Randomized study of antibiotic prophylaxis for general and gynaecological surgery from a single centre in rural Africa.

In a district rural hospital in Uganda, 850 surgical patients were evaluated prospectively over a 3-year period to compare the clinical efficacy of conventional postoperative penicillin therapy with single-dose ampicillin prophylaxis for hernia repair and ectopic pregnancy, and with single-dose ampicillin-metronidazole prophylaxis for hysterectomy and caesarean section. The high rate of postoperative infection usually encountered in African hospitals after conventional treatment with penicillin for 7 days was significantly reduced with the new regimen: from 7.5 to 0 per cent in hernia repair and from 10.7 to 2.4 per cent in ectopic pregnancy; from 20.0 to 3.4 per cent in hysterectomy and from 38.2 to 15.2 per cent in caesarean section. Length of hospital stay and postoperative mortality rates were also significantly reduced. Single-dose ampicillin prophylaxis with or without metronidazole, although rarely used in developing countries, is more cost effective than standard penicillin treatment.

Comparison of pregnancy and labour in teenagers and primigravidas aged 21-25 years in Transkei.

The outcome of pregnancy and labour in 601 primigravidas aged 19 years and under was compared with that of 221 primigravidas aged 21-25 years. The risks of antenatal complications, such as anaemia, haemorrhage and pre-eclampsia, were the same in both groups. The much-published low birth weight of babies born to teenagers was not observed; the weights of the babies in the two groups were similar. The caesarean section rates of 12% and 15% for the study and control groups, respectively, compared very well with the rate in the general obstetric population, indicating that the risk of cephalopelvic disproportion (the commonest indication for caesarean section) is the same among all primigravidas, whatever their age. The perinatal mortality rate was, however, slightly higher among the teenagers (58,2/1,000) than among the older mothers (40,7/1,000), although the difference was not statistically significant. Therefore the notion held by many people who practise midwifery that teenage mothers are, because of their age alone, more disadvantaged in terms of obstetric performance, is not absolutely true.

The pituitary reserve for gonadotrophins and prolactin in women under long-term use of depo-medroxyprogesterone acetate (DMPA) as a contraceptive.

PIP: Pituitary reserve was assessed in women who had used depo-medroxyprogesterone acetate (DMPA) for 1, 5 and 10 years, and their responses were compared to 2 control groups--IUD users and noncontraceptive users. 100 ug GnRH and 200ug TRH were injected as a bolus and the Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and Prolaction (PRL) responses noted. The basal PRL levels were similar in all groups. The PRL response to stimulation was significantly greater among 5 and 10 year DMPA users and also IUD users. The mean basal levels of LH were within the normal follicular phase range in all groups. However, the response to stimulation was significantly higher among 1 and 5 year DMPA users when compared with noncontraceptive users. The basal serum FSH levels in both the study and control groups were comparable to those of normally cycling women in the follicular phase. The response to stimulation was greater in the 10 year DMPA users when compared to both the noncontraceptive users and IUD users. The study shows that basal levels of FSH, LH and PRL were similar in the study and control groups. The observed amplified response to stimulation among longterm DMPA users could be the result of failure of gonadotropin cyclic release, possibly resulting in increased pituitary reserves.^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