ABSTRACT
The Confidential Enquiry into Maternal Deaths (CEMD) in South Africa has been operational for 15 years. This case study describes the process of notification and independent assessment of maternal deaths, predominantly in facilities. In the earlier years of the Enquiry, institutional maternal mortality ratio increased and was 176.2 per 100 000 live births in the 2008-10 triennium; thereafter it decreased to 146.7 in the 2011/12 period. The slow progress was due to the significant contribution of HIV/AIDs to maternal mortality and challenges in implementing the recommendations that were devised from the findings of the Enquiry. Nevertheless, the CEMD process has been maintained and strengthened so it is currently able to perform routine maternal death surveillance at both national and district levels, identify deficiencies within the health system, generate reports and also provide early warning about alarming trends such as the increasing numbers of deaths due to caesarean-section-associated haemorrhage.
Subject(s)
Maternal Mortality , Confidentiality , HIV Infections/epidemiology , Humans , Maternal Mortality/trends , Organizational Case Studies , Population Surveillance , South Africa/epidemiologyABSTRACT
OBJECTIVE: To determine whether antepartum X-ray pelvimetry (XRP) reliably identified women suitable for a trial labour or repeat elective caesarean section after one previous section. DESIGN: A prospective controlled trial in which women were randomly allocated to either an antepartum XRP group who had XRP at 36 weeks gestation to determine mode of delivery, or a control group who had a trial labour without antepartum XRP. Following delivery, all controls had postpartum XRP. SETTING: Department of Obstetrics and Gynaecology, King Edward VIII Hospital, Durban, South Africa. SUBJECTS: Three hundred-six women with a history of one previous caesarean section. MAIN OUTCOME MEASURES: Mode of delivery, birthweight and maternal and perinatal mortality and morbidity in the two groups. RESULTS: In the antepartum XRP group, 23 of 144 (16%) of women delivered vaginally compared with 60 of 144 (42%) controls (P < 0.0001). Of the 84 women with adequate antepartum XRP only 23 (27.7%) delivered vaginally. In the control group, 33 of 60 (55%) women who had vaginal deliveries had inadequate postpartum XRP and would have had a caesarean section if this information was known in the antepartum period; 62 of 84 (74%) caesarean sections in the control group had adequate postpartum XRP. Birthweight of the infants was similar in the two groups. There were no maternal or perinatal deaths. Maternal morbidity was similar in the two groups. Neonatal morbidity was minimal. CONCLUSION: Antepartum XRP is not necessary prior to a trial labour in women with one previous caesarean section. It increases the caesarean section rate and is a poor predictor of the outcome of labour.
Subject(s)
Pelvis/diagnostic imaging , Vaginal Birth after Cesarean , Adult , Birth Weight , Cesarean Section , Female , Gestational Age , Humans , Maternal Age , Parity , Pelvimetry/methods , Pregnancy , Prenatal Care , Prospective Studies , Radiography , Trial of LaborABSTRACT
Labor outcome of primiparae less than 17 years was compared with non-juvenile primiparae in a population with a high incidence of contracted pelvis. Juvenile primiparae were referred to hospital on the basis of age, whereas non-juveniles were referred for an obstetric complication. There was no statistical difference in rates of cesarean section, Ventouse, operative delivery, low birth weight, or perinatal mortality between 538 juveniles and 5294 older "high risk" mothers. Symphysiotomy rates were actually higher in the juveniles (12.6% vs. 9.7%, P less than 0.05). These data support the practice of hospital referral for juvenile African women in labor.
Subject(s)
Obstetric Labor Complications/epidemiology , Pregnancy in Adolescence , Adolescent , Adult , Birth Weight , Cesarean Section , Developing Countries , Female , Humans , Infant, Low Birth Weight , Infant, Newborn , Parity , Pregnancy , Risk Factors , South Africa , SymphysiotomyABSTRACT
Between January 1982 and April 1985 13 patients with severe secondary postpartum haemorrhage after caesarean section were seen at King Edward VIII Hospital, Durban. The bleeding occurred in the second, third and fourth weeks after delivery, but there were no maternal deaths. Eight of these patients were treated by total abdominal hysterectomy and 1 by revision of the uterine wound and ligation of the bleeding uterine vessels. The last 4 patients, seen in 1985, were treated by selective transcatheter embolisation with Gelfoam pledgets. This method was successful in 3 patients and failed in 1. It is suggested that the latter method has a place in the treatment of these patients.
Subject(s)
Cesarean Section/adverse effects , Postpartum Hemorrhage/etiology , Embolization, Therapeutic , Female , Humans , Postpartum Hemorrhage/surgery , Pregnancy , Surgical Wound DehiscenceABSTRACT
Amniotic fluid prostaglandin levels were measured serially in 15 patients who underwent successful induction of labor and compared with those of patients presenting in spontaneous labor. At comparable cervical dilation the induced group demonstrated significantly lower prostaglandin levels. Four of these patients delivered without any increment in prostaglandins while in the remaining patients increases in prostaglandins followed the attainment of efficient uterine contractions by several hours. These data support the hypothesis that oxytocin acts directly on myometrial cells and not primarily by prior generation of prostaglandin synthesis in the membranes.
Subject(s)
Amniotic Fluid/metabolism , Dinoprostone/analogs & derivatives , Labor, Induced , Oxytocin , Prostaglandins E/metabolism , Prostaglandins F/metabolism , Female , Humans , PregnancyABSTRACT
Ultrasonographic placental grading for estimation of fetal maturity before elective caesarean section was assessed at 38 weeks' gestation in 100 patients. It was impossible to grade the placenta in 5 cases, but in 95 it could be graded with confidence. In 90 cases the placenta was graded as II or III, and all the infants in these two groups had achieved lung maturity. Five patients had grade I placentas, and one of these patients had an immature baby. Amniocentesis for determination of the lecithin/sphingomyelin ratio and the presence of phosphatidyl glycerol was attempted in all cases. We failed to obtain liquor amnii from 6 of the 100 patients.
Subject(s)
Gestational Age , Placenta , Cesarean Section , Female , Humans , Phosphatidylcholines/analysis , Phosphatidylglycerols/analysis , Pregnancy , Sphingomyelins/analysis , UltrasonographyABSTRACT
A patient with septic abortion complicated initially by hepatorenal failure and later by rhinocerebral phycomycosis (mucormycosis) is described. It is believed that the outcome was fatal because the patient was diabetic and had been extensively treated with antibiotics.
Subject(s)
Abortion, Septic/complications , Mucormycosis/complications , Acute Kidney Injury/complications , Adult , Anti-Bacterial Agents/adverse effects , Brain Diseases/complications , Female , Humans , Nose Diseases/complications , Pregnancy , Pregnancy Complications, Infectious , Pregnancy in Diabetics/complicationsABSTRACT
Six cases of fetal ascites are described. The condition was associated with bowel perforation, congenital heart disease, cardiopulmonary hypoplasia and syphilis, and syphilis alone; there was no identifiable cause in 1 case. All the infants died.
