Vaginal delivery in first pregnancy following a primary caesarean section.

A retrospective study was performed on 131 women who had trial of scar in their first pregnancies following a primary caesarean section. The vaginal delivery rate was 81.7% and this rate was not significantly influenced by the indication for the previous caesarean section. It is advocated that patients for trial of scar should be selected on individual merits rather than on the nature of the indication for previous caesarean section.

Characteristics of maternal deaths following cesarean section in a developing country.

A retrospective analysis was made of 27 maternal deaths after cesarean section occurring over a 5-year period. Sepsis was the single most important cause of maternal death (81.5%). The commonest indications for the cesarean sections were obstructed labor (59.3%) and cord prolapse (18.5%). The causes of maternal deaths were classified as avoidable and recommendations were made for their prevention.

PIP: A retrospective analysis of 27 maternal deaths associated with cesarean section and occurring at Nigeria's University of Ilorin Teaching Hospital in 1982-86 was performed. The cesarean section rate for the 48,974 deliveries that took place at the hospital during the study period was 4.1%. The death rate was 18.1/1000 cesarean sections compared with 1.89/1000 vaginal deliveries. Maternal sepsis was responsible for 22 (82%) of the cesarean section-associated maternal deaths; the remaining deaths were attributed to hemorrhage (1 primary and 3 secondary) and eclampsia (1 case). Obstructed labor was the single most important indicator for cesarean section (67%) and the most significant predisposing factor to maternal sepsis (63%). Most deaths from sepsis occurred on the 2nd-4th postoperative days. The skill of the surgeon was not a significant factor in maternal deaths. The most common antibiotic used to combat sepsis was a combination of ampicillin and gentamicin--a regimen that does not cover anaerobic organisms. Some patients did not receive antibiotics until the 3rd postoperative day because they were not on stock in the hospital pharmacy. Administrative difficulties, most notably inadequate laboratory backing and funding, also played some role in the high maternal death rate in this series.

Antimicrobial properties of amniotic fluid from some Nigerian women.

Fifty-one amniotic fluids were aspirated via the vaginal route from 51 pregnant Nigerian mothers. Their antimicrobial activity was tested against Staphylococcus aureus, Escherichia coli and Candida albicans. Inhibition rates were 39.2% for Staph. aureus 19.6% for E. coli and 41.2% for C. albicans. The overall inhibitory capacity was 64.7%. Sixteen fluids (31.4%) were active against one organism, three fluids (5.9%) were active against two organisms and one fluid (2%) was active against the three organisms. Age, parity and meconium-staining of liquor had no correlation with antimicrobial properties. The possible explanations for these are given.

Outcome of induced labor in 931 term pregnancies.

An analysis of 931 consecutive inductions of labor over an eight-year period is presented. The success rate was 90.4%. Spontaneous vaginal delivery was achieved in 83.5% of cases and the induction-delivery interval was less than 12 hours in 82.6% of cases. The preinduction state of the cervix most significantly influenced the outcome of labor, followed by maternal age and parity. Provided induction of labor was by synchronous use of forewater amniotomy and oxytocin titration, labor outcome was regularly predictable two hours after induction using the concept of latent period of labor and the cervical dilatation at eight hours from the induction. When the latent period was two hours or less, 64.2% of the patients delivered within eight hours, and vaginal delivery was achieved in all women in whom the cervical dilatation was 8 cm or more at eight hours from the induction of labor. The maternal complication rate was 12.1%, the early neonatal morbidity was 11.6%, and the stillbirth rate was 2.3%.