Perinatal mortality in northern Benin.

PIP: The perinatal mortality rate (PMR) at the Hopital Evangelique in the Borgon region of Benin was 224/1000 in 1984 compared to 164/1000 in 1994. Despite the decrease, the rate was still high. Perinatal deaths for 1994 were reviewed retrospectively from case notes and data routinely recorded (presentation, distance traveled, and prenatal care). The probable causes of death were determined. A total of 511 babies were delivered by 484 women in 1994 at the hospital. There were 62 stillbirths (26 cases of birth asphyxia, 14 cases of antepartum hemorrhage, 7 cases of ruptured uterus, and 6 cases of intrauterine death before labor) and 22 neonatal deaths (7 cases of birth asphyxia and 11 cases of prematurity). Maternal errors accounted for 14 stillbirths and 4 neonatal deaths; logistical difficulties accounted for 8 stillbirths and 4 neonatal deaths; and the errors of management/referring maternity accounted for 4 stillbirths and 1 neonatal death. Some examples of maternal errors included a patient (gravida 6, para 5) who had not received prenatal care and presented with antepartum hemorrhage after being in labor for 72 hours. She had a ruptured uterus and required hysterectomy. Another patient (gravida 6, para 5) who had not received prenatal care presented to a maternity unit in labor with a shoulder presentation. On arrival, and after referral, intrauterine death was diagnosed and the fetus was delivered. Examples of logistical problems included a primigravida referred from a maternity unit more than 50 km away for delay in the second stage of labor. She delivered normally after arrival; however, the baby was asphyxiated and died. A patient who was gravida 2, para 1 was referred from a maternity unit with a cord prolapse. The fetal heart beat was present on leaving the maternity unit but was absent on arrival at the hospital. Bad management cases related to prolonged labor or attempts at a traumatic vaginal delivery. Maternal errors were the main source of deaths; thus, prenatal and intrapartum care should be more accessible to reduce the PMR.^ieng

Short chain fatty acids stimulate epithelial mucin 2 expression through differential effects on prostaglandin E(1) and E(2) production by intestinal myofibroblasts.

BACKGROUND: The mucus layer protects the gastrointestinal mucosa from mechanical, chemical, and microbial challenge. Mucin 2 (MUC-2) is the most prominent mucin secreted by intestinal epithelial cells. There is accumulating evidence that subepithelial myofibroblasts regulate intestinal epithelial cell function and are an important source of prostaglandins (PG). PG enhance mucin secretion and are key players in mucoprotection. The role of bacterial fermentation products in these processes deserves further attention. AIMS: We therefore determined whether the effect of short chain fatty acids (SCFA) on MUC-2 expression involves intermediate PG production. METHODS: Both mono- and cocultures of epithelial cells and myofibroblasts were used to study the effects of SCFA on MUC-2 expression and PG synthesis. Cell culture supernatants were used to determine the role of myofibroblast derived prostaglandins in increasing MUC-2 expression in epithelial cells. RESULTS: Prostaglandin E(1) (PGE(1)) was found to be far more potent than PGE(2) in stimulating MUC-2 expression. SCFA supported a mucoprotective PG profile, reflected by an increased PGE(1)/PGE(2) ratio in myofibroblast supernatants and increased MUC-2 expression in mono- and cocultures. Incubation with indomethacin revealed the latter to be mediated by PG. CONCLUSIONS: SCFA can differentially regulate PG production, thus stimulating MUC-2 expression in intestinal epithelial cells. This mechanism involving functional interaction between myofibroblasts and epithelial cells may play an important role in the mucoprotective effect of bacterial fermentation products.