Supracervical hysterectomy in Trinidad

With mounting evidence of the beneficial effects of the retained cervix, supracervical hysterectomy is gaining popularity worldwide. In this series of 123 patients, obesity and pelvic adhesions were the chief factors that prevented amputation of the cervix at the time of hysterectomy. We propose that these are cogent indications for planned supracervical adbominal hysterectomy in order to minimize damage to the adjacent viscera. This option is best justified by a risk/benefit analysis

Caesarean section delivery in Trinidad

A 7-year retrospective survey was conducted in order to determine local trends in caesarean section rates, maternal outcome and indications for the procedure. The annual rate of caesarean births has not exceeded 10.0% of deliveries. The overall rate, at 7.4% for the period of study, was not significantly different from that obtained a decade and a half ago. Significant procedure-related morbidity was uncommon. In view of preventable anaesthetic maternal deaths, a plea is made for an increased use of regional in preference to general anaesthesia in selected cases

Eighteen years of maternity care in a new teaching hospital

A new maternity hospital was inaugurated in Trinidad in 1981 to provide access for pregnant women to specialist antenatal care and to trained attendants during childbirth. As an academic tertiary-care institution, it also became a referral centre for high-risk pregnancies and obstetric emergencies. The efficacy of the services provided since inception was evaluated by measurement of mortality statistics, which are the most sensitive indices of maternal care. Over a period of 18 years, there were almost 100,000 births. Although the caesarean section rate was low, the perinatal and maternal mortality rates suggest that there is still a wide gap in obstetric standards between the developed world and this country. Improved vigilance for high-risk groups is required to identify potentially preventable deaths

Obstetric hazards of maternal obesity

To test the hypothesis that obesity represents a risk factor in pregnancy, we conducted a prospective case-control study to determine whether or not there was any divergence in the obstetric outcome among 132 obese women from that in a control group of 136 non-obese patients. Obese mothers had an increased incidence of pregnancy-induced hypertension and gestational diabetes but there was no significant difference in the duration of pregnancy or in the frequency of low Apgar score at 1 minute. The favourable fetal outcome in obese parturients reflects an increased awareness of the possible medical and obstetric complications and an early recourse to abdominal delivery