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PubMed1999

Cost-effectiveness of routine blood type and screen testing for cesarean section.

OBJECTIVE: To evaluate the usefulness and cost-effectiveness of admission blood type and screen testing for cesarean section. STUDY DESIGN: A retrospective review was conducted on patients transfused with blood during an admission that required a cesarean section over a three-year period at a tertiary care hospital. RESULTS: Of 3,962 patients who underwent cesarean section, 132 (3.3%) required a blood transfusion during their hospital stay. Medical records of 125 of the 132 patients were evaluated as to urgency and risk factors. (Seven charts could not be located.) Most of the blood transfusions were related to previously identified risk factors, including previous cesarean section, chorioamnionitis, placenta previa, abnormal presentation (breech or transverse lie), multiple pregnancies, abruptio placentae and admission anemia. Three patients received an urgent blood transfusion without a previously identifiable risk factor. Thus, we found an overall urgent blood transfusion rate without admission risk factors to be 0.8 per 1,000 cesarean sections. CONCLUSION: In the absence of significant risk factors, routine admission blood type and screen testing for cesarean section does not enhance patient care and should be eliminated. In the rare event that a patient without a previously identified risk factor requires an urgent blood transfusion, O negative blood could be given in the interim pending formal determination of type and cross-match.

Blood Grouping and Crossmatching↗

PubMed1996

[Postpartum hysterectomy].

Between the 1st July 1990 and the 30th June 1995, 34 caesarean hysterectomies and 2708 (22%) caesarean sections were performed from 12,227 births on the I. Department of Obstetrics and Gynaecology Semmelweis University Medical School in Budapest. From all 34 cases, hysterectomy were performed in 9 cases (26%) after complicated delivery, in other 9 cases (26%) during elective caesarean section and in 16 cases (47%) during urgent caesarean section. The incidence of caesarean hysterectomy is 2.7/1000 labour in our study. We listed the placenta increta, placenta accreta, placenta adherens, placenta praevia, uteroplacental apoplexia, scar disruption, uterus rupture, atony, sepsis puerperalis, abruptio placentae, haematoma paravaginale as urgent indications and so elective indications were myoma uteri, cervical carcinoma, ovarial tumour and in-situ cervical carcinoma. We collect the elective and urgent indications of caesarean hysterectomy and summarize the possible operative and postoperative complications in our study.

Cesarean Section↗

PubMed2004

Maternal and obstetric risk factors for sudden infant death syndrome in the United States.

OBJECTIVE: The objectives of this study were to 1). study the incidence of sudden infant death syndrome (SIDS) among singleton births in the United States and 2). identify maternal and obstetric risk factors for SIDS. METHODS: A cohort of all live births in the United States from 1995 to 1998, formed the source population (n = 15627404). The data were obtained from the National Centers for Health Statistics Linked Births and Infant Deaths File. A nested case-control study was used to examine risk factors for SIDS. From this birth cohort, all SIDS deaths (n = 12404) were first identified (case group). From the remaining non-SIDS births, a 4-fold larger sample (n = 49616) was randomly selected as a control group. RESULTS: The overall incidence of SIDS was 81.7 per 100000 live births. More mothers in the case group than in the control group were reported to have placenta previa (odds ratio [OR]: 1.70; 95% confidence interval [CI] 1.24, 2.33), abruptio placentae (OR 1.57; 95% CI 1.24, 1.98), premature rupture of membranes (OR 1.48; 95% CI 1.33, 1.66), or small for gestational age (OR 1.40; 95% CI 1.30, 1.50 for the 10th percentile). SIDS cases were also more likely to be male. Mothers of cases were more likely to be younger, less educated, and nonwhite, and more of them smoked during pregnancy and did not attend prenatal care. CONCLUSION: This analysis confirms the importance of several well known demographic and lifestyle risk factors for SIDS. In addition, placental abnormalities were risk factors for SIDS. LEVEL OF EVIDENCE: II-2

Birth Weight↗

PubMed2000

Induction of apoptosis in placentas of pregnant mice exposed to lipopolysaccharides: possible involvement of Fas/Fas ligand system.

To explore the pathogenesis in placental dysfunction and abruptio placentae, we analyzed the occurrence of placental cell apoptosis and the role of Fas and Fas ligand (L) in that process in an inflammatory placental dysfunction model of pregnant mice, using lipopolysaccharides (LPS). In the present study, Day 13 pregnant mice were injected i.p. with LPS (50 microg/kg) or saline as a control, and the placentas were isolated at various time points after the injection. Analysis of the isolated DNA in agarose-gel electrophoresis revealed a typical ladder pattern of bands consisting of 180-200 base pairs (bp), which is regarded as a hallmark of apoptosis. The intensity of the bands increased time-dependently, reaching a maximum level at 12 h after LPS injection. In accord with the biochemical data, histochemical analysis using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) revealed that nuclei positive for double-stranded DNA breaks were found in decidua, diploid trophoblasts in the basal zone, and spongiotrophoblasts. The number of positive nuclei was maximized at 12 h after LPS injection. As a next step, we investigated the possible involvement of Fas and Fas L in the induction of apoptosis of the placental cells after LPS injection. Western blot analysis indicated that LPS increased the expression of Fas and Fas L in the placenta by about 4-fold at 12 h and 18 h, respectively, after injection. The cells expressing Fas and Fas L were identified, using immunohistochemistry and nonradioactive in situ hybridization, as decidua, diploid trophoblasts in the basal zone, and spongiotrophoblasts. Furthermore, when the expression of 4-hydroxy-2-nonenal (HNE)-modified proteins was assessed to evaluate the relation of oxidative stress elicited by LPS to the induction of apoptosis, once again decidua, diploid trophoblasts in the basal zone, and spongiotrophoblasts were positive. Therefore, the placental dysfunction by LPS may be brought about by the Fas-mediated apoptosis of various placental cells in a paracrine/autocrine fashion, possibly under the influence of oxidative stress.

Aldehydes↗

PubMed1990

Metabolism of cocaine by human placentas: implications for fetal exposure.

To assess placental metabolism of cocaine, placentas were obtained at the time of delivery and the microsomes were extracted by ultracentrifugation within 2 hours. Placental microsomes were cultured with cocaine at physiologic plasma concentrations similar to those of cocaine users (0.75 micrograms/ml). Two control groups were established. In the first group an anticholinesterase was added to the culture to suppress enzyme activity, and in the second cocaine was cultured alone without placental microsomes to obtain baseline spontaneous conversion of the drug. The results indicate that cocaine is biotransformed by the human placenta, presumably by cholinesterase activity. This suggests that the placenta may provide a moderate degree of protection from cocaine-induced morbidity, such as abruptio placentae and fetal growth retardation, by converting cocaine into less active metabolites. These results also have pharmacogenetic implications because cholinesterase activity varies among individuals. Hence placentas that cannot transform the drug may place the conceptus at greater risk of developmental abnormalities.

Biotransformation↗

PubMed2000

Routine use of external cephalic version in three hospitals.

BACKGROUND: External cephalic version has been advocated as a safe alternative to vaginal breech delivery or cesarean birth. The purpose of this study was to determine the efficacy of routine use of external cephalic version at 36 weeks or more of gestation in three different levels of hospitals. METHODS: External cephalic version was performed on 923 women with a single breech fetus at three hospitals in Italy. The procedure was attempted with a tocolytic agent for uterine relaxation and with no maternal analgesia. The version technique adopted was the "forward roll." RESULTS: Version was successfully performed on 579 fetuses (62.7%); each hospital had a similar success rate, and 56.9 percent of the women delivered vaginally. The procedure was more successful in multiparas and in women with an incomplete type of breech, polyhydramnios, and posterior localization of the placenta. Vaginal bleeding was experienced by 14 women; eight cesarean sections were performed for suspected abruptio placentae, confirmed in four cases. Two cephalic-turned fetuses experienced an episode of persistent bradycardia and were turned again to breech; in five cases a nonstress test recorded after the version showed repeated variable decelerations and in one case a cesarean section was performed. Neonatal outcomes were good in 922 infants. A fracture of the femur attributable to the version was observed in one newborn. CONCLUSIONS: External cephalic version is effective in reducing the number of cesarean deliveries in term breech infants in different obstetric settings, with no major neonatal adverse outcomes.

Adult↗

PubMed1994

Vitamin C deficiency causes hematological and skeletal abnormalities during fetal development in swine.

The influence of maternal vitamin C deficiency on fetal development was studied in swine with a hereditary lack of ability to synthesize ascorbic acid (OD pigs). Thirteen pregnant sows homozygous (od/od) for the defect were depleted of ascorbic acid for 24 to 38 d at various stages of gestation. Six normal (OD/OD) sows were used as controls. Only a few experimental sows showed clinical symptoms of vitamin C deficiency. Nevertheless, severe pathological changes were seen in the uterus and fetuses. Characteristic findings were hemorrhages and hematomas in both fetal and maternal placenta, and general edema and subcutaneous hemorrhages in the fetuses. Similarities were noted to the abruptio placentae syndrome in women. Depletion of vitamin C resulted in a pronounced decline in ascorbic acid concentration in most maternal and fetal organs as well as in plasma and embryonic fluids. No morphological malformations were found in the fetuses, but the ossification of the skeleton was severely deranged. Macroscopically the lesions comprised swelling of the costochondral junction and separation of the epiphysial cartilage from the spongiosa in ribs and limb bones. Another characteristic finding was loosening of the periost from the cortex, often resulting in subperiosteal bleedings. Microscopically normal osteoblasts were few and the formation of osteoid defective.

Animals↗

PubMed1995

Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features.

OBJECTIVE: Our purpose was to describe placental lesions associated with normal and abnormal fetal growth in infants delivered for obstetric indications at < 32 weeks' gestation. STUDY DESIGN: Maternal and neonatal charts and placental tissues from 420 consecutive nonanomalous live-born singleton infants delivered at < 32 weeks' gestation with accurate gestational dates were retrospectively studied. Excluded were cases with maternal diabetes, chronic hypertension, hydrops fetalis, diagnosed congenital viral infection, and placenta previa, leaving four primary indications for delivery: preeclampsia, preterm labor, premature rupture of membranes, and nonhypertensive abruptio placentae. The presence and severity of placental lesions was scored by a pathologist blinded to clinical data. Birth weight and length percentiles were calculated from published nomograms. Asymmetric intrauterine growth retardation (n = 32) was defined as birth weight < 10th percentile with length > 10th percentile and symmetric intrauterine growth retardation (n = 48) as both weight and length < 10th percentile for gestational age. A "growth restriction index" was developed to express a continuum of growth in both length and weight. Contingency tables, analyses of variance, and multiple regression analysis defined significance as p < 0.05 (with corrections for multiple comparisons). RESULTS: A greater proportion of cases with intrauterine growth retardation had lesions of uteroplacental insufficiency (p < 0.001) or chronic villitis (p < 0.02) than did appropriately grown preterm infants. Cases with asymmetric intrauterine growth retardation tended to have more lesions than did cases with appropriate-for-gestational-age infants. Four multiple regression analyses used the growth restriction index as outcome and the histologic lesion that had significant relationships to fetal growth as independent predictors in univariate analyses. Overall, uteroplacental fibrinoid necrosis, circulating nucleated erythrocytes, avascular terminal villi, and villous infarct were significant independent predictors of fetal growth (adjusted R2 = 0.312). With addition of preeclampsia as a variable, villous fibrosis, avascular villi, infarct, and preeclampsia were independent predictors of fetal growth (adjusted R2 = 0.341). In the 65 preeclampsia cases no histologic lesion was an independent predictor of fetal growth, whereas in the nonpreeclampsia cases, villous fibrosis and avascular villi were independent predictors of fetal growth (adjusted R2 = 0.075). CONCLUSIONS: In nonanomalous preterm infants intrauterine growth retardation is most commonly symmetric and is primarily related to the cumulative number and severity of lesions reflecting abnormal uteroplacental or fetoplacental blood flow. The growth restriction index may contribute to the study of the biologic range of fetal growth. The statistical relationship of most placental lesions to intrauterine growth retardation depends on the presence or absence of preeclampsia.

Analysis of Variance↗

PubMed1994

Infants with single umbilical artery studied in a national registry. 3: A case control study of risk factors.

This case control study reports associations between single umbilical artery (SUA) in newborns and some maternal biological characteristics. The study is based on chromosomally normal singleton infants born in Sweden between 1983 and 1990. Information on the maternal characteristics studied was obtained prospectively. There were 2920 cases identified and 5840 controls were selected. An association was found with: previous perinatal death, retained placenta, placenta praevia, maternal diabetes, epilepsy and hydramnios. Increased odds ratios were seen also for spontaneous abortion and abruptio placentae but did not reach statistical significance. No association was found with previous induced abortion, involuntary childlessness, or the use of contraceptives after the last menstrual period.

Case-Control Studies↗

PubMed1998

Resistance index of uterine artery and placental location in intrauterine growth retardation.

BACKGROUND: Our aim was to investigate the relationship between placental location and resistance index (RI) of uterine arteries in cases with intrauterine growth retardation (IUGR). METHODS: Placental location and flow velocity waveforms of uterine arteries in 86 normal and 20 IUGR cases from 33 to 38 weeks of gestation were examined using a combined real-time scanner and pulsed Doppler ultrasonography. The location of placenta was classified as lateral when most of it was located to either the right or the left side of the uterine midline. Otherwise it was called central. Cases where the placenta was located in the uterine fundus or in the lower segment were not included. RI values were calculated from the uterine arteries on the placental side, on the non-placental side and in case of central placentas as a mean of both uterine arteries. In normal cases, the calculations were done every second week from 33 to 38 weeks of gestation, and the difference in variance among three gestational ages in each artery was tested by a one-way ANOVA. In IUGR cases, a standard deviation score (SDS) was calculated individually in each artery as (RI - normal mean)/normal SD. Differences in SDS between three categories of uterine arteries were examined by non-parametric tests. RESULTS: In normal cases, there was no significant difference in variance of RIs among three gestational ages in each category of arteries. In IUGR cases, SDSs on the placental side were higher than those on the non-placental side and those in central placenta, (p<0.01, Wilcoxon's and Mann Whitney's tests, respectively). SDSs in five of eight cases with central placentas were below 1.0. Two of 12 cases with lateral placentas had higher SDSs on the non-placental side than on the placental side and resulted in abruptio placentae. CONCLUSIONS: Deviation of RIs in uterine arteries with IUGR could be affected by the pathologic conditions of the utero-placental blood flow on the placental side of lateral placenta rather than in central placenta and might be done by dramatic increase in resistance to flow of the myometrial vessels on the non-placental side.

Female↗

PubMed2001

Pathologic features of the placenta in women with severe pregnancy complications and thrombophilia.

OBJECTIVE: To compare placental pathology between women with and without thrombophilia who had severe preeclampsia, intrauterine growth retardation, severe abruptio placentae, or stillbirth. METHODS: After delivery, 68 women with singleton pregnancies with one of the above complications were evaluated for an inherited thrombophilia: factor V Leiden, methylenetetrahydrofolate reductase and prothrombin gene mutation, and deficiencies of protein S, protein C, and antithrombin III. Thirty-two women were thrombophilic (group A), and 36 women were not (group B). There was no difference in maternal age, parity, and type of pregnancy complication. A single pathologist examined each placenta. RESULTS: The gestational age at delivery, birth weight, and placental weight were significantly lower in group A. Three parameters showed significant differences between the groups: thrombophilic women had a higher number of villous infarcts (P <.01), more multiple infarcts (P <.05), and a higher incidence of placentas with fibrinoid necrosis of decidual vessels (P <.05). CONCLUSION: Placentas of women with severe complications and thrombophilia have an increased rate of vascular lesions.

Adult↗

PubMed1984

Complement system in abnormal pregnancy and chorionic neoplasia: immunotherapy and chemotherapy of chorionic neoplasia.

In normal pregnancy, the activity of the alternate pathway elevates latently and compensatorily for the suppression of cellular immunity. Aging of the placenta becomes a trigger for the onset of labor and production of C3-a. In cases of hydatidiform mole, abruptio placentae, threatened abortion, and chorionic malignancy, the activity of the complement system is depressed, especially that of C3-activator and alternate pathway. This may in turn result from activation of complement by the pathologic lesion of the chorionic villi. In pathologic lesions of the placenta, activation of alternate pathway can lead to a number of diseases. Immunotherapy is effective in the prevention of malignant transformation of hydatidiform mole. Immunotherapy and combination chemotherapy are markedly effective for treatment of metastatic chorionic malignancy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2001

Placenta previa: obstetric risk factors and pregnancy outcome.

OBJECTIVE: To determine the incidence, obstetric risk factors and perinatal outcome of placenta previa. STUDY DESIGN: All singleton deliveries at our institution between 1990 and 1998 complicated with placenta previa were compared with those without placenta previa. RESULTS: Placenta previa complicated 0.38% (n = 298) of all singleton deliveries (n = 78 524). A back-step multiple logistic regression model found the following factors to be independently correlated with the occurrence of placenta previa: maternal age above 40 years (OR 3.1, 95% CI 2.0-4.9), infertility treatments (OR 3.1, 95% CI 1.8-5.6), a previous Cesarean section (OR 1.8, 95% CI 1.4-2.4), a history of habitual abortions (OR 1.3, 95% CI 1.3-2.7) and Jewish ethnicity (OR 1.3, 95% CI 1.1-1.8). Pregnancies complicated with placenta previa had significantly higher rates of second-trimester bleeding (OR 156.0, 95% CI 87.2-277.5), pathological presentations (OR 7.6, 95% CI 5.7-10.1), abruptio placentae (OR 13.1, 95% CI 8.2-20.7), congenital malformations (OR 2.6, 95% CI 1.5-4.2), perinatal mortality (OR 2.6, 95% CI 1.1-5.6), Cesarean delivery (OR 57.4, 95% CI 40.7-81.4), Apgar scores at 5 min lower than 7 (OR 4.4, 95% CI 2.3-8.3), placenta accreta (OR 3.6, 95% CI 1.1-9.9) postpartum hemorrhage (OR 3.8, 95% CI 1.2-10.5), postpartum anemia (OR 5.5, 95% CI 4.4-6.9) and delayed maternal and infant discharge from the hospital (OR 10.9, 95% CI 7.3-16.1) as compared to pregnancies without placenta previa. In a multivariable analysis investigating risk factors for perinatal mortality, the following were found to be independent significant factors: congenital malformations, placental abruption, pathological presentations and preterm delivery. In contrast, placenta previa and Cesarean section were found to be protective factors against the occurrence of perinatal mortality while controlling for confounders. CONCLUSION: Although an abnormal implantation per se was not an independent risk factor for perinatal mortality, placenta previa should be considered as a marker for possible obstetric complications. Hence, the detection of placenta previa should encourage a careful evaluation with timely delivery in order to reduce the associated maternal and perinatal complications.

Abortion, Habitual↗

PubMed2002

Congenital thrombophilia associated to obstetric complications.

During pregnancy there are hemostatic changes that result in a hypercoagulable state and can have thrombotic consequences. This condition can be aggravated in women who are carriers of congenital thrombophilic factors. This thrombotic tendency can manifest as thrombotic lesions in the placenta with compromise of utero-placental circulation, which are common characteristics present in obstetric complications, such as preeclampsia/eclampsia, miscarriage, fetal loss, intrauterine growth retardation, and abruptio placentae. In this paper we review data concerning about the association of congenital thrombophilia in pregnancy with obstetric complications, mainly preeclampsia and fetal loss, focusing in factor V Leiden and its related activated protein C resistance, prothrombin mutation G20210A and hyperhomocysteinemia related with C677T mutation of methylenetetrahydrofolate reductase. Although factor V Leiden has been the thrombophilic factor most studied, all three thrombophilic mutations have been related with obstetric complications; however, contradictory results about the specific association of each mutation with each type of obstetric complication are described. These discrepancies could obey to the ethnic difference of the studied groups, or to the fact that some studies were performed in closed populations with few migratory movement, where the genetic pool is relatively homogeneous, as well as the different inclusion and exclusion criteria. Even though this variability is present, the significance of recognizing true associations between these thrombophilic mutations and obstetric complications is essential in order to determine the likelihood of routinely screening for these conditions in pregnant women with risk factors for thrombosis and for carrying out specific prophylactic measures.

Female↗

PubMed1984

The epidemiology and clinical history of asymptomatic midtrimester placenta previa.

The current case-controlled study examines the epidemiologic factors and subsequent clinical history in 139 patients with asymptomatic low placentation and 137 patients with normal placental position diagnosed in the second and third trimesters by gray-scale ultrasonography. Increased maternal age or parity and previous endometrial or myometrial damage were significantly associated with asymptomatic midtrimester low implantation. Three percent of early low implantations persisted as instances of placenta previa at term. However, in low implantation, the antepartum course was associated with perinatal complications in 45% of patients. Statistically significant increases in third-trimester bleeding, abruptio placentae, and suspected intrauterine growth retardation were shown in the patients with low implantation, when compared to the control patients. Forty-two percent of the patients with low implantation were delivered by cesarean section. The need for cesarean delivery, loss of blood, and prolonged hospitalization were statistically increased in the patients with low implantation. Infants born to mothers with low implantation showed statistically significant increases in prematurity, low birth weight, and perinatal mortality when compared to infants born to control patients.

Adult↗

PubMed1982

Changes in placental ultrasonic appearance. II. Pathologic significance of Grade III placental changes.

Changes in placental texture and structure on ultrasonic examination have been suggested as correlating to advancing fetal pulmonary maturity. The association of preterm appearance of Grade III changes in the placenta in the complicated pregnancy suggests that these changes are associated with a decrease in placental function and premature senescence of the placenta. Placentas were routinely graded on all obstetric examinations performed during a 1-year period of time. Those pregnancies in which Grade III changes in the placenta prior to term were reviewed. A high incidence (78%) of perinatal problems were found in association with preterm appearance of Grade III changes. Perinatal complications included maternal hypertensive disorders, intrauterine growth retardation, abruptio placentae, and fetal distress in labor. The high incidence of these disorders in preterm pregnancies with Grade III changes in the placenta suggests that the sonographic changes found reflect placental dysfunction or senescence rather than normal maturational development. The appearance of Grade III changes in the placenta in the preterm pregnancy is suggested as a predictive indicator of potential perinatal problems in late pregnancy.

Female↗

PubMed2000

Placental lesions associated with cerebral palsy and neurologic impairment following term birth.

OBJECTIVE: The aim of this study was to determine the association of placental findings with cerebral palsy and related forms of neurologic impairment (NI) following birth at > or =37 weeks gestation (term). DESIGN: In a retrospective comparison, placentas from 40 term infants with NI ascertained on the basis of clinicopathologic review for medicolegal consultation were compared with placentas from 176 consecutive meconium-stained term infants at low risk for NI. RESULTS: After stratification for severity, 9 lesions were significantly increased in placentas from infants with NI: 5 lesions generally considered to occur within days of the time of labor and delivery (meconium-associated vascular necrosis, severe fetal chorioamnionitis, chorionic vessel thrombi, increased nucleated red blood cells, and findings consistent with abruptio placenta) and 4 lesions generally believed to have their onset long before labor and delivery (diffuse chronic villitis, extensive avascular villi, diffuse chorioamnionic hemosiderosis, and perivillous fibrin). Findings independently associated with NI by logistic regression in this descriptive study were severe fetal chorioamnionitis (odds ratio [OR], 13.2; 95% confidence interval [CI], 1.2-144); extensive avascular villi (OR, 9.0; 95% CI, 1.6-51); and diffuse chorioamnionic hemosiderosis (OR, 74.8; 95% CI, 6.3-894). The risk of NI increased as a function of the number of lesions present (OR, 10.1; 95% CI, 5.1-20 for each additional lesion), particularly when lesions generally considered to occur near the time of labor and those believed to occur well before labor were found in the same placenta (OR, 94.2; 95% CI, 11.9-747). CONCLUSIONS: These findings suggest that placental pathology can contribute to an understanding of the mechanisms that contribute to NI at term.

Birth Injuries↗

PubMedDate not supplied

[Obstetrical anesthesia and resuscitation in Africa].

In Africa, the obstetrical risk is related to the difficulty to monitor the pregnancy during which obstetrical emergency may occur and will have to be treated by the practitioner with, sometimes, inadequate facilities. The authors examine the problems concerning successively the expectant mother, the foetus and the placenta. Then, they propose some solutions in the field of anesthesia and intensive care. The expectant mothers are exposed to the heat and sometimes are suffering from undernutrition, so it requires special attention when using anesthetics. In addition, they frequently present an increased morbidity:--universal diseases among which renovascular syndromes often lead to eclampsia and to abruptio placentae;--tropical diseases may raise problems either to anesthesia (sickle cell anemia, bilharziosis) or to intensive care (algid pernicious fever, malignant amebiasis). Children are subject to an increased stillbirth rate in accordance with pregnancy duration and with the intensive facilities available at the time of the birth. Either infective or mechanical complications may occur in placenta and they may cause some distress to both mother and foetus. With respect to all these cases, the authors examine the various analgesia methods for obstetrical purpose and point out their indications and contraindications. It seems that regional anesthesia is suitable for health posts without facilities. Peridural anesthesia is operative with a great number of situations but it requires some technical training. Then methods to monitor both mother and foetus are exposed. According to the available facilities, ways and means are given to solve problems of anesthesia: labour maternal complications (Mendelson's syndrome, eclampsia, obstetrical complications either mechanical and hemorrhagic) or secondary complications (bacterial or parasitic complications, renal insufficiency); foetal complications either during labour, or at birth, or after delivery.

Africa↗