Â By Sola Ogundipe
THE range of choices available to Nigerian couples in the care and management of their unborn babies has become wider in recent times, thanks to better access to ultrasound facilities.
This development was made apparent during a recentÂ workshop for obstetricians and gynecologists organised by Nordica Fertility Centre, Lagos and Asaba.
While the importance of ultrasound scan in healthcare delivery particularly pregnancy management is undeniable,Â more caregivers are canvassing the need for emphasis on ultrasound scan in maternal healthcare.
However, with the proliferation of ultrasound centres all over the country, there may be need for caution.Â
In the view ofÂ Medical DirectorÂ Nordica Fertility Centre, Lagos and Asaba, Dr. Abayomi Ajayi, there is a real need for gynaecologists to acquire skills in the use of scans. Calling for continuous medical education in the country.
Also, consultant obstetrician and gynaecologist at the University of Leicester, United Kingdom, Dr. Adebimbe Matiluko, argued thatÂ ultrasound care should be an integral part of health care, particularly for reducing maternal and infant deaths in the country.
Matiluko said trans-vaginal scan as pivotal in the management of patients.
According to her, it can be used in diagnosing ectopic pregnancies (pregnancies in wrong places), which are responsible for the death of many women. â€Its application is mainly in early pregnancy: to know whether the pregnancy is alive or not.
â€Through trans-vaginal scans,Â abnormalities in babies can be detected right from early pregnancy. If the woman is not going to terminate the pregnancy, she can be prepared so that she will not be surprised during delivery.â€
And as we apply this technology more freely and more comprehensively in our management in Nigeria, then we can also offer improved skills in detecting some congenital abnormalities in pregnancyâ€.
Matiluko whose series of lectures have been directed mostly at assisting practitioners give optimal care to expectant mothers in order to achieve the goal of drastically reducing the countryâ€™s maternal mortality told Parenting, â€œgone are the days when it was absolutely impossible to know the kind of foetus a woman is carrying, ultrasound can help detect up to 90 percent of cases of abnormalities and prepare a woman and the family for what to expect; in fact families now have choices to make in the care and management of their unborn childâ€, she emphasized.
According to her, â€œthe offer of screening opens up an array of issues in terms of the viability of the pregnancy, prognosis of the abnormalities identified and the management that can be offeredâ€.
She stated that even as there are limitations in the management of an aspect of pregnancies doe not t prevent screening whatsoever, â€œat least it offers opportunity to identify the problems presented and some form of advise can equally be offered on what sort of management is required and where to go and get the management if it is unavailable in the countryâ€.
Titled: â€œUtilizing ultrasound screening for congenital abnormalitiesâ€ Matiluko said the course offers specialist opportunities to know more about various new ways in the use of ultrasond screening in pregnancy management.
Although she explained that it is not rare to find congenital abnormalities all over the world, because all pregnant women have about two to three chances of having one abnormality or the other-â€œsome we have reasons for or have ways of reducing likelihood of them not happening, like spina bifida in which if a woman takes folic acid for about 12 weeks before pregnancy and for twelve of pregnancy, it can be reducedâ€.
Although in making choices after screening a pregnancy, there could be ethical dilemma such as if the fetus is discovered with abnormalities and there is need to terminate.
Matiluko observed, â€œin such situations like mental disabilities, limb deformities and medical congenital or chromosome abnormality that could affect cognitive motor, a lot of people would struggle to have terminations depending on the environment.
â€œIn various countries, the women choices are dependent on the laws of the land, some would agree the woman terminate such pregnancy if she feels significantly affected by the prognosis and the abnormalities are lethal; but where the abnormalities are not lethal, there would be no ground for termination of pregnanciesâ€.
One great advantage of ultrasound screening for pregnancy says Matiluko is that it allows every woman and her care giver to determine the outcome of every pregnancy.
â€œFor instance, if a woman has had a child with congenital heart defect, a future screening for other pregnancies would always be recommended and offered because we know that such a woman has about one percent chance of having another child with such defect in another pregnancy so she would automatically be screened within the limitations of ultrasound scanâ€.
However, not all abnormalities can be prevented, but could be well managed if detected early using the ultrasound scan, said Matiluko.
She encouraged every pregnant woman to ask her doctor or sonographer questions about her pregnancy and the series of examinations carried out on her; â€œit is the right of every pregnant woman to know the sort of examination she is required to take and the outcome for her to assist in her careâ€, the UK practitioner stated.
Speaking on why use of ultrasound training is essential for practitioners, Medical Director, Nordica Centre, Dr. Abayomi Ajayi, said, â€œit has become imperative for practitioners to insist patients do screening for congenital abnormalities because we have missed a lot of congenital abnormalities and it is because the structure is not just there to train practitioners to do this routinelyâ€.
He explained that patients face a lot of heartaches when they suddenly come to reality that they have babies with congenital abnormalities; â€œit is therefore thought we should offer practitioners in-training to help pregnant women know forehand what exactly is going on within her bodyâ€.
He said as part of the training, practitioners are taken through the psychology of understanding how the patients would feel when it is discovered there is an abnormal fetus, â€œthere is a process of breaking bad news and that is why experts are coming from other land to share there experiences with usâ€.