ABSTRACT
PIP: Because of the psychological effects of cultural beliefs about death among Bantu peoples, women in Zaire who experience intrauterine deaths of their babies desire rapid expulsion of the fetus. From January 1980-December 1983, 60 intrauterine deaths occurred among 21,836 deliveries at the Department of Gynecology and Obstetrics of the University Clinics of Mont Amba in Kinshasa, Zaire. A retrospective study was conducted of the records of the 47 women in whom fetal death did not occur during delivery. Labor was induced by intraamniotic instillation of hypertonic saline solution in 19 cases in which labor did not spontaneously begin. Women with cardiac or renal problems, hypertension, severe anemia, or intrauterine hemorrhage were excluded. The pregnancy ages varied from 22 to 45 weeks at the moment of diagnosis and averaged 33 weeks. The time elapsed between the injection of the saline solution and the beginning of uterine contractions varied from 6-24 hours. The duration of labor varied from 9-24 hours and averaged 15 hours. Complications included 2 cases of complete and 1 of partial retention of the placenta, 2 cases of hemorrhage due to low serum fibrinogen levels, and 1 case of uterine rupture during labor. In the 2 cases of afibrinogenemia, the serum fibrinogen levels were under 250 mg/100. The sole indication for this procedure in this obstetrical service is fetal retention following death in utero in the last 2 trimesters of pregnancy. Prostaglandins are not routinely available as yet. Saline instillation under the circumstances has proven satisfactory even though sonography is not available for locating the placenta.^ieng
