Gordon Narayansingh

The prevalence of Chlamydia trachomatis in fresh tissue specimens from patients with ectopic pregnancy or tubal factor infertility as determined by PCR and in-situ hybridisation

The prevalence of chlamydial DNA determined by PCR and in-situ hybridisation (ISH) in fresh tissue specimens (endometrium, fallopian tube and ovary) was investigated in 33 women presenting with ectopic pregnancy (EP), 14 women with tubal factor infertility (TFI) and 50 control patients from the UK and the West Indies. In the UK EP group, chlamydial DNA was detected by PCR in 56% of patients; similar results were found in the Trinidad EP group (67%). In the TFI group, chlamydial DNA was detected in (71%) of patients by PCR. The detection of Chlamydia trachomatis DNA by ISH was highest in the TFI group (43%). Women presenting with EP and TFI showed evidence of previous or current genital C. trachomatis infection, underlining the importance of this microorganism in the development of these conditions. Importantly, chlamydial DNA could be detected in DNA preparations from the endometrium, fallopian tube and ovary of EP and TFI patients at the time of surgery.

Fetal outcome among obese parturients

A controlled study of the fetal outcome among 300 obese gravidae revealed a perinatal loss ten times greater than among non‐obese mothers. Diabetes mellitus, pre‐eclampsia and advanced maternal age overwhelmingly contributed to this difference. However infants of obese grand multiparae were not at additional risk. Considering live infants the 1 min Apgar score was significantly lower in the study group and was confined to those mothers not at the extremes of maternal age, parity and gestational age. There was no difference in Apgar scores among infants delivered by cesarean section. However significantly more infants of obese mothers delivered vaginally were depressed. These results emphasize the need for stricter obstetric care in the elderly obese mother and those with pre‐eclampsia and diabetes. The uncomplicated obese parturient appears to be at no additional risk in terms of fetal outcome.

Born before arrival (BBA) in Trinidad-a seven year case-control study

A retrospective case-control study was made of 326 babies born before arrival (BBA) at hospital, in a Caribbean developing country. Each baby born before arrival was matched with hospital-delivered controls within the same week of delivery. Control group 1 (n=302) was matched by maternal age and parity and control group 2 (n=262) by gestational age and fetal birth weight. BBA occurred significantly more often in Afro-Caribbean when compared with those of Indo-Caribbean origin and was more common in grand multiparous women, those who had poor antenatal care and those who had a similar previous event. Perinatal mortality was more common than in the control groups. Unlike other studies, young maternal age and marital status were not significant contributing factors. These findings suggest that clinical features exist for identification of women at high risk for BBA which can therefore assist in its prevention and attendant serious consequences.

Late Presentation of Vulval Carcinoma in Trinidad

Carcinoma of the vulva is a disease mainly of post-menopausal women, and constitutes between 3 percent-5 percent of gynaecological malignancies. A retrospective study was undertaken of the clinical presentations, treatments and outcomes of all patients with vulval carcinoma presenting to the two major hospitals in North Trinidad between 1972-1989 (AU)

Use of oral salbutamol after cervical circlage - is it justified?

SummaryWe reviewed 247 cases of cervical circlage of which 19l (77-3 per cent) had concomitant tocolytic agents. There was no added benefit of prolonged pregnancy compared with patients who had no tocolytics.

Childhood vaginal bleeding in Trinidad

SummarySummaryIn a review of 40 girls with vaginal bleeding in Trinidad, the predominant causes were accidental falls (45 per cent) and prolapsed urethral mucosa (36·5 per cent). All 3 cases of sexual abuse sustained solely vaginal (internal) lacerations compared to the other 18 with falls where only vulval (external) lacerations were discovered. Foreign bodies and worms found in the vagina, vulvo-vaginitis and a cavernous haemangioma were less common aetiological factors. These findings are in contrast to two previous British studies where precocious puberty and genital tumours were the major causes of vaginal bleeding in childhood.

Elective cesarean hysterectomy for uterine fibroids

Cesarean hysterectomy has not been universally accepted as a popular procedure in obstetrics, mainly because of its association with high morbidity, as most of these cases were done under life-threatening emergency circumstances [ 11. Nevertheless, in countries where there is a high incidence of uterine fibroids, it is possible that women can benefit from this two-in-one procedure. We selected patients who had an obstetric indication for cesarean section, suffered from symptomatic uterine fibroids, and had no desire for future pregnancies. The eight patients who were identified had a mean age of 37.9 years (range 31-45 years). There was zero mortality and negligible morbidity. The mean operating time was 88 min and there was a mean blood loss of 863 ml. Five patients received blood transfusions (Table 1) and the anemia of one patient who refused blood transfusion and whose post-