Cesarean section.

PIP: The leading cause of maternal mortality and morbidity in developing countries is the lack of cesarean section deliveries due to the tremendous logistical, cost, and training problems associated with this procedure. This article describes the need for raising cesarean section rates in developing countries and what can be done with existing inadequate health care in these countries to increase these rates. 5 to 10% of all births should be done by cesarean section, yet only 0.3% of births in rural Zaire are cesarean sections. To help educate health officials about women who may need a cesarean section, this article provides: 5 basic warning signs of pregnancy complications, characteristics of high risk women, and women in their 3rd trimester who need to be referred. Crucial factors that delay mothers from getting prenatal care include cultural obstacles and undereducated traditional birth attendants. Complication signs include severe vomiting, swelling of face, feet and hands, vaginal bleeding, headache and fever. High risk mothers are age 18 or 35 years, have had 5 or more previous births, and under 150 cm. in height, experienced an abortion or stillbirth with previous pregnancy or delivered by cesarean section, had previous cephalo-pelvic disproportion or in labor 12 hours, or has chronic medical problems. Third trimester women experiencing or developing hypertensive diseases, non-vertex presentation, severe anemia, multiple birth or antepartum bleeding should be referred to a health center where a cesarean can be done if necessary.^ieng