Complications of home delivery: a retrospective analysis.

This study was conducted to analyze the cases who had attended Nepal Medical College Teaching Hospital (NMCTH) after home delivery in order to broadly review the complications. This is a retrospective descriptive study. The number of total deliveries during the study period of two years (April, 2002- April, 2004) was 1619, among which 88 (5.4%) were cases who attended after home delivery. Majority of women (35.2%) were primi, 57.9% belonged to 20-25 year age group, 17% were young primi, and 85.2% were full term deliveries whereas 9.1% were preterm. More than half of them (57.9%) had regular antenatal check up. Most of them came from within 1-2 km distance of NMCTH. 51.1% were brought only after 2 hrs of delivery. The most common reason for attending hospital was retained placenta (84.1%-74 cases) among whom 51 (68.9%) needed controlled cord traction, 8 cases (10.8%) needed manual removal, rest of the cases had placenta lying in the vagina. Fifteen (17%) cases had post partum hemorrhage, 9 cases (10.2%) were brought in a state of shock. 71.6% were anemic, 11 (12.5%) had Hb <7 gm%. Other complications included cervical, third degree perineal tear. Blood transfusion was needed in 19 (21.6%) cases. All cases improved with proper resuscitation, use of antibiotics and definitive management of complications. Most of them were discharged within 4 days of admission. Perinatal mortality rate was 65.9/1000 births. This study showed that home deliveries were associated with increased maternal morbidity especially the third stage complications. Studies done in developed countries have shown that home birth is safe for normal, low risk women, with adequate infrastructure and support i.e. given a well trained midwife and facilities to transfer to hospital if necessary. In our context, a community based obstetric service must be developed with emphasis on regular and quality antenatal care, health education to women and proper training of birth attendants.

Parto domiciliario no programado: consecuencias para el recién nacido / Unplanned home delivery consequences to the newborn

Objetivos: Comparar la morbilidad (policitemia, hipotermia, sepsis precoz, convulsiones, hipoglucemia, anemia) y mortalidad entre niños nacidos en su domicilio sin que esto hubiera sido planeado con la de los niños nacidos de parto natural en el Hospital Diego Paroissien. Material métodos: Se revisaron retrospectivamente las historias clínicas de 106 niños nacidos en su domicilio en forma no programada y recibidos vivos en el servicio de Neonatología del Hospital D. Paroissien dentro de las 24 hs posteriores al nacimiento durante el período comprendido entre el 1/1/88 hasta el 31/12/91 inclusive. Estas historias clínicas se compararon con las de un grupo formado por 106 bebes nacidos en el hospital apareados por peso y fecha de nacimiento. Resultados: Se observó mayor frecuencia de policitemia neonatal (22,64 por ciento) en los recién nacidos domiciliarios y de hipotermia al ingreso (28,3 por ciento) vs los niños nacidos en el hospital (p < 0,0001). La mortalidad no presentó diferencias estadísticamente significativas. Conclusiones: Los recién nacidos en domicilio constituyeron una población de alto riesgo (mayor incidencia de policitemia e hipotermia)

Atención a la mujer en la comunidad: Embarazo, parto, puerperio, métodos anticonceptivos / Healthcare to the woman

Con el objetivo de facilitar el trabajo de las parteras tradicionales y de los equipos de capacitación en salud hasta los niveles locales más pequeños, el Colectivo de Mujeres de Matagalpa ha realizado el presente documento; con el fin de que la mujer sea la protagonista de su propio proceso de salud, reconociendo y defendiendo sus derechos sexuales y reproductivos y humanos. Utilizando un lenguaje sencillo, se presenta en siete capítulos, incluyendo en cada uno de ellos las acciones a ejecutar en caso de urgencias durante el parto, las complicaciones del embarazo, etc.

Prenatal tetanus immunization and other practices associated with neonatal tetanus.

The relationship between neonatal tetanus (NT) on one hand, and maternal tetanus immunization and other prenatal and natal practices on the other hand, was examined in a case-control study done at San Lazaro Hospital (SLH) in Manila from late 1990 to mid 1991. Included as cases were 54 patients diagnosed as NT on the basis of WHO criteria, and 50 controls who were patients 0-4 months of age, hospitalized at SLH during the study period and with no past history of tetanus. The result showed that the following were statistically associated with the risk of NT: home delivery (OR = 30.5); delivered by a traditional birth attendant (OR = 5.2); use of instrument other than scissors to cut the cord (OR = 19.3); traditional birth attendant who dressed the cord (OR = 12.7); and having less than two doses of tetanus toxoid (OR = 15.3). The need to intensify prenatal tetanus immunization, health education of the mothers as well as the training of birth attendants is evident from this study if NT has to be prevented.