An audit of perinatal mortality

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.

Therapeutic alternatives for the hirsute woman

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).

Maternal mortality at Mount Hope Women's Hospital, Trinidad

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.

Another look at the effects of advanced maternal age

The reproductive performance of primigravidae aged 30 years and over was compared with that of a group of younger primigravidae. Other patients were at greater risk for antepartum complications such as pre-eclampsia and uterine fibroids. Induction of labour was undertaken more frequently, and the Caesarean Section rate was higher but there was no worsening of perinatal mortality.

Perinatal implications for macrosomic babies

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.

Postpartum shock and uterine inversion

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

Operative outcome following vaginal hysterectomy

The peri-operative factors surrounding the patient subjected to vaginal hysterectomy were reviewed. Most of the patients were post-menopausal, and the indication for surgery cases was utero-vaginal descent. Regionalanaesthesia was associated with less blood loss, while lower blood losses were associated with fewer complications and shorter hospitalization. Overall, the morbidity was low (8%), and the mortality was zero

The efficacy of cervical cerclage

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

The epidemiology and management of patients with hydatidiform mole

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

Indications and risks of abdominal hysterectomy

A retrospective analysis of 602 consecutive abdominal histerectomies revealed that uterine fibroids servel as the principal indication for the procedure. Malignant disease accounted for only 4.5% cases. The main complciations encountered were at the abdominal wound and vaginal vault. The use of prophylactic antibiotics is supported, but routine cross-matching of blood for all patients is questioned

Complications of grand multiparity

The outcome of pregnancy in 300 consecutive grand multiparae receiving care in a teaching hospital was investigated. The incidence of grand multiparity was surprisingly low but one in four patients was less than 30 years old. There were no instances of uterine rupture and, compared to previous reports in the literature, there was a marked decline in the overall maternal and perinatal risks. The impact of impact of active obstetric management and neonatal intensive care in a tertiary unit and improved socio-economic conditions appear to have averted the menace of grand multiparity

Perinatal outcome in diabetic pregnancies

The perinatal mortality rate among 151 pregnant diabetics was 9.3 per cent, which is less than that reported elsewhere. This is attributable to strict control of maternal blood glucose levels, planned delivery at 38 weeks and a liberal use of Caesarean Section. Our results defend the concept of delivery of the infant of the diabetic mother not later than the 38th week of pregnancy, since 60 per cent of perinatal deaths occurred beyond this period of gestation

Combined vaginal-abdominal delivery of twins

Seven cases of combined vaginal-abdominal delivery of twins were encountered. The indications for operative intervention for the second twin were obstructed labour umbilical cord prolapse. Good maternal and foetal results were achieved

Re-evaluation of diagnostic uterine dilatation and curettage: a review of 203 patients

Two handred and three patients were reviewed to assess the efficacy of diagtnostic uterine dilatation and curettage. Thirteen (6.4%) had definitive pathological changes of the endometrium; of the 4 patients with endometrial carcinoma, 3 presented eith post-menopausal bleeding. Anaemia was present in 11/3% of those with menorrhagia. The complication rate was 3.4% and the mean hospital stay, 3 days. It is suggested that in pre-menopausal women with abnormal uterine bleeding, medical management and outpatient endometrial biopsy should be the preferred diagnostic approach. fora post-menopausal women, curettage under general anaethesia remains the diagnostic method of choice