Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Audit of the quality of gynaecological care is essential so that errors due to medical interventions can be reduced to the bare minimum. The aim of this study was to determine the incidence and nature of adverse gynaecological events. The clinical records of all women admitted with gynaecological conditions over 9 months were assessed for adverse events, defined as an injury caused by medical management rather than the underlying disease. ⋯ The frequency of adverse events increased with age, the presence of co-existing illnesses, and severity of the illness on admission. Therapeutic mishaps (n = 67; 8%) were the most common type of adverse event. Lessons learnt from audit should reduce adverse events considerably.
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The objective of the study was to assess the risk factors associated with obstetric brachial plexus injury. It was a retrospective analysis over a 7-year period, of women whose labours were either complicated by shoulder dystocia or had neonates who sustained brachial plexus injury. The 133 women included were divided into two groups: (1) Non-brachial plexus injury (Non-BPI) group: 106 women with labours complicated by shoulder dystocia. (2) Brachial plexus injury (BPI) group: 27 women whose neonates sustained BPI. ⋯ The neonatal variables were similar in both groups. Mean birth weight was more than 4 kg in both groups. In the presence of similar neonatal variables, brachial plexus injury is more likely to occur in neonates of primiparous women in the presence of shoulder dystocia, if labour is accelerated.
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Recent studies have cast doubt on the recommended 30-min decision--delivery interval (DDI) in emergency caesarean sections. The practicability, justification, anticipated beneficial effect on neonatal outcome and its medico-legal implications have been questioned. We set out to determine (1) the DDI for emergency caesarean sections in two Nigerian tertiary care centres (2) the effect of DDI on perinatal outcome (particularly if the DDI is longer than the internationally recommended 30 min) and (3) the factors causing delays in intervention if any. ⋯ Although the 30-min interval should remain the gold standard, DDI up to 3 hours may not be incompatible with good perinatal outcome as shown in this study. As in other studies, anaesthetic delay is the major cause of delay in carrying out emergency caesarean sections. Finally, since prolonged DDI may not be the cause of an adverse perinatal outcome in the majority of cases, litigation on these grounds may be unjustified.
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The incidence of placenta praevia and accreta has been increasing with rising caesarean section rates. We highlight the increasing incidence of severe post-partum haemorrhage due to placenta accreta. Four cases occurred within 3 years (2002--2004) in a small District General Hospital (DGH) with a delivery rate of 1,800 per year. ⋯ Patients were counselled regarding this condition, and the possible need for hysterectomy was discussed. Two of them had to be managed by post-partum hysterectomy and the other two were treated conservatively. The purpose of writing these case reports is to warn others of the need for vigilance, particularly in keeping their primary caesarean section rates down and being prepared for long-term complications.