Obstetric destructive procedures

Abstract

Throughout the developing world managing prolonged obstructed labor remains problematic and involves the use of destructive procedures. There were 2870 deliveries between 1990 and 1993 at the Baptist Medical Center in Nalerigu Ghana. 17.9% of these deliveries were to women aged 15-19 years while 35% were to women aged 20-24. 92.8% had gestations at term and nulliparous patients constituted 59% of patients. 28 of the deliveries were destructive operations. There was a mean average of 99 cesarean sections performed annually most commonly due to obstructed labor and a mean of 4.4 maternal deaths per 1000 births. Cesarean sections are associated with more than 70% of maternal deaths. The destructive operations were performed on fetuses of quite low birth weight. The most common presentation during the destructive operation was cephalic (75%) followed by transverse lie (17.9%). The distance which patients travel to the hospital is a significant factor in the incidence of destructive procedures performed for long-obstructed labor with fetal death.