DE A R U 1 NWOBI, CHIGOZIE IVO PG/M.Sc/03/37246 SONOGRAPHIC ASSESSMENT OF FOETAL CIRCUMFERENCE AS A PREDICTOR OF G AGE IN MAIDUGURI, NORTH EAST N EPARTMENT OF MEDICAL RADIOGRAPHY AND SCIENCES, UNIVERSITY OF NIGERIA, N A THESIS SUBMITTED TO THE DEPARTMENT OF MEDICA RADIOLOGICAL SCIENCES, FACULTY OF HEALTH SCIENC UNIVERSITY OF NIGERIA ENUGU CAMPUS Webmaster Digitally Signed by Webmaster’s Nam DN : CN = Webmaster’s name O= U OU = Innovation Centre FEBRUARY 2012 OR L THORACIC GESTATIONAL NIGERIA D RADIOLOGICAL NSUKKA AL RADIOGRAPHY AND CES AND TECHNOLOGY, me University of Nigeria, Nsukka
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DEPARTMENT OF MEDICAL RADIOGRAPHY AND RADIOLOGICAL
A THESIS SUBMITTED T
RADIOLOGICAL SCIENCES, FACULTY OF HEALTH
UNIVERSITY OF NIGERIA ENUGU CAMPUS
1
NWOBI, CHIGOZIE IVORPG/M.Sc/03/37246
SONOGRAPHIC ASSESSMENT OF FOETAL THORACIC CIRCUMFERENCE AS A PREDICTOR OF GESTATIONAL
AGE IN MAIDUGURI, NORTH EAST NIGERIA
DEPARTMENT OF MEDICAL RADIOGRAPHY AND RADIOLOGICAL SCIENCES, UNIVERSITY OF NIGERIA, NSUKKA
A THESIS SUBMITTED TO THE DEPARTMENT OF MEDICAL RADIOGRAPHY AND
RADIOLOGICAL SCIENCES, FACULTY OF HEALTH SCIENCES AND TECHNOLOGY
UNIVERSITY OF NIGERIA ENUGU CAMPUS
Webmaster
Digitally Signed by Webmaster’s NameDN : CN = Webmaster’s name O= University of Nigeria, NsukkaOU = Innovation Centre
FEBRUARY 2012
CHIGOZIE IVOR
SONOGRAPHIC ASSESSMENT OF FOETAL THORACIC CIRCUMFERENCE AS A PREDICTOR OF GESTATIONAL
AGE IN MAIDUGURI, NORTH EAST NIGERIA
DEPARTMENT OF MEDICAL RADIOGRAPHY AND RADIOLOGICAL , UNIVERSITY OF NIGERIA, NSUKKA
O THE DEPARTMENT OF MEDICAL RADIOGRAPHY AND
SCIENCES AND TECHNOLOGY,
Webmaster’s Name DN : CN = Webmaster’s name O= University of Nigeria, Nsukka
2
SONOGRAPHIC ASSESSMENT OF FOETAL THORACIC CIRCUMFERENCE AS A PREDICTOR OF GESTATIONAL
AGE IN MAIDUGURI, NORTH EAST NIGERIA
BY
NWOBI, CHIGOZIE IVOR PG/M.Sc/03/37246
DEPARTMENT OF MEDICAL RADIOGRAPHY AND RADIOLOGICAL SCIENCES
FACULTY OF HEALTH SCIENCES AND TECHNOLOGY COLLEGE MEDICINE
UNIVERSITY OF NIGERIA ENUGU CAMPUS
FEBRUARY, 2012.
3
TITLE PAGE
SONOGRAPHIC ASSESSMENT OF FOETAL THORACIC CIRCUMFERENCE AS A PREDICTOR OF GESTATIONAL
AGE IN MAIDUGURI, NORTH EAST NIGERIA
BY
Nwobi, Chigozie Ivor PG/M.Sc/03/37246
A Dissertation Submitted to the Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, College Medicine, University of Nigeria, Enugu Campus
IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MASTER OF SCIENCE (M.Sc) DEGREE IN
MEDICAL IMAGING
SPECIALTY: MEDICAL IMAGING
SUPERVISOR: PROF. K. K. AGWU
FEBRUARY, 2012.
4
APPROVAL PAGE
Name: NWOBI, CHIGOZIE IVOR
Reg. No. PG/M.Sc/03/37246
Degree: M.Sc
Specialty: Medical Imaging (Medical Ultrasound)
Title of Dissertation: Sonographic Assessment of Foetal Thoracic
Circumference as a Predictor of Gestational
Age in Maidurguri, North East, Nigeria
Examination Committee
…………………. ………………………. Dr. C. U. Eze Prof. K. K. Agwu Head of Department Supervisor
……….…………….. Dr. T. T. Marchie External Examiner
Date of Approval …………..
5
DEDICATION
To my parents; Chief J. U. Nwobi and Late Augustina Nwobi of blessed
memory. My Aunty, Miss Margaret Nweze, for their love and support.
6
ACKNOWLEDGEMENT
I am grateful to Almighty God for his love and guidance for granting me
grace to successfully complete this study. The success of this study was
made possible by many people who were involved in supervision,
support, provision of material resources, advice and encouragement. My
gratitude goes to my supervisor, Prof. K. K. Agwu for his constructive
criticism, motivation and support. I appreciate Dr. Ahidjo Ahmed
(Former Head, Radiology Department, University of Maiduguri Teaching
Hospital UMTH, Consultant Radiologist) and Prof. Audu Bala (former
Deputy CMAC, UMTH and consultant Obstetrics and Gyaenacologist)
for their permission and provision of subjects for data collection and for
also sharing their experiences and expertise in the study. The staff of
radiology and O&G departments are appreciated for their collaboration
and provision of enabling environment for the study.
Special thanks to Prof. Tahir A., Chief Medical Director, University of
Maiduguri Teaching Hospital, for his encouragement and support to
seeing the completion of this work.
Dr. Eze C.U., Head of department of Medical Radiography and
Radiological Sciences, Dr. Okeji Mark, Dr. Ogbu S.O.I, Mr. Ochie Kalu,
Mr. Nwadike and Mrs. Angel Mary provided advice and contributions to
the dissertation, for which I am grateful.
7
I acknowledge Mrs. Idigo F.U. and Dr. Okaro, former heads of
department, for the guidance and assistance in making the work possible.
Finally, I want to acknowledge, My late elder brother,Simon Nwobi, my
brothers and sisters, colleagues, friends and relations for their moral
support and love during the period of the study.
8
ABSTRACT
The purpose of this research was to establish a nomogram of thoracic
circumference as a predictor of GA. The foetus of 907 singleton pregnant
woman referred to the Radiology Department of UMTH and obtained through
consecutive enlistment were scanned for the purpose of establishing a
nomogram of thoracic circumference (TC) as a predictor of gestation age. Only
apparently healthy subjects were enlisted and those between gestational age of
15 weeks-41 weeks were included. A cross sectional prospective research
design was adopted for this study using a convenient sampling technique.
Ethical approval was also obtained from the ethical committee of the hospital
and informed consent was obtained from each participant before data collection
commenced. The sonographic examinations were performed using a two-
dimensional, high resolution, real time ultrasound, ALOKA Prosound 3500
manufactured in Japan in 2005, and equipped with a 3.5MHz curvilinear,
transabdominal transducer. The TC was measured and in accordance with the
recommendations of American College of Radiology (ACR). Regression
analysis was applied to establish the relationship between TC and GA and the
coefficient by Pearson’s moment correlation. The BPD, HC, AC and FL were
also measured and the accuracy of TC in predicting GA compared with these
biometric parameters. Geometric mean was used to determine fetal growth rate.
Student t test (two tails) was used to determine if there was statistical
difference between TC of Caucasian and that of Nigerian population. The TC
values ranged from 9.159cm to 32.168cm for the 15-41 weeks of gestation. The
growth rate at the second trimester was 0.8169/week and third trimester
0.8217/week. The coefficient of the relationship between TC and GA was
0.974 and the regression analysis yielded the equation y = 4.65 + 1.13TC. The
accuracy of TC in predicting GA is 97.40% while those of BPD, HC, AC
and FL accuracy were 98.24%, 98.06%, 97.12%, and 98.62% respectively.
There was no statistically significant difference between TC and other
established biometric parameters in predicting GA. The accuracy of TC to
predict GA was highest at the second trimester.
9
TABLE OF CONTENTS
Title Page i
Approval Page ii
Dedication iii
Acknowledgement iv
Abstract vi
Table of Contents vii
List of Tables x
List of Figures xi
List of Appendices xiii
List of Abbreviations xiv
CHAPTER ONE: INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of the Problems 4
1.3 Objectives of the Study 5
1.4 Significance of the Study 6
1.5 Scope of the Study 6
1.6 Limitations of the Study 7
1.7 Literature Review 7
1.8 Operational Definition of Terms 11
10
CHAPTER TWO: THEORETICAL BACKGROUND
2.1 Embryology of Foetal Chest Development 15
2.2 Anatomy 17
2.3 Hereditary Defect of Foetal Chest 18
2.4 Sonographic Assessment of Thoracic Circumference as
Prediction of Gestation Age 21
2.5 Sonographic Assessment of other Parameters to Determine
Gestation Age 24
2.6 Other Imaging Modalities used for Fetal Dating 32
2.7 Clinical Methods of Estimating Gestational Age 33
CHAPTER THREE: RESEARCH METHODS
3.1 Introduction 36
3.2 Research Design 36
3.3 Setting of Study 36
3.4 Study Population 37
3.5 Determination of Sample Size and Sampling Technique 38
36 Sources of Data 38
37 Ethical Consideration 39
3.8 Recruitment of Subject, Inclusion/Exclusion Criteria 39
3.9 Method of Data Collection 40
3.10 Dating Model 47
11
3.11 Method of Data Analysis 48
CHAPTER FOUR: PRESENTATION OF RESULTS AND
DISCUSSION
4.1 Introduction 49
4.2 Results 49
4.3 Inferential Analysis 56
4.4 Feta Thoracic Circumference Growth Rate 56
4.5 Prediction of GA from TC 56
4.6 Discussion 63
CHAPTER FIVE: SUMMARY AND CONCLUSIONS,
5.0 Summary of Major Findings 66
5.1 Conclusions 67
5.2 Recommendations Based on Finding 67
5.3 Study’s Contributions to Knowledge 68
5.4 Areas of Further Studies 68
References 69
Appendices 75
12
LIST OF TABLES
Table 1: Age Variability in Weeks 32
Table 2: Distribution of the participants according to tribe 50
Table 3: Mean values of TC matched against GA 53
Table 4: Comparism between 50th percentile TC in Nigerians
(derived nomogram) and the caucasians 55
Table 5: Predic5ted GA from equation 75th Percentile in Nigerians
GA = 4.65 + 1.13 TC 57
Table 6: Regression model for TC against BPD, FL, HC. 62
Table 7: Gestational age groups and their coefficient of determination 62
Table 8: Mean values of BPD, FL, HC and TC with GA 78
Table 9: Comparison of mean values of TC and HC against GA 79
13
LIST OF FIGURES
Fig 1: IUGR Pictural diagram 14
Fig 2: Foetal chest sonogram 17
Fig 3: Foetal ribs and spines sonogram 17
Fig 4: Four Chamber sonogram with colour Doppler 22
Fig 5: Four heart chamber view and chest circumference of foetus 22
Fig 6: Foetal skull with Biparietal diameter 25
Fig 7: Foetal Derived Head Circumference Sonogram 27
Fig 8: Correct Femur Length outline Sonogram 30
Fig. 9a: Incorrect the femur (f) length sonogram should not be measured
unless it is perpendicular to the transducer 30
Fig.9b: Incorrect bowed femur length sonogram 31
Fig 10:Sonographic appearance of derived thoracic circumference 41
Fig 11: Imaging of the Four Heart Chamber View 43
Fig 12: Illustration of the levels the four heart chamber 44
Fig 13: Illustration of the two perpendicular diameter used to drive
the Thoracic Circumference 45
Fig 14: Sonographic appearance of thoracic circumference with the
four chamber view of the foetal heart 45
Fig 15: Age distribution of the participants 51
Fig 16: Gestational age distribution of the foetus 52
Fig 17: Scatter diagram of mean TC against weeks of gestation 54
14
Fig 18: Scatter diagram of TC against BPD 58
Fig 19: Scatter diagram of TC against HC 59
Fig 20: Scatter diagram of TC against AC 60
Fig 21: Scatter diagram of TC against FL 61
Fig. 22: Sonogram of foetal thoracic circumference 80
15
LIST OF APPENDICES
Appendix i: Ethical clearance UMTH 73
Appendix ii: Participant consent form 74
Appendix iii: Table 8: mean values of BPD, FL, HC and TC
With GA. 76
Appendix iv: Table 9: comparison of mean values of TC and HC
against GA 78
Appendix v: Fig 22. Sonogram of foetal thoracic circumference
source manjucakesh 79
Appendix vi: Data capture sheet 80
Appendix vii: Raw date sheet 82
16
LIST OF ABBREVIATIONS
AA - Aorta
AC - Abdominal Circumference
ACR - American College of Radiology
AGA - Average Gestational Age
ASD - Atrial Septal Defect
BPD - Biparietal Diameter
CRL - Crown Rump Length
DA - Dutus Arteriosus
D1 - One Diameter
FE - Foetal Ear
FCC - Foetal Chest Circumference
FHS - Foetal Heart Structure
FL - Femur Length
GA - Gestational Age
HC - Head Circumference
HL - Humeral Length
IUGR - Intra Uterine Growth Restriction
LA - Left Atrial
LMP - Last Menstrual Period
MPA - Main Pulmonary Artery
MHz - Megahertz
17
OOD - Outer Orbital Diameter
RA - Right Atrial
TC - Thoracic Circumference
UMTH - University of Maiduguri Teaching Hospital
VSD - Ventricular Septal defect
YSD - York sac Diameter
18
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
The introduction of sonography by Donald and colleagues in 1958 is now
regarded as one of the major milestones of modern medicine (Johnson,
2005). For the first time it became possible to obtain information about
the foetus and its environment directly with a non-invasive diagnostic
procedure considered safe even when used repeatedly. In Nigeria there is
unprecedented growth in the application of ultrasound in general and in
obstetrics in particular due to its diagnostic/evaluation yield to physicians
and fetal gender determination (Johnson, 2005; Eze et al., 2010).
Ultrasound is useful in terms of accurate assessment of gestational age,
detection of abnormalities, evaluation of foetal growth and well being,
and guiding obstetricians and gynaecologist with in-utero diagnosis and
treatment (Johnson, 2005).
Diagnostic ultrasound plays key role in providing solution to obstetric
problems. In the developed world such as Japan and Great Britain,
ultrasound is also a screening test and the “routine-scan” is seen as part of
obstetrics care, capable of providing important information for improving
pregnancy management (Johnson, 2005). Accurate knowledge of
gestational age is prerequisite for best obstetric care, including evaluation
19
of fetal growth and management of preterm and post term pregnancies as
stated by Pekka and Vilho 2001 and Ola-oja,2005 . Every 30 seconds a
baby dies of preterm birth (Berghella, 2010). Over 1 million babies die in
the world every year due to problems related to being born too soon
(Requejo and Meriald, 2010). Failure to obtain accurate gestational age
can result to poor maternal and foetal outcomes (Konje et al, 2002) .
The estimation of GA is one the commonest indications for obstetrics
ultrasound investigation (Eze et al. 2010).Currently, real time scanners
which produce dynamic images of the moving fetus can be depicted on a
monitor screen. Very high frequency sound waves of between 3.5 to 7
megahertz (MHz) are generally used for this purpose. Repetitive arrays of
ultrasound beams scan the foetus in thin slices and are displayed on the
monitor screen. Movements such as foetal heartbeat and malformations in
the foetus can be assessed and measurements can be made accurately on
the images displayed on the screen. Such measurements form the corner
stone in the assessment of gestational age, size and growth in the foetus
(Johnson, 2005).
However, before the advent of ultrasound, assessment of foetal age was
purely by clinical evaluation and dependent on last menstrual period
(LMP) given by the patient and/or physical examination of the fundal
height of the pregnant women and Delee’s or quickening test. These
20
methods sometimes are inaccurate and unreliable due to the various
reasons (Agwu et al., 2008, Mongelli and Gardosi,2008). These includes
presence of Uterine leiomyoma coexisting with pregnancy resulting in
wrong fundal height measurement particularly when the date of the LMP
is not accurately known, as it is generally the case (Campbell et al.,
1985;Apfel and Green, 1999; Chuldleigh and Thilaganathan,2004; Agwu
et al. 2008). However, even when certain LMP is known it has been
shown that ultrasound is more accurate (predictive error 7.4-7.7 day) than
LMP (10 day) between estimated day of delivery and actual day of
delivery at 11-16weeks of gestation. Ultrasound is superior to LMP by at
least 1.7 day according to Pekka et al, 2001; Agwu et al,2008 ; Mongelli
and Gardosi, 2008)
With the introduction of ultrasound over five decades ago, the
assessment of foetal age has been improved, through the use of these
• Maternal conditions: Diseases – diabetes and Hypertension
women.
3.9 Method of Data Collection
The age, tribe and parity of the women were also recorded on data
capture sheet. The data was collected by taking measurements of two
fetal thoracic diameters at right angle to each other and later thoracic
circumference derived with a formulae(TC=��{ (D12+D2
2)/2}). Those
measurements were taken at the level of the four heart chamber view and
during diastole. Apart from fetal thoracic diameters, the BPD, HC, AC
and FL were also measured.
58
Fig. 10: Sonographic appearance of derived thoracic circumference
3.9.1 Instrumentation
Measurement were obtained with a modern real-time ultrasound
(ALOKA prosound 3500, produced in Japan) two-dimensional real-time
gray scale ultrasound machine with good resolution equipment. The
equipment less than 30 months old from date of manufacturing (2005)
was used, with a 3.5MHz transabdominal curvi-linear transducer. The
electronic calipers calibrated for an assumed ultrasound velocity of
1540m/s in soft tissue. The equipment has a calibration which reading of
the GA as measurements were made and give a composite (average) GA.
3.9.2 Patient Preparation
1. Full urinary bladder was achieved by giving 1 litre of water
ingested within 15 to 20 minutes time period to the subject.
D1
D2
59
2. If for any reason the patient cannot have fluids, sterile water were
used to fill the bladder through a Foley’s catheter by obstetrician or
Radiologist.
3. The patient were positioned supine with 3.5MHz transducer.
4. The patient breathing technique were normal respiration.
3.9.3 Scanning Protocols
The procedure was explained to each patient and the subject was asked
to take a litre of water in order to achieve a full bladder. Once a patient
has full bladder, the examination was commenced with transabdominal
scan. A research assistant (experienced 19 years, registered AIUM
sonographer) was used. Technique adopted was
the STANDARD ultrasound examination of the foetus of these three
organizations (AIUM–ACR-ACOG, 2007). The fetus were scanned at
various tomographic planes for best technique to demonstrate the thoracic
circumference of the foetal chest dimensions, after applying Ultrasound
gel on the abdomen. The foetuses were scanned in both longitudinal and
transverse axis using transabdominal probe at plane to identify the lie
and presentation of the foetus. The foetal well being accessed by
examining the fetal heart and other indicators.
60
3.9.4 Scanning Technique to Demonstrate Fetal Thoracic
Circumference
The patient lies either supine (in early pregnancy) or in Foyler position
i.e. 55o caudad angulation on the examination couch. A general survey
(sweep) using a 3.5MHz transducer was initially performed to ensure
that the foetus, the placenta and the uterus were normal. The foetal four
heart chamber view was used as landmark for measurement of the fetal
thoracic circumference according to De Vore, 2009. The four chambers
were identified when the ultrasound beam was directed at right angle to
the foetal chest (Chitkara et. al. 1987; De Vore, 2009).
Fig. 11: Imaging the four-chamber view is accomplished by directing the ultrasound beam perpendicular to the fetal chest. At this level, the four-chamber view is identified. This view contains the right atrium (RA), left atrium (LA), right ventricle (RV) and left ventricle (LV). Source: De Vore, 2009
To obtain the four chamber view of the fetal heart, the long axis of the
spine was identified. Then the transducer rotated 900 at the level of the
61
foetal thorax. Or from the abdominal circumference, the transducer was
gradually angled cephalad. Sliding up towards the head until the required
four heart chamber view was obtained (Chikara al. 1987,Sanders et al.,
1998). In the four chamber view one sees the prominent Eustachian valve
within the right atrium and the valve of the foramen ovale flapping within
the left atrium (Kuldeep et al ., 2002). The atrioventricual valves are seen
with the tricuspid valve lying closer to the cardiac apex than the mitral
valve (Kuldeep et al., 2002).
The image was frozen during diastole i.e. when both the tricuspid and
mitral valves are open. The data were obtained by measuring two foetal
thoracic diameters at right angle to each other than thoracic
circumference was derived.
Fig. 12: This illustrates the level that the four-chamber view is imaged (green). The main pulmonary artery (MPA), ductus arteriosus (DA), and the aorta (AA) are not imaged at the level of the four-chamber view. SVC=superior vena cava, RV=right ventricle, RA=right atrium, LV=left ventricle, LA=left atrium Source: De Vore, 2009
62
One diameter (D1) was taken along the ventricular septum. The other (D2)
was taken along the line joining the mitral and tricuspid valves. Both are
taken from outer to outer fetal thoracic surfaces in such a way that they
are at right angle to each other as illustrated in the diagram below.
Fig.13: Illustration of two diameters used to drive the thoracic circumference
Fig. 14: Sonographic appearance of thoracic circumference with the
four-chamber view of the fetal heart
Thus from D1 and D2The foetal thoracic circumference was derived using
this formular.
TC=��{ (D12+D2
2)/2}
D1
D2
Heart
Fetal thoracic circumference
D1
D2
Thoracic circumference
63
It was assumed that the thoracic at the four heart chamber view is either
circular or oval in shape as the foetal head at the standard landmark for
BPD’s measurement. These formular applied to the calculation of the
head circumference were also applied to the foetal thoracic
circumference.
Other parameters measured
The BPD the proximal edge to the proximal edge of the deep border
(outer-inner) (Altman et al., 1997; Ugwu et. al, 2007) at the standard
landmark as described in chapter two.
The head circumference (HC) was measured by tradeball on the outer
skull vault (Ugwu et. al, 2007).
Abdominal circumference (AC) it is the length of the outer perimeter of
the abdomen taken on axial plane at the level of the umbilical vein-ductus
venosus complex (Hadlock et al., 1982).
The femur length was measured from the major trochanter to the lateral
femoral condyle along then longest axis of the central shaft exclusive of
the epiphyses as described by (Beigi et al., 2000)
The following information items were collected from each of obstetric
case scanned in data capture sheet.
64
1. Patient age, tribe, parity
2. Biparietal diameter (BPD)
3. Derived Fetal thoracic circumference (TC)
4. Fetal head circumference (HC)
5. Fetal femur length (FL)
6. Abdominal circumference (AC)
7. Average gestational age (AGA)
The measurement were taken from the 15th -41 weeks’ of GA .
3.10. Dating Model
Due to some factors such as faulty memory, bleeding in early pregnancy
and the use of contraceptives the LMP as a gold standard has several
potential of inaccuracy (Campbell et al., 1985; Apfel and Green, 1999;
Chuldleigh and Thilaganathan,2004;Agwu et al. 2008). Also with the
illiteracy of many women in the locality of the study, which the majority
doesn’t know their LMP. For these reasons the LMP was not used. Rather
the measurements were correlated to the composite (average) gestational
age obtained from the BPD, HC, AC and FL. This is because the
combination of more than one parameter increases the reliability,
sensitivity and accuracy of foetal biometry (Mercer et al., 1987; Ogunsina
et. al., 2001; Subbarao et al., 2003)
65
3.11 Method of Data Analysis
The analysis of the data involved the use of test statistics. The package
SPSS version 17.0, was used in the analysis. All comparative tests were
performed at 5% significant level. The analyses were done using both
descriptive and inferential statistics. Descriptive statistics used include
frequency, standard deviation, percentage, means, range geometric mean,
tables and charts were used to describe the data Inferential statistics used
include Student ‘t’ test was used to test the average means values and
Pearson correlation coefficient was used to show relationships between the
TC and BPD, HC,AC, FL and weeks of gestation. Geometric mean was used to
calculate the growth rate.
66
CHAPTER FOUR
PRESENTATION OF RESULTS AND DISCUSSION
4.0 Introduction
The results obtained from the measurements were analysed and
presented. The mean of the several biometric parameters were measured
were analysed and presented. The mean measurement were BPD, FL,
HC, AC and TC. The mean values of the measured biometric parameters,
BPD, FL, HC,AC, TC were compared and correlated with each other, to
ascertain their statistically acceptability.
4.2 Results
4. 2.1 Demography
Descriptive analysis of data
A total of 907 singleton women participants were employed in the study. The
TC values ranged from 9.159cm to 32.168cm within 15-41 weeks of as
gestation demonstrated in table 4.Twenty eight different tribes were involved
in the study, the major tribes were Kanuri 299(30.97%), Igbo176
(18.07%),Fulani80(8.82%),Hausa32(3.80%), Marghi 17(1.87%) as
shown table 2. Their age ranged from 15 to 42 (mean age is 32).
67
Table 2: Distribution of the participants according to tribe S/NO. TRIBE FREQUENCY PERCENTAGE
1. Babur 9 0.96 2. Bade 8 0.94
3. Bago 9 0.96
4. Baseyap 9 0.97
5. Bura 13 1.93
6. Chibok 9 0.95
7. Daba 8 0.94
8. Dajju 8 0.94
9. Fulani 80 8.82
10. Hausa 32 3.80
11. Hidi 9 0.96
12. Idoma 21 2.31
13. Igala 8 0.93
14. Igbo 176 18.07
15. Jukun 8 0.94
16. Kanakura 9 0.95
17. Kanuri 299 30.97
18. Kilba 8 0.94
19. Kuteb 6 0.71
20. Mandara 10 0.82
21. Marghi 17 1.87
22. Michika 9 0.97
23. Nakere 8 0.94
24. Shuwa 43 4.12
25. Tiv 10 0.72
26. Waja 8 0.94
27. Yabe 8 0.94
28. Yoruba 65 7.17
Total 907 100 The majority of pregnancies were between 30 and 40 weeks old
(151=46.6%). The distribution of the scanned women according to the
pregnancy age is illustrated in fig 15
68
Fig 15: Age distribution of the participants
This shows that majority of women age group scanned (20-24 age)
Was 88.07%, while the least age group was 40-42 age 6.03%
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69
Fig 16: Gestational age distribution of foetus in weeks
This shows that majority of the group foetal gestational age measured
was 46% (30-40). While the least group of foetal gestational age was
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APPENDIX I
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APPENDIX II
PARTICIPANT CONSENT FORM
RESEARCH TITLE: SONOGRAPHIC ASSESSMENT OF FOETAL
THORACIC CIRCUMFERENCE AS A PREDICTOR OF
GESTATIONAL AGE IN A NIGERIAN POPULATION
1. BACKGROUND INFORMATION
This is a request form to consent to be participant in a study titled:
Sonographic Assessment of Foetal Thoracic Circumference as a Predictor
of Gestational Age in a Nigerian Population.
The research finding generated by this study will aid in best estimate of
gestational age (GA) of pregnant women from the second and third
trimester.
The research finding will be valuable to health care practitioner’s in
predicting more accurate GA and Foetus at risk, thus prompt and better
management of women at risk by doctors.
2. VOLUNTARY NATURE OF THE STUDY
The participation is voluntary in nature. You have the right to refuse
participation and/or withdraw at any point during the study. This decision
will not affect your current and future relationship with the hospital.
3. STUDY RISK
There is no evidence that ultrasound scan posses risk to the foetus and/or
the mother. It is a reliable imaging modality for assessing foetal GA.
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4. COST ADDITION
There is no financial cost to you for consenting to participate in this
study. As a participant, the study will be part of your normal obstetric
scan which you have already paid for prior to the scan.
5. CONFIDENTIALITY
Your identity will not be included and revealed as part of the study
gathering and it is impossible to identify you in any way after gathering
the data. The records are private. All information obtained will be
handled with strick confidentiality.
6. FEEDBACK
My name is Nwobi Chigozie, the researcher, I can be contacted through
the GSM no. 08034545811 or my Supervisor, Prof. K.K. Agwu via
07089585847
7. STATEMENT OF CONSENTS
I agreed that I have read and understood the content of the consent form
(or some one read and explained the study in my local language: Hausa,
Kanuri, e.t.c.). I am aware of the nature and benefit of this study and my
questions have been answered to my satisfaction .Hence, I hereby give
my consent to be a participant to this study.
....................................................... ……………………. Signature of participant/ thumb print Date ....................................................... ……………………. If applicable, Interpreter’s signature Date
....................................................... ……………………. Signature of researcher Date
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APPENDIX III
Table 8: Mean values of BPD, FL, HC and TC with GA