RESUMO
Umbilical cord prolapse occurs when a loop of cord is present below the presenting part when the amniotic membranes are ruptured. The incidence is 0.2% of total births. The case presented here is unusual because the definition of cord prolapse cannot be applied to it and the lady did not complain of any history of urinary incontinence or hematuria. The presentation of umbilical cord through maternal urethra led to the speculation of an opening between the anterior uterine wall and the bladder. Fetal demise was diagnosed by abdominal ultrasound. At laprotomy, a communication was found between the bladder and the uterus thus letting the cord traverse through the bladder.
RESUMO
OBJECTIVE: Report maternal perceptions of antenatal care provision and identify deficiencies in the current model of care provision. METHODS: A survey was conducted to record maternal views about quality of antenatal consultations provided at a tertiary level hospital. Trained nurses and female health workers interviewed the patients attending antenatal visits during the month of July 2009. A standard questionnaire was use to enter the responses. Data were entered into the statistical package for social sciences (SPSS) for appropriate statistical analysis of the results. Data analysis generated two groups. One group had up to 4 antenatal visits and the other group had more than 4 visits. RESULTS: Responses were obtained for 244 patients. Chi-square test was applied for the comparison of variables between the two groups. Significantly higher number of women preferred to follow the 4 visit care plan (n=118/244 vs. n=103/244, respectively; p=0.004). Patient satisfaction was also significantly higher among women in the 4 visit group (n=112/244 vs. n=90/244; p=0.04). More than 50% of patients said that they did not receive any information about the process of labor, breast-feeding or contraception. CONCLUSION: Women included in the study did not want frequent visits to antenatal clinic. Efforts should be made to provide information about labor, breast-feeding and contraception.
RESUMO
BACKGROUND: The risks and safety of cesarean section (CS) differ from place to place in the world. According to the World Health Organization, the best outcomes for mothers and babies appear to occur with CS rates of 5-15%. Increasing maternal age and high parity are among the chief determinants of cesarean deliveries. MATERIALS AND METHODS: A retrospective cohort study was done at the tertiary care facility, King Fahd Medical City, Riyadh from 1 January to 31 December 2008. Observations were recorded from the labor ward registers. Sample size estimated was n=2192. A total of 2907 patients were recruited. All CS at viable gestation were included. Vaginal deliveries were taken as the comparison group. Non probability convenient sampling was done. Factors associated with cesarean deliveries were analyzed using univariate and bivariate analysis methods. Level of significance was set at P≤0.05 and confidence interval (CI)=95% respectively. RESULTS: Independent sample t test and Pearson's chi-square test showed that increasing maternal age, parity (P=0.0001 and 0.002 respectively), and prematurity (P=0.0001) were significant associates for CS. Binary logistic regression also confirmed significant association of increasing parity and prematurity (P=0.02 and 0.0001 respectively). Non-reassuring cardiotocography was the most common indication for CS. CONCLUSION AND RECOMMENDATIONS: Increasing maternal age and parity as well as prematurity were the factors significantly associated with CS. Fetomaternal outcome was comparable between vaginal and abdominal deliveries, despite the high CS rate. Non-reassuring cardiotocography was the most common indication. Secondary tests for evaluation of fetal well being might help to reduce the high CS rate.
