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Tropical Journal of Obstetrics and Gynaecology

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Are Destructive Operations Still Relevant to Obstetric Practice in Developing Countries?

Frank O. Ezugwu, Samuel E. Anya, Hyacinth E. Onah, John M. Okaro

Abstract


Context: From our clinical observation, we often see caesarean section being performed in situations where destructive operations would have been more appropriate.


Objective: To determine the proportion of cases of obstructed labour that meet defined criteria for destructive vaginal operation vis-à-vis the proportion that actually undergo the operation.


Study Design, Setting and Subjects: A retrospective audit of all cases of obstructed labour seen at a university teaching hospital in South-Eastern Nigeria, over a fifteen- year period.


Results: Out of 2947 patients presenting with obstructed labour during the study period, 67 (2.3%) met the set criteria for destructive vaginal delivery. Only 11 (16.4%) of these had destructive vaginal operations while the remaining 56 (83.6%) had caesarean section. Consultants were more likely than junior residents to perform craniotomy instead of caesarean section for the same indications (p < 0.02). Senior residents occupied an intermediate position. No maternal death occurred in the craniotomy group while three maternal deaths were recorded in the caesarean section group. Rates of infection, blood transfusion, vesico-vaginal fistula and Asherman's syndrome were also higher in the caesarean than in the craniotomy group.


Conclusion: Only one-sixth of women who are suitable candidates for destructive vaginal operations are offered the procedure at the UNTH, Enugu, the rest being delivered by caesarean section, despite the higher complication rate of caesarean delivery in such cases. The reasons for this situation and the ways to either reverse it or else eliminate the need for destructive operations are discussed.


Key Words: Destructive Operations, Obstructed Labour, Fetal Death [Trop J Obstet Gynaecol, 2002, 19: 90- 92]



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