Search

The safety of vaginal birth for singleton preterm breech has not often been addressed before. We retrospectively compared the perinatal outcome of two groups of preterm breech delivery. Sixty-six patients delivered vaginally and 32 delivered abdominally between 26 and 36 completed weeks. Vaginal delivery was allowed under the same protocol for singleton breech delivery at term. Both groups had similar maternal characteristics. Intergroup differences in early neonatal outcome, as measured by Apgar score, were not significant. Intrapartum and early neonatal deaths in vaginal and cesarean delivery were compared. There was no significant difference in intrapartum death and early neonatal mortality between those who delivered vaginally and those who delivered by cesarean section (16.6 vs. 15.6%). So even with optimum neonatal care facilities, cesarean section does not offer any advantage over vaginal delivery in a developing country. This study does not advocate the routine use of cesarean section for delivering preterm breech fetuses.

Postpartum fistulas are frequent in the tropical environment. They are mostly found in very young women who live in remote areas. Without treatment women with fistulas will be condemned to the disconsolate life of social outcasts. Good operative treatment is crucial. The different operative methods are discussed. The operation through vaginal approach can be performed in any hospital. It does not need special surgical skill. More important than surgery is prevention of postpartum fistulas through a well-organised primary health care program which reaches out into the villages and which includes adequate prenatal controls and competent midwifery.

The mode of delivery and outcome in 158 twin births in a Nigerian sub-urban hospital are reviewed. Apgar scores at one minute were significantly higher for twin 1 compared to twin 2 in vertex deliveries only. There was no significant difference in Apgar scores at 5 minutes between the twins for the various modes of delivery. Apgar scores were generally higher for the controls (a set of singleton births) compared to twin births for all the modes of delivery except breech births. Birth weights were also significantly higher for controls compared to twin births although no significant difference occurred between the twins. Perinatal mortality rates were generally higher for twin 2 compared to twin 1, and for the twins compared to controls irrespective of mode of delivery. Better outcome could not be ascribed to any particular mode of delivery in twin births and would depend on the judgement and expertise of the labour attendant.

This institution based case control study emanated from the fact that manual vacuum aspiration (MVA) has been recently introduced in Ethiopia and Gandhi Memorial hospital is currently serving as the pioneering centre. Abortion is an important everyday medicolegal, social, political and public health issue. The objectives of the study were to focus on abortion issues, to show that MVA is alternative instrument applicable in our setting and to highlight some of the determinants that can influence the choice of instruments in the management of incomplete abortions of less than 12 weeks of gestation. A total of 1896 patients who fulfilled the inclusion criteria underwent evacuation and curettage with MVA and SMC during the study period. The main considered variables included socio-demographic characteristics, service-providers, complications in relation to operators and method of surgery, duration of the surgery, patient pain evaluation and uterine factors. MVA is found to be equally safe, effective, simple and fast set of instruments which can be employed in the management of incomplete abortions. Integration of MVA in the medical training is recommended as it is a measure which can greatly contribute towards the reduction of maternal morbidity and mortality especially in a developing country like ours where resources are scare and alternatives are quite limited.

Although comparable with rates in other African countries, the "vertical transmission rate of HIV-1 for the Black population in Durban [South Africa] is high." The data was reported by Dr. Hoosen Coovadia and colleagues at the University of Natal Medical School in Durban. Coovadia followed HIV-1 positive women who gave birth at the King Edward VIII Hospital in Durban to estimate the rate of vertical transmission and the influence of various maternal risk factors on transmission rates. In the study cohort, which included 229 women and 181 infants, Coovadia observed a transmission rate of 34%, comparable with the estimated 20-45% reported in other regions of Africa. Women who had cesarean section deliveries were less likely to transmit HIV-1 to their infant. Although this association was previously reported by the European Collaborative study, Coovadia pointed out that it has not been reported in an African cohort before. While cesarean section delivery was protective against transmission, lower maternal hemoglobin levels were associated with an increased risk of transmission in this cohort. Coovadia added that "clearance of maternal antibodies is virtually achieved by 12 months of age and that this age could be used as a cutoff for the diagnosis of vertical infection in areas relying on antibody tests.", (full text)

We report three cases of failed termination of pregnancy in which the children were subsequently born with arthrogryposis (AMC) (multiple congenital contractures). Arthrogryposis is a sign with many causes. We suggest that the multiple congenital contractures seen in these children are due to vascular compromise during the attempted termination with secondary loss of functional neurons leading to fetal akinesia and subsequent contractures. Two of the children have additional evidence of intrauterine vascular compromise. Limitation of movement secondary to the rupture of the fetal membranes and continuous leakage of amniotic fluid after the attempted termination may have compounded the contractures in two of the children.

Data from a prospective study undertaken at an urban hospital in Durban, South Africa, were used to investigate associations between maternal-infant HIV transmission, mode of delivery, and specific circumstances of cesarean deliveries. A total of 141 children of HIV-infected women were followed until the children were 15 months of age to determine their HIV status. supplementary data were collected from obstetric records, masked to the HIV status of the children. In this African and predominantly breast-fed population, infants delivered vaginally were more likely to be infected (39.8% infected) than were infants delivered by cesarean section [22.9% infected; odds ratio (OR), 0.45; 95% confidence interval (CI), 0.20-0.99]. There were no significant differences between cesarean deliveries undertaken following prior rupture of membranes and those undertaken with membranes intact, but numbers for this comparison were small. Singleton cesarean deliveries without concurrent obstetric complications had lower rates of transmission than did vaginal deliveries (OR, 0.20; 95% CI, 0.04-0.94). These results suggest that certain intrapartum events may modify the risk of HIV transmission and highlight the importance of collecting more detailed intrapartum information in order to clarify the route by which mode of delivery may be associated with maternal-infant HIV transmission.

The present study comprised 50 cases of normal vaginal delivery and 50 cases of caesarean section. The cord blood level of immunoglobulin G was significantly higher in normal vaginal delivery cases than in caesarean section cases (mean level is 1653.2 +/- 443.1 mg/dl and 898.3 +/- 415.6 mg/dl respectively). The immunoglobulin G was low in cord blood but had higher concentration in all the 7 cases in study group who had fever with rigor in antenatal period. Thus the babies delivered with caesarean section had lower immunoglobulin level than normal vaginal delivery.

At Kaziba hospital in rural Zaire, the frequency of deliveries by Caesarean section rose from 6.2% in 1971 to 12% in 1992, and the fraction of repeated sections rose from 17% to 49%. During the same period, the overall maternal mortality decreased from 0.3% to 0.12%, and deaths connected with Caesarean section from 3.2% to 0.7%, but still the risk of dying remained 13 times higher for births by Caesarean section compared with vaginal deliveries. The frequency of vacuum deliveries was halved during the period, and mean birth weight decreased by about 100 g. Perinatal mortality remained at about 2%. Among 760 Caesarean sections performed in the years 1991 and 1992, 93% were emergency cases. Spinal anesthesia was used in 97%, and blood transfusion was given to 4% of the women. The main indications were mechanical (30%), previous Caesarean section (20%), foetal asphyxia (19%), and suspected uterine rupture (10%). Uterine rupture was verified in 37 cases (4.9%), of which 27 were Caesarean scar ruptures. 259 of the operations were performed by a nurse or a dentist. Operations carried out by persons other than physicians were complicated by wound infections at a higher rate (20.8%) than those carried out by experienced doctors (11.2%). In areas with a poorly developed health system, a high rate of Caesarean section represents a hazard to maternal health. The need for knowledge about alternative methods like vaginal extraction, symphyseotomy and active management of labour is underlined.

The aim of this paper is to determine the antecedent factors, clinical presentation, complications and management of uterine rupture in the context of modern obstetric practice in Singapore. We conducted a retrospective study of 26 proven cases of uterine rupture in Kandang Kerbau Hospital, Singapore between January 1983 to December 1992. These cases were analysed with regards to their past history, clinical presentation, complications, management and outcome. The incidence of uterine rupture was 1 in 6331 deliveries. The ratio of cases with scarred uteri against those with unscarred uteri was 3:1. The commonest antecedent factor was previous lower segment caesarean section for the scarred group and cephalo-pelvic disproportion in the unscarred group. Overall, 46.2% of the patients had augmentation with oxytocin. The major clinical presentations were abnormal cardiotocogram (25%) and blood-stained amniotic fluid (20%) in the scarred group, and postpartum haemorrhage (50%) and shock (33%) in the unscarred group. Repair of the uterus with or without tubal ligation was performed in 95% of the patients with scarred uteri, whereas 67% of the patients with unscarred uteri underwent total abdominal hysterectomy with or without salpingo-oophorectomy. There was 1 (3.8%) maternal death. Maternal morbidity included bladder injuries, broad ligament haematoma, disseminated intravascular coagulation and gastrointestinal bleeding. The overall incidence of fetal loss was 7.4%. When compared to a previous study on uterine rupture in the same hospital, there was an improvement in obstetric performance.

The perinatal and maternal outcomes of 65 symphysiotomies and 108 caesarean sections carried out after failed trial of assisted delivery at the Port Moresby General Hospital between 1988 and 1994 were retrospectively analyzed. There were no significant differences in perinatal outcomes between the treatment groups. There were no maternal deaths in either group. Mothers who had symphysiotomy had a longer postoperative stay in hospital but fewer complications requiring further surgery. There are many advantages of symphysiotomy, particularly in developing countries, following a failed trial of assisted delivery, provided the indications for it are strictly met. Obstetricians experienced in the technique are able to apply it at the optimal time, with long-term benefit to their patients, who thereby avoid the risks of pregnancy subsequent to caesarean section.

Objective: To establish a mother-baby's rooming-in program (RI) in a hospital that provides a tertiary level of care., Material and Methods: Babies born to healthy mothers were included, both delivered vaginally (P) and by cesarean section (C). Information was gathered on the cause for RI suspension, the type of infant's feeding and the mother's opinion about the program., Results: Sixty-eight per cent of P infants and 98% of C infants participated in the program. The time from delivery to RI was uncovered; for P babies it was 5.8 hours and for C babies it was 17 hours. The RI was suspended in 1% of P and 6.7% of C infants, but with no justifiable medical reason in the infants. The mother's opinion about RI was very favorable. Only 50% of the infants started breast feeding within the first 6 hours after birth; however, all of them were breastfed at the time of discharge., Conclusions: It is possible to establish RI and initiate breast feeding in a tertiary care hospital, even in mothers with cesarean section.

Anticipation and suspicion are critical aspects to any discussion of intrauterine adhesions. Curettage between the second and fourth week postpartum is more likely to cause adhesions than is any other endometrial trauma. Infertility, recurrent abortion, or menstrual aberrations after any uterine trauma should cause the physician to suspect the presence of intrauterine adhesions. Hysterosalpingography and hysteroscopy are the ideal methods to make the diagnosis of IUA, and the latter is the safest, least traumatic, and most precise method of treating adhesions. The addition of an intrauterine splint and high-dose estrogen therapy completes the therapeutic approach. Before attempting conception the cavity should be inspected to verify its normality.

Two hundred twenty-two women undergoing incidental diagnostic dilation and curettage (D&C) at the time of elective laparoscopic tubal ligation were studied retrospectively to ascertain if the risks of a D&C were warranted in a group of young, healthy women with a low risk of endometrial pathology. The endometrial sampling was associated with five uterine perforations and one readmission for bleeding and did not uncover any significant pathology in women under 35. The endocervical curettings did yield pathology of some clinical significance in women of all ages. The risk of uterine perforation was significantly higher in women who were < 15 weeks postpartum. We conclude that in a population of asymptomatic women under the age of 35, a diagnostic D&C is not indicated at the time of elective laparoscopic tubal ligation.

This paper had identified a contemporary ethicolegal dilemma concerning the circumstances, if any, in which a pregnant woman's refusal of medical treatment may be judicially overridden either in her interests or those of the unborn child. On the one hand, the obstetrician will be concerned about the interests of both his patients in potentially life-threatening situations when they can be protected by what might be regarded as relatively straightforward procedures and where to fail to take those steps might expose the practitioner (at least outside New Zealand where its accident compensation legislation has impact in this regard) to allegations of negligence. On the other hand, the imposition of treatment in these circumstances will necessarily interfere with the woman's rights of autonomy and self-determination. In such cases also, the conduct of medical procedures in the face of an express prohibition by the woman may give rise to liability for battery. (In New Zealand, such a potential liability would not, in the writer's view, be affected by the prohibition on proceedings for damages for medical misadventure as contained in the Accident Rehabilitation and Compensation Insurance Act 1992.) At the heart of an analysis of this issue is the status of the fetus as it is the fact of the woman patient's pregnancy which distinguishes the cases discussed in this paper from others in which the Courts have had to deal with refusals of treatment by those competent to do so. In regard to this aspect, the approach of the Courts in various jurisdictions has arguably been confused and contradictory.(ABSTRACT TRUNCATED AT 250 WORDS)

One hundred cases each, in induced and spontaneous labour, were analysed to compare which group could achieve safer motherhood. It was observed that induced group with controlled labour has many maternal and foetal advantages like undisturbed domestic arrangements, avoidance of fatigue of patients and her relations, short duration of labour and minimal exposure to stress of labour, lower incidence of caesarean section and minimised perinatal morbidity and mortality.

Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.

In this prospective study, 100 mothers who have undergone caesarean section in Jimma Hospital from 23rd June 1992 to 24th September 1993 were analysed to determine the incidence, indications and post operative complications of caesarean delivery. During the study period, there were 1236 deliveries, of whom 100 mothers were delivered by caesarean section; giving a caesarean birth rate of 8%. The leading indications for caesarean section were cephalopelvic disproportion (44%), malpresentations and malpositions (21%), repeat caesarean section (16%), antepartum haemorrhage (8%) and foetal distress (6%), accounting for 95% of the indications for caesarean section. There was no maternal death, but the overall morbidity rate was 20%. The causes of morbidity were wound infection (27.1%), sepsis (21.4%), endometritis (33.3%), haemorrhage (8%) and wound dehiscence (10%). The gross perinatal mortality rate of 120 per 1000 live births was not significantly higher than the rate for all deliveries, which was 92.5% per 1000 live births (P < 0.5). The single most important cause of perinatal death was prolonged and obstructed labour. In order to reduce the high perinatal mortality and maternal morbidity, there is a strong and urgent need to prevent prolonged and obstructed labour through effective antenatal care and referral system.

Post-caesarean endometritis-myometritis (PCEM) was diagnosed in 49 Mozambican women. They were compared with 47 control women without signs of PCEM after caesarean section. The patients and controls were matched for age, parity and days post partum. Features of the socio-economic background and of past and current obstetric history were registered. Endocervical, intracavitary and blood cultures were carried out. Screening for syphilis seropositivity and HIV-1 and HIV-2 antibodies was performed. Socio-economic and obstetric background factors were similarly distributed in cases and referents, though previous caesarean section was less frequent among cases than among referents (OR 0.12). Moderate high-risk factors in existing antenatal card tended to be more frequent among cases than among referents (OR 3.29). Microbiological findings indicated more anaerobes in the vagina, in the endocervix and in the uterine cavity, though the differences only approached significance. It is concluded that women with PCEM in the setting studied expose few characteristic background features discriminating them from women with uneventful post-caesarean outcome. Further research efforts should be directed towards case-control studies with focus upon surgical factors and on a more comprehensive microbiology and serology approach.

High caesarean birth rates are an issue of international public health concern. Determinants of caesarean birth are reviewed in order to formulate strategies to reduce these high rates. A strong independent profession of highly qualified midwives, who care for women with low-risk pregnancies, may contribute to a relatively low caesarean birth rate. Different clinical policies which influence the intervention rate, are discussed for the most frequent reasons to perform caesarean section: dystocia, repeat caesarean birth, breech delivery and foetal distress. The risks and safety of caesarean birth differ from place to place in this world. As the relative safety of the procedure is an important factor contributing to the rise of caesarean birth, the fact that this has only been achieved in some parts of the world should restrict the indications to perform the operation in the best interests of pregnant women.

A prospective and cooperative study was done in 152 patients that were submitted to cesarean section. Seventy eight patients received intrauterine device (IUD) T CU 220 during cesarean section, and the other 74 patients only got the cesarean section without IUD. The events that were analyzed during the puerperium were pain, bleeding and infection. We didn't find any difference in the results between both groups, these were analyzed with the help of the square chi (X2). These results suggest that with an adequate selection of the patients, the insertion of the IUD during the cesarean section is a secure and helpful method for the fertility control for patients with high risk of reproduction.

Maternal morbidity and mortality remain major problems of public health in developing countries. Having long been neglected, maternal health is now being included among the priorities of a large number of countries. The rate of maternal mortality in Senegal is 850 per 100,000 live births, among the highest in the world. The main causes of maternal mortality in Africa are obstructed labour and uterine rupture, hypertensive disorders of pregnancy, puerperal infection and haemorrhage. An epidemiological survey of obstetric disorders was initiated in 1992 in Senegal to characterise the requirements for surgical coverage during pregnancy and delivery. In 1992, the national rate of caesarean section was low (0.66% of estimated births). However, rates differed greatly between regions, and between rural and urban areas. The indications for caesarean section were classified into three groups, each corresponding to a different public health issue. The rate of maternal mortality associated with surgery was high: 4.7%, of which 29% during surgery and 71% post op. Perinatal prognosis was also poor, with a mortality rate of approximately 30%. There are only 18 reference obstetrics units functioning, and they give a very uneven coverage of the country. These finding have led to new guidelines to improve the quality and cover of maternal care over the coming years.

This paper provides accurate figures and detailed analysis of the causes of perinatal mortality in the main referral hospital in Vanuatu in 1992, and discusses possible improvements in management. The perinatal mortality rate for the Vila Central Hospital area was 30.4 per 1000 births (with a stillbirth rate of 14 per 1000). These figures include mothers who presented for the first time in labour without any antenatal care, and cases of very low birthweight (less than 1 kg). These results were achieved with very low intervention rates. The commonest cause of death in Vanuatu was birth asphyxia, with prematurity, unexplained stillbirth and major congenital abnormality as the other main causes. Even though there is still scope for improvement, especially in the prevention of birth asphyxia, the perinatal mortality rate in Vanuatu compares favourably with that in other developing countries. Increased family planning uptake will be expected to lead to a reduction in perinatal mortality.

This retrospective study was carried out to examine indications for Caesarean section (CS), foetal outcome and postoperative complications and to recommend ways of reducing maternal and neonatal deaths. In a five year period (September 1987 to August 1992), among 11,657 consecutive deliveries at Yekatit 12 Hospital, Addis Abeba, Ethiopia, there were 645 CSs, an overall CS rate of 5.5%. During this study, the indications for CS were cephalopelvic disproportion (31.2%), foetal distress (21.4%), previous CS (17.5%), placenta praevia (6.6%), cord prolapse (4.2%) and others (19.1%). There were 99 perinatal deaths, a gross perinatal mortality rate of 153.5 per 1,000 live births, which was a significantly higher rate than the total rate for all deliveries (67.5 per 1,000 live births, p < 0.01). There were seven maternal deaths (case fatality rate of 1.1%). The very high perinatal mortality in this study calls for a better and more effective antenatal service to improve foetal and maternal survival. This could be achieved by strengthening the referral system for pregnant women with obstructed and prolonged labour.

The effect of illegal abortion on subsequent reproduction was studied in 46 Nigerian women who gave a history of illegal termination of pregnancy. There was a statistically significant increase in the incidences of premature rupture of membranes, premature labour and low birth weight when compared to 53 primigravida who gave no such history of abortion. The perinatal mortality was also significantly higher in the abortion group. In contrast, pre-eclampsia was less common in the abortion group. These findings indicate that illegal abortion has adverse effects on pregnancy outcome in Nigerian women.

In this study the case records of 1414 patients who delivered at Alshaty hospital within one year were examined and some important variables related to caesarean section cases and their outcome were discussed. The caesarean section rate was found to be 9.9%. The high number of grand multigravida and primigravida among these Saudi mothers have contributed to this high caesarean section rate. The high emergencies in these sections (73.6%) have resulted in higher incidence of maternal and fetal morbidity namely postoperative pyrexia (37%), maternal anemia (20%) and extensive neonatal resuscitation (34%). The main indications of caesarean section in this hospital were repeated caesarean section (34.3%), failure of progress (19.3%) and fetal distress 12.9%. The relation and interaction between the three groups were thoroughly discussed based on the mechanisms of these indications. It is concluded that the changing trend of indications of caesarean section was mostly related to the change in departmental management rather than change in the characteristics of the patients.

The pattern and associations of 62 instances of external birth trauma (EBT) in 57 of 2222 consecutive hospital-born neonates were studied. Macrosomia and vaginal instrumental or breech delivery were identified as significant risk factors for EBT. In contrast to previous reports, subgaleal hemorrhage (SGH) was the predominant form of trauma (n = 33) and it was associated with vacuum application in 28 of 33 (85%) neonates. Brachial plexus palsy (BPP) (n = 10) occurred with the highest frequency (6.4%) after breech delivery. Fractures were uncommon. Multiple injuries (10 items in 5 babies) were mainly associated with vacuum extraction. The high rate of vacuum extraction (VE) and problems with its use including a high VE failure rate (30/242 = 12.4%) were considered contributory to the unusual pattern of EBT seen in the study. Regular audit of delivery practices, greater care in excluding cephalopelvic disproportion and judicious use of VE are recommended to reduce the morbidity from EBT.

Authors analysed the course of pregnancy and labor at 141 under 18 aged girls, between 1981-1990. The rise of number of labors at teen-agers was observed in the last 5 years. This tendency should pay our attention on this group of patients.

At the paper the problems of girls hospitalized at the Gynaecological and Obstetrician ward of the hospital situated on the border of city agglomeration were described. The data regards as pregnancy, delivery and puerperium and they were collected in last two years.

Indications for caesarean section had been studied in a 2-year period and the incidences were compared to that of the same 15 years back. Though there are more incidences of caesarean section, still perinatal death is a major concern to all. The study included a total of 291 perinatal deaths of which there were 208 early neonatal deaths and 83 stillbirths over a period of 2 years from January, 1990 to December, 1991. Caesarean section is being increasingly performed for foetal interest, but this study reveals that perinatal mortality is still high though cesarean section rate has increased in recent times.

A significant increase in endometrial thickness and volume was observed in 30 patients given oestrogen and progestin supplementation following curettage for first trimester abortions, compared with 30 women who received no treatment. This indicates an enhanced regeneration of the endometrium following treatment. The ability to induce this response, creating a space between the intra-cavity surface area a short time after abortion, may theoretically be suggested as preventative treatment to reduce the risk of intrauterine adhesions.

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.

Forty-four mothers with eclampsia and their newborns managed during the year 1988 at the University Hospital of Banaras Hindu University, Varanasi were analyzed. The incidence of eclampsia was 2.2% of all hospital deliveries. Eclampsia was more common in women (below 20 years) and at gestation of 36 weeks and below, and amongst the mothers deprived of antenatal care. The maternal mortality amongst cases of eclampsia was 31.8% and perinatal loss was 38.6%. A relatively high incidence of eclampsia and maternal and perinatal loss was considered to be related to lack of antenatal care and late referral to the hospital. Our findings suggest that more frequent use of properly timed cesarean section can improve the maternal outcome.

In a pilot study group of 25 women presenting in our clinic after exposure at ovulation to undesired pregnancy, endometrial suction by means of a Pipelle catheter was performed. Sixteen of the 25 women had proven fertility and 9 had never tried to conceive. The women were aged 18 to 38 years. Pathological dating of endometrial sampling verified that the patients were actually post-ovulation in all cases studied. hCG tests were performed 10 to 14 days after endometrial suction and all were negative. We conclude that endometrial suction in the luteal phase is a possible means of postcoital non-hormonal contraception, and we are currently expanding our study.

This case report presents a patient with a psoas abscess related to a dilatation and (aspiration) curettage for an incomplete abortion with an IUD. Psoas abscess is extremely rare in obstetrics and gynecology and a life threatening condition. It is important to recognize the clinical presentation. Psoas abscess should be suspected in patients presenting with fever, pain in the leg, thigh, or low back region. Whether antibiotic prophylaxis in abortion curettage may prevent this and other complications is discussed.

In Ghana, infection has been identified as a major cause of birth-related mortality. Results of a 2-month observation of infection control practices among Ghanaian obstetric nurses and midwives indicated that most personnel did not practice basic rules of asepsis. Problems included frequent breaks in technique, inadequate sterilization and disinfection, and repeated exposure to large amounts of blood and vaginal secretions. Supplies were limited and, even when available, not always used appropriately. The situation in developing countries is different from that in the United States. Therefore, an observational needs assessment is essential to plan relevant and practical measures for change.

Objective: Our purpose was to compare the complication rate of first-trimester suction curettage with that of second-trimester dilation-and-evacuation abortions in the same clinical setting., Study Design: Retrospective analysis (chart review) of the 3772 induced abortions performed between 1986 and 1990 at the Family Planning Clinic of the Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada., Results: Among the 3355 cases with known follow-up (89%), the complication rate was 5.1% for the 2908 suction curettages at < 15 weeks' gestation compared with 2.9% for the 447 dilation-and-evacuation procedures at 15 to 20 weeks' gestation. Serious complications were few and not increased among patients undergoing dilation and evacuation., Conclusion: A careful approach to second-trimester dilation-and-evacuation procedures can make them comparatively as safe as suction curettages, contrary to common belief derived from large surveys done in the late 1970s.