BY

DR. ALEXANDER E OMU

DEPARTMENT OF OBSTETRICS AND
GYNAECOLOGY
FACULTY OF MEDICINE, KUWAIT
UNIVERSITY
 LEARNING OBJECTIVES
• To understand basic concepts of new
developments in different branches of
Obstetrics and Gynaecology.
• To understand the concept of evidence
base- practice in Obstetrics and
Gynaecology.
* To be made aware of the significant role of
medical audit in clinical practice and review
basic vital statistics.
Since the description of the double helical structure of
DNA by Watson and Crick in 1953 there have been many
discoveries in the genetic and molecular function of the
normal and abnormal.

1. One of such advances is in reproductive technology:

* Ovarian hyperstimulation
* In vitro fertilization & ICSI / TSE ICSI
* Human embryology cryopreservation
* Pre-gestational diagnosis (PGD):FISH
* Sex Pre-selection
* Pregnancy in older women

2. Cloning in animals and tissue from stem cells

3. Laparoscopy
* diagnosis and treatment of ectopic pregnancy
* Infertility: diagnosis and treatment
* Therapeutic
* Surgical contraception
* Assisted vaginal hysterectomy
* Myomectomy etc

4. Hysteroscopy
* Uterine polyp removal
* Myomectomy
* Uterine adhesions / syneciae
5. Ultrasound - In fetal-maternal Medicine
and
Diagnosis and treatment
3D
* intrauterine therapy
* Congenital anomalies
* Ectopic pregnancy
* Multiple pregnancy
6. Magnetic Resonance Imaging and CT scan
Tumor volume – in Oncology
and involvement of lymph nodes

7. T V T (Tension free Vaginal Tape) for stress

incontinence
8. Internet Information technology
* General use of internet
* Internet and research

9. HUMAN GENOME

10. Evidence – based – practice - and Medical audit

( Vital statistic)
Vital statistics
In Obstetrics vital statistics are related to data about birth
and deaths
Birth rates
Death of the fetus or newborn
(stillbirth and neonatal death-perinatal death)
Maternal deaths
Factors
Background
Region or country of origin
*Population at risk
The period of time data is collected
The source of the data (who dealt with the data
Ministry of health or institute)
Methods of expression
as rates per
1000 or 100,000 or 1,000,000
(perinatal mortality) (Maternal
Uses of vital statistic

For planning of health services

Hospital
Regions
Countries
Comparison between
Individuals
Hospitals
Countries
As medical Audit
Birth Rate
number of birth in the year X 100
1. Birth rate =
mid – year population
Source of information and notification of birth
This rate has many flaws, because all ages are
accounted for
2. General fertility rate
number of births in the year X 1000
=
number of women aged 15-44 years
3. Total period fertility rate (TPFR). Average
number of children who would be born per
woman, throughout their fertile life span
(15 – 44 years)

Birth rates in
Developing countries 35 – 50 per 1000
Developed countries 12 – 15 per 1000

Implications
Population increase + immigration/emigration
Availability of resources or lack
Maternal Mortality
A maternal death is one that can be attributed to
pregnancy or childbirth and up to the 6 weeks of
the puerperium. In UK, deaths up to one year after
child birth or an abortion
a. Direct
Obstetric haemorrhage
Preeclampsia
Infection
b. Indirect: from previous existing disease
mitral stenosis, hypertension
c. Fortuitous: deaths not directly related to
pregnancy e.g road traffic accidents
 Number of maternal deaths x1000
Maternal mortality =
Total births

Number of maternal deaths x1000

WHO and (MMR) = Live births
US

Causes of drop of MMR

The control of infection

Blood transfusion
Operative delivery
advance in anaesthesia
and resuscitation
Causes of Maternal deaths
Pulmonary embolism
Hypertensive disorders of pregnancy
Anaesthesia
Amniotic fluid embolism
Abortion
Ectopic pregnancy
Haemorrhage
Placenta praevia
Abruptio placenta
Sepsis
Ruptured uterus
Other direct causes
Medical disorder
Diabetes mellitus
Acute fatty liver of pregnancy
Comparison of MMR in Developing and Developed countries and
factors affecting MMR
Region No. of children Woman married MMR(/100.000) Literacy of woman
per woman 15-19 live birth
Africa 6.4 44 640 15
North 6.2 34 500 18
West 6.8 70 700 6
East 6.6 32 660 14
Central 6.0 49 690 9
Southern 5.2 2 570 56
Asia 3.9 42 420 34
West 5.8 25 340 31
South 5.5 54 650 17
Southeast 4.7 24 420 53
East 2.3 2 55 92
Latin America 4.5 16 270 70
North America 1.8 11 50 99
Oceania 2.8 10 100 88
Europe 2.0 7 30 93
Developing count. 4.4 39 450 32
Developed count 2.0 8 30 97
World 3.8 30 390 54
About 560,000 women die from pregnancy and childbirth every year
Strategies for reducing MMR
1. Education
2. Improving health care
3. Economic emancipation
4. Obstetric care
ANC
Labour facilities etc
5. Family planning
6. Other measures
 Perinatal Mortality
Perinatal mortality is a term used for a total of all the
stillbirths and the first week neonatal deaths. (from 24
weeks of gestation)
Stillbirth (SB) Obstetric related
early neonatal death
Perinatal mortality rate (PNMR)
SB + One week neonatal death x 1000
= Total births
SB + One week neonatal death x 1000
(WHO) PNMR =
US Live births
Neonatal death rate is the number of infants dying in the
first month per 1000 live births
Infant mortality rate is the number of infants dying in the
first year of life per 1000 life births
Causes of Perinatal death
A. Still Birth
Unknown (because of maceration) 25-40%
Congenital abnormality 33%
IUGR
Preeclampsia
SLE
Diabetes mellitus
Poor nutrition
Placental disease
abruptio placenta
placental praevia
Fetal infection
Diabetes mellitus
Rhesus isoimmunisation
Cord accidents
Prolapse, entanglement
Neonatal Causes of Perinatal Death
Preterm labour 60-80%
(Incidence 6-7%)
RDS
hyaline membrane disease
Congenital anomalies 25%
Hypoxia 10%
Infection
Intracranial haemorrhage
Shoulder dystocia
Factors affecting perinatal mortality
Age, Parity
Socio-economic class
Smoking
Preterm
IUGR
Racial origin
Poor obstetric care
Grand multiparity
Adolescent pregnancy
Reduction of Perinatal mortality
Maternal formal and informal education
Improved socio-economic conditions
(better standard of living)
Reduction of births per woman
Improved nutrition
Family planning
Improvement in obstetric technology
Improvement in neonatal technology
Reduce cigarette smoking
Prevalence of some Obstetric Procedures
at the Maternity Hospital 2000

Caesarean section 19%

Vaginal delivery after a
Previous C section 60%
Vacuum Extraction 3.5%
Forceps delivery 1.5%
Breech presentation 4.0%
at delivery
Cervical Cerclage 1.4%