Maternal mortality in Suriname: implementation of maternal death surveillance and response to reduce preventable maternal death = Maternale mortaliteit in Suriname: implementatie van maternale sterfte surveillance en response ter reductie van voorkombare moedersterfte

Dit proefschrift beschrijft het implementatie proces van moedersterfte surveillance en respons (MDSR) in Suriname met als primaire doel de reductie van voorkombare moedersterfte. Het proefschrift laat zien dat de betrokkenheid van zorgverleners en samenwerking met beleidsmakers van essentieel belang is. Onderzoek laat specifieke hiaten zien in de kwaliteit van de zorg voor vrouwen tijdens de zwangerschap en postpartum. Hierdoor kunnen doelgerichte aanbevelingen worden gedaan om moedersterfte te voorkomen. Dit proefschrift beschrijft deze onderzoeken en de interventies gebaseerd op deze aanbevelingen

Contraceptive use during lactational amenorrhea

OBJECTIVE: The study uses data from nationally representative sample surveys in developing countries to estimate the overlap between lactational amenorrhea and contraceptive use during the first 6 months postpartum. METHOD: Secondary analyses of survey data were used to tabulate the proportion of the population in lactational amenorrhea among contraceptive users of all women, for postpartum women and for the country as a whole. RESULTS: Among postpartum women, the proportion in lactational amenorrhea was particularly high in Africa and the Near East and lower in Latin America and the Caribbean where breast-feeding practices have declined. The median duration of use for oral contraceptives is also presented as an aid to interpreting the significance of the findings. CONCLUSIONS: The significance of the findings is considered in the context of planning reproductive health services in the postpartum period. Decisions about timing of contraceptive use for postpartum women, while arrived at on an individual basis, also result from program strategies that focus counseling immediately postpartum or at a later interval, such as when menses resume. On a national level the impact of postpartum contraception policies on use of commodities may be substantial.(AU)

Postpartum depression in Jamaican women: an analysis done at six-weeks postpartum at the University Hospital of the West Indies

This study aimed at determining the incidence of postpartum depression and to see if there are any differences in the risk factors between this Jamaican population and other countries. Data was gathered over a six week period, 14.2.96 to 25.3.96, in the postnatal clinic at the University Hospital of the West Indies. The Edinburgh Postnatal Scale was used to detect postpartum depression in the women. A Likert Scale was used to assess their attitudes toward their babies. Demographic, obstetric and psychosocial data were gathered from these women. The results showed a 26 percent incidence of pospartum depression in a population of 189 women. The factors that found significance were : attitude scores (P value <0.001, T value >1.96), having a worse than expected experience in having their babies (T value >1.96) and having being less frightened due to the information they received on the ward and the clinic (T value >1.96). The women detected with postpartum depression did not necessarily look or feel depressed. This study population had only one risk factor in common with studies from other countries, i.e. having a worse than expected experience in having their babies. This factor was significant in the first week of the puerperium while in this study it was significant at six weeks postpartum. (AU)

Postpartum shock and uterine inversion

A 21-Year-old woman, para 1+0, developed profound postpartum shock secondary to acute inversion of the uterus. Fundal re-inversion as inversion was achieved by prompt manual replacement of the uterus from below. An aggressive approach to uterine inversion is the keystone of success (AU)

Sterilization patterns in a maternity unit

An evaluation of the characteristics of 425 women on whom surgical sterilizations were performed revealed that 40 percent were 35 years or older and 48 percent had 5 or more children. Thirty-five per cent were Roman Catholics, and there was an equal incidence among the two major ethnic groups in Trinidad. Parental desire was the chief indication for tubal ligation. Complications were few, regardless of the timing of the procedure. A plea is made for intensifying efforts in promoting postpartum sterilizations following vaginal delivery, particularly for mothers whose life circumstances would prohibit them from returning for interval sterilization (AU)

Plasma zinc levels throughout pregnancy: a study in Jamaican women, with relevant aspects of nutrition

In a prospective study plasma zinc levels were determined by atomic absorption spectrophotometry in 135 Jamaican women over a two year period. A total of 1237 such determinations were made at fixed intervals throughout pregnancy. Each patient was investigated at 15, 20, 25, 30, 35 and 38 weeks gestation, in labour, and once in the early and in the late puerperium. Zinc being an essential trace element with a wide physiological role in many aspects of metabolism, supplementary studies on the relationship between zinc, folic acid, vitamin A, dietary intake in general, taste acuity and weight gain in pregnancy were undertaken. Results show that plasma zinc levels are lowered during pregnancy, moreso during the second trimester. The levels rise significantly during labour and then fall rapidly towards normal during the puerperium. Daily dietary zinc intake was of the order of 8-10 mg/day (the RDA for pregnancy being 15 mg/day) while protein intake averaged 67 g/day (the RDA being 80-90 g/day). Average weight gain in pregnancy was 12 kg. Plasma vitamin A and red cell folate levels were within normal range in all patients, indicating that there was no state of zinc deficiency interfering with the absorption of these vitamins. Clinical observations and laboratory investigations revealed no signs of any dietary deficiency among the patients. Viewed together, all the facets of this study suggest that the pattern of fall of plasma zinc in pregnancy is a normal physiological change not related to socio-economic status, parity or age. It is concluded that the lowered plasma zinc observed in pregnancy does not reflect a state of true zinc deficiency nor even a state of inadequate dietary zinc intake; it is most likely due to the heavy demand for zinc in the developing fetal tissues and by the expanding maternal blood volume (AU)

The endocervical and tubal flora in the puerperium

Bacteriological swabs of the endocervix and fallopian tubes were taken from 115 patients having postpartum tubal ligation. Although the majority of women harboured pathogenic organisms in the endocervix, only a small number developed pyrexia, and the incidence of tubal colonization was low (AU)

The endocervical and tubal flora in the puerperium - abstract

Bacteriological swabs of the endocervix and Fallopian tubes were taken from 115 patients undergoing postpartum tubal ligation. Despite the fact that the majority of women harboured pathogenic organisms in the endocervix, only a small number developed pyrexia, and the incidence of tubal colonization was low (AU)

Obesity in the Jamaican parturient

The reproductive performance of one hundred obese negro women was compared with that of an equivalent number of negro women of average weight. The main hazards of obesity were hypertension and diabetes mellitus. The incidence of prolonged labour was not increased, and there was a low incidence of prematurity. The infants were significantly larger in the obese group but despite this, disproportion seldom occurred. The obese patients gained less weight antenatally, and lost more in the puerperium, than the controls. There was an age-related difference in mean antenatal weight-gain and puerperal weight-loss in the obese, but not in the controls.(Summary)

Cavernous haemangioma in a post partum uterus

A case of haemangioma of the uterus in a 37-year old woman who died of intraperitoneal haemorrhage from a massive primary liver-cell carcinoma is presented. The relationship of the haemangioma with the placental site and pregancy is discussed (Summary)

Sickle-cell disease in pregnancy

17 patients with sickle-cell disease were followed through pregnancy. 9 of them had sickle-cell anaemia, 7 had sickle-cell/haemoglobin-C disease, and one had an unusual form of sickle-cell thalassaemia. The maternal and foetal hazards are discussed, and seem to be considerably less serious than in most other reports. Complications were more frequent in the puerperium. 5 out of 7 cases of sickle-cell/haemoglobin-C disease had no complications at any time. The birth-weight of the infants in this series was very much below average. The incidence of sickle-cell disease amongst pregnant women in Jamaica seems to be very similar to the incidence in the general population (Summary)

Complications of the puerperium

The two vitally important considerations for the tropical infant are breast-feeding and avoidance of infection. Artificial feeding may be safe in good social circumstances, but when mothers lack money, knowledge, and facilities the bottle-fed baby usually receives a dilute mixture of unsatisfactory milk adulterated with a starchy pap, often grossly contaminated. Malnutrition and gastro-enteritis inevitably result (AU)