Bharat Bassaw

Diabetes in pregnancy.

Objective: To determine whether there is an association between the level of glycemic control and perinatal complications in pregnant diabetic patients. Methods: Two hundred sixty confirmed cases of pre‐existing diabetes, gestational diabetes and impaired glucose tolerance were analyzed to assess risk factors, modality of treatment, level of blood sugar control and effect on perinatal morbidity and mortality. Results: Risk factors for the development of diabetes included age (> 25 years), East Indian ethnic origin, glycosuria, and a history of diabetes in a first‐degree relative. Treatment consisted of diet alone or in combination with soluble insulin. There is a marked increase in perinatal mortality and maternal morbidity if normoglycemia is not maintained. Conclusions: A greater emphasis must be placed on the detection of diabetes in pregnancy and effective treatment should be instituted as early as possible to achieve normoglycemia if associated complications are to be reduced.

Vaginal breech delivery and perinatal mortality in twins.

An objective analysis of our clinical experience with the intrapartum management of twin gestations was undertaken in order to determine whether or not routine caesarean section is justified when the first twin presents by the breech. The perinatal mortality rate for breech first twins delivered vaginally was not statistically different from vertex presentations. There was no perinatal loss among babies delivered vaginally by the breech. There was no difference in perinatal outcome for the breech first twin born abdominally or vaginally. Our findings have allayed the fear that non-vertex vaginal delivery of the first or second twin is dangerous. We conclude that in the absence of a uterine scar or a footling presentation, there is no valid reason to prohibit vaginal delivery when either twin presents by the breech.

Determinants of successful deanship

With the significant changes taking place in health and education as well as the rising demands and expectations, deans of medical faculties must exhibit strong and effective leadership skills. Deans need to focus on the broad scope and to translate their dreams into applied institutional operations and functions. It is thus necessary that the deans must identify the institutions core ideology, lead strategic planning, create a common vision and offer direction to the collective membership of the institution. Some personal qualities that appear to be critical for effective deanship include being visionary, fair, trustworthy and exemplary. Prospective deans should receive training in leadership. New deans must be properly informed on the strategic plan of the faculty before they are appointed.

Correlation of fetal outcome with mode of delivery for breech presentation

The objective of this retrospective analysis of 344 singleton pregnancies of gestational ages greater than 24 weeks conducted at a tertiary hospital was to determine the fetal outcome in relation to the mode of delivery of the fetus with a breech presentation. Caesarean section was performed in 157 mothers, and 187 babies were delivered vaginally. There was no statistical difference in the perinatal outcome for breech fetuses delivered either abdominally or vaginally. Cord prolapse and arrest of the after-coming head were responsible for five fetal losses, four of which were delivered vaginally. Neonatal morbidity comprising nerve injury, birth asphyxia and seizures occurred in 11 newborns, nine of whom were delivered vaginally. One mother sustained a massive intra-operative haemorrhage during a caesarean section which necessitated an emergency hysterectomy. We conclude that a policy of planned vaginal birth for selected breech fetuses with a low threshold to proceed to caesarean section may be in the best interests of both mother and child.

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.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.

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.

Prevention of hypertensive disorders of pregnancy

A prospective randomised clinical trial comprising 510 pregnant patients was performed to determine whether supplementation with calcium, low-dose aspirin or a combination of calcium and low-dose aspirin can lower the incidence of hypertension in pregnancy. Greatest benefits were obtained with calcium. Perinatal mortality was lowest in the aspirin group.

Knowledge, attitudes, practice on human papilloma virus and cervical cancer among Trinidadian women

Cervical cancer remains a major reproductive health problem among women especially in developing countries where about 190,000 women die from this disease annually. Despite efforts to reduce the burden of this disease, most attempts in low-resourced countries have not been successful partly from lack of awareness by women of this common cancer, as well as the role the human papilloma virus (HPV) plays in its aetiology and pathogenesis. To determine knowledge, attitudes and practice of women in Trinidad (a developing country) on HPV, cervical cancer and the HPV vaccine, we conducted a cross-sectional survey among 426 women in the reproductive age. A majority (58.4%) of participants had attained secondary level education. Whereas 326 (76.5%) women knew of cervical cancer, only 108 (25.4%) were aware of HPV and 68 (15.9%) knew of the association between HPV and cervical cancer. This study highlights the limited awareness of Trinidadian women with respect to HPV and its implication in cervical cancer aetiology. If the scourge of cervical cancer is to be adequately addressed, especially in low-resourced countries, then mass educational programmes on HPV, cervical cancer prevention, including screening and early detection and treatment of pre-cancerous lesions of the cervix, must be given high priority.

Obstetric deaths in Trinidad

We determined the causal pathways of pregnancy-related deaths over a 16-year period. Pregnancy-induced hypertension was the chief contributor to our high maternal mortality rate of 36.9 per 100 000 births. Anaesthetic-related deaths were due to a combination of Mendelsons syndrome and faulty intubation technique. An improvement in the health-management system to identify high-risk mothers who need intensive emergency care and the availability of experienced personnel for obstetric anaesthesia appear to be indispensable requirements for reducing and minimising adverse maternal outcome in Trinidad.

Caesarean section for the second twin

SummarySummaryOver 12 years, we performed abdominal delivery of the second twin after the first had been delivered vaginally, in 21 patients. The commonest indications for caesarean section for the second twin were obstructed labour and a contracted cervix.