BackgroundOver 80% of deliveries in Sudan occur in rural areas, attended by village midwives (VMWs).ObjectiveTo determine the impact of Helping Babies Breathe training and regular peer–peer skills practice (HBBT+RPPSP) on VMW resuscitation practices and outcomes.MethodsIn a prospective community-based intervention study, 71/82 VMWs, reporting to six East Nile rural medical centres, with previous experience in community health research, consented to HBBT+RPPSP. Outcomes included changes in the resuscitation practices, fresh stillbirths (FSB) and early neonatal deaths <1 week (ENND).ResultsThere were 1350 and 3040 deliveries before and after HBBT+RPPSP, respectively, with no significant differences between the two cohorts regarding maternal age, education or area of birth. Drying of the newborn increased almost tenfold (8.4%, n=113 to 74.9%, n=1011) while suctioning of the mouth/nose decreased fivefold (80.3%, n=2442 to 14.4%, n=437) following HBBT+RPPSP. Pre-HBBT+RPPSP9/18 (50%) newborns who had mouth-to-mouth ventilation died, compared with 13/119 (11%) who received bag-mask ventilation post-HBBT+RPPSP. Excluding 11 macerated fetuses, there were 55 perinatal deaths: 14 FSB/18 ENND (6 months pre-HBBT+RPPSP) and 10 FSB/13 ENND (18 months post-HBBT+RPPSP). FSB rates decreased from 10.5 to 3.3 per 1000 births ((χ2)=8.6209, p=0.003), while ENND rates decreased from 13.5 to 4.3 per 1000 live births ((χ2)=10.9369, p=0.001) pre-HBBT+RPPSP and post-HBBT+RPPSP, respectively.ConclusionIn a selected group of VMWs, HBBT+RPPSP was associated with improvements in newborn resuscitation and perinatal outcomes. HBBT+RPPSP could have immense benefits if propagated nationally to all 17 000 VMWs in Sudan.

VMWs, despite a high illiteracy rate, absorbed and sustained HBB skills for at least a year. Regular, low intensity, manikin-based skills training with peers may have helped sustain FMV, but not hand-cleansing skills.

Please cite this paper as: Carlson V, Omer M, Ibrahim S, Ahmed S, O’Byrne K, Kenny L, Ryan C. Fifty years of Sudanese hospital‐based obstetric outcomes and an international partnership. BJOG 2011;118:1608–1616. Objective  To present 50 years of hospital‐based maternal and perinatal outcomes in Sudan, and the role of an international collaboration with an Irish maternity hospital, over the period 2002–2009, in recent health‐indicator improvements. Design  Retrospective descriptive study. Setting  Omdurman Maternity Hospital, Sudan. Population  All women who delivered at Omdurman Maternity Hospital, and their newborn infants, from July 1957 to October 2007, comprising 339 448 births. Methods  The original logbook data was extracted. Infant and maternal health indicators were calculated according to World Health Organization definitions. Main outcomes measures  Total annual births, maternal mortality ratio and maternal complications, neonatal mortality and stillbirth rates, and rates of delivery methods. Results  Total births increased 50‐fold from 499 in 1958 to 24 913 in 2007. Significant reductions in morbidity and mortality began in the mid‐1990s. From 2001 to 2007, maternal mortality fell from 329 to 36 per 100 000 live births: an 85% reduction. Stillbirth rates almost halved, from 35 to 19 per 1000 births in 2001 and 2007, respectively. Neonatal mortality rates remained largely static, at 24 per 1000 live births in 2007, but there is recent evidence of a decline. Conclusion  This hospital‐based data offers a unique historical portrait of health outcomes in one of the largest maternity hospitals in Africa, and shows steady, sustained improvements in maternal, stillbirth and neonatal mortality rates since the 1990s. The partnership was associated with a number of positive infrastructural, educational, and staffing achievements. Whether it directly contributed to improved health outcomes has not been established.

No abstract

Congenital cystic adenomatoid malformation of the lung (CCAM) is an uncommon developmental abnormality presenting most often in the neonatal period. We report the clinical, radiological and pathological findings in a 9-year-old boy who presented with acute chest pain.

Topics: Obstetric Complications, Neonatal Morbidity and MortalityI neffective uterine contractions, malpresentation, and cephalopelvic disproportion all cause prolonged labor, which is associated with neonatal asphyxia. High birth weight increases the risk of prolonged labor and a large fetal head circumference may help in predicting prolonged labor. The authors aimed to study the association between postnatal head circumference and the incidences of prolonged labor, signs of fetal distress, and maternal distress as well as the risk for vacuum extraction and emergency cesarean sections.The authors conducted a population-based study on data collected from nulliparous patients listed in the Swedish Medical Birth Register. All women who gave birth to single infants at term (Z37 or <42 wk) between 1999 and 2008 (n = 265, 456) were included. The reference group consisted of births in which the fetal head circumference was 35 cm (the most common circumference). Diagnoses and delivery methods of the patients in the reference group were as follows: 21% of the women had prolonged labor, 11% showed signs of fetal distress, 3% showed signs of maternal distress, 15% were delivered by vacuum extraction, and 7% underwent emergency cesarean section. The mean head circumference overall was 34.8 ± 1.4 cm (median, 35.0 cm). Prolonged labor, signs of fetal distress, signs of maternal distress, or a combination were diagnosed in 94% of the vacuum extractions (20% with 2 indications) and 81% of the emergency cesarean sections (12% with 2 indications). Mean maternal age, maternal height, body mass index, and birth weight increased as fetal head circumference increased. Prolonged labor increased as fetal head circumference increased in size (14% to 38% over the range of fetal head sizes). The odds of vacuum extraction were 3.5 times higher in infants with the largest circumference compared to infants in the reference group. A large head circumference increased the risk of a vacuum extraction more than the risk of an emergency cesarean. Spontaneous vaginal delivery was more likely in fetuses with a smaller head circumference (80% in reference group with head circumference 35 cm vs. 58% in the group with head circumferences 38-41 cm).The results of this study show that large fetal head circumference is associated with increased odds for prolonged labor, fetal distress, maternal distress, vacuum extraction, and emergency cesarean delivery.

Aim To detect the feasibility and accuracy of fetal assessment scans limited to 2 min of scanning time. Method 50 randomly selected patients beyond the second trimester underwent a conventional fetal growth scan by three obstetric ultrasonographers and two fetal medicine specialists. All the information obtained within the first 2 min were recorded. Data included fetal presentation, biometry (a single measurement of each variable), placental site, deepest vertical pool, fetal heart activity, movements and the umbilical artery SD ratio. A conventional scan followed with calculation of the mean of each biometric variable. The differences between the two scans data were calculated using Wilcoxon's signed rank test (SPSS 17). Results Examination was completed within the 2 min time frame in 42 ladies (84%). There was no significant difference at the 5% cut-off between the data collected in 2 min compared to the conventional assessment. Conclusion A great deal of reliable information about the fetus is obtainable in only 2 min of scanning by experienced personnel. This might for allow turn-around times between patients of less than 10 min, with major implications for access and cost. There is considerable scope for more research to include assessment of the quality of communication and patients' satisfaction.