Maternal deaths in 1990 at Kamuzu Central Hospital

The records of 74 maternal deaths were available. It was clear that most of these deaths resulted from very basic problems; and not from a lack of high technology. The majority were direct deaths; and of these 52 percent arrived in such poor condition that they died within 24 hours; and half of these died from haemorrhage. The availability of blood is poor in all hospitals

Retrospective study of 600 consecutive admissions with abortions at Kamuzu Central Hospital.

PIP: In Malawi, physicians analyzed retrospective data on 600 consecutive abortion cases who were admitted to the gynecology ward at Kamuzu Central Hospital in Lilongwe during January-May 1990. These cases comprised 45% of all admissions to this ward during the study period. 71% of the patients had first-trimester abortions and 29% had second-trimester abortions. 85% of cases were admitted with incomplete abortion, 38% of whom were septic. 38 abortion cases required a blood transfusion. The gravidity group with the greatest number of patients was the primigravidity group (about 170), followed by gravidities 3 and 2 (100 each). 33 (5.5%) women had an obvious induced abortion. There may have been more induced abortions, since women tend not to admit to induced abortion. 24 of the obvious induced abortion patients were students and primigravidae. Six women, all of whom had an induced abortion, required major surgery. Three of these women died. An educated mother of four sought the help of a traditional healer who had induced the fatal abortion with sticks. The healer had perforated the left cornu of the uterus, which later necrotized. Surgeons performed a subtotal hysterectomy with bilateral salpingo-oophorectomy. Traditional healers also used sticks to induce an abortion in a 20-year-old student and a 22-year-old student, resulting in a perforated uterus in both cases. Necrosis of the uterus developed. Surgeons performed a subtotal hysterectomy in both cases. The 20-year-old died 19 days later. The 22-year-old recovered. The other two surgery patients were 20- and 22-year-old primigravidae. Sticks were used to induce their abortions. Surgeons performed laparotomy on and drained pus from the 22-year-old. Postoperatively, she suffered from a burst abdomen. She was HIV-positive. The 20-year-old suffered from a perforated uterus and a hematoma in the right broad ligament. Surgeons performed a total hysterectomy. Both women recovered.^ieng

Perinatal mortality rates in isolated general practitioner maternity units.

OBJECTIVE: To determine the perinatal mortality rate among normally formed, singleton babies with birth weights greater than or equal to 2500 g in Bath health district based on the intended place of delivery at the time of onset of labour or at the time of diagnosis of intrauterine death. DESIGN: The numbers of live births and stillbirths were collected monthly returns from the maternity units concerned. Deaths of infants aged less than or equal to 1 week were collected in the same returns. The intended place of delivery was confirmed at the monthly perinatal mortality meeting, during which maternal and fetal factors were discussed. SETTING: A rural health district of 400,000 population where one third of all deliveries occurred in seven isolated general practitioner maternity units, 8% in the integrated general practitioner unit, and the remainder in the consultant unit. SUBJECTS: All babies of women whose deliveries were booked in the district before the onset of labour or the diagnosis of intrauterine death, excluding twins, babies with lethal congenital malformations, and those less than 2500 g. MAIN OUTCOME MEASURES: Outcome of all deliveries and parity of mothers. RESULTS: 14,415 Deliveries were analysed. The perinatal mortality rate was 2.8/1000 births in the consultant unit (7950 deliveries), 4.8 in the isolated general practitioner units (5237 deliveries), and zero in the integrated general practitioner unit (1228 deliveries). Perinatal deaths attributable to asphyxia were more common in the isolated general practitioner units (1.5 per 1000) than the consultant unit (0.6 per 1000). The perinatal mortality rate among babies born to nulliparous women was 3.2/1000 births in the consultant unit and 5.7 in the isolated general practitioner units; for those born to multigravid women it was 2.4 and 4.2 respectively. CONCLUSIONS: The outcome of delivery was not influenced by parity. Both antenatal and intrapartum care were responsible for the higher perinatal mortality rate in the isolated general practitioner units. The integrated unit, which shared midwifery staff with the consultant unit, seemed to work well. Analysis by intended place of delivery at the time of onset of labour or diagnosis of intrauterine death suggested that the care given in isolated units needs to be improved, perhaps by better training of general practitioners and consultant supervision of antenatal care.