Obstetric care

Caesarean section rates in an African country

The use of caesarean section (C.S.) has been analysed in the 12 hospitals of the Midlands Province of Zimbabwe during a 2-year period. Maternal mortality rate, perinatal mortality rate, low birthweight rate, percentage of high risk pregnancy, C.S. rate and instrumental delivery rate have been extracted for each hospital. The rate of C.S. delivery varied between 2.2 and 16.8 per 100 deliveries but was not correlated with the number of high-risk pregnancies. Increased use of C.S. was not linked to better perinatal results. An important determinant of the C.S. rate appears to be the physician and the ratio between the rate of instrumental deliveries (ID) and C.S. differentiated the 12 hospitals into two groups. Although there was no difference in the number of high risk patients in these two groups, outcomes were much better in the hospitals with a high ID rate than in the hospitals with a high C.S. rate, suggesting that attitudes of medical staff can influence both the mode of delivery and the perinatal outcome in a developing country.

How accurate is maternal height measurement in Africa?

Maternal height is one of the risk parameters for dystocia that is often used in antenatal clinics which are organized by health centers and dispensaries in developing countries. In this paper, the results of an analysis on the reliability of height measurements in four African countries: Benin, the Congo, Senegal and Zaire are presented. Different causes appear to reduce this reliability: attraction to round numbers, assignment of some standard size, and in one situation an overrecording (probably intentional) of an at-risk woman. Different solutions are being suggested, and the importance of assessing the quality of risk factor measurement in improving the efficacy of the risk approach strategy is stressed.

Is it worth weighing pregnant women in a developing country?

In order to find out which criteria could be useful for pregnancy screening and referral, the maternal weight gain curves of 251 patients have been reviewed. Three alarm signs (gain greater than 1.0 kg/w; no gain for 4 weeks and weight loss) have been assessed and correlated with the occurrence of macrosomia, twin pregnancy, fetal intrauterine growth retardation and intrauterine death. Although excessive weight gain appears statistically linked to preeclampsia, macrosomia and twin pregnancy the sensitivity and specificity of a system using these criteria are unacceptably low.