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Caesarean deliveries, especially repeat caesareans in women with placenta praevia, significantly increase the risk of emergency peripartum hysterectomy.

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Caesarean section in the second stage of labour is associated with a higher risk of maternal but not perinatal morbidity.

The objective of the study was to determine which background factors predispose women to primary postpartum haemorrhage (PPH) at the Obafemi Awolowo University Hospital. The study consisted of 101 women who developed PPH after a normal vaginal delivery and 107 women with normal unassisted vaginal delivery without PPH Both cases and controls were investigated for sociodemographic risk factors, medical and obstetric histories, antenatal events and labour and delivery outcomes. Data were abstracted from the medical and delivery records and risks were estimated by multivariate logistic regression. The results of the univariate analysis revealed a number of potential risk factors for PPH but after adjustment by logistic regression three factors remained significant. These were prolonged second and third stages of labour and non-use of oxytocics after vaginal delivery. Previously hypothesised risk factors for PPH such as grand multiparity, primigravidity and previous episodes of PPH were not significantly associated with PPH. We conclude that primary PPH in this population is mostly associated with prolonged second and third stages of labour and non use of oxytocics. Efforts to reduce the incidence of PPH should not only be directed at proper management of labour but also training and retraining of primary health care workers and alternative health care providers in the early referral of patients with prolonged labour.

Autotransfusion is useful in the management of ruptured ectopic pregnancy.

Vernix caseosa peritonitis (VCP) is a rare and serious complication of caesarean section. It is thought to occur as a result of spillage of amniotic fluid and or meconium into the maternal peritoneal cavity at caesarean section. It manifests as an acute abdomen days to weeks after a seemingly uncomplicated caesarean section. Only 18 cases have been reported in the literature and all but one are from the USA. The pathophysiology is incompletely understood. In the past, the management of VCP included a laparotomy and removal of suspected abdominal organs which were invariably found to be normal on histopathological examination. However, the characteristic intraoperative finding was a cheesy white exudate that coats the visceral organs. The organs themselves were not inflamed. Histological examination of biopsy specimen of the cheesy exudates is the only way to make a diagnosis of VCP. This would reveal anucleate squamous cells along with lanugo hair and foreign body giant cell reaction. From recent case reports, peritoneal lavage appears to be the mainstay of treatment of VCP. Increased awareness of this condition is crucial so that it is considered in the differential diagnosis of post-caesarean acute abdomen thereby avoiding the unnecessary removal of healthy intra-abdominal organs. This review article summarises the current state of knowledge on VCP.

Promoting choice is central to current NHS policy. In seeking to better understand the choices women make, this study aimed to identify if women would choose to give birth in a stand-alone birth centre, and the factors influencing this choice. A survey approach was adopted, and 121 responses were obtained (a response rate of 53%). The majority (n = 76, 62.8%) of responders would choose to have their baby in a stand-alone birth centre. The provision of a homely environment, opportunities for a natural birth, use of water in labour and accessibility were the main reasons given for choosing to give birth at a specific stand-alone birth centre. Compared to second or subsequent births, women expecting their first baby were six times more likely to give ‘can use water in labour and birth’ as a reason and this was significant (P = 0.001). Among women who would not choose to deliver in a stand-alone birth centre, the main reasons were preference to give birth in a co-located unit and concerns over safety. There was no significant difference about concerns for transfer between primagravid women and multigravid women. Nevertheless, in contrast to previous studies, 87% of women perceived that birth in a stand-alone birth centre provided a safe alternative to a hospital birth or home birth. Women also stated that they would access a stand-alone birth centre for pregnancy testing, antenatal education and antenatal and postnatal care.