Review of shoulder dystocia at the Birmingham Women's Hospital.

A retrospective audit was performed of all deliveries between 1 January 1991 and 31 December 1995 at the Birmingham Women's Hospital, the main University Teaching Hospital in the West Midlands. This was performed by using the computer database of all hospital deliveries, at the Women's Hospital during the above-mentioned period, by entering a CCL code for shoulder dystocia. During that period of time there were 28 932 deliveries with a mean caesarean section rate of 16.7%. One hundred and fifty-four cases were identified, of which 134 case notes were available for review. The incidence of shoulder dystocia was 0.53%. Audit was performed of pre-pregnancy, antepartum and intrapartum risk factors, the severity of shoulder dystocia, the category of person delivering the baby, fetal outcome at birth and subsequent pregnancy outcome in cases of those with subsequent pregnancies. Overall, the majority of cases of shoulder dystocia were mild, and dealt with by midwives (101 cases 74%). No severe cases were encountered, however three out of eight moderate cases delivered by obstetricians had evidence of fetal trauma (one Erbs palsy and two limb fractures). Twenty women had a pregnancy after the pregnancy complicated by shoulder dystocia. Of these, 18 women delivered vaginally and there were two cases (10%) of repeat shoulder dystocia.

Health and the environment-a comparative study of agricultural and industrial workers in Nigeria.

Although several attempts have been made in the developed countries to study the effect of various environmental factors on morbidity, it is disappointing that in developing countries where very poor conditions exist, very little information is available on the subject. This study was therefore designed to examine the influence of the living and working environment on the state of health of two groups of Nigerian workers namely farmers and industrial workers. The study was carried out in two villages Badeku and Ewekoro. 200 farmers from Badeku and 150 industrial workers from Ewekoro were selected by appropriate sampling methods. Most of the data were obtained by means of a questionnaire administered by the authors. In addition to a detailed clinical examination of each subject, blood stool and urine specimens were obtained for laboratory investigations. A high incidence of hookworm and ascaris infection, anaemia, leg ulcer, malaria parasitaemia and onchodermatitis was found among the farmers. The industrial workers on the other hand had a higher incidence of chronic bronchitis and hypertension. Some of these findings have been attributed to poor environmental hygiene of the homes and work places, atmospheric pollution and other health hazards associated with living and working in the rural areas.

Infection of the mastoid bone with a Paragonimus-like trematode.

Three unusual cases of mastoid abscess are described. Case histories and the clinical, laboratory, radiological, surgical, and histopathological findings in the patients are reported. Operculated eggs measuring about 60 mu times 40 mu were seen in pus obtained from two cases, but no adult worm was recovered. The findings suggest that the infections could have been caused by either Paragonimus species or Poikilorchis (Achillurbania) species.