clove and Dystocia

We conducted a retrospective study on neglected shoulders during 12 months at the Maternity Hospital of Befelatanana, 31 cases among 4685 deliveries were reported. The majority of the pregnancies are not under medical supervision and no ultrasound is carried out during the third trimester. There were 8 cases of uterine rupture, 2 haemorrhage shocks, 6 syndromes of prerupture, 6 umbilical cord prolapses at the third degree and 6 tears of the cervix. 20 caesarean sections have been performed as well as a turning of foetus in utero in 3 women, 4 hysterectomies, and a conservative suture with uterine tube ligation in the other cases. Often linked to a large multiparity the neglected shoulder remains quite frequent in developing countries such as Madagascar and regular prenatal consultations together with a rigorous clinical exam are highly recommended by the authors to make an early diagnosis and provide a better care management.

Topics: Adolescent; Adult; Cesarean Section; Dystocia; Emergencies; Female; Humans; Hysterectomy; Infant, Newborn; Labor Presentation; Madagascar; Obstetric Labor Complications; Pregnancy; Pregnancy, Multiple; Retrospective Studies; Shock, Hemorrhagic; Shoulder; Uterine Rupture

High maternal mortality rate (12 death per 1,000 births, in 1997) has suggested this study in order to improve cesarean's management, then to reduce maternal death. Therefore, during the year 1998, 529 women among 8,366 had cesareans, which are 6.8%. The epidemiological profile reveal evacuation (82.4% of the cases); their average age is 29 years old and the average parity were 3. Principal indications are: dystocia (26.8%), fetal distress (38.1%), dynamic dystocia, previous uterine incision (11.2%). Maternal prognosis is mediocre because of a high mortality rate (2% of cesarean) and an important morbidity related to infection (29.5%). The same things happens with fetal prognosis. Classifications of indications to cesarean in 3 categories according to priorities help to plan and appreciate management of cesarean in a rational way. The reason why cesareans had to be a compulsory (42% of our cases) is to reduce maternal mortality. Cesarean as precautions (51.2%) and cesarean as needs (3.9%) were decided because of a bad surveillance of pregnancy and birth. In fact in order to reduce the maternal death with indication of cesareans, National Health System has to increase surgical structures with appropriate equipment and medicine, held by competent and sufficient number of staff. The female condition must be improved and population should be aware that they need to come to birth places and participate to the health care's cost.

Topics: Adult; Cesarean Section; Dystocia; Female; Fetal Death; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Madagascar; Maternal Mortality; Morbidity; Pregnancy; Prognosis; Retrospective Studies; Socioeconomic Factors