The productive operating theatre and lean thinking systems.

The concept of 'lean thinking' first originated in the manufacturing industry as a means of improving productivity whilst maintaining quality through eliminating wasteful processes. The purpose of this article is to demonstrate how the principles of 'lean thinking' are relevant to healthcare and the operating theatre, with reference to our own institutional experience.

Eclampsia, study of 342 cases.

OBJECTIVES: To conduct a prospective review of all cases of eclampsia over a 4-year period and to establish prognostic factors that may assist in reducing morbidity and mortality in these patients. METHODS: The population studied was split into two groups: Group1 (survivors) and Group 2 (deceased). We compared their demographic, clinical, biological and radiological data. Patients were regularly followed for 2 months after discharge. Quantitative and qualitative statistic tests were used. RESULTS: 342 cases of eclampsia were studied. Based on 37,467 pregnancies in the 4-year period, in our catchment area, we estimated an overall incidence of 0.91%. 62.5% of patients were nulliparous and 82% of all patients had no ongoing antenatal care. 71% were delivered by Cesarean section. 23 (6.7%) maternal deaths were recorded. Our findings suggested that poor prognosis factors were: diastolic blood pressure 115 mm Hg, Glasgow Coma Scale 8, thrombocytopenia, liver cytolysis, acute renal failure, cerebral edema and hemorrhage, and pulmonary edema. CONCLUSIONS: This disease remains a veritable health problem in our country. We need to improve antenatal follow-up by increasing mothers' awareness and by facilitating access to medical care.

Pneumomediastinum and pneumothorax associated with labour.

A 19-year-old primiparous woman in labour presented with spontaneous pneumomediastinum, pneumothorax and surgical emphysema. The membranes were intact and the fetus had a breech presentation. There was little improvement in her symptoms and labour progressed slowly. A caesarean section was performed under intrathecal block resulting in the birth of a healthy infant. The patient's symptoms resolved with supportive management. This condition is very rare and is generally self-limiting. Management aims to avoid worsening of pneumothorax and pneumomediastinum. Recurrence is unlikely.