Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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In view of the rising trend in caesarean section rates all over the world and women requesting caesarean section without any medical indication, we conducted a questionnaire survey to assess the opinion of clinicians in the field of obstetrics to assess their views regarding this issue. We found that clinicians agree that the caesarean section rates are increasing and most of them hold the media and women responsible for this rising trend. However, in situations where no definite medical indication was evident, most of the clinicians favoured caesarean section. The findings of this study suggest that there is a need for change in the attitude of clinicians before attempting to educate women regarding the caesarean section for non-medical reasons.
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This study reviews the deliveries of macrosomic babies and their outcomes. A total of 330 macrosomic (birth weight > or =4 kg) cases were studied retrospectively from July 1999 to December 1999 in the Maternity Hospital of Kuala Lumpur. The variables studied included induction of labour, mode of delivery and the incidence of maternal and perinatal complications. ⋯ Two cases of stillbirths were documented but no maternal death occurred during the period of study. Vaginal delivery is the most frequent mode of delivery for a fetus weighing in excess of 4 kg and vaginal delivery should be attempted in the absence of contraindications, because vaginal delivery has less maternal morbidity compared to caesarean delivery. However, shoulder dystocia remains a significant complication of vaginal delivery for macrosomic fetuses.
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A total of 21 cases of severe burns in pregnancy managed at the University of Maiduguri Teaching Hospital, Maiduguri, over a 10-year period, spanning January 1991-December 2000 inclusively were reviewed. The pregnancy loss was 92.9%, with the pregnancies spontaneously terminated within 10 days of sustaining the injury. Maternal mortality was 47.6% with sepsis as the most common cause of death. ⋯ Prophylactic systemic antibiotics should be given to minimise the development of sepsis. Patients are best managed in the obstetrics ward during the first 2 weeks of injury. A multidisciplinary approach is encouraged in managing cases of severe burns in pregnancy.
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Anaemia is one of the most common disorders in pregnancy. The most common cause is iron deficiency. Iron deficiency anaemia is relatively easy to diagnose using a serum ferritin of <15 ng/ml. ⋯ The calculated positive and negative predictive values are: STfR 64% and 75%; S:F 84% and 87%; Hb 58% and 57%; mean corpuscular volume 91% and 55%, respectively. Ferritin remains the gold standard for the diagnosis of iron deficiency anaemia. However, because ferritin is an acute phase reactant, soluble transferrin receptor assay may be a better test in ill and hospitalised patients where ferritin may be normal or elevated, despite iron deficiency.
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The caesarean section rate in the Royal Gwent Hospital has, as in the rest of the UK, risen significantly over the last 10 years. A commonly proposed reason for this increase is that women themselves are now more likely to request an elective caesarean section, when there is little or no medical indication. The aim of this survey, carried out prospectively, was to find out whether patients' requests for caesarean section are contributing significantly to the rise in the section rate, by attempting to actually quantify the influence of patients' choice on the decision to perform a caesarean section. The results showed that it is possible to quantify this influence, and that maternal request does play a major role in the decision-making process.