Rupture of the gravid uterus in Trinidad.

PIP: The features of uterine rupture occurring at the Port-of-Spain General Hospital in Trinidad were reviewed in 42 patients over the 1971-1978 period in order to determine whether or not there were any avoidable factors and to establish the major causes of maternal demise. There was adequate documentation in the case notes of 32 of the 42 patients, and these were analyzed. During this period there had been 63,000 deliveries, and incidence of rupture of 1/1500 pregnancies. The frequency of uterine rupture in Trinidad was higher than in the metropolitan counties. In Uganda it was as high as 1/93 pregnancies. 12 patients were between 20 and 29 years, 16 between 30-39 years, and 3 were over age 40. 17 women were of parity 1-4; 12 were grandmultiparae. The gestational age of all patients studied ranged from 37-40 weeks. Fetal malpresentation was present in 10 patients -- breech (4), shoulder (5), and brow (1). Rupture of the uterus occurred spontaneously in 29 women, 12 in the upper segment and 17 in the lower segment. 11 ruptures occurred through previous Caesarean scars. 50% of the patients were treated by hysterectomy, 9 following vaginal delivery and 7 after Caesarean section. There were 21 stillbirths and 1 neonatal death. There was a perinatal mortality rate of 68% and a maternal mortality rate of 12.5%.^ieng

Sterilization patterns in a maternity unit.

PIP: The Mt. Hope hospital built by the World Health Organization to assist in family planning and maternity services has used sterilization since 1981. In the study of 425 women who had surgical sterilization in 1984 40% were over 35 years old and 48% had 5 or more children. Roman Catholics made up 35%, Moslems 22.5% and there was an equal division between the 2 major ethnic groups of Trinidad. There has been a major effort to encourage postpartum sterilization following vaginal delivery where the patients would not normally return for sterilization; 209 patients or 3.2% have undergone this among 6,530. There were 66% married, 24.5% living together, and 9.5% single, divorced or separated. The main reason for the procedure was reaching the desired family size. This study indicates that voluntary sterilization has become a common and safe contraceptive procedure. It is most suitable for couples where pregnancy is dangerous and no longer wanted. Voluntary postpartum sterilization has not been accepted everywhere and in other studies many young single women who requested it in developing countries had regrets. In the United States it has grown from 3.4% - 7% in 1981. However, it is not as popular in third world countries where the women are in a high risk group for maternal health problems; and because of domestic pressure, they will return for sterilization, resulting in many undesired pregnancies.^ieng

Rupture of the gravid uterus in Trinidad

Thirty-two cases of rupture of the gravid uterus were managed over an eight-year period. The maternal mortality was 12.5 per cent and the foetal loss was 68 per cent. The chief pre-disposing factors were previous Caesarian scars and grandmultiparity. Fifty per cent had hysterectomies. A call is made for eliminating highly parous women by instituting effective contraceptive measures in order to avoid one of the most serious tragedies in obstetrics. (AU)

The oxytocin challenge test in high-risk pregnancies

One hundred and eleven oxytocin-challenge tests were performed on ninety patients considered to be at risk from placental insufficiency. While perinatal outcome was satisfactory after a negative cardiotocogram, a positive test was associated with significant foetal loss. Prompt delivery by Caesarean section appears to be the safest course for patients with unsatisfactory oxytocin challenge tests. (AU)

The obstetric outcome of patients with previous myomectomy or hysterotomy

Fifty-four pregnancies were managed in women who had had a previous myomectomy or hysterotomy. Rupture of the uterus occurred, prior to the onset of labour, in one of 8 post-hysterotomy pregnancies (12.5 percent), and in 3 of 24 pregnancies (12.5 percent) when the uterine cavity was opened at the time of myomectomy. Careful monitoring during the last trimester of pregnancy with a view to elective Caesarean section is advocated in patients with hysterotomy or myomectomy scars extending into the endometrial cavity (AU)

An assessment of the role of diagnostic laparoscopy in Trinidad

The chief application of diagnostic laparoscopy among 246 women was in the investigation of infertility. The inaccuracy of the salpingogram was evident, and endoscopic findings conflicted with clinical parameters in several patients with pelvic pain. The occasional use of laparoscopy to resolve the diagnosis of uterine perforation or to locate a lost intra-uterine device is illustrated (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)

Sterization patterns in a maternity unit

An evaluation of the characteristics of 425 womwn on whom surgical sterilization were performed revealed that 40% were 35 years or older and 48% had 5 or more children. Thirty-five per cent were Roman Catholics, and there was an equal incidence among the two major ethnic groups of Trinidad. Parental desire was the chief indications for tubal ligation. Complications were few, regardless 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