Induction of labor with misoprostol or oxytocin in Tanzania.
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Adult↗
Biomedical subjects
J van Roosmalen
Publications and source records attributed to J van Roosmalen.
[The UN Millennium Project; especially the prevention and treatment of the HIV-virus and AIDS in order to reduce child and maternal mortality].
Reducing child and maternal mortality are important UN Millennium Development Goals. The AIDS epidemic, which is targeted in another Millennium Development Goal, has a negative influence on child and maternal health. Although on a mondial level, the influence of HIV/AIDS on child and maternal mortality appears to be slight, HIV/AIDS constitutes a significant factor in Sub-Saharan Africa. In the Netherlands, the introduction of aggressive antiretroviral therapy has reduced the chance of vertical transmission to < 1%. In low-wage countries, financial means and political commitment for similar handling are lacking. Possible strategies for the prevention of vertical transmission for these countries are as follows: multivitamin supplements during pregnancy, prophylaxis against opportune infections with cotrimoxazol, a vaginal douche with chlorhexidine for cases where the membranes have ruptured more than 4 hours previously, and a single dose of nevirapine.
Acquired Immunodeficiency Syndrome↗
[No caesarean section on demand without a proper indication].
The risk/benefit ratio of caesarean section versus vaginal birth does not justify performing the operation solely on demand of the woman without a medical indication. Underlying fear of childbirth should be addressed by other means rather than simply performing the operation. These considerations should not be outweighed by women's freedom to decide.
Cesarean Section↗
[Breech presentation at term: the caesarean section that is routinely advised is ultimately not safe for the child].
Recently, the results have become available on both the neonatal and the maternal outcome of deliveries after randomisation in the Term breech trial. At 2 years, in contrast to the original results in which perinatal death and serious neonatal morbidity were higher in the planned vaginal delivery group, no differences were evident in the combined outcdme variable, including death after delivery and neurodevelopmental delay. There were also no apparent differences between the two groups in neurodevelopmental abnormalities as screened by the ASQ postal enquiry. These are the most important findings that should be discussed with the parents during counselling regarding the mode of delivery of a foetus in breech presentation.
Adult↗
[Foeto-foetal conflict of interests in multiple pregnancies with severe discordant growth; ethical dilemmas].
Two pregnant women, 19 and 26 years old, presented at the beginning of the third trimester with one growth-retarded foetus in a multiple pregnancy. Both cases were managed conservatively. In the first woman, one foetus died at 30 weeks of gestation, after the mother developed pre-eclampsia. After the death of the impaired foetus pre-eclampsia resolved and the second child was born healthy at 36 weeks of gestation. The second woman had triplets with one severely growth-retarded foetus. This foetus died at 3I weeks of gestation. At 33 & 317 weeks, caesarean section was performed on both maternal and foetal indications. Two healthy premature neonates were born. In multiple pregnancy with discordant growth, the interests of the foetuses may be in opposition, which creates an ethical dilemma. This may be resolved by carefully addressing the interests of all those involved and keeping in mind the prognosis, duration of pregnancy and the best interests of the healthy foetus, which should not be harmed by intervention. Therefore, active intervention is not always the best option; the least harm it does is increasing the risk ofpreterm birth.
Adult↗
[Diagnostic image (224). A pregnant woman with vaginal blood loss].
In a pregnant woman presenting with vaginal bleeding and a vaginal tumour, vaginal metastasis ofa trophoblast tumour from a mola pregnancy was diagnosed.
Adult↗
[Diagnostic image (173). A pregnant woman with an abnormal position of the fetus. Intra-abdominal pregnancy presenting as a abnormal fetal position].
A 42-year-old pregnant Namibian woman presented with an abnormal position of the foetus due to intra-abdominal pregnancy.
Adult↗
A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction.
OBJECTIVE: To compare vaginal misoprostol with dinoprostone for induction of labour. DESIGN: Randomised multicentre trial. SETTING: Labour wards of one university hospital and two teaching hospitals. POPULATION: Six hundred and eighty-one women with indication for labour induction at >or=36 weeks of gestation, singleton pregnancy and no previous ceasarean section. METHODS: Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary. MAIN OUTCOME MEASURES: Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction. RESULTS: Three hundred and forty-one women received misoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6-1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5-0.98). CONCLUSIONS: Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.
Administration, Intravaginal↗
Waiting too long: low use of maternal health services in Kalabo, Zambia.
OBJECTIVE: To determine the level of use of maternal health services and to identify and assess factors that influence women's choices where to deliver in Kalabo District, Zambia. METHODS: A cross-sectional descriptive study conducted between 1998 and 2000, with 332 women interviewed using semi-structured questionnaires. Focus group discussions were held and hospital data and registers were checked. RESULTS: Although 96% of respondents would prefer to deliver in a clinic, only 54% actually did, because of long distances, lack of transport, user fees, lack of adequate health education given during antenatal clinic attendances, poorly staffed and ill-equipped institutions with poorly skilled personnel. CONCLUSION: Unmarried women, women with higher education and women with formal employment, who are able to pay the user fees and live near a clinic are more likely to deliver in a clinic. This does not guarantee survival, however; maternal mortality is high in the district; health facilities are poorly staffed, poorly skilled and ill-equipped.
Adolescent↗
[Evaluation and validation of a perinatal death audit by means of feedback to the caregivers].
OBJECTIVE: To evaluate a perinatal audit procedure by communicating the results to the caregivers (midwives and obstetricians) involved, in order to determine whether the audit led to specific suggestions for improving practice and whether evaluation of the panel assessments by caregivers leads to a different evaluation of the audit process. DESIGN: Descriptive evaluation study. METHOD: Because of privacy regulations, the results of a recently published audit concerning perinatal mortality were reported at an aggregated level. At their own request, two participating hospitals received panel assessment reports of their own cases. The audit procedure, the 77 panel assessments and the care provided were then evaluated during closed meetings with the caregivers affiliated to the respective hospitals. RESULTS: In two audited cases of mortality the caregivers judged the panel's assessments as being too light and as too severe in one other case (Cohen's kappa: 0.98). Detailed case description was considered essential to the audit procedure. While aggregated reporting of audit results provides a general understanding of substandard factors in the care provided, feedback of results on an individual practice level led to specific suggestions for improvement (in relation to medical aspects, patient-caregiver relationship and collaboration between caregivers). Lack of anonymity appeared not to be an issue for the caregivers. CONCLUSION: The feedback of perinatal audit results to the caregivers involved as well as discussion of these results led to specific starting points in the areas of collaboration, documentation and policymaking at both individual and institutional level.
Adult↗
[The neglected control of proteinuria during pregnancy].
In two women, primigravidae aged 29 and 27 years, no dipstick test for proteinuria was carried out despite symptoms of preeclampsia at 34 5/7 and 25 5/7 weeks of pregnancy, respectively. Both babies died in utero. The women were treated in the intensive care unit; the first woman died due to 'haemolysis, elevated liver enzymes, low platelet count' (HELLP) syndrome, while the second woman was able to return home in a reasonable condition on antihypertensive medication. Dipstick tests for proteinuria should always be carried out in pregnant women with symptoms of preeclampsia in order to avoid the death and serious morbidity which can be associated with eclampsia.
Adult↗
Infertility in rural Ghana.
OBJECTIVES: This study measured the prevalence of self-reported infertility, as well as the level of knowledge of causes of infertility. Infertility was defined as failure to achieve conception after a minimum of 12 months of exposure. METHODS: Prevalence and knowledge of infertility were assessed in a representative community-based survey using a structured questionnaire in a rural district in Ghana among a random sample of 2,179 men and women from 15 to 49 years. RESULTS: The prevalence of infertility was 11.8% among women and 15.8% among men. The knowledge of causes of infertility was limited; only 46.5% of the respondents reported any cause. Most respondents failed to identify reproductive tract infections as causes of infertility. CONCLUSIONS: Infertility in Ghana and other sub-Saharan countries deserves more recognition as a public health problem. Prevention and treatment of infertility should be incorporated in reproductive health programs, while male participation in reproductive health programs and research needs to be encouraged. Public education about the causes of infertility is recommended.
Adolescent↗
Contraception and induced abortion in rural Ghana.
This article describes the results of a community-based survey on birth control in a rural district in western Ghana. Structured interviews with 2179 women and men aged 15-49 years were used to study the prevalence of contraceptive methods and induced abortion. In addition, the influence of induced abortion on reported fertility in relation to residence and education was analysed. The results show that 59.8% had used a contraceptive method at some time in life, while use of induced abortion was reported by 22.6% of respondents. Prevalence of ever-use of any method to avoid childbirth, contraception and/or induced abortion was 67.1%. Urban residence and higher education were associated with more induced abortions and higher use of contraceptive methods. Differences in use of induced abortion were partly responsible for the education and residence-related changes in fertility. Induced abortion needs to be considered when discussing methods in use to avoid childbirth in developing countries.
Abortion, Induced↗
Gender and unwanted pregnancy: a community-based study in rural Ghana.
This study investigates attitudes concerning unwanted pregnancies in a rural district of western Ghana. Structured questionnaires were used to interview men and women between 15 and 49 years of age (n = 2179) to measure the prevalence of unwanted pregnancy, how often it led to induced abortion and to establish the reasons why a pregnancy was considered unwanted. At some time in their life at least one unwanted pregnancy was experienced by 41% of men and 43.6% of women. Men and women reported a similar proportion of pregnancies (17.3% and 16.1%, respectively) as unwanted. The proportion of unwanted pregnancies terminated by induced abortion varied with the reason why the pregnancy was undesirable. Among both men and women socio-economic problems were most commonly cited with unwanted pregnancies. Pregnancies perceived by women as unwanted ended more often in an induced abortion than those unwanted by men. Reproductive health programs need to make contraceptives available, accessible and acceptable for both women and men. More research is needed to facilitate a clear understanding of the impact of gender on unwanted pregnancy and its prevention.
Abortion, Induced↗
Substandard care in immigrant versus indigenous maternal deaths in The Netherlands.
As part of the Confidential Enquiry into the Causes of Maternal Deaths in The Netherlands, substandard care was assessed in immigrant versus indigenous maternal deaths. Except for substandard care related to the women's and relatives' decisions, substandard care factors were hypothesised to occur in similar frequency among both groups of women. The results, however, indicate that substandard care factors related to all aspects of care were disproportionately more frequent in immigrant women. More research into the interpretation of these worrying data is needed.
Emigration and Immigration↗
[Term breech presentation: an indication for cesarean section].
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Adult↗
[Delayed birth of the second child in multiple gestation].
Five case histories illustrate the issue of delayed interval deliveries. In the first two cases, the first child was born at a gestational age of 20 and 18 weeks, respectively. The first woman (40 years old) gave birth to the second child after successful prolongation of pregnancy to a gestational age of 38 weeks. In the second case (28 years old), the attempt to delay delivery failed and the second child was born at 19 weeks of gestation. The third case (32 years old), illustrates the enormous differences in neonatal course between a child born at 26 weeks of gestation, who had to be treated at length for respiratory distress syndrome, hypotension and patent ductus arteriosus, and his twin brother born two weeks later and who recovered more quickly. The fourth case (24 years old) describes delayed delivery to allow administration of antenatal glucocorticoids. The last case (32 years old) deals with a serious maternal complication of placental abruption during an attempt to delay the birth of the second twin. Early tocolytic and antibiotic therapy may delay delivery and, in combination with antenatal glucocorticoids to stimulate lung maturation, may thereby improve the condition of the second twin. The role of cervical cerclage remains controversial. There is an important publication bias in the literature due to under-reporting of the failed attempts of delayed deliveries. In multiple gestation with imminent very preterm birth, delayed delivery of the second child is a feasible management option.
Adult↗
[Pain in the symphyseal region after parturition: possibly osteomyelitis].
A 29-year-old woman 3 weeks after her first childbirth suffered from atypical and progressive pain in the pelvis, which turned out to be a symptom of osteomyelitis of the pubic bone. She recovered after treatment with antibiotics and 6 weeks' stabilization of the pelvis. Symptoms of osteomyelitis resemble those of pubic osteitis, symphyseal rupture and symphysiolysis. Radiologically, osteomyelitis is characterized by development of infiltrates, cortical involvement and local osteopenia. Isolation of micro-organisms in a bone culture after puncture is regarded as proof of the diagnosis. The treatment is primarily with antibiotics, if abscesses or sequestra develop these should be relieved and/or removed.
Adult↗