1
|
Ngongo CJ, Raassen TJIP, Mahendeka M, Lombard L, van Roosmalen J. Iatrogenic genito-urinary fistula following cesarean birth in nine sub-Saharan African countries: a retrospective review. BMC Pregnancy Childbirth 2022; 22:541. [PMID: 35790950 PMCID: PMC9254569 DOI: 10.1186/s12884-022-04774-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Genito-urinary fistulas may occur as complications of obstetric surgery. Location and circumstances can indicate iatrogenic origin as opposed to pressure necrosis following prolonged, obstructed labor. Methods This retrospective review focuses on 787 women with iatrogenic genito-urinary fistulas among 2942 women who developed fistulas after cesarean birth between 1994 and 2017. They are a subset of 5469 women who sought obstetric fistula repair between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. We compared genito-urinary fistula classifications following vaginal birth to classifications following cesarean birth. We assessed whether and how the proportion of iatrogenic genito-urinary fistula was changing over time among women with fistula, comparing women with iatrogenic fistulas to women with fistulas attributable to pressure necrosis. We used mixed effects logistic regression to model the rise in iatrogenic fistula among births resulting in fistula and specifically among cesarean births resulting in fistula. Results Over one-quarter of women with fistula following cesarean birth (26.8%, 787/2942) had an injury caused by surgery rather than pressure necrosis due to prolonged, obstructed labor. Controlling for age, parity, and previous abdominal surgery, the odds of iatrogenic origin nearly doubled over time among all births resulting in fistula (aOR 1.94; 95% CI 1.48–2.54) and rose by 37% among cesarean births resulting in fistula (aOR 1.37; 95% CI 1.02–1.83). In Kenya and Rwanda the rise of iatrogenic injury outpaced the increasing frequency of cesarean birth. Conclusions Despite the strong association between obstetric fistula and prolonged, obstructed labor, more than a quarter of women with fistula after cesarean birth had injuries due to surgical complications rather than pressure necrosis. Risks of iatrogenic fistula during cesarean birth reinforce the importance of appropriate labor management and cesarean decision-making. Rising numbers of iatrogenic fistulas signal a quality crisis in emergency obstetric care. Unaddressed, the impact of this problem will grow as cesarean births become more common. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04774-0.
Collapse
|
2
|
Ngongo CJ, Raassen T, Lombard L, van Roosmalen J, Weyers S, Temmerman M. Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa. BJOG 2020; 127:702-707. [PMID: 31846206 PMCID: PMC7187175 DOI: 10.1111/1471-0528.16047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula. DESIGN Retrospective record review. SETTING Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia. POPULATION A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014. METHODS Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries. MAIN OUTCOME MEASURES Mode of delivery, stillbirth. RESULTS Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990-94 to 64% (331/514) in 2010-14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514). CONCLUSIONS In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth. TWEETABLE ABSTRACT Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.
Collapse
Affiliation(s)
| | | | | | - J van Roosmalen
- Athena Institute VU University Amsterdam, Amsterdam, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - S Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - M Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya.,Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| |
Collapse
|
3
|
Sobhy S, Arroyo-Manzano D, Murugesu N, Karthikeyan G, Kumar V, Kaur I, Fernandez E, Gundabattula SR, Betran AP, Khan K, Zamora J, Thangaratinam S. Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2019; 393:1973-1982. [PMID: 30929893 DOI: 10.1016/s0140-6736(18)32386-9] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/15/2018] [Accepted: 09/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Universal and timely access to a caesarean section is a key requirement for safe childbirth. We identified the burden of maternal and perinatal mortality and morbidity, and the risk factors following caesarean sections in low-income and middle-income countries (LMICs). METHODS For this systematic review and meta-analysis, we searched electronic databases including MEDLINE and Embase (from Jan 1, 1990, to Nov 20, 2017), without language restrictions, for studies on maternal or perinatal outcomes following caesarean sections in LMICs. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990. Two reviewers undertook the study selection, quality assessment, and data extraction independently. The main outcome being assessed was prevalence of maternal mortality in women undergoing caesarean sections in LMICs. We used a random effects model to synthesise the rate data, and reported the association between risk factors and outcomes using odds ratios with 95% CIs. The study protocol has been registered with PROSPERO, number CRD42015029191. FINDINGS We included 196 studies from 67 LMICs. The risk of maternal death in women who had a caesarean section (116 studies, 2 933 457 caesarean sections) was 7·6 per 1000 procedures (95% CI 6·6-8·6, τ2=0·81); the highest burden was in sub-Saharan Africa (10·9 per 1000; 9·5-12·5, τ2=0·81). A quarter of all women who died in LMICs (72 studies, 27 651 deaths) had undergone a caesarean section (23·8%, 95% CI 21·0-26·7; τ2=0·62). INTERPRETATION Maternal deaths and perinatal deaths following caesarean sections are disproportionately high in LMICs. The timing and urgency of caesarean section pose major risks. FUNDING Ammalife Charity and ELLY Appeal, Barts Charity, and the UK National Institute for Health Research.
Collapse
Affiliation(s)
- Soha Sobhy
- Barts Research Centre for Women's Health, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, UK; Barts and the London School of Medicine and Dentistry, and WHO Collaborating Centre for Women's Health, Queen Mary University of London, London, UK
| | | | - Nilaani Murugesu
- Barts Research Centre for Women's Health, Queen Mary University of London, London, UK
| | - Gayathri Karthikeyan
- Department of Obstetrics and Gynaecology, Madurai Medical College, Madurai, India
| | - Vinoth Kumar
- Department of Surgery, Tirunelveli Medical College, Tirunelveli, India
| | - Inderjeet Kaur
- Department of Obstetrics and Gynaecology, Fernandez Hospitals, Hyderabad, India
| | - Evita Fernandez
- Department of Obstetrics and Gynaecology, Fernandez Hospitals, Hyderabad, India
| | | | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Khalid Khan
- Barts Research Centre for Women's Health, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, UK; Barts and the London School of Medicine and Dentistry, and WHO Collaborating Centre for Women's Health, Queen Mary University of London, London, UK
| | - Javier Zamora
- Barts Research Centre for Women's Health, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, UK; Barts and the London School of Medicine and Dentistry, and WHO Collaborating Centre for Women's Health, Queen Mary University of London, London, UK; Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain; CIBER Epidemiology and Public Health, Madrid, Spain
| | - Shakila Thangaratinam
- Barts Research Centre for Women's Health, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, UK; Barts and the London School of Medicine and Dentistry, and WHO Collaborating Centre for Women's Health, Queen Mary University of London, London, UK.
| |
Collapse
|
4
|
Mocumbi S, Hanson C, Högberg U, Boene H, von Dadelszen P, Bergström A, Munguambe K, Sevene E. Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment. Reprod Health 2017; 14:147. [PMID: 29126412 PMCID: PMC5681779 DOI: 10.1186/s12978-017-0408-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula is one of the most devastating consequences of unmet needs in obstetric services. Systematic reviews suggest that the pooled incidence of fistulae in community-based studies is 0.09 per 1000 recently pregnant women; however, as facility delivery is increasing, for the most part, in Africa, incidence of fistula should decrease. Few population-based studies on fistulae have been undertaken in Sub-Saharan Africa, including Mozambique. This study aimed to estimate the incidence of obstetric fistulae in recently delivered mothers, and to describe the clinical characteristics and care, as well as the outcome, after surgical repair. METHODS We selected women who had delivered up to 12 months before the start of the study (June, 1st 2016). They were part of a cohort of women of reproductive age (12-49 years), recruited from selected clusters in rural areas of Maputo and Gaza provinces, Southern Mozambique, who were participating in an intervention trial (the Community Level Interventions for Pre-eclampsia trial or CLIP trial). Case identification was completed by self-reported constant urine leakage and was confirmed by clinical assessment. Women who had confirmed obstetric fistulae were referred for surgical repair. Data were entered into a REDCap database and analysed using R software. RESULTS Five women with obstetric fistulae were detected among 4358 interviewed, giving an incidence of 1.1 per 1000 recently pregnant women (95% CI 2.16-0.14). All but one had Caesarean section and all of the babies died. Four were stillborn, and one died very soon after birth. All of the patients identified and reached the primary health facility in reasonable time. Delays occurred in the care: in diagnosis of obstructed labour, and in the decision to refer to the secondary or third-level hospital. All but one of the women were referred to surgical repair and the fistulae successfully closed. CONCLUSION This population-based study reports a high incidence of obstetric fistulae in an area with high numbers of facility births. Few first and second delays in reaching care, but many third delays in receiving care, were identified. This raises concerns for quality of care.
Collapse
Affiliation(s)
- Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Agostinho Neto 679, 1100, Maputo, Mozambique. .,Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, Plan 4, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden
| | - Helena Boene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique
| | | | - Anna Bergström
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.,University College London, Institute for Global Health, Gower St, London, WC1E 6BT, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Public Health, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | | |
Collapse
|
5
|
Wilson A, Truchanowicz EG, Elmoghazy D, MacArthur C, Coomarasamy A. Symphysiotomy for obstructed labour: a systematic review and meta-analysis. BJOG 2016; 123:1453-61. [PMID: 27126671 DOI: 10.1111/1471-0528.14040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obstructed labour is a major cause of maternal mortality. Caesarean section can be associated with risks, particularly in low- and middle-income countries, where it is not always readily available. Symphysiotomy can be an alternative treatment for obstructed labour and requires fewer resources. However, there is uncertainty about the safety and effectiveness of this procedure. OBJECTIVES To compare symphysiotomy and caesarean section for obstructed labour. SEARCH STRATEGY MEDLINE, EMBASE, Cochrane library, CINAHL, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction. SELECTION CRITERIA Studies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes. DATA COLLECTION AND ANALYSIS Quality of the included studies was assessed using the STROBE checklist and the Newcastle Ottawa scale. Relative risks (RR) were pooled using the random effects model. Heterogeneity was assessed using I(2) tests. MAIN RESULTS Seven studies (n = 1266 women), all of which were set in low- and middle-income countries (as per the World Bank definition) and compared symphysiotomy and caesarean section were identified. Meta-analyses showed no significant difference in maternal (RR 0.48, 95% CI 0.13-1.76; P = 0.27) or perinatal (RR 1.12, 95% CI 0.64-1.96; P = 0.69) mortality with symphysiotomy when compared with caesarean section. There was a reduction in infection (RR 0.30, 95% CI 0.14-0.62) but an increase in fistulae (RR 4.19, 95% CI 1.07-16.39) and stress incontinence with symphysiotomy (RR 10.04, 95% CI 3.23-31.21). CONCLUSION There was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section. TWEETABLE ABSTRACT Symphysiotomy could be an alternative to caesarean section when resources are limited.
Collapse
Affiliation(s)
- A Wilson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - E G Truchanowicz
- Centre for Cardiovascular Sciences, Institute for Biomedical Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - D Elmoghazy
- Faculty of Medicine, Minia University, Minia, Egypt
| | - C MacArthur
- Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
6
|
Abstract
BACKGROUND Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions during childbirth. It is performed with local analgesia and does not require an operating theatre nor advanced surgical skills. It may be a lifesaving procedure for the mother or the baby, or both, in several clinical situations. These include: failure to progress in labour when caesarean section is unavailable, unsafe or declined by the mother; and obstructed birth of the aftercoming head of a breech presenting baby. Criticism of the operation because of complications, particularly pelvic instability, and as being a 'second best' option has resulted in its decline or disappearance from use in many countries. Several large observational studies have reported high rates of success, low rates of complications and very low mortality rates. OBJECTIVES To determine, from the best available evidence, the effectiveness and safety of symphysiotomy versus alternative options for obstructed labour in various clinical situations. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 July 2012). SELECTION CRITERIA Randomized trials comparing symphysiotomy with alternative management, or alternative techniques of symphysiotomy, for obstructed labour or obstructed aftercoming head during breech birth. DATA COLLECTION AND ANALYSIS Planned methods included evaluation of studies against objective quality criteria for inclusion, extraction of data, and analysis of data using risk ratios or mean differences with 95% confidence intervals. The primary outcomes were maternal death or severe morbidity, and perinatal death or severe morbidity. MAIN RESULTS We found no randomized trials of symphysiotomy. AUTHORS' CONCLUSIONS Because of controversy surrounding the use of symphysiotomy, and the possibility that it may be a life-saving procedure in certain circumstances, professional and global bodies should provide guidelines for the use (or non-use) of symphysiotomy based on the best available evidence (currently evidence from observational studies). Research is needed to provide robust evidence of the effectiveness and safety of symphysiotomy compared with no symphysiotomy or comparisons of alternative symphysiotomy techniques in clinical situations in which caesarean section is not available; and compared with caesarean section in clinical situations in which the relative risks and benefits are uncertain (for example in women at very high risk of complications from caesarean section).
Collapse
Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of FortHare, Eastern Cape Department of Health, East London, South Africa.
| | | |
Collapse
|
7
|
Destructive operations—a vanishing art in modern obstetrics: 25 year experience at a tertiary care center in India. Arch Gynecol Obstet 2010; 283:929-33. [DOI: 10.1007/s00404-010-1820-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 12/14/2010] [Indexed: 11/27/2022]
|
8
|
Abstract
BACKGROUND Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions during childbirth. It is performed with local analgesia and does not require an operating theatre nor advanced surgical skills. It may be a lifesaving procedure for the mother or the baby, or both, in several clinical situations. These include: failure to progress in labour when caesarean section is unavailable, unsafe or declined by the mother; and obstructed birth of the aftercoming head of a breech presenting baby. Criticism of the operation because of complications, particularly pelvic instability, and as being a 'second best' option has resulted in its decline or disappearance from use in many countries. Several large observational studies have reported high rates of success, low rates of complications and very low mortality rates. OBJECTIVES To determine, from the best available evidence, the effectiveness and safety of symphysiotomy versus alternative options for obstructed labour in various clinical situations. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 3) and PubMed (1966 to 31 August 2010). SELECTION CRITERIA Randomized trials comparing symphysiotomy with alternative management, or alternative techniques of symphysiotomy, for obstructed labour or obstructed aftercoming head during breech birth. DATA COLLECTION AND ANALYSIS Planned methods included evaluation of studies against objective quality criteria for inclusion, extraction of data, and analysis of data using risk ratios or mean differences with 95% confidence intervals. The primary outcomes were maternal death or severe morbidity, and perinatal death or severe morbidity. MAIN RESULTS We found no randomized trials of symphysiotomy. AUTHORS' CONCLUSIONS Because of controversy surrounding the use of symphysiotomy, and the possibility that it may be a life-saving procedure in certain circumstances, professional and global bodies should provide guidelines for the use (or non-use) of symphysiotomy based on the best available evidence (currently evidence from observational studies). Research is needed to provide robust evidence of the effectiveness and safety of symphysiotomy compared with no symphysiotomy or comparisons of alternative symphysiotomy techniques in clinical situations in which caesarean section is not available; and compared with caesarean section in clinical situations in which the relative risks and benefits are uncertain (for example in women at very high risk of complications from caesarean section).
Collapse
Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200
| | | |
Collapse
|
9
|
Steel A, Fakokunde A, Yoong W. Management of complicated second stage of labour in stillbirths: A review of the literature and lessons learnt from two cases in the UK. J OBSTET GYNAECOL 2010; 29:464-6. [DOI: 10.1080/01443610902980860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Nkwo PO, Onah HE. Does a preference for symphysiotomy over caesarean section reduce the operative delivery rate? Trop Doct 2009; 39:198-200. [DOI: 10.1258/td.2009.080070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We analysed the data from a hospital that had practiced symphysiotomy and caesarean section (c/s) for many years and where symphysiotomy was acceptable to the parturient women, in order to determine the effects of symphysiotomy on c/s and on the overall operative delivery rates. Regression analysis revealed significant negative correlation between symphysiotomy and c/s ( R = −0.610, P = 0.03 at 95% confidence interval [CI]) and a non-significant negative correlation between symphysiotomy and combined operative deliveries ( R = −0.108, P = 0.383 at 5% CI). This study has confirmed that, in our environment, the practice of symphysiotomy significantly reduces the c/s rate and may save some women from operative deliveries in subsequent pregnancies. With the widespread aversion for c/s in the developing countries and a preference for symphysiotomy in some communities, symphysiotomy should be offered as an alternative to c/s whenever possible. Urgent revival of the dying skill of symphysiotomy is recommended in developing countries.
Collapse
Affiliation(s)
- Peter O Nkwo
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Hyacinth E Onah
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| |
Collapse
|
11
|
Why Vaginal Breech Delivery Should Still Be Offered: A Response. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006. [DOI: 10.1016/s1701-2163(16)32159-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
Symphysiotomy for feto-pelvic disproportion. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
13
|
Abstract
OBJECTIVE To identify, from the best available evidence, underutilized and promising technologies that may reduce maternal mortality from obstructed labor. METHODS The author sought systematic reviews of randomized trials, individual randomized trials, and, in the absence of randomized data, non-randomized studies and clinical consensus. Data were presented according to the level of the evidence. RESULTS Obstructed labor causes approximately 8% of maternal deaths, and indirectly contributes to a greater percentage. Proven or widely accepted technologies that help reduce mortality from obstructed labor include contraception, external cephalic version, the partogram, augmentation of labor, selective amniotomy, selective episiotomy, vacuum extraction, caesarean section, symphysiotomy, and destructive procedures for non-viable fetuses. Technologies of uncertain usefulness include maternal height and shoe size, vaginal cleansing, upright posture for delivery and vaginal lubrication. Unuseful technologies include pelvimetry, estimating fetal weight, early labor induction, routine amniotomy and augmentation, routine episiotomy, and starvation during labor. CONCLUSION Access to well-established technologies, particularly safe caesarean section, can reduce maternal mortality in resource-poor countries.
Collapse
Affiliation(s)
- G J Hofmeyr
- East London Hospital Complex, Effective Care Research Unit, University of Witwatersrand, South Africa.
| |
Collapse
|