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11 5 with a mean of 2 52.7 mI . (SO ± 21 2 . 2 Ill. , . I t was e vident {roil the v o l umes r ecorded that there was a t e nde nc y to round off vctunes to the ne are st SO u r • Thirty-four s Ubj e c t s (7 . 4' 1. had primary post-partull haemorrhage (los s greater than or equal t o 500 mI ) . TABLE 1.' LABOUR AND ITS COMPLICATIONS I N STUDY PARTICI PANTS I yp e g f de livery Number of s u b j ects Percent" ) Spontaneou s 370 78 . 4 Spontaneous + episi ot omy .3 19 . 7 Vac uum + e pisiot omy ...2 ----L..2 TOTAL ill .l.!lJL..Q Durati on 9f lab Qu r Normal « 24 hrs) 431 9 4 .9 Prolonged (> 2' hrs ) all ..ll --.2.,J. .lQ.Q...Q c omplicat i on s of labour Genita l trac t in jury All perineal tears 5. 1 2 . 7 Ce rvical 1 0 . 2 Retained pl ac enta • 1.3 Dys tocia 31 .. Primary postpartum haemorr hage 34 7 •• Pre -ter m labour 14 ),0 =
n . OTHER IMMEDI ATE COMPL.ICATIONS OF LABOUR : Genital tract injury occurred in 12 . 7% (60) o f the women . one subject had a cervical tear, another ha d a vu lva haerna t oma , a nd the remain i ng 58 ha d perine a l tears. Of those s ub j ects with t e ars , t he majority, 47 , h ad a first de gree tear, 10 women ha d a second de gree t e ar, a nd o ne subject ha d a thi r d d egree tear. Other i mmediate comp l ications of labour a r e l i s t e d i n TABLE 1.6 above. I NFANT OUTCOMES : 485 babies were born to the 472 mothers. Th e r e were 1 3 pairs of twins, givi ng a tw i n p regnancy rate of 2 . a% . Seve nteen infants (3 .5%) were stillbirths, t wo of whom were born macerated. Data were missing o n the life status of thr e e infa nts. The va le to female ratio was 1.08 . Birth weights fo r sing l eton i nfants r an ge d from 0 . 99 t o 4 .82 kg . (kilograms) with a mea n o f 2.98 kg ± 0 .51. Fourt e e n percent o f single t on bir th were l ow- birt h- we i ght i n f a nt s we ighing l e s s t h a n 2 .5 kilograms ()e.g). Whe n we co nsider all infa nts, i nc luding twins, the pe rcenta ge of l ow- b i rth- we ight infants was 16 . 9%.
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A PROSPECTIVE STUDY OF EARLY PUERPE
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dysuria (26%). Nearly 60% of the st
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on l y greatl y enri ch ed the s ub
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5.4 De t e r mi na nt s o f morbidi
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Ta ble 2 .1 1 Di ag nos es in t rea
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CHAPTER 1 IN T RODU CTI ON As mor e
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impair mater nal health [ 13 ] . Th
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Many African countries l ike Ghan a
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Sex ratio (M/F) (1 989) 0 . 98 Rura
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growt h r ate of 2 .5% [ 21] . I t
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Sex ratio (M as a % o f F) Crude bi
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hours in t he h o s p i t ll;l. Nor
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irths ( 19 ) . Although no communit
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It i s ob vious froID. the above in
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The need for adequate puerperal car
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for )0% and 20% respectivel y (33]
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The Za r i a s t ud y ( a}, also re
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embolism coul d be classified a s a
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serious h e alth consequences becau
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o ne known pat hoge n [54] _ Candid
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a de qua t e trr ea tinerrc fo r th
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3 6 Three of the 31 bacteriuric cas
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sinc e direct bladd er s ampling h
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developing world countries have i n
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Unlike t he developed world, breast
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i n t h e puerper ium will occur i
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ED; siotomy wou nd inf ection: I n
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4' The incidence o f deep vein thro
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percent in Bali, Indonesia [37]. Th
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Pos t p a r t um Anaemia: Anaemia i
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study situat ions and ma y be up t
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wome n with caesarean deliveries (-
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deficien t , 50% f o l a t e defici
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days {178, 179] . In a study of pre
Page 79 and 80: 22,774 births s t udied were 6 .1%,
Page 81 and 82: ca r d i a c failure, a ssoc iated
Page 84 and 85: of the disease in zaria has been at
Page 86 and 87: Africa. and the incidence is still
Page 88 and 89: i ncreased occu rrenC:2 of psychiat
Page 90 and 91: African studies respectively h a d
Page 92 and 93: about the i r mari t a l s tat us,
Page 94 and 95: CHAP TE R 4 M!ill!Q.!2S 4 .1 : THE
Page 97 and 98: Bearing in mind t he fact t ha t th
Page 99 and 100: - Fre e medical consultation for ..
Page 102 and 103: Examination : SUbjects wer e examin
Page 105: •• Lowe r genita l t ract i nte
Page 108 and 109: " c linica l assessment and lIlanaq
Page 110 and 111: sample cJ9scr ipt i on ; The charac
Page 112: Further mUltivariate logistic regre
Page 116 and 117: discharge s i n c e they were aa s
Page 119 and 120: 104 ETHNIC ORIGINS: The majority of
Page 121: 106 ap prenticeship- trained occupa
Page 124: YES 1l6'l\ FIG. 1.4 ANTENATAL CARE
Page 129: Labour e ve nts , c omplications a
Page 133: 5 .2 : FOLLOW-UP AND MORBIDI'I'Y FI
Page 136: 5 .2 . 1 Comparinq clinic a t t e n
Page 140 and 141: 200 ,eo 100 FIG. 2.1 :HOW SUBJECTS
Page 142 and 143: FIG.2.3: THE DAY OF FEVER ONSET REP
Page 145: 13 . I n a l l 21 2 ( 59 . 1\> s Ub
Page 148 and 149: 133 sUbjects said they did. A wide
Page 151: 136 Diastolic blood pressure readin
Page 156 and 157: 141 OTHER PATHOLOGI CAL FI NDI NGS
Page 159 and 160: 144 FOLLOW-UP OUTCOMES: At the end
Page 161: 5. 3 : I NCI DENCE OF MORBI DITY 5
Page 165 and 166: 150 LOWER GENITAL TRACT I NFECTIO N
Page 167 and 168: 152 ACUTE URIN ARY TRACT I NFECTION
Page 169: 154 !i\!m.!!!Ari. : The occurrence
Page 172 and 173: 15 7 regr ession was performed, t o
Page 174 and 175: 15. The s tat i stically significan
Page 176 and 177: 161 s t atistically !li gnifica nt
Page 178 and 179: 16 3 t.o de t ermi ne t hose wi th
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165 was 280 nr (SO ± 166 ml.) and
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1 6 7 The results o f multiva riate
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169 The s atur a t ed rnode I of th
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CHAPTER 6 !l!SQJ.SSI ON AND RECOMME
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175 higher ed ucation levels a nd l
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177 a bout half of t he women who h
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180 ranked t he i r health as satis
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1 8 2 I nformal i nf ormat ion obta
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1 8 6 bact eriur ia r ates often r-
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190 lacerations or i ncisions which
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The non-infectiolIs morbid!ties : P
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194 About 60 % of the su b j ec t.s
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197 for preventing postpartum infec
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'" comparable to t h e high 57% rep
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201 p ostpartum pe r Lcd and also f
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203 bcv ev e r , a bou t 3 to 10 t
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205 The ve ry small number of patie
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210 i n f orm ation on t he ea rly
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212 depend o n the type of mo r b i
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one d id not fUlly escape t he l i
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3 . What i s the ex tent o f pos t
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2 21 38 . Kah n AR, Jahan FA ( 1 98
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225 85 . Ph ill i p s I , ' Ba s s
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22. 122. Thacker 58, Banta HD (1982
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232 17 1. Hype r tensive di s o rde
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234 191. Cox ML ( J.963) . Incidenc
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'" 223 . Pugb TF , J erat h BK, Sch
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APPENDIZ A MAP OF GHANA AND STUDY "
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STUDY FORM A: Pa g e 2. PREGNANCY/l
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STUD Y FORM B : Page 2 IF YES, Did
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STUDY FORM B: Page 5 Bima nual Pa l
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3) Gaped wound/Delayed wound healin
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APPENDI X F R.ESULTS OF MUTI VARI A
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APPENDI X r II THE PREDICTORS OF PO
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APPENDIX L DETERMINANTS or POSTPART
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