Browsing by Author "Wikedzi, Meck"

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    Obstetric and gynaecologic case records and commentaries.
    (University of Dar es Salaam, 1988) Wikedzi, Meck
    The dissertation has been prepared and presented in three parts. The first two parts consist of 20 case records and commentaries (10 gynaecological and 10 obstetrics) that were personally managed by the author from admission to discharge. Detailed account of management for each case is clearly described and commentary made. The third part contains a 6 month survey report on elective induction of labour done at Muhimbili Medical Centre starting from 1st May 1987. During this period, a total of 268 patients were electively induced. Two hundred and forty two of these were term pregnancies with live foetuses while the remaining 26 patients had in utero foetal death as the sole inducation for the labour induction. There were no preterm induction during this period. The success rate meaning vaginal delivery, in the term pregnancy induction was 76.9. The induction delivery interval was less than 12 hours in 68.8. However, the induction delivery interval in the 24 out of 26 cases of intrauterine foetal deaths were beyond 12 hours, and the remaining 2 cases failed in the induction. The pre-induction state of the cervix (Bishop Score) and parity were factors found to influence the outcome of labour in term pregnancy induction. Maternal age had no inf luence on the labour outcome. Caesarean section because of various indications was the leading maternal complication encountered.There was only one stillbirth among the term pregnancy induction that had followed placental abruption. Of the live born babies, 2.1% had a five minutes apgar score of 6 or less. There was no premature delivery among the 242 term pregnancy induction. From this study, pre-eclampsia and prolonged pregnancy are the common indications for induction of labour. However, a large proportion of patients with unfavourable Bishop Score (35%) are subjected to oxytocin induction with subsequent higher failure rate. Patients with intrauterine foetal death who constitutes 9.7% of the induced group are subjected to prolonged stressful induction using oxytocin which is less effective in such cases. High parity and a favourable cervix are associated with better outcome of induced labour, so they are reliable antepartum determinants of the outcome of induced labour.