BMJ 1994;308:720 (12 March)

Letters

Intrapartum monitoring in rural Africa

EDITOR, - K Mahomed and colleagues conclude that ultrasound monitoring during labour can improve neonatal outcome.1 Seventeen cases of ischaemic encephalopathy occurred in the low technology group (monitoring with a Pinard stethoscope and routine monitoring combined) compared with three cases in the high technology group (electronic monitoring and ultrasound scanning combined). But to achieve this the caesarean section rate was almost double in the high technology group, with 87 excess caesarean sections. This is a serious consideration in a hospital that has limited theatre time and where overstretched doctors are often unavailable; the study shows that in 3- 5% of cases caesarean section was delayed, often because of inadequate resources.

I recently spent a year working at Jane Furse Memorial Hospital in rural South Africa, where we delivered almost all the high risk cases locally; transfer to a teaching hospital was difficult and took a long time. The overall caesarean . . . [Full text of this article]


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Relevant Article

Randomised controlled trial of intrapartum fetal heart rate monitoring
K Mahomed, R Nyoni, T Mulambo, J Kasule, and E Jacobus
BMJ 1994 308: 497-500. [Abstract] [Full Text]

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