Squatting position for delivery.

The study was conducted on 200 normal pregnant women who were randomly classified into 2 groups of 100 cases each. The control group comprised mothers in supine position throughout labour and delivery (46 primigravidae and 54 multigravidae). The squatting group consisted of cases who were kept ambulatory during the 1st stage and were asked to squat on ordinary delivery cots during the 2nd stage of labour. Third stage of labour was conducted in supine position. The squatting group comprised 42 primigravidae and 58 multigravidae. There was a mean difference (shortening) of 3 hours in primigravidae and 2 hours in multigravidae in the duration of 1st stage of labour between the squatting and control groups. In the duration of 2nd stage of labour the mean differences in primigravidae and multigravidae of the squatting and control groups were 20 and 13.5 minutes respectively. In the squatting group there were 79 normal vaginal delivery, 16 forceps delivery and 5 caesarean sections whereas in the control group there were 80, 18 and 2 cases respectively. Although foetal complications were comparable in both the groups, the incidence of maternal injuries was observed in 14 cases in control group and 38 cases in squatting group. It was concluded that without proper birthing chairs which can give good perineal support, the usual supine position is preferable.

Rupture uterus: changing trends in etiology and management.

Sixty-four cases of rupture uterus which occurred during the period 1980-89 were studied and compared with 70 cases in the preceding decade (1970-79). The changing trends in etiological factors and management of this condition have been demonstrated. While spontaneous rupture continued to account for about two-thirds of the cases (70.3%), the incidence of traumatic rupture uterus has become less than half, from 17.1 to 7.8%, and that of scar rupture has increased to more than double (from 11.4 to 23.4%). As regards management, there are improved results seen with conservative repair of the uterus. It was also seen that a subtotal hysterectomy was more commonly resorted to than total hysterectomy in the later decade. There was a decrease in the overall morbidity from 42.8 to 35.9% and also in the mortality rate from 24.3 to 18.7%.