Singapore - Maternal and perinatal morbidity after Caesarean delivery at full cervical dilatation

Radha P, Shephali T, Muhammad Fairuz AR, Tee CS

Correspondence: Dr Pandian Radha, radhahk@gmail.com

ABSTRACT

Introduction This study aimed to assess maternal and perinatal outcomes following second stage Caesarean sections.

Methods: A retrospective study was conducted in a Singapore-based tertiary referral centre from January 1, 2009 to December 31, 2009. The medical records of all the women who underwent emergency Caesarean sections in the second stage of labour were reviewed.

Results: Out of 2,501 emergency Caesarean sections performed, 116 were Caesarean sections in the second stage of labour. Women with non-vertex, twins and preterm deliveries were excluded, and 110 (4.4%, 110/2,501) Caesarean sections were recruited. The majority of the Caesarean sections were determined and performed by registrars or consultants. With regard to maternal outcome, 2.7% (3/110) of patients had primary postpartum haemorrhage and 4.5% (5/110) of patients had vertical or lateral lower uterine segment tears. As for neonatal outcome, although the Apgar scores of newborns were low at birth for 8.2% (9/110) of patients, the Apgar score was > 4 at 5 minutes for all patients.

Conclusion: Overall, there was no statistically significant adverse maternal or perinatal outcome.

Keywords:  Caesarean section, maternal morbidity, perinatal morbidity

Singapore Med J 2012; 53(10): 655–658

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Singapore - Cesarean section scar pregnancy: a case series at a single tertiary centre

Pang YP, Tan WC, Yong TT, Koh PK, Tan HK, Ho TH

Correspondence: Dr Pang Yi Ping Cindy, cindypangyp@yahoo.com

ABSTRACT

We present a case series of four patients with Caesarean scar pregnancies (CSPs) managed at our gynaecological unit between October 2008 and May 2009.

Three patients were detected while asymptomatic, and were treated with elective intragestational sac methotrexate injections.

The last patient had presented following complications from a termination of pregnancy for a CSP that was misdiagnosed as intrauterine. Following treatment, this patient and another developed arteriovenous malformation, which responded to bilateral uterine artery embolisations and gonadotropin releasing hormone (GnRH)-agonist treatment.

Keyword:  Caesarean section, ectopic, methotrexate, pregnancy

Singapore Med J 2012; 53(10): 638–642

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Nigeria - Moving midwives to work in rural areas helps improve essential obstetric care

A scheme supporting newly graduated, unemployed, and retired midwives to work in rural areas of Nigeria and provide essential obstetric care has helped to improve maternal, newborn, and child health and could potentially serve as a model for other low-income countries.

This includes helping redistribute health workforce in low-income countries to reduce the health inequities between urban and rural areas.

In a Health in Action article in this week's PLoS Medicine, a group of Nigerian researchers from the National Primary Health Care Development Agency in Abuja, and the Federal Ministry of Health, describe the Midwife Service Scheme in which midwives are posted for one year to selected primary care facilities in hard-to-reach areas or among underserved populations with the capacity to provide basic essential obstetric care linked to a secondary health care facility that is able to provide comprehensive emergency obstetric care.

The authors say: "The [Midwife Service Scheme] Strategy of the Nigerian government recognises that strategically redistributing and improving the skill set of existing cadres of health workers is achievable on a large scale."

After one year of the scheme, there was an uneven improvement in maternal, newborn, and child health indices in the six geopolitical zones of Nigeria and despite major challenges to continuing the scheme—such as the retention, availability and training of midwives, and varying levels of commitment from state and local governments across Nigeria—there are plans to overcome these challenges and further develop the scheme.

The authors say: "The initiative potentially serves as a model for other developing countries within and outside sub-Saharan Africa who may need to redistribute their health workforce to reduce the inequities that exist among geographical zones and between urban and rural areas."

More information: PLoS Med 9(5): e1001211.doi:10.1371/journal.pmed.1001211

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