“I have a heart to help the mothers”: 25 years of the Village Birth Attendant Program in Milne Bay Province, Papua New Guinea

@#In many low-resource settings an estimated one-third of all births take place unsupervised with traditional and non-traditional villager birth attendants the only providers of care during pregnancy and childbirth. The training of village birth attendants (VBAs) in Milne Bay Province began in 1991, and has continued during a period of significant shifts in national and international public health policy. As part of a wider provincial-wide review of the VBA program we undertook 6 focus group discussions, 13 in-depth interviews and 8 key informant interviews in three districts in Milne Bay Province in 2014. In this paper we describe the role, responsibilities and function of VBAs, and the challenges facing both VBAs and those involved in their training and in supporting their work in the community. In this setting, VBAs continue to assist women during childbirth, and are frequently having to try and manage difficult obstetric complications with little or no support from their communities or local health facilities. Some VBAs reported being called too late by the community, with insufficient time to refer women on to a health facility, resulting in maternal deaths. Many VBAs continued with their practice, motivated by a heartfelt desire to serve, despite feeling ‘neglected’ and ‘overlooked’, while others continued because of their religious convictions and dedication to help their communities. There is an urgent need to better define what VBAs can and should do in this setting, what communities can realistically expect of their VBAs, and how professional health care workers can work more constructively with this long-standing cadre of lay health workers. There is a need for all health facilities and VBA trainers to support their VBAs, and to fully recognize the often difficult situations VBAs are required to work in while continuing to advocate for supervised, health facility births.

Familial ovarian cancer: report of ovarian carcinoma in three sisters

@#This is a report of ovarian carcinoma occurring in two sisters diagnosed almost at the same time, prompting prophylactic oophorectomy in a third sister. Histology of the overtly normal ovary in the third sister showed a focus of ovarian cancer. Discussion and a review of the literature suggest that any program designed to reduce the incidence of late-stage ovarian carcinoma should include the surveillance of family members of the index case, including the performance of prophylactic oophorectomy in the unaffected members of the family after they have completed their families.

A retrospective survey of patients with one previous caesarean section delivered at the Port Moresby General Hospital: a comparative study of those delivered vaginally and those delivered by repeat caesarean section

@#We studied 510 patients in a retrospective, nonrandomized, comparative survey of vaginal births and repeat caesarean section after one primary caesarean section at the Port Moresby General Hospital. 478 (94%) were allowed a trial of scar (TOS). The most common indications for elective caesarean section in the other 32 patients were cephalopelvic disproportion (CPD) 31%, contracted pelvis 19% and preeclampsia 12.5%. In 41% of patients TOS was terminated by emergency caesarean section. Logistic regression analysis showed that the following were significantly associated with repeat caesarean section after TOS: parity of one, no vaginal birth after the primary caesarean section, narrow obstetric conjugate, birthweight of 2500 g or greater, short stature, high level of the head at admission to the labour ward and region of origin.

A case-control study of primary caesarean section at the Port Moresby General Hospital, Papua New Guinea, to identify epidemiological predictors of abnominal delivery

@#A retrospective study of 274 consecutive primary caesarean sections and 274 unmatched controls was carried out at Port Moresby General Hospital from January to December 1992. The primary caesarean section rate was 3.5%. Stepwise logistic regression analysis showed that primary caesarean section was significantly associated with maternal height of less than 150 cm; nulliparity; symphysis-fundal height of more than 38 cm at admission in labour; cervical dilatation of less than 4 cm at admission in labour; and the level of fetal head at admission in labour of 3/5 or higher.

A case of factor V deficiency presenting as menorrhagia

@#Factor V deficiency is a rare hereditary disorder. We report a patient with factor V deficiency who presented with menorrhagia and pelvic haematoma. The Haematology Department at the Royal Brisbane Hospital performed the definitive factor assays leading to the diagnosis. The challenges of her management were obtaining adequate supplies of factor V and her socioeconomic circumstances. The main future challenge will be the supervision of her pregnancies.

A survey of under-18 year old and 20-29 year old primigravidae delivered at the Port Moresby General Hospital: a comparative study of their sociodemographic and sexuality characteristics and contraceptive knowledge and experience

@# From July 1992 to August 1993, 330 under-18 year old primigravidae (cases) and 330 randomly selected 20-29 year old primigravidae (controls) who were delivered at the Port Moresby General Hospital were sequentially studied, using a standardized, pretested, precoded questionnaire. In stepwise logistic regression analysis, significantly more of the cases had menarche at less than 15 years of age, learned before menarche that sex causes pregnancy, were of highland origin, were unemployed, or had partners who were unemployed; significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned this pregnancy. PIP: This study aims to identify factors (explanatory variables) which are associated with the risk of an adolescent becoming pregnant. From July 1992 to August 1993, 330 18 year old primigravidas (cases) and 330 randomly selected 20-29 year old primigravidas (controls), who were delivered at the Port Moresby General Hospital in Papua New Guinea, were sequentially studied. Trained research assistants administered a standard, pretested, precoded questionnaire. By using stepwise logistic regression analysis, it was revealed that significantly more of the cases had menarche at 15 years of age (81% vs. 49%), learned before menarche that sex causes pregnancy (51% vs. 32%), were of highland origin, were unemployed, or had partners who were unemployed. Moreover, significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned their pregnancy.