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BACKGROUND: Pregnant women, particularly in developing countries are facing a huge burden of preeclampsia (PE) leading to high morbidity and mortality rates. This is due to delayed diagnosis and unrecognised early targeted preventive measures. Adapting innovative solutions via shifting from delayed to early diagnosis of PE in the context of predictive diagnosis, targeted prevention and personalisation of medical care (PPPM/3 PM) is essential. The subjective assessment of suboptimal health status (SHS) and objective biomarkers of oxidative stress (OS) and angiogenic growth mediators (AGMs) could be used as new PPPM approach for PE; however, these factors have only been studied in isolation with no data on their combine assessment. This study profiled early gestational biomarkers of OS and AGMs as 3 PM approach to identify SHS pregnant mothers likely to develop PE specifically, early-onset PE (EO-PE) and late-onset PE (LO-PE). METHODS: A prospective cohort of 593 singleton normotensive pregnant (NTN-P) women were recruited at 10–20th (visit 1) and followed from 21 weeks gestation until the time of PE diagnosis and delivery. At visit 1, SHS was assessed using SHS questionnaire-25 (SHSQ-25) and women were classified as SHS and optimal health status (OHS). Biomarkers of OS (8-hydroxy-2-deoxyguanosine [8-OHdG], 8-epi-prostaglansinF2alpha [8-epi-PGF2α] and total antioxidant capacity [TAC]) and AGMs (vascular endothelial growth factor [VEGF-A], soluble Fms-like tyrosine kinase-1 [sFlt-1], placental growth factor [PlGF] and soluble endoglin [sEng]) were measured at visit 1 and time of PE diagnosis. RESULTS: Of the 593 mothers, 498 (248 SHS and 250 OHS) returned for delivery and were included in the final analysis. Fifty-six, 97 and 95 of the 248 SHS mothers developed EO-PE, LO-PE and NTN-P respectively, versus 14 EO-PE, 30 LO-PE and 206 NTN-P among the 250 OHS mothers. At the 10–20th week gestation, unbalanced levels of OS and AGMs were observed among SHS women who developed EO-PE than LO-PE compared to NTN-P women (p

In this review, we investigated the diagnostic value of the sonographic "whirlpool sign" in identifying ovarian torsion. This was done by performing a search in PubMed, Scopus, Embase, Web of Science, CINAHL, and Google scholar. Additional search for the grey literature was made in EThOS.bl.uk, explore.bl.uk, opengrey.eu, greylit.org, and clinicaltrials.org. A total of eight studies were included in this meta-analysis. Sensitivity and specificity of whirlpool sign were extracted from the studies and computed into the Metadisc statistical software for pooled analysis. The whirlpool sign showed a high sensitivity and specificity for the diagnosis of ovarian torsion.

The diagnosis of diabetic kidney disease can be delayed by limitations of primary biomarkers, which are microalbuminuria and estimated glomerular filtration rate. A number of Doppler ultrasound studies have associated an increase in intrarenal vascular resistance with the disease, which makes ultrasound a potential adjunct tool for early diagnosis. However, there is inadequate evidence to establish the effectiveness of including Doppler ultrasound in the diagnostic process. This systematic review was therefore conducted to determine the value of using Doppler ultrasound in early detection of diabetic kidney disease. Electronic literature searches were carried out in PubMed, CINAHL, Web of Science and EMBASE. All published prospective studies with records of intrarenal Doppler ultrasound, microalbuminuria and estimated glomerular filtration rate were obtained, and their relationship as parameters for diabetic kidney disease assessed. The meta-analysis of Doppler ultrasound versus albuminuria shows insignificant statistical difference between high resistive index of ≥ 0.7 and albuminuria, with the resistive index being the favoured parameter on the forest plot, making Doppler ultrasound highly comparable with albuminuria for the detection of diabetic kidney disease. Again, there was a significant statistical difference between high intrarenal resistive index of ≥ 0.7 and low estimated glomerular filtration rate of 2, with the resistive index being the favoured parameter on the forest plot, making Doppler ultrasound a superior parameter compared with estimated glomerular filtration rate for early detection of diabetic kidney disease.

Introduction: Ghana is one of the fastest growing economies in sub-Saharan Africa which is expected to undergo a significant epidemiologic transition because of industrialisation and economic development. Having transitioned from low to middle income status recently, this study investigated the epidemiology of left ventricular dysfunction (LVD) in patients who were referred for echocardiography. Material and Methods: We conducted a retrospective cross-sectional study on an out-patient population who were referred to the Precise Specialist Clinic in Kumasi, Ghana for echocardiography, from January 2016 to December 2018. Descriptive statistical analyses were performed and the results summarised in the proportions, tables and pie charts. Categorical variables and proportions were compared using Fisher’s exact test and test of proportions respectively. P-value Results: The results show that 61% of the out-patient population referred for echocardiography between 2016 and 2018 had LVD at a mean age of 59 years. In this LVD population, Heart Failure with preserved ejection fraction (HFpEF) and Heart Failure with reduced ejection fraction (HFrEF) accounted for 73% and 27% respectively. The majority of patients with HFrEF also had left ventricular diastolic dysfunction, mitral regurgitation and tricuspid regurgitation.Conclusion: This study shows that, HFpEF was seen in over 70% of patients with LVD, and it occurred at a relatively younger age. Efforts should be made for prevention, early detection and control of conditions such as hypertension, diabetes and obesity which have been shown to be associated with HFpEF.

Low-resource settings have the highest incidence of maternal and perinatal mortality (99%), with nearly half of them resulting from intrapartum complications. Due to inadequate access to ultrasound in antenatal care, high-risk conditions that are amenable to early sonographic detection may only be detected for the first time in labor, such as placenta previa, malpresentation, multiple gestation, and other conditions that predispose to intrapartum hemorrhage or obstructed labor. Intrapartum ultrasound triage prior to labor ward admission could play a critical role in assessing women in labor who have been referred from their primary health facilities to deliver in referral centers. It could also be useful in triaging the significant number of women who bypass their primary facilities for childbirth in hospitals with no adequate antenatal record to show. In addition, existing studies show high acceptance of intrapartum ultrasound by women in low-resource settings, with the potential of promoting a positive childbirth experience.

Background. Iodine deficiency is a public health problem. The universal salt iodization (USI) program is the main, simple, and cost-effective intervention strategy to control iodine deficiency. The study examined the iodine status in school-aged children in Ashanti region, Ghana, using thyroid volumes along with urinary iodine concentrations, the methods recommended by the WHO/ICCIDD for monitoring the sustained impact of USI programs. Methods. This cross-sectional study was conducted among school-aged children (6–12 years) from randomly selected schools in the central and northern part of the Ashanti region, Kumasi Metropolis, and Ejura-Sekyedumase Municipality, respectively. A total of 852 children were enrolled in the study. Thyroid volume and urinary iodine concentrations of the children were determined using the standardized methods recommended by WHO/ICCIDD. Anthropometric measurements were also evaluated. Results. The mean values of thyroid volume in female and male school-aged children were 3.53 ± 0.09 and 3.32 ± 0.07, respectively. The thyroid size was significantly associated with age (P<0.0001), weight (P<0.0001), height (P<0.0001), BMI (P<0.05), and BSA (P<0.0001) by Pearson’s correlation in both males and females. The P50 (median) thyroid volumes of school children investigated in this study were generally larger compared to the WHO/ICCIDD reference data by age and body surface area. The median value of urinary iodine concentration was 201.85 μg/L, which showed significant sex difference (P value μg/L) was observed among 34.4% of male children and 27.6% of female children. Also, 12.8% of the male and 19.5% of the female children had UIC below requirement (μg/L). The criteria of thyroid volume per age yielded a goitre prevalence of 2.2%. In contrast, the criteria of thyroid volume by body surface area yielded a goitre prevalence of 0.9%. Conclusion. The study clearly indicated that adequate iodine nutrition exists generally among the school children. However, insufficient and excessive iodine intakes still persist among some of the children. The establishment of local reference values for thyroid volume that might be applicable to precisely define goitre prevalence in the Ghanaian context is highly recommended.

Introduction We aimed to examine the agreement between ultrasound and digital vaginal examination in assessing cervical dilatation in an African population and to assess the value of ultrasound in detecting active labor. Method A cross-sectional study was conducted in a teaching hospital in Ghana between April and September of 2016. Anterior–posterior and transverse diameters of cervical dilatation were measured with ultrasound and the mean value was compared with digital vaginal examination in 195 women in labor. Agreement between methods was examined with correlation coefficients and with Bland–Altman plots. Active labor was defined when cervix was dilated ≥ 4 cm with vaginal examinations. ROC curve analysis was conducted on the diagnostic performance of ultrasound in detecting active labor. Results Data were analyzed in 175 out of 195 (90%) cases where ultrasound could clearly visualize the cervix. The remaining 20 cases were all determined by digital vaginal examination as advanced cervical dilatation (≥ 8 cm), advanced head station (≥ + 2), and with ruptured membranes. The Pearson correlation coefficient (r) was 0.78 (95% CI 0.72–0.83) and the intra-class correlation coefficient was 0.76 (95% CI 0.69–0.81). Bland–Altman analysis obtained a mean difference of − 0.03 cm (95% CI − 0.18 to 0.12) with zero included in the CI intervals, indicating no significant difference between methods. Limits of agreement were from − 2.01 to 1.95 cm. Ultrasound predicted active labor with 0.87 (95% CI 0.75–0.99) as the area under the ROC curve. Conclusion Ultrasound measurements showed good agreement with digital vaginal examinations in assessing cervical dilatation during labor and ultrasound may be used to detect active labor. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Uterine perforation is a rare major complication of surgical abortion which can be detected by ultrasound. In the last four decades, over 70% of case reports on uterine perforation in surgical abortions were from developing countries. Yet ultrasound was rarely used in detecting uterine perforation. This case report presents two cases of uterine perforation in surgical abortions which were detected by ultrasound prior to laparotomy. In the first case, a 34-year old woman was referred to our facility as a case of hypovolaemic shock following termination of pregnancy. An ultrasound examination performed to exclude an intra-abdominal abscess collection revealed a 1.2cm defect in the fundal region of the uterus with extrusion of abdominal contents into the endometrial cavity through the defect. In the second case, a 31-year old woman presented with a history of vomiting, abdominal pain, abdominal distension and absolute constipation after undergoing an evacuation of the uterus for a spontaneous abortion at 7 weeks’ gestation. Transabdominal ultrasound showed a defect of 1.4cm wide at the fundus of the uterus, with a structure extending from the abdominal cavity through the defect and into the endometrial cavity. It also showed distension of multiple bowel loops within the abdominal cavity. Sonographic detection of uterine perforation led to appropriate management in both cases. In developing countries, where the incidence of major complications of abortion is still very high, utilizing ultrasound can be helpful in detecting complications such as uterine perforation.

Background Iodine deficiency is a major public health problem affecting people worldwide, particularly pregnant women. Iodine requirements increase substantially during pregnancy making pregnant women vulnerable to iodine deficiency and its disorders such as abortions, stillbirths and pregnancy goitre as well as congenital abnormalities, cretinism and mental retardation in their children. The primary aim of this study was to evaluate the prevalence of iodine deficiency and goitre among pregnant women attending antenatal sessions at two selected hospitals in Ashanti region, Ghana. Methods A cross-sectional study was carried out in 239 pregnant women who attended the antenatal clinic at Kwame Nkrumah University of Science and Technology (KNUST) Hospital or Ejura District Hospital, both in Ashanti Region, Ghana. Socio-demographic data and information related to iodine were captured using a questionnaire. Urinary iodine concentration (UIC) was determined on spot urine samples using the Sandell-Kolthoff reaction with ammonium persulfate as digesting agent. Each woman’s thyroid volume was also measured by ultrasonography. Results The overall median UIC was 155.9 μg/L, indicating adequate iodine intake in the study population. However, goitre prevalence in the pregnant women was 11.3%, denoting mild iodine deficiency. The median UIC for pregnant women who attended KNUST Hospital was higher (163.8 μg/L) than that of Ejura District Hospital (149.0 μg/L). The proportion of women who did not consume iodised salt was significantly higher (p

The joy that every expectant couple, family, or community has when a woman gets pregnant is suddenly turned into sorrow and mourning when the woman dies during pregnancy or child birth, or when the baby dies. According to the World Health Organization (WHO), the five major causes of maternal mortality are hemorrhage, sepsis, complications of abortion, eclampsia, and obstructed labour (Bale et al, 2003). The WHO similarly lists the most common causes of neonatal mortality as infections, birth asphyxia, birth injuries, preterm births, and birth defects (Bale et al., 2003). It is worth noting that these mortality causes are conditions for which timely ultrasound imaging could be of immense help in early diagnosis and hence intervention, leading to the reduction of mortality rates among mothers and their babies. It is also notable that most of these avoidable deaths (99%) occur in developing countries, where ultrasound imaging is currently underutilized, and financial constraints have been cited as the main reason. However, the usefulness of ultrasound imaging in preventing these needless deaths has not been fully exploited. It is anticipated that low resource settings could benefit by prudent application of this modern technology which is a relatively affordable and safe imaging modality. In recent times technology has made this modality so affordable and widely available, that it is unacceptable to watch such needless deaths occur when ultrasound application could help improve survival rates. This chapter discusses the usefulness of ultrasound imaging at various stages of pregnancy, whether in apparently normal or high risk situations. Current advances in obstetric ultrasound application and imaging techniques that are helpful for improving pregnancy outcome are discussed. The chapter also addresses the availability of more affordable but high quality ultrasound equipment that can improve obstetric healthcare, accentuating the need to implement sustainable ultrasound practice standards in developing countries where the current rate of maternal and perinatal mortalities is unacceptably high. It must be emphasised that the objective and focus of this chapter is the role ultrasound plays in the diagnosis and in some cases follow-up or interventionary guidance, not the management of the various conditions. Readers may consult other literature for the specific management of these conditions.