Biomedical subjects
Publications and source records attributed to S Roopnarinesingh.
A nine-year review of 103 cases of shoulder dystocia identified obesity, diabetes mellitus and post-datism as important predisposing risk factors. There was a positive correlation with birthweight. Abnormal labour patterns were invariably absent and perinatal outcome was disastrous. The best strategy is to anticipate and avoid this obstetrical emergency.
A severely pre-eclampic patient developed peripartum cardiomyopathy and bilateral femoral emboli. Medical therapy for cardiac failure was commenced prior to delivery by Caesarean Section. Bilateral femoral embolectomy was performed on the sixth postpartum day.
A retrospective analysis of 21 hirsute women seen at a gynaecological endocrine clinic revealed a high incidence of infertility, menstrual irregularities and abnormal androgen profile. Polycystic ovarian syndrome (PCOS) was the underlying abnormality in the majority of cases. Cyproterone acetate (CPA) with ethinyl oestradiol in a reverse sequential regime was more effective and better tolerated but much more expensive than the combination of spironolactone and the oral contraceptive pill (OCP).
The occurrence of spontaneous triplet pregnancy among teenagers is a rare event. The present communication describes two cases encountered at the Mt. Hope Maternity Hospital since its inception in 1981.
The reproductive performance of primigravidae aged 30 years and over was compared with that of a group of younger primigravidae. Other patients were at greater risk for antepartum complications such as pre-eclampsia and uterine fibroids. Induction of labour was undertaken more frequently, and the Caesarean Section rate was higher but there was no worsening of perinatal mortality.
A five-year record review was undertaken for all babies with a diagnosis of foetal macrosomia. The perinatal mortality rate of 23 per 1,000 total births was similar to the overall hospital rate. Neonatal morbidity was significant, and the most important contributory factor to foetal injury was impaction of the shoulders during parturition. In order to avoid this catastrophe, elective abdominal delivery may be prudent if the foetal weight is estimated at greater than 4,500 grams.
A ten-year survey of the magnitude and causes of obstetrical deaths at Mount Hope revealed a maternal mortality rate of 33.3 per 100,000 live births. The leading causes of death were the hypertensive disorders, and the most common identifiable factors were inadequate antenatal care and substandard clinical management.
A controlled study of the fetal outcome among 300 obese gravidae revealed a perinatal loss ten times greater than among nonobese mothers. Diabetes mellitus, pre-eclampsia and advanced maternal age overwhelmingly contributed to this difference. However infants of obese grand multiparae were not at additional risk. Considering live infants the 1 min Apgar score was significantly lower in the study group and was confined to those mothers not at the extremes of maternal age, parity and gestational age. There was no difference in Apgar scores among infants delivered by cesarean section. However significantly more infants of obese mothers delivered vaginally were depressed. These results emphasize the need for stricter obstetric care in the elderly obese mother and those with pre-eclampsia and diabetes. The uncomplicated obese parturient appears to be at no additional risk in terms of fetal outcome.
A retrospective study of the outcome of pregnancy in 187 women with cervical cerclage revealed a three-fold increase in the crude perinatal survival rate. The McDonald and Shirodkar techniques produced comparable results. Mersilene was as effective as black silk. A significant number of pregnancies with cerclage insertion prior to 14 weeks ended in spontaneous abortions. Postcerclage morbidity was minimal, and abdominal delivery was indicated in only four patients for cervical dystocia. The continued use of this procedure, for selected cases, is justified.
A 21-year-old woman, para 1 + 0, developed profound postpartum shock secondary to acute inversion of the uterus. Fundal re-inversion was achieved by prompt manual replacement of the uterus from below. An aggressive approach to uterine inversion is the keystone of success.
The epidemiology, clinical features and method of evacuating the uterus were reviewed in 30 patients with hydatidiform mole. The incidence was greatest in patients with blood group O and among young East Indians. There was no seasonal variation nor was there any progression to choriocarcinoma. Only one partial mole and one invasive mole were encountered. Evacuation was achieved chiefly by suction curettage and concomitant augmentation with a Syntocinon infusion.
The peri-operative factors surrounding the patient subjected to vaginal hysterectomy were reviewed. Most of the patients were post-menopausal, and the indication for surgery in all cases was utero-vaginal descent. Regional anaesthesia was associated with less blood loss, while lower blood losses were associated with fewer complications and shorter hospitalization. Overall, the morbidity was low (8%), and the mortality was zero.
A postmortem study of the degree of displacement of the tracheal tube was performed on 13 neonates of varying birthweights. There was significant movement of the tube on flexion and extension of the neck, and on opening the infant's mouth. Our findings lend support to certain techniques of tracheal tube placement; the ultimate aim is to position it accurately.
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Explore the source record for details and available documents.