Obstetric and gynaecologic cases and commentaries

This book consists of four parts, Part 1 the introduction to obstetric and gynaecologic services describes organization and provision of services in the department. Selection of patients is based on the referral systems and especially for obstetric services on risk approach. This part also describes certain common obstetric and ecological procedures done. The second party consists of 20 case reports and commentaries 10 gynaecologic and 10 obstetric. These represent cases seen frequently in our centre and which were managed by the author during the 3 year residency. Needless to say, the treatment regimen described in the case records reflect the current practice in the department at that time. The third party, consists of two long commentaries - one in obstetrics and another in gynaecologic. The obstetric long aommentary, is a prospective study on factors associated with preterm birth done by the author during the residency. In this case control study 105 mothers having preterm births at Muhimbili Medical Centre (MMC) were interviewed. Premature rupture of membranes fever, and multiple pregnancy were the most important conditions associated with preterm birth. Previous preterm birth and previous perinatal death were important factors significantly associated with preterm birth in subsequent pregnancies. It is concluded that it is possible to identify a group of pregnant women at increased risk for preterm birth based on past obstetric performance as well as certain manifestations occurring in early pregnancy. The gynaecological long commentary is similarly prospective study of factors associated with ectopic pregnancy at Muhimbili Medical Centre done by the author. 1n this study, ninety eight consecutive patients treated for ectopic pregnancy during a seven month period were interviewed in a case control study, history of previous pelvis infection, previous abortion abdomino-pelvic surgery and infertility were found to be important predisposing factors and that this pattern does not differ from these described elsewhere. The last part is a community obstetrics study. It is a comparative study of indications and outcome of cesarean sections at Muhimbili Medical Centre, and a district hospital in Kilosa. The results show that a very low cesarean section rate at the district hospital (2.4%) is associated with a prohibitively high stillbirth rate as well as high cesarean section associated maternal mortality rate. Poor antenatal care, late referrals to the district hospital, as well as inadequate facilities and lack of skilled physicians are suggested as main contributors to this poor obstetric outcome at the district hospital. Health education retraining of maternal and child health personnel as well as a more active management of labor recommended. Active management of labor especially where mild disproportion is suspected should lead to a reduced cesarean section rate.