Lateral femoral cutaneous nerve block for split skin grafting.

Wound with loss of skin needs grafting for early healing and to prevent deformity and disability. For skin grafting lateral femoral cutaneous nerve block can be used as regional anesthesia. The efficacy of 55 lateral femoral cutaneous nerve block was assessed in 52 patients of 10 to 70 years of age. The nerve block was found effective in all cases. 90.91% showed excellent results. The procedure seemed to be easy, safe and less costly for the purpose of skin grafting.

Induced abortion in rural Bangladesh (mortality levels and physicians' attitudes).

PIP: Reports on the 1st nationwide survey on incidence of abortion related mortality in Bangladesh. Abortion is illegal except where a woman's life is in danger, but is believed to be commonly practiced for termination of unwanted pregnancies by village "dais" and other untrained practitioners. Data on all maternal deaths was collected from midwives, nurses, family welfare visitors, rural physicians, obstetricians, and other workers in some 800 health centers, covering all accessible areas of Bangladesh. Of 1933 pregnancy related deaths, 498 were found to be due to complications from induced abortions. These represented some 31% of the cases hospitalized from abortion related complications. Village dais performed 42% of the abortions reported. Nearly 1/2 were induced by inserting an object such as a stick or root into the uterus. Nearly 80% of the women were aged 20-39, with a mean of 3.1 living children. 46.3% of the abortions were conducted in the 1st trimester, 38.7% in the 2nd, and 15% in the 3rd. Fatalities occurred more frequently among those further along in gestation. On the basis of these and other findings, it is estimated that if all abortions reported had been conducted by physicians using medically approved procedures, 84% of the reported deaths could have been avoided. Using various data, an estimated 7800 women are thought to have died in Bangladesh in 1978 due to abortion complications, while an estimated 500,000 births were averted by abortions that year. In another part of the survey, 379 physicians were interviewed about their attitudes toward abortion. Nearly 99% indicated approval of abortion in 1 or more circumstances not approved by law. Other recent surveys have shown considerable approval of abortion. The government may wish to consider expanding programs for training physicians and medical practitioners to perform menstrual regulation and abortions safely.^ieng

Induced abortion in rural Bangladesh: mortality levels and physicians' attitudes.

PIP: Between December 1978-May 1979, 1118 health workers in 63 hospitals and 732 nonhospital facilities were interviewed to identify case reports of maternal and abortion-related deaths in Bangladesh. Of 1933 pregnancy-related deaths identified, 498 (25.8%) were due to induced abortion. Findings of an earlier study of maternal mortality was used to estimate that about 21,600 pregnancy-related deaths occur each year in Bangladesh. An estimated 7.5% of all pregnancy-related deaths were identified in this survey. Health workers reported 1590 cases of complications from abortion, of which 498 (31.3%) ended in death. Village dais (traditional birth attendants) and traditional practitioners were the largest groups of operators (42.1% and 18.1% respectively). Menstrual regulation or dilatation and curettage (medically approved procedures) were used in only 9.1% of the cases. Nearly 1/2 of the complicated abortions were induced by inserting a foreign object, such as a stick or root (sometimes treated with an herb), into the uterus and leaving it until either abortion or complications occurred. The proportion of complicated abortions resulting in death was lowest for medically approved procedures (4.9%) and highest for vigorous physical activity (100%) and abdominal pressure (66.7%), although the last 2 accounted for only 2.3% of abortion procedures. Women who died after abortion had a longer duration of pregnancy than women who survived. An extrapolation from these results gives a figure of 780,000 abortions in Bangladesh in 1978 and 7800 deaths that year from abortion complications. In this study, the attitudes toward abortion on the part of 396 physicians working in rural health complexes and subdivision and district hospitals were surveyed. Most of those interviewed (98.9%), indicated their approval of induced abortion in 1 or more circumstances not approved by the abortion law of the country.^ieng

Oral contraceptives and family health in rural Bangladesh.

A case-control survey of mothers was undertaken in rural Bangladesh to assess the health problems of oral contraceptive users compared with two groups of nonusers. The complaint most often reported was weakness--more than 80% of all women surveyed. Significantly more pill users than nonusers reported experiencing dizziness and eye problems. However, only one fifth of dizziness complaints among pill users could be attributed to the pill. Although more pill users reported a decrease in lactation, a greater problem among the control group was total cessation of lactation related to a subsequent pregnancy. Therefore, in this context the pill may postpone weaning more often than it reduces lactation. That few women choose to use oral contraceptives in the early postpartum period, when a reduction in breast milk would be most hazardous to the child, contributes to this favorable balance. The attitude toward early termination of pregnancy was positive for 61% of pill users and 34% of nonusers. It is likely that abortion services would be favorably received in this traditional society.