sensitivity of our initial prenatal screening program appears to be greater than what was reported by similar scan studies that reported values of 22-41%82021 to as high as 74-85%.222324 These may be due largely to the level and experience of the people performing the examination. The performing Radiologist in this study had received extensive training from a renowned center in the UK before initiation of the program. Levi et al.20 found a lower sensitivity in the earlier part of their study that improved later as the examiners/sonographers mastered the techniques, gained more experience, and training was enhanced. There were three fetuses in this study that had severe anomalies and were followed to term. Due to early prenatal diagnosis, these patients had appropriate specialists present at the delivery and appropriate interventions were instituted as soon as it was possible. The mode of delivery was changed in two of the cases with gastroschisis [Figure 1] and pleural effusion [Figure 2]; an earlier delivery date was recommended for the fetus with unilateral megaureter [Figure 3] to prevent further damage to the contralateral kidney. All three cases underwent surgical interventions.

Bottom Line: The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country.The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%).Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University College Hospital, Ibadan, Nigeria.

ABSTRACT

Background: Congenital anomalies are among the leading causes of fetal and infant morbidity and mortality worldwide. Prenatal ultrasound (US) screening has become an essential part of antenatal care in the developed world. Such practice is just evolving in the developing countries such as Nigeria. The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country.

Materials and methods: This was a prospective evaluation of the prenatal US screenings conducted at a major referral hospital in Southwestern Nigeria. All pregnant women referred to the antenatal clinic for mid-trimester screening during the period of study were assessed.

Results: Two hundred and eighty-seven pregnant women (5 with twin gestations) were presented for fetal anomaly scan during the study period. Twenty-nine anomalies (9.9%) were detected among the scanned population. Sixteen of the anomalies were followed to delivery/termination with a specificity of 93.5%. The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%). Six (20.6%) of the anomalies were lethal. Five of the anomalies were surgically correctable.

Conclusion: Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.

No MeSH data available.


Related in: MedlinePlus