Obstructed labour: its contribution to maternal mortality.

Every year 85,000 women die from obstructed labour and many many more lose their baby and have debilitating physical damage as a result. In this paper the extent of the problem is described. Methods by which obstructed labour can be prevented are given. Early detection and prompt referral for appropriate treatment are vital if damage is to be minimised. This requires particular attention in midwifery education which must include community experience which fosters dialogue and strengthens prevention. This paper is based on one originally given at the ICM/WHO/UNICEF pre-congress workshop in Kobe, Japan, October 1990.     

Obstructed labor in Ibadan.

Over a period of 13 years, 380 cases of obstructed labor were managed amongst 39,456 deliveries. Absent prenatal care and poor intrapartum care at peripheral hospitals were major contributing factors. The average duration of labor in those with obstruction was three times that in the normal obstetric population. About 82% of patients with obstruction had an emergency cesarean section while 10% had destructive operations. The main etiological factor was unrecognised positional disproportion. Common associated complications were ruptured uterus, genital and wound sepsis. Maternal and perinatal morbidity and mortality were high. Adequate health education, incorporation of traditional birth attendants into health care programs and the provision of more health care centers will reduce the occurrence of this complication.     

排便障碍综合征及其评估手段

排便障碍综合征是一种常见的盆底功能障碍性疾病,病因包括肛门直肠结构和(或)功能的异常,大多数患者为功能性排便障碍。形态学和功能学检查手段有助于明确病因,也为手术治疗提供了重要依据。     

Obstructed Labour Due to a Vesical Calculus

EDITORIAL COMMENT: We accepted this short case report because although the condition is rare it is appropriate for obstetricians to know that a vesical calculus can cause obstructed labour as in this primipara.     

Obstetric fistula: a preventable tragedy

Obstetric fistula disables millions of women and girls in developing countries, primarily in sub-Saharan Africa and South Asia. The United Nations Population Fund (UNFPA) recently launched a global campaign to end fistula, labeling this condition a preventable and treatable tragedy. Obstetric fistula overwhelmingly results from obstructed labor, which occurs in cases of cephalopelvic disproportion and malpresentation. Cephalopelvic disproportion often complicates deliveries in young, primiparous women of low gynecologic age. Social factors, including young age at marriage and malnutrition of girl children, can also contribute to cephalopelvic disproportion. These social etiologies must be addressed by prevention campaigns. Direct prevention of fistula can occur during delivery when skilled providers identify women and girls at risk for obstetric fistula and link them with innovative interventions, such as Fistula Prevention Centers, through which they can more readily access emergency obstetric care, and by setting strict time limits for laboring at home without progress. Community-based programs, such as the Tostan program in West Africa, use social education to prevent fistula. Moreover, effective surgical techniques for fistula repair are available in some settings and should be expanded to reach those in need. Midwives can play a key role in the prevention and treatment of this tragic obstetric complication.     

Infertility: a preventable epidemic?

Infertility with a broad etiological background has only been treated, but not prevented. With the exception of ovulation induction, the success rate of pregnancy in most cases has been rather dismal in view of the high socioeconomic burden. A questionnaire survey of the cost of infertility investigation and treatment has been undertaken, and it has been estimated that the cost of infertility due to the sequelae of sexually transmitted diseases ranges in the vicinity of $64 billion, which is to be compared with the prevention cost of $335,000. Recommendations on preventative aspects are discussed.     

Preterm labour.

Spontaneous preterm labour remains a major obstetric problem because of the high incidence of neonatal mortality or long-term handicap associated with it. The drugs available for the management of preterm labour are poorly effective and have potentially serious side-effects for the mother or fetus. In recent years, there has been a remarkable increase in the knowledge of the biochemical mechanism underlying uterine quiescence and contractility. Many of the G protein-coupled receptors that participate in the regulation of myometrial activity have been cloned and characterized, and their intracellular signalling pathways have been elucidated. The role of G protein receptor kinases in uterine tachyphylaxis is better understood. New developments in our understanding of the cellular mechanisms involved in uterine contractions in idiopathic and infection-associated preterm labour are expected, which will lead to better, more selective therapy for this problem. However, much research remains to be done before the mechanism of human parturition is fully understood.     

Alcohol abuse--a persistent preventable risk for congenital anomalies.

OBJECTIVE: To examine whether alcohol abuse (ALC) continued to be a health hazard to pregnant women in the 1990s. STUDY DESIGN: Analysis of a perinatal data base comprising 170,258 women with singleton pregnancies. Univariate cross table analysis and logistic regression were conducted to examine the association between alcohol abuse and congenital malformations coded according to the International Classification of Diseases (ICD). RESULTS: 14,727/170,258 mothers (8.6%) admitted to ALC during pregnancy and 36,705/170,258 (21.6%) to smoking. Anomaly rates for ALC (365/14,092, 4.3%) vs. Non-ALC (6187/149,344, 4.0%) differed significantly (p<0.001). The rates of specific anomalies varied between <0.1% and 1.1%. Odds ratios for 16 ICD 9 anomaly categories were >1 in 14 instances overall (Sign test, p=0.004), in 12 instances in women <30 years (p=0.08), and in 13 instances in women over 30 years (p=0.02). Congenital anomalies of the "respiratory system" (ICD9 748), of "genital organs" (ICD9 752.1), of the "integument" (ICD9 757), and "other anomalies of limbs/other musculoskeletal anomalies" (ICD 755/756) were statistically significantly associated with ALC, especially in women>30 years. CONCLUSION: ALC in pregnancy continued to be an important factor independently associated with an increased incidence of a broader range of congenital anomalies than previously recognized. Risk for anatomic anomalies was increased in offspring of ALC women over age 30, consistent with previous reports of increased risk of neurobehavioral abnormality in offspring of women over 30.     

Fetus-in-fetu: a rare entity

Fetus-in-fetu is a malformed parasitic monozygotic diamniotic twin that is found inside the body of the living child or adult. A 3-year-old male child presented with a retroperitoneal mass, which on radiological examination showed retroperitoneal teratoma. Pathological examination revealed fetus-in-fetu with partially developed vertebral column.     

Serum relaxin as a potential marker for preterm labour.

OBJECTIVE: To determine whether high serum relaxin concentrations in the 30th week of pregnancy were associated with preterm labour. DESIGN: Case-control study. SETTING: Two antenatal clinics of the Department of Obstetrics and Gynecology University Hospital of Aarhus. SUBJECTS: A cohort of 991 women (82% of 1203 eligible) in the 30th week of pregnancy attending one of the two antenatal clinics. The cases comprised 23 (2.4%) women without pre-eclampsia or small for gestational age babies, who were delivered spontaneously before 37 completed weeks gestation. The control group of 46 women was randomly selected from the rest of the cohort, all of them were delivered at term. INTERVENTIONS: Blood samples were collected at 30 weeks gestation and stored for analysis. MAIN OUTCOME MEASURES: Serum relaxin concentrations estimated by ELISA technique, length of gestation at delivery. RESULTS: The mean serum relaxin concentrations in the 30th week of pregnancy was 455 (SD 169) pg/ml and 327 (SD 139) pg/ml in the cases and controls, respectively (P = 0.003, t test). In women with preterm delivery a negative correlation was found between relaxin concentration in the 30th week of pregnancy and the gestational age at parturition (r = -0.53, P = 0.02). CONCLUSION: High relaxin concentrations may be associated with preterm delivery but the present results need confirmation in large scale studies.