ABSTRACT
Perinatal mortality rates are considered in the western world to be a quantitative barometer of maternity care. This 6-year prospective perinatal audit was conducted at a tertiary hospital in order to determine foetal outcome, and the common causes of foetal and early neonatal deaths. Of a total of 30,987 births, there were 469 stillbirths and 391 early neonatal deaths, giving a perinatal mortality rate of 27.7 per 1000 total births. The leading causes of stillbirths were the hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies. Neonatal deaths were mainly due to the respiratory distress syndrome (57.8), birth asphyxia (22.2) and sepsis (13.5). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended.
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant Mortality , Medical Audit , Birth Weight , Prospective Studies , Cause of Death , Fetal Death , Pregnancy Complications , Caribbean Region/epidemiologyABSTRACT
A severely pre-eclamptic patient developed peripartum cardiomyopathy and bilateral femmoral emboli. Medical therapy for cardiac failure was commenced prior to delivery by Caesarean Section. Bilateral femoral embolectomy was performed on the sixth postpartum day.
Subject(s)
Pre-Eclampsia/complications , Pregnancy Complications, Cardiovascular , Embolism/surgery , Femoral Artery/surgery , Heart Failure/drug therapy , Puerperal Disorders , Cesarean SectionABSTRACT
A retrospective analysis of 21 hirsute women seen at a gynecological endocrine clinic revealed a high incidence of infertility, menstrual irregulaties and abnormal androgen profile. Polycystic ovarian syndrome (PCOS) was the underlying abnormality in the majority of cases. Cyproterone acetate (CPA) with ethinyl oestradiol in a reverse sequential regime was more effective and better tolerated but much more expensive than the combination of spironolactone and the oral contraceptive pill (OCP).
Subject(s)
Hirsutism/drug therapy , Spironolactone/therapeutic use , Severity of Illness Index , Retrospective Studies , Cyproterone/therapeutic use , Drug Evaluation , Ethinyl Estradiol/therapeutic use , Hirsutism/complications , Hirsutism/diagnosisABSTRACT
A ten-year survey of the magnitude and causes of obstetrical deaths at Mount Hope revealed a maternal mortality rate of 33.3 per 100,000 live births. The leading causes of death were the hypertensive disorders, and the most common identifiable factors were inadequate antenatal care and substandard clinical management.
Subject(s)
Humans , Pregnancy , Female , Maternal Mortality/etiology , Pre-Eclampsia/mortality , Prenatal Care , Trinidad and Tobago , Eclampsia/mortalityABSTRACT
A five-year record review was undertaken for all babies with a diagnosis of foetal macrosomia. The perinatal mortality rate of 23 per 1,000 total births was similar to the overall hospital rate. Neonatal morbidity was significant, and the most important contributory factor to foetal injury was impaction of the shoulders during parturition. In order to avoid this catastrophe, elective abdominal delivery may be prudent if the foetal weight is estimated at greater than 4,500 grams.
Subject(s)
Humans , Pregnancy , Infant, Newborn , Adolescent , Adult , Female , Fetal Macrosomia/complications , Dystocia , Trinidad and Tobago , Birth Injuries/complicationsABSTRACT
A 21-Year-old woman, para 1+0, developed profound postpartum shock secondary to acute inversion of the uterus. Fundal re-inversion was inversion was achieved by prompt manual replacement of the uterus from below. Anaggressive approach to uterine inversion is the keystone of success
Subject(s)
Humans , Pregnancy , Adult , Female , Shock, Hemorrhagic/etiology , Uterine Prolapse/therapy , Postpartum PeriodABSTRACT
A retrospective study of the outcome of pregnancy in 187 women with cervical cerclage revealed a three-fold increase in the crude perinatal survival rate. The McDonald and Shirodkar techniques produced comparable results. Mersilene was as effective as black silk. A significant number of pregnancies with cerclage insertion prior to 14 weeks ended in spontaneous abortions. Postcerclage morbidity was minimal, and abdominal delivery was indicated in only four patients for cervical dystocia. The continued use of this procedure, for selected cases, is justified
Subject(s)
Humans , Pregnancy , Adult , Female , Pregnancy Outcome , Abortion, Spontaneous/etiology , Uterine Cervical Incompetence/surgery , Suture Techniques/standards , Sutures , Uterine Cervical Incompetence/complications , Retrospective Studies , Evaluation StudyABSTRACT
The epidemiology, clinical features and method of evacuating the uterus were reviewed in 30 patients with hydatidiform mole. The incidence was greatest in patients with blood group O and among young East Indians. There was no seasonal variation nor was there any progression to choriocarcinoma. Only one partial mole and one invasive mole were encountered. Evacuation was achieved chiefly by suction curettage and concomitant augmentation with a Syntocinon infusion