22

COMMENT

Hydramnios in the reports dur ing the last 7 years has been taken to imply sufficient fluid present to detect a fluid trill. This is obviously a very crude diagnost ic criterion. However the incidence has remained much the same over the years a t abou t 1.6 per cent. The appal l ing per ina ta l mor ta l i ty however in this group mus t engage one 's a t ten t ion . The majo r i ty of such deaths are associated wi th exposure of the foetal meninges as in anencephalus or meningocoele of various sorts. We have more recent ly noted a very puzzling group in which hydramnios a round 30-34 weeks is detected, arid may sub- sequent ly cease to be observed. A number of such cases have come to our a t ten t ion , and an obstet r ic ian has f requent ly ordered an x-ray at about 32 weeks so obvious does the hydramnios appear to be a t tha t t ime, and yet subsequent ly different obstet r ic ians examin ing the case m a y wonder why an x-ray was thought necessary. This is because the hydramnios disappears to a great extent . A n u m b e r of the babies are born subsequent ly with what is t e rmed " idiopathic hydrops foetalis". In these cases haemolyt ic disease as caused by the rhesus factor is no t responsible for the per inata l loss. Very li t t le in fo rmat ion has bu i l t up abou t these cases as yet, as they have only been recognised recently, and it is no t possible to say wi th a ny accuracy what the prognosis is in a future pregnancy. Neither am I i n a posit ion to s tate the cause of the " idiopathic hydrops foetalis", a nd this is obviously a very in teres t ing facet of obstetr ics for future research.

P R O L O N G E D LABOUR, (R.C.O.G. TABLE 14)

DR. GEORGE HENRY

Summary:

(a) Total number of cases . . . . . . . . . . . . Incidence against total deliveries 28 weeks

maturity and over (5,273) . . . . . . . . .

(b) Maternal mortality . . . . . . . . . . . .

(c) Gross foetal loss . . . . . . . . . . . . . . .

Perinatal mortality rate . . . . . . . . .

(d) Multiple pregnancies . . . . . . . . . . . .

Estimated cause of delay: Inco-ordinate uterine action . . . . . . . . . Disproportion . . . . . . . . . . . . . . . Occipito posterior position of occiput . . . . . . Obstlalcted labour . . . . . . . . . . . . . . . Cervical dystocia . . . . . . . . . . . . . . . Hydrocephalus . . . . . . . . . . . . . . .

Methods of delivery: Forceps . . . . . . . . . . . . . . . . . . Caesarean section . . . . . . . . . . . . . . . Spontaneous vertex . . . . . . . . . . . . . . . Breech Vacuum extractor . . . . . . . . . . . . . . . . Craniotomy . . . . . . . . . . . . . . . . . .

60

1.1 per cent.

Nil 3 f Deadborn

~. 1st week ~2ND 49-1

1 set of twins

. . . . . . 4 1

. . . . . . 13

. . . . . . 2

. . . . . . 2

. . . . . . 1

. . . . . . 1

Total

... 32

... 14 (1 Deadborn)

... 10 (1 NND}

. . . 2

. . . 2

... 1 (Deadborn)

----2 =1

Causes of foetal loss associated with Table 14 : DEADBORN = 2

Primipara. Booked. Postmature 44½ weeks. 38 hours labour. F/H. ceased during labour. Craniotomy/forceps.

Primipara. Unbooked. Emergency admission. Obstructed labour--multiple fibroids. 57 hours labour--F/H, gone before L.S.S.

NEONATAL DEATHS-~ 1 1st week:

Hydrocephalus/spina bifida. Lived 2 days.

COMMENT

The statistical data of this table do not warrant close study as labour is considered to start with the onset of regular uterine contractions rather than observed dilatation of the cervix. Consequently the duration of labour varies considerably in its estimation from case to case. The Rotunda maintains a conservative attitude to vaginal examinations in labour, these being perfor- med only when labour is failing to progress or in the presence of a possible cord prolapse. The midwives rely entirely on rectal examinations.

Liberal use is made of intravenous Syatocinon drip therapy in prolonged labour .

There were two s t i l lb i r ths in th i s group. The first case (No. 75517) was a p r i m i p a r a , uncer ta in of her da tes , who went to 44½ weeks ges ta t ion . The foetal h e a r t went out ea r ly in l abour a n d de l ivery was effected b y forceps fol lowing c ran io tomy . The second case (No. 79400) con ta ined m a n y avo idab le factors which were no t t he r e spons ib i l i t y of t he Hosp i t a l . A 42 y e a r old p r imig rav ida b o o k e d for nurs ing home conf inement a n d referred to hosp i t a l a f te r 48 hours l abou r in obs t ruc ted labour . Caesarean sect ion was pe r fo rmed when a dead b a b y was de l ivered from a gross ly in fec ted uterus . The p a t i e n t ' s pos t -opera- t ive r ecovery was uneventful .

P E R S I S T E N T P O S T E R I O R P O S I T I O N O F T H E O CCIPU T A N D T R A N S V E R S E A R R E S T , (R.C.O.G. TABLE 15)

DR. G. R. HENRY

Summary: ~^~f P.O.P. =94 (a) Total number of cases . . . . . . . . . . . . z~] D.T.A. =194

Incidence against total births 28 weeks maturity and over (5,367) . . . . . . . . . . . . 5.3 per cent.

(b) Maternal mortality . . . . . . . . . . . . Nil [ Deadborn = 5

(c) Gross foetal loss . . . . . . . . . . . . . . . 7~ l s tweekNND' s =2 LLate NND's =Nil

Perinatal mortality rate . . . . . . . . . 24.3

PERSISTENT OCCIPITO POSTER*OR (P.O.P.): (I) Total number ............... 94

Incidence against total cases in Table 15 . . . . 32.6 per cent.