Reducing the perinatal mortality rate in developing countries.
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Biomedical subjects
Publications and source records attributed to J V Larsen.
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The results of a survey of a rural population requiring obstetric care are presented. It was found that 56,6% of this population had significant risk factors which warranted hospital delivery. A plea is made for the provision of more 'waiting mothers' areas', especially by provincial hospital authorities, to overcome the problems of communication experienced in rural areas. It is concluded that 85% of patients at risk can be detected by meticulous antenatal screening and be admitted to such waiting areas before the onset of labour, with a consequent improvement in perinatal and maternal mortality rates. The need for the provision of adequate postnatal facilities is discussed, and comments are made regarding the implications of the survey with regard to staff utilization.
The morbidity and mortality of illegal abortion are briefly discussed with reference to South Africa, where it seems that 1 in every 8-10 pregnant women deals with an unwanted pregnancy in this way. A review of the literature regarding legal abortion has been undertaken, detailing mortality and morbidity with various methods in many countries. The medical problems resulting from a permissive abortion policy have been highlighted, and an attempt has been made to define the place of medically induced abortion in health services, as it is understood by countries with extensive experience in this field. It is hoped that this contribution will help to define the real issues in the current abortion debate in South Africa.
A patient who presented with incomplete abortion developed severe persistent haemorrhage from the genital tract after evacuation of the uterus, as a result of erosion of a major vessel in a sacculus in a previous caesarean section scar. Detection and management of this condition are discussed.
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Maise meal fortified with folic acid was administered to subjects in late pregnancy in a daily dose of either 500 or 300 mug of folic acid. Changes in hematological and folate nutritonal status were compared to those in subjects receiving 300 mug folic acid/day in tablet form, and also in subjects in a previous study who received unfortified maize meal (control group) or meal containing 1,000 mug folic acid/day. In all groups receiving folic acid, red cell and serum folate levels rose progressively, and the rate of rise increased with increasing doses of folic acid. Maize meal containing a daily dose of 500 mug folic acid produced an effect similar to that of 300 mug daily in tablet form. Maize containing 300 mug added folic acid daily was effective in preventing the progression of folate depletion in late pregnancy.
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