Pharmacological measures to prevent post-operative urinary retention; a prospective randomized study.

One hundred patients undergoing vaginal surgery for genital prolapse were randomly allocated to one of four post-operative management groups which included a control group and three groups receiving differently acting pharmacological agents (distigmine bromide, phenoxybenzamine hydrochloride, and prostaglandin F2 alpha) variously reported as being useful in preventing urinary retention after vaginal surgery. The incidence of an elevated residual volume in the control group was 10.7%. All the pharmacological agents appeared to increase by about three times the incidence of an elevated residual urinary volume with statistical significance (P less than 0.05) being noted for distigmine bromide and PGF2 alpha. While this increased incidence occurred irrespective of the type of surgery in the case of distigmine bromide and phenoxybenzamine . HCl, the increase was most marked (P less than 0.01) when PGF2 alpha was used after anterior repair surgery.

Computerization of data: a person-based medical record system.

The collection and evaluation of obstetric data is essential for assessing the effectiveness of the health and social services in a country. A computerized system in use on a national level is described. The person-based system aims to include all patients who encounter government medical services, including obstetric and infant data. The scope of the service is to make individual patient records easily available to the practitioner, but is designed to allow statistical analysis of the data.

Risks in pregnant teenagers.

The teenage population delivering in Malta during 1983-1986 were identified and the maternal characteristics and obstetric outcome of these patients were statistically compared to those of mothers aged 20-29 years. Teenage mothers were more likely to be primigravida and poor attenders for antenatal care. They were more likely to be cigarette smokers and the pregnancies were more frequently complicated by threatened abortion. The perinatal mortality and morbidity was increased from problems of prematurity.

Anti-Co3 and severe hemolytic disease of the newborn.

Irregular antibodies have been described to cause hemolytic disease of the newborn of varying severity. A case of anti-Colton 3 causing moderate to severe hemolysis in the newborn in two pregnancies is described. Only two cases of hemolytic disease of the newborn have been previously described; these resulted in mild hemolysis. The management of the condition is reviewed in the light of the current management of hemolytic disease of the newborn.

Multiple pregnancy in the Maltese population.

This study analyses the multiple birth statistics for the Maltese Islands since 1959. Hospital twin births delivering during the period of 1983-1985 are analysed for a number of variables. The incidence of multiple pregnancy for the Maltese Islands appears to have decreased slightly since 1959 with an overall rate of 10.21 per 1000 maternities. The ratio of dizygotic to monozygotic twinning was computed to be 1.64. Patients with multiple pregnancies are shown to be generally elderly and multiparous. The pregnancy outcome is more likely to be complicated by an operative delivery, while the infant is more likely to be premature and of low birth weight. The perinatal mortality rate for multiple pregnancies is markedly in excess of that for singleton births.

Maternal mortality in the Maltese Islands.

Maternal mortality statistics from the Maltese Islands since 1935 are reviewed to show that there has been a marked decrease in maternal mortality rates. This decrease is probably related to reductions in family size and improvements in the perinatal care of mothers. Hypertensive disease is now the most important cause of maternal mortality.

PIP: This study attempts to analyze national maternal mortality and morbidity statistics collected for the Maltese Islands since 1935 in order to identify the current major causes of maternal deaths on the Islands. In 1926, the maternal mortality rate was an estimate 387.3/100,000 live births, white the rate in 1982 was 32.9/100,000 live births. This reflects a sharp decrease in the last 45 years. This decrease is probably related to reductions in family size and improvements in the preinatal care of mothers. Maltese women are having fewer pregnancies, are beginning childbearing when they are in their 20s or early 30s and are spacing their pregnancies at longer intervals. Improvements in the socioeconomic status of pregnant women in the Maltese Islands have also played an important role in decreasing maternal mortality and morbidity. hypertensive disease is now the most important cause of maternal mortality.

Endometrial adenocarcinoma in the Maltese population an epidemiological study.

The Maltese population has been shown to have a high incidence of endometrial adenocarcinoma when compared to other European countries. This high incidence has been correlated to the high prevalence of abnormal glucose metabolism and rather high dietary fat intake in the Maltese population. Hypertension and low parity were also found to be more frequent in the carcinoma group.

Perinatal mortality in the Maltese Islands.

This study analyzes the perinatal mortality statistics for the Maltese Islands since 1950 and compares them to those of other European countries. The mortality rate has taken a variable downward trend which can be correlated to important events during this period. Hospital perinatal mortality statistics are reviewed in the light of the national statistics.

PIP: This study analyzed national perinatal mortality statistics collected for the Maltese Islands in 1950-80. The perinatal mortality rate is defined as the number of stillbirths (after the 28th week of pregnancy) plus deaths occurring in the 1st week of life/1000 live births. During this period, the perinatal mortality rate showed a variable but definite downward trend that paralleled a decline in the crude birth rate. The sharp drop in the birth rate registered after 1962 may have contributed to the marked downward trend in the stillbirth rate after 1963 by decreasing the load on antenatal services. The early (1st week of life) neonatal death rate exhibited a sharp decline in 1953, which was the year several antenatal clinics aimed at serving women from the lower socioeconomic group in Malta were opened. These clinics helped to identify disorders of pregnancy that contribute to chronic placental insufficiency and fetal anoxia. Also contributing to the decline in perinatal mortality has been the increase in hospital versus home deliveries. In 1979, home deliveries accounted for only 1.8% of all deliveries in the Maltese Islands. The main government teaching hospital (St. Luke's) accounted for 54.9% and a smaller state-run hospital (Craig) delivered 4.6%; 2 private hospitals, St. Catherine's and Blue Sisters', delivered 21.8% and 16.9%, respectively. In 1980, maternity services at the 2 private hospitals were terminated, but a new maternal and child health complex equipped to provide better intrapartum and postpartum care was established at St. Luke's Hospital. An analysis of 339 perinatal deaths registered at St. Luke's Hospital in 1979-82 indicated that 54.6% were due to unavoidable factors, 33.6% involved avoidable factors attributable to the hospital or to factors outside the hospital, and 11.8% were unexplained. Facilities now exist to reduce perinatal mortality in the Maltese Islands even further; efforts must now be made to identify high-risk pregnancies earlier and more precisely.

Homozygous beta thalassaemia and pregnancy.

Pregnancy complicating homozygous beta thalassaemia is a rare entity. Two cases are described, 1 of which was further complicated by thrombocytopenia due to secondary hyperslenism. These cases are discussed in the light of current management of homozygous haemoglobinopathies.

Pharmacokinetics of ethynyloestradiol in women for different populations.

The pharmacokinetics of a dose of 50 microgram ethynyloestradiol administered orally was studied in fourteen centres. Absorption was rapid and the highest serum concentrations of total ethynyloestradiol were found in most subjects at 1 h and by 24 h concentrations were less than 250 pg/ml. Calculation of the half-lives for absorption, distribution and elimination showed wide variations between subjects, the half-life of elimination varying from 2.5 h to more than 30 h. Bioavailability as measured by the area under the serum ethynyloestradiol concentration-time curve also showed more than a ten-fold variation. Intra-centre differences in the various parameters measured were as large as the inter-centre differences.

Rate of metabolism of norethisterone in women from different populations.

The rate of metabolism of orally administered norethisterone was compared in fourteen centres by measuring plasma levels of the steroid by radioimmunoassay at varying times after oral administration of a 1 mg dose. The inter-centre differences were of the same order as the intra-centre differences. Variations in metabolism appeared not to be due to variations in body size.

Obstetric deaths in Lusaka.

A detailed study of the obstetric services in Lusaka is presented. The maternal and perinatal mortality rates for 1976 were estimated at 1.7 and 55.1 per 1000 live births respectively. The persistent increase in mortality suggests a fall of accepted standards of maternity care. The causes of deaths are discussed. Avoidable factors were identified in 79.6% of the maternal deaths and 49.1% of the stillbirths. Recommendations are made for a more integrated type of maternity service, provisions of maternity centres, education programmes for the public and a more thorough perinatal care. Only a concerted effort of this nature will eventually result in a satisfactory progress in the obstetric services and a reduction of obstetric deaths and morbidity.

Preoperative cervical dilatation with 15(S)15-methyl PGF2alpha methyl ester pessaries.

A clinical trial comparing two vaginal dose schedules of 15(S)15-methyl prostaglandin F2alpha (PGF2alpha) methyl ester (4 or 6 mg) for preoperative dilatation of the cervix is described. The trial included 28 patients at 8-12 weeks' gestation. Vaginal pessaries containing either 1.0 mg (15 patients) or 1.5 mg (13 patients) of the prostaglandin analogue were administered every 3 hours (maximum, 4 doses). The success rates for the two groups were 93% and 100%, respectively. Sixty percent of the patients aborted before the planned vacuum aspiration. Minor side effects, primarily vomiting and diarrhea, occurred in approximately 80% of the cases and were more prominent with the higher dose pessary. It is concluded that the vaginal administration of 15(S)15-methyl PGF2alpha methyl ester is highly effective for preoperative dilatation of the cervix before suction curettage abortion.

PIP: A clinical trial comparing 2 vaginal dose schedules of 15(S)15-methyl prostaglandin F2alpha (PGF2alpha) methyl ester (4 or 6 mg) for preoperative dilatation is described. The trial included 28 patients at 8-12 weeks gestation. Vaginal pessaries containing either 1.0 mg (15 patients) or 1.5 mg (13 patients) of the prostaglandin analogue were administered every 3 hours (maximum, 4 doses). The success rates for the 2 groups were 93% and 10% respectively. A 96.4% overall success rate is comparable to that achieved in other studies. 60% of the patients aborted before the planned vacuum aspiration. Minor side effects, primarily vomiting and diarrhea, occurred in approximately 80% of the cases and were more prominent with the higher dose pessary. Since this higher dosage produced an unacceptably high occurrence of gastrointestinal side effects, the lower dosage of 4 mg is preferable. It is concluded that vaginal administration of 15(S)15-methyl PGF2alpha methyl ester is highly effective for preoperative dilatation of the cervix before suction curettage abortion.

Cervical cytology in Zambia.

The problem of cervical cancer in Zambia is discussed. The pathogenesis of carcinoma of the cervix is described and the benefits of cervical cytology are highlighted. The role of cervical cytology in the context of a developing country is also discussed and a plea is made for a selective mass screening programme, the objective of which will be to limit and prevent cancer of the cervix. The establishment of a Central Cytology Laboratory at the University Teaching Hospital is described in some detail. This service could be extended in stages until it is possible to screen all women over the age of 20 years, at least every 3 years.

An evaluation of cervical cytological screening in the University Teaching Hospital, Lusaka.

A diagnostic cytology service was started in the Obstetric and Gynaecology Department of University Teaching Hospital, Lusaka in September, 1974. Its primary aim was to diagnose precancerous lesions or early invasive cancer of the cervix. However, the service was offered to other disciplines in the hospital who could benefit from cytology. During the two and a half period, September 1974, to 31st December 1976, 2,877 cervical smears were examined. Of these, 138 smears (4.8%) showed evidence of cellular abnormality consistent with dysplasia, carcinoma in situe, or invasive cancer. Trichomonas vaginalis was diagnosed in 464 cases (16%), Candidiasis in 89 (3.1%), and Schistosomiasis in 19 (0.7%).

Treatment of acute pelvic infections with alphacillin (pivampicillin Hcl).

Fifty patients with acute pelvic inflammatory disease were treated with Alphacillin (Pivampicillin Hcl). The total daily dose consisted of 1050mg, given in three divided doses. Treatment was continued for six days. Full bacteriological investigations were performed. Therapy was continued so long as the condition of the patient improved. In case of failure change to other antibiotics or surgery were considered. The clinical response to Alphacillin was considered successful in 92% of patients. A significant observation in the trial was the low rate of residual pelvic pathology especially in patients with Acute/Chronic pelvic infection. The drug was found to be free from complications or any serious side effects. Mild epigastric discomfort was noticed in only 3 patients.

Induction of second-trimester abortion with a single dose (40 mg) of intra-amniotic prostaglandin F2a.

PIP: The study objective was to determine the effectiveness and safety of a single high dose (40 mg) of intraamniotically administered prostaglandin F2alpha (PGF2alpha). A total of 33 women in their 14-20th week of pregnancy were selected for the study. The outcome was considered successful if the fetus and/or placenta were expelled from the uterus within 48 hours. If the fetus and placenta were expelled completely through the cervical canal the trial was recorded as complete abortion. If the placenta was retained within the uterus, completely or partially, the trial was recorded as incomplete abortion. The patients' mean age was 22.6 years. 27 patients were under 28 years of age, and 9 patients were under age 20. 25 patients were African, 2 Caucasian, and 4 Asian. 2 others were of mixed race. The mean parity of the patients was 1.4 previous pregnancies with a standard error of +or- 1.4. 17 women were nullipara; 16 women were multipara. There was 1 case of technical failure in the series, an obese Asian patient with a 16 week pregnancy in whom difficulty was experienced in entering the amniotic sac. A bloody tap during amniocentesis was obtained in 4 patients. 28 of the 32 patients aborted within 48 hours, showing a success rate of 87.5%. At the end of the first 24 hour period, 19 patients (59.4%) had aborted and an additional 9 patients (28.1%) aborted during the following 24 hours. The mean induction abortion interval was 19.4 hours. Multiparous patients aborted more frequently and in a shorter period of time than did nulliparous patients. 92.3% of the multiparous patients aborted by 30 hours; only 84.2% of the primigravida had achieved this in 36 hours. In the successful group abortion was complete in 13 patients (46.4%). In the other 15 patients (53.6%) the placenta was partially or completely retained necessitating surgical evacuation. Minor side effects were observed in 28 patients (87.5%). None of these side effects required analgesia in the form of intramuscular pethidine. Gastrointestinal disturbances were common. Vomiting occurred in 11 patients. Diarrhea occurred in 3 patients. No instances of cervical laceration or cervicovaginal fistula were observed. Bleeding was minimal in 27 patients (84.4%). In another 5 patients the amount of bleeding was moderate. In the majority of patients bleeding ceased with 2 weeks after discharge from hospital. None of the patients needed hospital readmission. No signs of vaginal or pelvic infection or delayed uterine involution were observed.^ieng

Epidemiological aspects of acute pelvic inflammatory disease in Uganda.

PIP: The frequency of pelvic inflammatory disease (PID), a major gynecological problem in Uganda, has been largely attributed to the prevalence of gonorrheal infection, although other etiological factors must be considered. This paper analyzes some of the epidemiological aspects of the disease, using data from a prospective and comprehensive study of a series of 86 patients with acute PID admitted to the gynecological ward at Mulago in a 3-month period. A matched control of 100 patients admitted for conditions other than pelvic infection was used for comparison. 59% of the patients were between 20 and 29 years old (Table 1) and 74% were married (only 23 of these did not share their husbands with other wives or concubines) (Table 2). There was a high rate of sterility among the patients, averaging 25.6%, compared to 15% in the control group. Ther was an average of 2.89 pregnancies per parous patient, compared to 3.76 in the control group. Rate of pregnancy wastage was 28.6%, 50% of which were due to abortions. Table 4 shows that sexual activity starts at an early age (14 or earlier) among the local population. Most of the subjects belonged to lower socioeconomic class. Gonococal infection, the commonest etiological factor, was confirmed by bacteriological examination in 33 patients (38.3%). The incidence of PID in developing countries can be reduced through preventive measures and better midwifery services. Health education on venereal diseases, sex and family life should be aimed at a younger age. Expansion of maternity services in the rural areas should also help reduce the incidence.^ieng