I-cheng Chi

Maternal mortality at twelve teaching hospitals in Indonesia — an epidemiologic analysis

Records on 36,062 maternity cases admitted to 12 teaching hospitals throughout Indonesia between 1977 and 1980 were analyzed. A hospital maternal mortality rate of 37.4/10,000 cases (39.0/10,000 live births) was derived that was about ten times higher than rates reported from developed countries in the early seventies. Hemorrhage, infection and toxemia accounted for 91.2% of deaths resulting from direct obstetric causes and for 86.1% of total deaths. It is postulated that if all pregnant women received adequate antenatal care, and if all women wanting no additional children were sterilized, maternal mortality would be cut in half. It is recommended that maternal health services in Indonesia be integrated into its successful family planning program.

Laparoscopic and minilaparotomy female sterilisation compared in 15 167 cases.

Three methods of female sterilisation were compared in data from 23 countries: laparoscopy with occlusion by the tubal ring (7053 cases), minilaparotomy with occlusion by the tubal ring (3033 cases), and minilaparotomy with occlusion by the modified Pomeroy technique (5081 cases). The 12-month failure rate was 0.60 per 100 women for laparoscopy/ring and 0.30 per 100 women for minilaparotomy/Pomeroy. The surgical complication rate for laparoscopy/ring (2.04%) was more than twice that for minilaparotomy/Pomeroy (0.79%). The technical failure rate of minilaparotomy/Pomeroy was twice that of laparoscopy/ring, but the complication and method-failure rates were much lower. Failure and complication rates with minilaparotomy/ring were intermediate. For many women seeking sterilisation, a minilaparotomy procedure will be preferable to a laparoscopy procedure.

Immediate postpartum IUD insertions in a Chinese hospital — a two year follow-up

A data set consisting of 199 immediate postpartum IUD insertions performed at the Xuan Wu Hospital, Beijing, China was analysed in terms of insertion route, category of inserting personnel and device type. IUD expulsion and continuation of use were the outcome events of interest in this study. Based on our findings, the following hypotheses were derived for future confirmative studies: lower expulsion rates and hence, higher continuation rates of immediate postpartum IUD insertions are associated with (1) insertions through the abdominal incision wound for women who had a cesarean delivery as compared to immediate (< 10 min) vaginal insertions in women with vaginal delivery; (2) obstetrician insertions, as compared to midwife insertions, and (3) use of the Delta T, as compared to that of the Delta Loop. For the derivation of the latter two hypotheses, only the vaginal insertions were studied.

Technical failures in tubal ring sterilization: Incidence, perceived reasons, outcome, and risk factors

Six centers participated in comparative studies of female sterilization conducted by the international Fertility Research Program. The incidence of technical failures (or failed attempts) was compared between patients sterilized with the tubal ring and those sterilized with other tubal occlusion techniques. The tubal ring was associated with a higher failure rate than electrocoagulation, the Rocket clip, or the modified Pomeroy technique. Of 1,035 tubal ring sterilizations, there were 38 technical failures. Reasons given by the operators for the failures, by frequency of occurrence, were surgical complications, conditions preexisting in the patients, and problems with the instruments. Most of these failures were remedied by changing to other techniques. In two patients, the procedure was completed by changing the approach from laparoscopy to laparotomy. In five others, sterilization was not completed. Case-control analysis was performed and three risk factors were delineated: obesity, prior use of an intrauterine contraceptive device and previous abdominal operations.

Is Lactation A Risk Factor of IUD‐ and Sterilization‐related Uterine Perforation? ‐ A Hypothesis

A recent article reported a high risk of IUD‐related uterine perforation in lactating women in the U.S. This article prompted the authors to examine the large international datasets on IUDs and tubal sterilizations collected by Family Health International. The findings are somewhat suggestive of such a positive association in IUD users as well as in women undergoing laparoscopic or minilaparotomy sterilization. More definitive studies are urged.

Tubal ligation at cesarean delivery in five Asian centers: a comparison with tubal ligation soon after vaginal delivery

Increasingly more tubal sterilizations are being performed at the time of cesarean section in the United States and probably also in developing countries. This descriptive study provides us with hitherto unavailable information on the impact of this combined procedure on the women undergoing it. Five Asian centers were included for study. In these centers, 618 women had concurrent tubal ligation at cesarean section in 1973 and 1974. During this period, 3399 women had tubal ligation soon after term vaginal deliveries. The much higher morbidity and mortality in the former group were judged to be attributable to the indications leading to, or the complications of, cesarean section and not to the concurrent tubal ligation. Women undergoing the combined procedure of tubal ligation and cesarean section were more likely to have characteristics associated with later regretting the sterilization.

Deliveries after cesarean birth in two Asian university hospitals

The task force of the consensus conference on cesarean birth of the National Institutes of Health, USA, has recommended substituting a trial of labor and vaginal delivery for elective repeat cesarean section in selected women. This paper assesses the benefits and risks associated with that recommendation using data from two Asian teaching hospitals, one in Jakarta, Indonesia and the other in Colombo, Sri Lanka. Data recorded on the Maternity Record Form designed by the International Fertility Research Program and the International Federation of Gynecology and Obstetrics were used for analysis. Consistent findings were derived from the two hospitals, in spite of the different medical care delivery systems in their countries. No significant increase in maternal and infant mortality and morbidity were associated with women having vaginal delivery subsequent to cesarean birth as compared to those with repeat cesarean section. Savings in medical cost were considerable in the former group.

Incomplete Abortions in Accra and Bangkok University Hospitals 1972–1973

Chi, I‐cheng, Bernard, R. P., Ampofo, D. A. and Koetsawang, S. (International Fertility Research Program, Chapel Hill, North Carolina, USA, International Fertility Research Program, Geneva 1207, Switzerland, University of Ghana Medical School, Accra, Ghana and Mahidol University Medical School, Siriraj Hospital, Bangkok, Thailand). Incomplete abortions in Accra and Bangkok University Hospitals 1972–1973. Int J Gynaecol Obstet 13: 148–161, 1975.

Contraceptive practice after women have undergone "spontaneous" abortion in Indonesia and Sudan.

Studies of hospitalized “spontaneous” abortion patients in two Muslim countries (Indonesia and Sudan) revealed the need for contraception in this group of married women and indicated the potential role of maternity hospitals in providing them with contraceptive counseling. It could not be determined which of the abortions were induced outside the hospital and which were truly spontaneous. Of the 893 women treated at the Djakarta Hospital, 15.3% used contraceptives during the month of conception of the index abortion, compared to 10.0% of the 2 759 patients in Khartoum. After hospitalization for completion of the abortion, the rates of contraceptive use increased by more than one third in both cities. The highest rates of increase in contraceptive use after abortion were noted among poorly educated women, women with large families, and women with abortions diagnosed as septic. Among the nonseptic patients at all hospitals, those experiencing complications associated with the abortion reported a slightly higher rate of postabortion contraceptive use. In hospitals where contraceptive counseling was provided, there was a proportional increase in postabortion use of contraceptives by the study population.