Tubal ligation candidates who did not get their operation.

OBJECTIVE: To identify bottlenecks in the delivery of comprehensive family planning to women in contact with the Health Services and to find ways to reduce unmet demand for contraception. DESIGN: Exploratory descriptive study. SETTING: Large Bulawayo Government Hospital and the high density areas in the same city. SUBJECTS: Case notes of 284 women who indicated together with their partners that they had completed families and who had their tubal ligation forms duly signed but who never had their operation. Follow up of a sample of patients. INTERVENTIONS: Non intervention study. MAIN OUTCOME MEASURES: Are reproductive rights taken seriously? Is there service related unmet demand for family planning. RESULTS: Even those who had all their paperwork in order for a durante or post partum sterilization did not have any guarantee that this service would be given. The main reason was found to be lack of well motivated health staff. CONCLUSION: Much can be improved in contraceptive service delivery. Reproductive rights are not respected.

PIP: Family planning staff in a Bulawayo hospital were interviewed during June 1994 in order to identify bottlenecks in providing good contraceptive service. A file was produced by the family planning nurses [corrected] with 284 used tubal ligation (TL) forms covering the period September 1989-June 1994. Although each form was signed ante natally before labour [corrected] by the woman, [corrected] her partner or guardian, two witnesses, a junior doctor, a consultant in obstetric and gynecology, and the superintendent or his deputy, the TLs never took place. One woman had filled out a form twice with 3 years in between. The women were on average 35.5 years and had on average 6.6 children at the time the TO was supposed to happen. [sentence added] Case notes on these women were analyzed. Additionally, 34 of the women who had [corrected] sought postpartum sterilization or during caesarean section [corrected] were contacted and interviewed. The case notes and the [corrected] women gave a wide range of reasons why [corrected] they were not sterilized: delivered vaginally on a Friday, given preoperative breakfast by accident, doctors on strike, consent forms lost, doctors forgot, other operations having priority [corrected]. The main reason, however, why these women did not receive a[[corrected] TL is because the attending health personnel were poorly motivated. There is clearly much which can be done to improve the delivery of family planning services at the hospital.

Preterm labor in twin pregnancies: prediction by cervical assessment.

Patients attending a twin pregnancy antenatal clinic underwent cervical palpation at each visit to calculate a cervical score by subtracting dilatation from length. Prediction of the onset of labor by cervical assessment was studied in 223 already parous women with twin pregnancies who ultimately labored spontaneously. The lower the score, the shorter was the mean time until delivery, although there existed a subgroup of patients who had ripe cervices for several weeks before the onset of labor. The cervical score itself appeared to give better prediction of labor than did changes in the score. Cervical assessment identified a group of twin pregnancies at especially high risk of preterm labor, in that 76% of patients with a score of -2 or less at or before 34 weeks delivered preterm. There was no evidence that labor was precipitated by vaginal examination, although this requires further study.