An audit of perinatal mortality

Perinatal mortality rates are considered in the western world to be a quantitative barometer of maternity care. This 6-year prospective perinatal audit was conducted at a tertiary hospital in order to determine foetal out-come, and the common causes of foetal and early neonatal deaths. Of a total of 30,987 births, there were 469 stillbirths and 391 early neonatal deaths, giving a perinatal mortality rate of 27.7 per 1000 total births. The leading causes of stillbirths were hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies. Neonatal deaths were mainly due to the respiratory distress syndrome (57.8 percent), birth asphyxia (22.2 percent) and sepsis (13.5 percent). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended. (AU)

Examination performance of medical students: a view from Trinidad

We analysed the outcome of the final MBBS (Bachelor of Medicine and Bachelor of Surgery) examination oat the St. Augustine Campus, University of the West Indies, for 686 students attempting them for the first time between 1975 and 1986. The mean failure rate was lowest in medicine between 1975 and 1981, in obstetrics and gynaecology between 1982 and 1989 and in surgery during the last 7 years. The students' poor performance in some areas indicates the need for recognizing the importance of creating and establishing an educational climate in which the quality of teaching comes under scrutiny. The marking system in medicine should be reviewed.(AU)

Examination performance of medical students: a view from Trinidad

We analysed the outcome of the final MBBS (Bachelor of Medicine and Bachelor of Surgery) examination oat the St. Augustine Campus, University of the West Indies, for 686 students attempting them for the first time between 1975 and 1986. The mean failure rate was lowest in medicine between 1975 and 1981, in obstetrics and gynaecology between 1982 and 1989 and in surgery during the last 7 years. The students' poor performance in some areas indicates the need for recognizing the importance of creating and establishing an educational climate in which the quality of teaching comes under scrutiny. The marking system in medicine should be reviewed.

Maternal deaths associated with caesarean section

Twelve Caesarean section-associated maternal deaths were encountered over a 15-year period. The major operative risk factors were pregnancy-induced hypertension, obesity and general anaesthesia. Severe pre-eclampsia was the forerunner to postoperative cardiac failure, consumptive coagulopathy and difficult airway manipulation. We conclude that pregnancy-induced hypertension and its ramifications pose the greatest threat to maternal survival from Caesarean section. (AU)

The results of abdominal myomectomy

A survey of the records of 103 consecutive patients who underwent abdominal myomectomy revealed that menorrhagia and infertility were the commonest presenting complaints. The overall successful pregnancy rate was only 28.8 per cent , but the procedure was corrective in two-thirds of patients with leiomyomata-related infertility. Intra-operative blood loss, post-operative adhesion formation and recurrence of tumour remain major drawbacks of myomectomy

An audit of eclampsia

One hundred and three patients with eclampsia were managed during a period of eleven years. The perinatal mortality rate was 136 per 1000 total births and there were six maternal deaths. The maternal mortality rate was less among eclamptics delivered by Caesarean Section. Liberal use of diazepam and magnesium sulphate and early recourse to Caesarean Section were integral in the care of these women (AU)

An audit of eclampsia

One hundred and three patients with eclampsia were managed during a period of eleven years. The perinatal mortality rate was 136 per 1000 total births and there were six maternal deaths. The maternal mortality rate was less among eclamptics delivered by Caesarean Section. Liberal use of diazepam and magnesium sulphate and early recouse to Caesarean Section were integral in the care of these women.

The results of abdominal myomectomy

A survey of the records of 103 consecutive patients who underwent abdominal myomectomy revealed that menorrhagia and infertility were the commonest presenting complaints. The overall successful pregnancy rate was only 28.8 percent, but the procedure was corrective in two-thirds of patients with leiomyomata-related infertility. Intra-operative blood loss, post-operative adhesion formation and recurrence of tumour remain major drawbacks of myomectomy (AU)

Cold-knife cervical conization

Forty-six cervical conizations were performed over a ten-year period for diagnostic or therapeutic purposes. Twenty-nine women were under 45 years of age. The most common reason for conization was an abnormal Papanicolaou smear. The overall incidence of neoplasia was 80.4 per cent. The high complication rate of 28.4 per cent emphasizes the need for a less traumatic technique of excisional biopsy (AU)

Risk factors and treatment of endometrial carcinoma

A twelve-year retrospective study of 54 consecutive cases of endometial carcinoma revealed that post-menopausal bleeding was the commonest symptom, and the major associated risk factors were obesity and hypertension. Panhysterectomy was the corner-stone of treatment while adjunctive therapy was based on certain prognostic factors and the operator's preference (AU)

Risk factors and treatment of endometrial carcinoma

A twelve-year retrospective study of 54 consecutive cases of endometrial carcinoma revealed that post-menopausal bleeding was the commonest symptom, and the major associated risk factors were obesity and hypertension. Panhysterectomy was the corner-stone of treatment while adjunctive therapy was based on certain prognostic factors and the operator's preference.

Cold-knife cervical conization

Forty-six cervical conizations were performed over a ten-year period for diagnostic or therapeutic purposes. Twenty-nine women were under 45 years of age. The most common reason for conization was an abnormal Papanicolaou smear. The overall incidence of neoplasia was 80.4 per cent. The high complication rate of 28.4 per cent emphasizes the need for a less traumatic technique of excisional biopsy.

Pregnancy-induced hypertension: a predictor for the development of essential hypertension? - abstract

The burden of illness which hypertension places on the Trinidadian population is great. In an attempt to adequately plan health care delivery we examined the relationship between pregnancy-induced hypertension (PIH) and essential hypertension (EH) in our country. Ninety-eight women who had been admitted to Mount Hope Women's Hospital because of a pregnancy complicated by hypertension in 1981 were recalled to evaluate their current hypertensive status. A response rate of 34.3 per cent was obtained. We looked at predictive factors contributing to the development of EH. These included age of the patient, severity of hypertension, family history of hypertension, mother's parity and birth weight of the baby. Of the 34 women who responded, twenty-three (67.6 per cent) were not hypertensive while eleven were (32.4 per cent). Neither age nor the severity of hypertension was any indication as to the subsequent development of EH. The mother's parity, a family history of hypertension and the baby's birth weight appeared to be predictors of long-term hypertension. This study did not address other predisposing factors for the development of hypertension such as smoking or obesity. Despite similarities in the two cohorts with respect to blood pressures, more babies with birth weights < 2,500g were born to mothers who subseuqently became hypertensive. PIH was a recurring problem. Seventy-three per cent of women seen (72.7 per cent) had a previous or subsequent pregnancy that was complicated by hypertension. A prospective multicentre study in Trinidad examining this relationship between PIH and EH would substantiate these preliminary findings, albeit limited by the retrospective methodology and low recall. This information would assist future health planning (AU)

Is adolescent pregnancy hazardous?

A study of the pregnancy outcome in 3320 teenagers revealed a low incidence of pre-eclampsia and anaemia and high rates of eclampsia, prematurity and low birthweight. The perinatal loss was 2.2 per cent and there was one maternal death. A comprehensive programme designed to improve antenatal surveillance is recommended for adolescents. (AU)

Haemothorax and ascites associated with endometriosis

A young patient with pleuroperitoneal endometriosis presented with an haemorrhagic effusion. Two years later, she developed massive ascites with resolved after treatment with oral Danazol and Depo-Provera injections. (AU)