Javaid H. Rizvi

Genital fistulae. A continuing tragedy.

Fistulous communication between the genital tract and adjacent organs is a social calamity. It is among the most distressing, demoralizing and degrading conditions from which women suffer. The etiology of genital fistulae is varied but the overwhelming proportion are complications of neglected obstructed labour. This is of paramount importance in the developing countries. There is not only obstruction of labour but also obstruction at every level of management of obstructed labour, viz, obstruction of diagnosis, obstruction of decision making regarding what to do with the patient, obstruction of fund raising for medical care, obstruction of transport to get patients to a proper hospital and obstruction at secondary or tertiary healthcare level in organization of a caesarean section at the appropriate time. Genital fistula is the only major public health problem where prevention and treatment is surgery which is highly specialized.

Maternal Mortality in the Developing World: Many Unanswered Questions

Maternal mortality remains a scourge of motherhood even as we approach the end of the 20th century. The magnitude of maternal mortality in developing countries and its disparity with similar statistics from the developed world1) has touched a responsive cord in some policy makers and health services officials. With this background in mind, this commentary presents some of the problems encountered in attempting to reduce maternal mortality, and by asking some pertinent questions — offer some solutions.

Was That Hysterectomy Really Necessary? Audit of Operative Justification at the Aga Khan University Medical Centre, Karachi

EDITORIAL COMMENT: We accepted this paper for publication because readers may wish to use it as a model for scrutiny of their own hospital statistics, especially in Australia where the hysterectomy rate is probably considerably higher than in Pakistan.

An Audit of Labour Following Caesarean Section at the Aga Khan Medical Centre

Summary: An audit of labour following Caesarean section was carried out over a 70‐month‐period to assess our management of labour following Caesarean section and to support the hospital quality assurance review progress for obstetric care: 419 patients with 1 previous Caesarean section were given a trial of labour: 314 (75%) women had a vaginal delivery and 105 (25%) had a repeat Caesarean section. The highest failure rate was observed in women whose previous indication for Caesarean section was cephalopelvic disproportion. There were 6 (1.4%) cases of scar dehiscence and 4 (1%) of uterine rupture. Vaginal delivery following Caesarean section is a viable cost‐effective, safe procedure in a high quality labour and delivery unit in a developing country.