Unintended Pregnancy Determinants among Antenatal Clinic Attendees: A University of Port Harcourt Teaching Hospital Experience

An unintended pregnancy is a pregnancy that is either mistimed or unplanned. The objectives of this study were to determine the prevalence of unintended pregnancy as well as to document the determinant factors among pregnant women attending antenatal clinics at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State, Nigeria. It was a descriptive, cross-sectional study of 215 women attending the antenatal clinic of UPTH from July to August 2022. Information on socio-demographic characteristics, reproductive history, desirability of the current pregnancy at the time of conception, knowledge and use of contraceptive methods were collected using a pretested questionnaire and analyzed using SPSS version 26.0. Chi-square test was used for test of associations with the level of significance set at P < 0.05. The prevalence rate of unintended pregnancy from the study was 16.28% (≈16%). The contraceptive awareness was very high (209, 97.21%), however, 101 (46.98%) participants had never used any form of contraceptives. Univariate analysis using Chi-square test showed a statistically significant association between age and unintended pregnancy (P = 0.042), level of education and unwanted pregnancy (P = 0.033) as well as parity and unintended pregnancy (P = 0.019). The prevalence of unintended pregnancy among women attending antenatal clinics was high, possibly due to low contraceptive usage. More efforts should be geared towards ensuring access to comprehensive contraceptive care and contraceptive methods, this will enhance uptake and reduce the rate of unintended pregnancy.

Velamentous Cord Insertion: Interest of Antenatal Diagnosis and Review of the Literature

Velamentous insertion of the umbilical cord corresponds to the insertion of the cord directly on amniotic membranes. It is a rare situation whose frequency varies from 0.5% to 1.69% of single pregnancies. It must be diagnosed during the morphological ultrasound of the 2nd trimester, actively looking for the association with a vasa previa, due to the risk of fetal haemorrhagic threat. We report an antenatal diagnosis of velamentous cord insertion and its management with literature review.

Association of Squatting Activities of Pregnant Women during the Antenatal Period and Labor Outcomes

Aim: To investigate impact of antenatal squatting activities on labour outcomes. Methods: All eligible primigravida women, with singleton cephalic fetuses, who presented to ward 18 of Colombo South Teaching Hospital, Sri Lanka, during the period 1st of February to 28th of May 2017 were invited into the study. Those who were already in active stage of labor (at least more than two moderate contractions per 10 minutes) on admission were excluded. Demographic data such as age, ethnicity, religion, educational level, occupation, latrine type in use, and booking Body mass index (BMI) were collected via an interviewer administered questionnaire. Data related to labor (modified Bishop score at onset of active labor, labor augmentation, pain relief, labor duration, mode of delivery, episiotomy or tears) and neonatal outcome (birth weight, APGAR score at 1, 5, 10 minutes) were collected from delivery notes. A pre tested interviewer administered questionnaire was used to obtain data regarding routine squatting activities during the previous 6 months. Pain visual analogue scale was used on day after delivery to assess the degree of labour pain. Duration of each squatting activity per day and number of days engaged with the activity per week;were used to calculate total squatting hours per week. In the absence of an accepted threshold for adequate squatting, we employed the sample mean as an operational data-driven threshold to define “more” against “less” squatting activities. Women who did not have squatting activities were considered as the controls. We used chi-square and Fisher’s exact tests to compare characteristics and outcomes between those engaging in more and less levels of squatting activity. We fitted a series of logistic regression models with each dichotomized outcome as the dependent variable, more/less squatting activity as the main independent variable of interest, and age, gestation period, BMI and patient’s occupation as covariates. The resulting adjusted odds ratios (AOR) and their 95% confidence intervals (CI) and statistical significance (p < 0.05) were used to draw conclusions of adjusted associations. Results: We recruited 430 women into this study. Overall, 68% of the women were of 20 - 30 years old, 47% had normal body mass index and 65% were housewives. The most frequent squatting activities were for urination/defecation and clothes washing (146 and 62 minutes/week, respectively). Mean total time was 246 minutes per week, of which more than 147 women (34%) achieved above this level of squatting activities. Those with more squatting activities had a greater modified Bishop Score ≥ 6/10 (92% vs 82%;p < 0.01);labor duration of <6 hours (82% vs 56%;p < 0.01), less likely for labour augmentation (39% vs 51%;p < 0.01) and pain relief (53% vs 65%;p = 0.013). Similar results were obtained after adjustments for maternal age, BMI, gestational age and occupation. However, there were no significant differences in the mode of delivery (normal vaginal vs instrumental vs caesarean), episiotomy rate, birth weight and neonatal Apgar scores. Conclusion: Squatting activities of more than 246 minutes per week may improve labor outcome. Women should be encouraged to increase squatting exercises or incorporate more habitual squatting activities antenatally.

Sonography of the small intestine

In the last two decades, there has been substantial development in the diagnostic possibilities for examining the small intestine. Compared with computerized tomography, magnetic resonance imaging, capsule endoscopy and double-balloon endoscopy, ultrasonography has the advantage of being cheap, portable, flexible and user-and patient-friendly, while at the same time providing the clinician with image data of high temporal and spatial resolution. The method has limitations with penetration in obesity and with intestinal air impairing image quality. The flexibility ultrasonography offers the examiner also implies that a systematic approach during scanning is needed. This paper reviews the basic scanning techniques and new modalities such as contrast-enhanced ultrasound, elastography, strain rate imaging, hydrosonography, allergosonography, endoscopic sonography and nutritional imaging, and the literature on disease-specific findings in the small intestine. Some of these methods have shown clinical benefit, while others are under research and development to establish their role in the diagnostic repertoire. However, along with improved overall image quality of new ultrasound scanners, these methodshave enabled more anatomical and physiological changes in the small intestine to be observed. Accordingly, ultrasound of the small intestine is an attractive clinical tool to study patients with a range of diseases.

Characterization of focal liver lesions with SonoVue~-enhanced sonography: International multicenter-study in comparison to CT and MRI

AIM： To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography （CT） and magnetic resonance imaging （MRI）. METHODS： One hundred and thirty four patients withone focal liver lesion detected in baseline ultrasound （US） were examined with conventional US, contrastenhanced US （n = 134）, contrast-enhanced CT （n = 115） and/or dynamic contrast-enhanced MRI （n = 70）. The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology （n = 32） was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions.RESULTS： In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization （malignant/benign） of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available （n = 30）, sensitivity was 95.5% （CEUS）, 72.2% （CT） and 81.8% （MRI）, and specificity was 75.0% （CEUS）, 37.5% （CT） and 42.9% （MRI）. The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia （FNH） and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%.CONCLUSION： SonoVue-enhanced sonography emerges as the most sensitive, ost specific and thus most accurate imaging modality for the characterization of focal liver lesions.

Predictors of antenatal health service utilization among left-behind wives of male outmigrants:Evidence from Patna District,India

Objective:To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care(ANC)services utilization.Methods:A cross-sectional survey was conducted in rural regions of the Patna district,India.The sample size(n=328)was estimated using Cochran’s formula.Five parameters of the social support system were identified(autonomy,spousal support,family support,social circle support,and government support).The score for each was calculated as a composite score using multiple variables;these served as independent variables.The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria.Results:The regression results showed that four out of five social parameters had a significant effect on ANC behavior.Spousal support was the strongest predictor(standardized regression coefficient β=0.57,OR 1.16,95%CI 1.08-1.79,P=0.007).Government support was found to be the second strongest predictor(β=0.40,OR 1.49,95%CI 1.04-2.14,P=0.027),followed by family support(β=0.31,OR 1.36,95%CI 1.23-2.57,P=0.034)and autonomy(β=0.11,OR 1.32,95%CI 1.11-2.26,P=0.030).The social circle support was found to be non-significant in predicting ANC behavior(P>0.05).Conclusions:The policymakers could focus on the identified predictors to strengthen and modify the existing policies for leftbehind wives of male outmigrants.The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net.One strategy we suggest is to launch an awareness campaign focusing on husbands(male outmigrants)and family members.

Investigation of the effects of perceived stress on antenatal care behaviors and the labor process during the COVID-19 pandemic

Objective:The aim of this study was to examine of the effects of perceived stress on antenatal care behaviors and the labor process during the COVID-19 pandemic.Methods:This study was conducted with a descriptive design.The data were collected using an“Introductory Information Form”and the“Antenatal Perceived Stress Inventory”.Descriptive statistics were analyzed using Kruskal-Wallis,Mann-Whitney U,and multinomial logistic regression tests.Results:The sample of the study included 487 women.The mean total Antenatal Perceived Stress Inventory score of the participants was found as 2.30±0.80.The mean medical and obstetric risks/fetal health,psychosocial changes during pregnancy,and prospect of childbirth subscale scores of the participants were determined to be 2.29±1.08,2.26±0.87,and 2.34±0.86,respectively.It was determined that as the antenatal perceived stress levels of the participants who frequently attended physical examinations increased,they became 1.535 times more likely to perceive the care they received to be adequate(Odds ratio(OR):1.535;1.045–2.254 Confidence interval(CI);P=0.029).It was found that as the antenatal perceived stress levels of the participants whose clinical tests were frequently analyzed increased,they were 1.518 times more likely to perceive the care they received to be adequate(OR:1.518;1.080–2.135 CI;P=0.016).Moreover,as the antenatal perceived stress levels of the participants who frequently underwent fetal health follow-ups increased,they were 1.573 more likely to perceive the care they received to be adequate(OR:1.573;1.042–2.375 CI;P=0.031).Conclusion:It was concluded that as the antenatal perceived stress levels of the women who frequently underwent physical examinations,clinical test analyses,and fetal health follow-ups increases,they were more likely to consider that they received adequate care.

Portable ultrasonography in mass casualty incidents:The CAVEAT examination

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,and critical care settings.The increasing availability of lightweight,robust,user-friendly,and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident(MCI).Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid,focused protocols using hand-carried emergency ultrasonography could be developed.Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings,we propose a protocol for sonographic evaluation of the chest,abdomen,vena cava,and extremities for acute triage.The protocol is two-tiered,based on the urgency and technical difficulty of the sonographic examination.In addition to utilization of well-established bedside abdominal and thoracic sonography applications,this protocol incorporates extremity assessment for long-bone fractures.Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.

Evaluation of Tubal Patency with Transvaginal Three-dimensional Hysterosalpingo-contrast Sonography

Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women underwent 3D-Hy Co Sy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test. Results Among the 306 oviducts examined by 3D-Hy Co Sy, 99(32.4%) were patent, 126(41.2%) partially obstructed, and 81(26.5%) completely obstructed. Diagnostic results with 3D-Hy Co Sy were not statistically different from those obtained in the 39 women(78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance(κ=0.747, P=0.000). The 3D-Hy Co Sy procedure had a sensitivity of 84.8%(28/33), a specificity of 96.2%(25/26), and positive and negative predictive values of 93.3%(28/30) and 86.2%(25/29) respectively. Conclusion Transvaginal 3D-Hy Co Sy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.

Prospective study of differential diagnosis of hepatic tumors by pattern-based classification of contrast-enhanced sonography

AIM: To prospectively evaluate the usefulness of a pattern-based classification of contrast-enhanced sonographic findings for differential diagnosis of hepatic tumors. METHODS: We evaluated the enhancement pattern of the contrast-enhanced sonography images in 586 patients with 586 hepatic lesions, consisting of 383 hepatocellular carcinomas, 89 metastases, and 114 hemangiomas. After injecting a galactose-palmitic acid contrast agent, lesions were scanned by contrast- enhanced harmonic gray-scale sonography in three phases: arterial, portal, and late. The enhancement patterns of the initial 303 lesions were classified retrospectively, and multiple logistic regression analysis was used to identify enhancement patterns that allowed differentiation between hepatic tumors. We then used the pattern-based classification of enhancement we had retrospectively devised to prospectively diagnose 283 liver tumors. RESULTS: Seven enhancement patterns were found to be significant predictors of different hepatic tumors. The presence of homogeneous or heterogeneous enhancement both in the arterial and portal phase was the typical enhancement pattern for hepatocellular carcinoma, while the presence of peritumoral vessels in the arterial phase and ring enhancement or a perfusion defect in the portal phase was the typical enhancement pattern for metastases, and the presence of peripheral nodular enhancement both in the arterial and portal phase was the typical enhancement pattern forhemangioma. The sensitivity, specificity, and accuracy of prospective diagnosis based on the combinations of enhancement patterns, respectively, were 93.2%, 96.2%, and 94.0% for hepatocellular carcinoma, 87.9%, 99.6%, and 98.2% for metastasis, and 95.6%, 94.1%, and 94.3% for hemangioma. CONCLUSION: The pattern-based classification of the contrast-enhanced sonographic findings is useful for differentiating among hepatic tumors.

Hemodynamic and morphologic changes of peripheral hepatic vasculature in cirrhotic liver disease: A preliminary study using contrast-enhanced coded phase inversion harmonic ultrasonography

AIM: To provide the useful information for the diagnosis of liver cirrhosis by observing the morphology of peripheral hepatic vessels and the hemodynamics of microbubble arrival time in these vessels.METHODS: Twenty-one subjects including 5 normal volunteers and 16 patients (liver cirrhosis, n=10;chronic hepatitis, n=6) were studied by contrast-enhanced coded phase inversion harmonic sonography (GE LOGIQ9 series) using a 6-8 MHz convex-arrayed wide-band transducer. The images of peripheral hepatic artery,portal and hepatic vein were observed in real-time for about 2 min after intravenous injection of Levovist. The time when microbubbles appeared in the peripheral vessels (microbubble arrival time) was also recorded. The morphologic changes of peripheral hepatic vasculature were classified as marked, slight, and no changes based on the regularity in caliber, course, ramification, and the delineation of vessels compared to normal subjects.RESULTS: The microbubble arrival time at peripheral artery, portal, and hepatic vein was shorter in cirrhotic patients than in chronic hepatitis patients and normal subjects. The marked, slight and no morphologic changes of peripheral hepatic vasculature found in 5 (5/6,83.3%), 1 (1/6, 16.7% ), and 0 (0/6, 0%) liver cirrhosis patients, respectively, and in 1 (1/10, 10%), 6 (6/10,60%), and 3 (3/10, 30%) chronic hepatitis patients,respectively. There was a significant difference between the two groups (P＜0.001).CONCLUSION: Evaluation of the hemodynamics and morphology of peripheral hepatic vasculature by contrast-enhanced coded pulse inversion harmonic sonography can provide useful information for the diagnosis of liver cirrhosis.

Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome

Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Greyscale sonography and sonoelastography(SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area(CSA). Several authors have assessed additional parameters. "Delta CSA" is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The "CSA ratio" is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.

Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

AIM:To evaluate the usefulness of real-time virtual sonography(RVS)in biliary and pancreatic diseases.METHODS:This study included 15 patients with biliary and pancreatic diseases.RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography(CT)image,using pre-scanned CT volume data.The ultrasound used was EUB-8500with a convex probe EUP-C514.The RVS images were evaluated based on 3 levels,namely,excellent,good and poor,by the displacement in position.RESULTS:By combining the objectivity of CT with free scanning using RVS,it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures.The resulting evaluation levels of the RVS images were12 excellent(pancreatic cancer,bile duct cancer,cholecystolithiasis and cholangiocellular carcinoma)and 3 good(pancreatic cancer and gallbladder cancer).Compared with conventional B-mode ultrasonography and CT,RVS images achieved a rate of 80%superior visualization and 20%better visualization.CONCLUSION:RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.

A Correlation Study of the Effectiveness of Renal Scintigraphy and Sonography in the Detection and Evaluation of Renal Disorders

Purpose: To evaluate the amalgamation of scintigraphy and sonography techniques in prognosticating renal disease. Methods: All the patients were subjected to renal scintigraphy while 68 patients underwent renal ultrasonography. Ninety-six patients’ imaging data was statistically analyzed including 43 females and 53 males. Renal U/S reported anatomical renal anomaly in 94.1% of patients versus 85.4% detected by scintigraphy. There were 41 patients out of 68 diagnosed with hydronephrosis and 21 of them were suffering from mild hydronephrosis as suggested by U/S imaging. The data were statistically analyzed using SPSS 21 software. Results: Renal scintigraphy of 41 hydronephrotic patients validated that 19 patients had non-obstructive bilateral pelvic dilation while the remaining 22 with mild to severe obstruction. Ultrasonography diagnosed 4 patients with renal obstruction. Conversely, renal scintigraphy validated 2 of them with renal obstruction based on renal function. Conclusions: Renal scintigraphy is not significant in diagnosing kidney disease;rather this is a vibrant imaging tool providing supplementary data based on renal function. An effectively targeted intervention regime can be achieved by correlating renal scintigraphy and renal ultrasonography results to minimize renal disease incidence.

1.5 Harmonic Imaging Sonography with microbubble contrast agent improves characterization of hepatocellular carcinoma

AIM： TO investigate the usefulness of 1.5 Harmonic Imaging Sonography with the use of the contrast agent Levovist for the diagnosis of hepatocellular carcinoma （HCC） and for the evaluation of therapeutic response. METHODS： Phantom experiments were performed to compare the contrast effects of 2^rd harmonic imaging and 1.5 Harmonic Imaging Sonography. 1.5 Harmonic Imaging Sonography was employed to examine 36 patients with HCC （42 nodules） before and after the treatment and to compare against the findings obtained using other diagnostic imaging modaUties. RESULTS： In 1.5 Harmonic Imaging Sonography, the tumor vessels of HCCs were clearly identified during the early phase, and late-phase images clearly demonstrated the differences in contrast enhancement between the tumor and surrounding hepatic parenchyma. Blood flow within the tumor was detected in 36 nodules （85.7%） during the early phase and in all 42 nodules （100%） during the late phase using 1.5 Harmonic Imaging Sonography, in 38 nodules （90.5%） using contrast-enhanced CT, in 34 nodules （81.0%） using digital subtraction angiography （DSA）, and in 42 nodules （100%） using US CO2angiography. Following transcatheter arterial embolization, 1.5 Harmonic Imaging Sonography detected blood flow and contrast enhancement within the tumors that were judged to contain viable tissue in 20 of 42 nodules （47.6%）. However, 6 of these 20 cases were not judged in contrastenhanced CT. 1.5 Harmonic Imaging Sonography was compared with the US CO2 angiography findings as the gold standard, and the sensitivity and specificity of these images for discerning viable and nonviable HCC after transcatheter arterial embolization were 100% and 100%,respectively. CONCLUSION： 1.5 Harmonic Imaging Sonography permits the vascular structures of HCCs to be identified and blood flow within the tumor to be clearly demonstrated. Furthermore, 1.5 Harmonic Imaging Sonography is potentially useful for evaluating the therapeutic effects of transcatheter arterial embolization on HCC. 2005 The WJG Press and Elsevier Inc. All rights reserved

Postnatal management of antenatally detected hydronephrosis

With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.

Barriers and Enablers That Influence Utilization of Ultrasound Screening Services among Antenatal Women in Kajiado and Kisii Counties Kenya

Background: The World Health Organization recommends to have all pregnant women to undergo an obstetric ultrasound scan before 24 weeks gestation. However, this has been a challenge as a result of limited access to appropriate Point of Care Ultrasound Screening (POCUS) services in lower levels of developing countries’ Health Systems, cost of care, skills gap among care providers and unclear regulatory policy frameworks. Obstetric Ultrasound scan helps to confirm viability of a pregnancy, gestational age, multiple pregnancies and it also helps rule out fetal abnormalities early enough. Methods: One year after intervention, a cross-sectional study was carried in the two pilot counties of Kisii (rural) and Kajiado (peri-urban). This followed after selected midwives in the two counties were trained on basic obstetric ultrasound screening for ANC women. A total of 366 women who were either in their last phases of pregnancy or had delivered within three months before the survey were interviewed. Cumulatively, the 36 midwives had screened 1,250 mothers out of whom 18 high risk pregnancies were identified. Open Data Kit (ODK) was used to collect quantitative data and analysed using STATA version 15. Descriptive statistics were used to summarize the data test associations between variables. Bivariate and logistic regression was used to identify predictive variables, and ORs with 95% confidence intervals used to measure the strength of the associations. Findings: Slightly more than a third (36%) of the women had recently delivered. In total, Kisii (rural county) had a representation of 59% of the respondents. Half of the respondents were aged between 25 - 34 years, 55% of the women interviewed were housewives while 48% had secondary level of education. Only 21% of the women had undergone routine ultrasound screening before 24 weeks of gestation with the average distance travelled by majority (45%) of the respondents to access the POCUS service being 3 - 5 km. The need to confirm a pregnancy’s gestation was the major (68.1%) motivator for seeking the service in the two pilot counties. Employment status, household income, education level, pregnancy gestation and distance to the facility had a statistical significance (P < 0.05) with ultrasound utilization. Highest education level, pregnancy gestation and distance to the nearest ultrasound screening facility were found to significantly predict the likelihood of utilizing the ultrasound services (P < 0.05). The initial training and continuous hands-on coaching of midwives by TOTs contributed a lot to acquisition of the desired basic obstetric ultrasound screening skills. Conclusion: Women in developing countries are eager to access obstetric ultrasound screening services but for limited opportunities and sustainable implementation frameworks on Point of Care Ultrasound Screening (POCUS) services. Training and continuous coaching of frontline health professionals are critical in deployment of POCUS but there is limited access to standardised training content.

Evaluation of Early Stage Cleft Lip and Palate Using 3D-Ultral Sonography Screening

Congenital cleft lip palate occurs heterogeneously worldwide. Out of the one-hundred and thirty million newborns worldwide, 3.6 million identified with a disability, 7.6 million (approximately 5.8%) being born with a congenital anomaly. Additionally, 7.5% of them are registered with having cleft lip palate. In Mongolia, the statistics from the Mongolia Health Department reported that in 2012 cleft lip palate occurred among 1 out of 1072 individuals in Mongolia [1]. Over the years, there have been many measures taken to ameliorate these issues around the world. Recently, the sophisticated three-dimensional ultra-sonography equipment is evaluable in pediatric science. Thanks to this equipment, we are able to detect the orofacial defects and diagnose infants properly in advance. The purpose of this study is to evaluate the lip and palate of a fetus by using three-dimensional ultra-sonography in the second and third trimester of gestational period. Our research aims to detect fetus defects in the early stage of birth and diagnose it in advance [9]. Due to the lack of research on the above-mentioned issues in Mongolia, we decided to conduct this research by using three-dimensional ultra-sonography to detect and diagnose congenital cleft lip palate. By doing this research, we will be able to better assist those suffering from congenital malformation in Mongolia.

Sonography Cervical Assessment in Multiple Pregnancy in Correlation with Gestational Age

Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnancy (twin, triplet, quadruplet) delivered between 2002-2003, in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. A total of 68 multiple pregnancies underwent routine ultrasound for fetal assessment between 16 - 32 weeks when the cervix was observed. The sonographic measurements included cervix > 2.5 cm and <2.5 cm. The time of ultrasound was divided in five groups by gestational age from 18 - 20 weeks, 21 - 24 weeks, 25 - 26 weeks, 29 - 32 weeks and >32 weeks. The gestational age at delivery was our outcome parameter. The data was analyzed statistically using Fisher’s exact test and P-value below 0.05 was considered significant. Results: Endovaginal ultrasongoraphic cervical measurement in multiple pregnancies predicted increased preterm delivery risk regardless of maternal age, previous history of preterm deliveries or presence of vaginal infection. It was found that spontaneous preterm labor < 32 weeks is a relatively rate outcome with cervix > 25 mm;this majority reached > 32 weeks while the patient who had cervix < 25 mm, 1 in 25 of the women who underwent a cervical ultrasound assessment will have preterm labor. The finding in ultrasound justifies the results of higher aggressive management inpatient with cervix Conclusion: Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions.

Comparison of detection results of hypoxic-ischemic encephalopathy at different degrees in infant patients between brain electrical activity mapping, transcranial Doppler sonography and computer tomography examinations

BACKGROUND： It has been proved that brain electrical activity mapping （BEAM） and transcranial Doppler （TCD） detection can reflect the function of brain cell and its diseased degree of infant patients with moderate to severe hypoxic-ischemic encephalopathy （HIE）. OBJECTIVE： To observe the abnormal results of HIE at different degrees detected with BEAM and TCD in infant patients, and compare the detection results at the same time point between BEAM, TCD and computer tomography （CT） examinations. DESIGN ： Contrast observation SETTING： Departments of Neuro-electrophysiology and Pediatrics, Second Affiliated Hospital of Qiqihar Medical College. PARTICIPANTS： Totally 416 infant patients with HIE who received treatment in the Department of Newborn Infants, Second Affiliated Hospital of Qiqihar Medical College during January 2001 and December 2005. The infant patients, 278 male and 138 female, were at embryonic 37 to 42 weeks and weighing 2.0 to 4.1 kg, and they were diagnosed with CT and met the diagnostic criteria of HIE of newborn infants compiled by Department of Neonatology, Pediatric Academy, Chinese Medical Association. According to diagnostic criteria, 130 patients were mild abnormal, 196 moderate abnormal and 90 severe abnormal. The relatives of all the infant patients were informed of the experiment. METHOOS： BEAM and TCD examinations were performed in the involved 416 infant patients with HIE at different degrees with DYD2000 16-channel BEAM instrument and EME-2000 ultrasonograph before preliminary diagnosis treatment （within 1 month after birth） and 1,3,6,12 and 24 months after birth, and detected results were compared between BEAM, TCD and CT examinations. MAIN OUTCOME MEASURES： Comparison of detection results of HIE at different time points in infant patients between BEAM. TCD and CT examinations. RESULTS： All the 416 infant patients with HIE participated in the result analysis. （1） Comparison of the detected results in infant patients with mild HIE at different time points after birth between BEAM, TCD and CT examinations： BEAM examination showed that the recovery was delayed, and the abnormal rate of BEAM examination was significantly higher than that of CT examination 1 and 3 months after birth [55.4%（72/130）vs. 17.0% （22/130 ）,x^2=41.66 ;29.2% （ 38/130 ） vs. 6.2% （ 8/130 ）, x^2=23.77, P 〈 0.01 ], exceptional patients had mild abnormality and reached the normal level in about 6 months. TCD examination showed that the disease condition significantly improved and infant patients with HIE basically recovered 1 or 2 months after birth, while CT examination showed that infant patients recovered 3 or 4 months after birth. （2） Comparison of detection results of infant patients with moderate HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination 1,3,6 and 12 months after birth [90.8% （178/196）,78.6% （154/196）,x^2=4.32,P 〈 0.05;64.3% （126/196）,43.9% （86/196） ,x^2=16.44 ;44.9% （88/196） ,22.4% （44/196）,x^2=22.11 ;21.4% （42/196）, 10.2% （20/196）,x^2=9.27, P 〈 0.01]. BEAM examination showed that there was still one patient who did not completely recovered in the 24^th month due to the relatives of infant patients did not combine the treatment,. TCD examination showed that the abnormal rate was 23.1%（30/196）in the 1^st month after birth, and all the patients recovered to the normal in the 3^rd month after birth, while CT examination showed that mild abnormality still existed in the 24^th month after birth （1.0% ,2/196）. （3） Comparison of detection results of infant patients with severe HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination in the 1^st, 3^rd, 6^th and 12^th months after birth[86.7% （78/90）,44.4% （40/90）,x^2=35.53;62.2% （56/90）,31.1% （28/90）,x^2=17.51 ;37.8% （34/90）,6.7% （6/90）, x^2=27.14, P 〈 0.01]. BEAM examination showed that mild abnormality still existed in 4 infant patients in the 24^th month after birth. TCD examination showed that the abnormal rate was 11.1% （10/90） in the 3^rd month after birth, and all the infant patients recovered in the 6^th month after birth. CT examination showed that the abnormal rate was 6.7%（6/90） in the 12^th month after birth, and all of infant patients recovered to the normal in the 24^th month after birth.CONCLUSION ： BEAM is the direct index to detect brain function of infant patients with HIE, and positive reaction is still very sensitive in the tracking detection of convalescent period. The positive rate of morphological reaction in CT examination is superior to that in TCD examination, and the positive rate is very high in the acute period of HIE in examination.