As part of a survey of 600 women enrolled in a study of postpartum progesterone-only contraception (400 women who opted to use progesterone-only contraception and 200 controls) participants were asked about menstrual history and lactation experience. The mean longest menstrual cycle duration was found to be 29.5+/-SD3.5 days and the mean shortest cycle duration was 26.6+/-SD2.8 days. The mean duration of menstrual bleeding was 3.75+/-SD1.16 days. Few women reported menstrual period problems such as dysmenorrhoea (6.5%) and menorrhagia with clots (0.7%). However, 3% of the women reported irregular cycles with intervals of longer than 1 month. Overall the women reported breastfeeding their previous baby for a mean duration of 14 months. The group of women electing to use hormonal contraception reported that they had breastfed their last baby for 13.5+/-SD7.5 months while control women had done so for 14.1+/-SD9.4 months. The longest mean duration that women reported to have breastfed a previous infant was 19.5+/-SD9.6 months in the hormonal contraception group and 19.1+/-SD8.6 months in the control group.
Adult ; Breast Feeding ; Female ; Humans ; Lactation - physiology ; Menstruation - physiology ; Papua New Guinea - epidemiology

The shake test, the tap test and the turbidity test were evaluated to determine their accuracy in predicting lung function maturity, ie their ability to predict respiratory distress syndrome (RDS). The turbidity test was the most efficient with a sensitivity of 60%, a specificity of 97%, a positive predictive value of 82% and a negative predictive value of 92%. The shake test had a sensitivity of 40%, a specificity of 95%, a positive predictive value of 63% and a negative predictive value of 88%. The tap test at 2 minutes had a sensitivity of 57%, a specificity of 78%, a positive predictive value of 35% and a negative predictive value of 89%. It was fortuitous that the simplest and cheapest test was found to be the most efficient test of the three. We recommend that the turbidity test or at least one of these tests should be used to determine the maturity of lung function when non-urgent elective deliveries are contemplated, to help reduce the incidence of RDS in this group of patients.
predictive ; Respiratory distress ; Syndrome ; Restrained Drinking Scale ; prediction

From June 1998 to December 1999, mothers of 150 babies who died in the early neonatal period and 150 controls whose babies did not die were studied. In multiple logistic regression analysis the following variables were positively associated with early neonatal deaths: lack of antenatal attendance, thick meconium staining of the liquor, male sex, very low birthweight and delivery at gestational age less than 34 weeks. Maternal betelnut chewing was negatively associated with neonatal deaths. When babies with birthweight below 1000 g were excluded, the following variables were associated with early neonatal deaths: unmarried status, thick meconium staining of the liquor and gestational age below 34 weeks. The negative association with betelnut chewing persisted. The main causes of early neonatal deaths were respiratory distress syndrome, septicaemia, birth asphyxia, meconium aspiration syndrome and congenital abnormalities. Avoidable factors in these deaths were associated with the patient (53%), the labour ward (28%), the antenatal clinic (9%), the postnatal ward (8%) and the special care nursery (2%).
Neon ; Meconium ; Mores ; Betal nut ; Port - alcoholic beverage

Blood from 2100 women attending the antenatal clinic of the Port Moresby General Hospital (PMGH) and the 9 Mile urban clinic of Port Moresby was tested for syphili using the laboratory-based Venereal Disease Research Laboratory (VDRL) syphilis serology test and two clinic-based syphilis tests, Abbot Determine and Abbot Syfacard-RR (Rapid Plasma Reagin (RPR) card test). The Abbot Determine and the Syfacard-R tests were compared with the VDRL test, the gold standard in this study. The validation test results of Determine versus VDRL were as follows: sensitivity 92.0%; specificity 94.6%; the predictive value of a positive test 42.6%; and the predictive value of a negative test 99.6%. The validation tests for RPR versus VDRL were as follows: sensitivity 56.3% specificity 96.5%; predictive value of a positive test 41.2%; and the predictive value of a negative test 98.1%. The RPR test costs 3.5 kina (about one US dollar) a test, the VDRL less than 1 kina a test whilst the Determine test kit costs about 5 kina a test. When laboratory time, salaries and other supplies are costed the Determine test is expected to cost relatively much less. Our recommendation is that the Determine test be made available in areas of the country where VDRL is unavailable or where logistics do not allow for test results to be available early enough to make a difference to the care of th pregnant woman and her fetus.
VDRL test ; Rapid plasma reagin ; predictive ; Clinic ; Rapid

Between June 2001 and December 2002, 152 antenatal patients at Port Moresby General Hospital who were Venereal Disease Research Laboratory (VDRL) serology positive and 150 unselected antenatal patients who tested negative were studied to determine the gestational age at which the tests were performed, the time it took for results to become available, the proportion of patients who received treatment, the sociodemographic characteristics associated with VDRL positivity and the effect of VDRL positivity on maternal and perinatal outcomes. The prevalence rate of VDRL positive among antenatal clinic attenders in Port Moresby at that time was 4.4%. Of the 152 VDRL-positive patients in this study 97% were also Treponema pallidum haemagglutination (TPHA) positive. Significantly more of the positive patients were of highlands origin, lived in settlements, had previous marriages, had lower parities, delivered preterm babies, had stillbirths, had growth-restricted babies and had babies with lower Apgar scores at both 1 and 5 minutes. The mean birthweight was significantly lower among the positive patients. Significantly more of the positive patients were married to spouses with occupations which were regarded as 'risky' for sexually transmitted infections. There was no difference between the two groups with respect to patient's education, marital status, husband's education, gestational age at delivery and the number of days the baby spent in the Special Care Unit. The study concluded that the current antenatal screening does not provide adequate coverage for our patients. If the current availability of clinic-based strip tests provided by a non-government organization can be continued by the Ministry of Health we should be able to overcome this problem.
VDRL test ; Clinic ; Mores ; seconds ; Port - alcoholic beverage

From March 1995 to February 1998, 110 patients diagnosed with tuberculosis (TB) in pregnancy or the puerperium at the Port Moresby General Hospital (PMGH) were surveyed. 96% were diagnosed as a result of the symptoms of tuberculosis, 4% through contact tracing. 11 of 40 patients who first attended antenatal clinic in the second trimester were not diagnosed until after delivery. The mean birthweight of term infants of TB patients was significantly less than term infants in a previous survey at PMGH. 45% of babies were growth restricted. With increasing duration of treatment, both increasing maternal weight gain in pregnancy and higher mean birthweight were found. Maternal and perinatal mortality were high in the study patients. There were 6 maternal deaths and a perinatal mortality rate of 137/1000. The majority of maternal and fetal losses occurred in patients who had pulmonary, miliary and meningeal TB. Improvement in the detection of tuberculosis in antenatal patients and the introduction of adequate treatment before delivery should prevent maternal deaths and perinatal morbidity and mortality.
Longitudinal Studies ; Papua New Guinea - epidemiology ; Pregnancy ; Pregnancy Complications, Infectious - epidemiology

From July 1992 to August 1993, 330 under-18 year old primigravidae (cases) and 330 randomly selected 20-29 year old primigravidae (controls) who were delivered at the Port Moresby General Hospital were sequentially studied, using a standardized, pretested, precoded questionnaire. In stepwise logistic regression analysis, significantly more of the cases had menarche at less than 15 years of age, learned before menarche that sex causes pregnancy, were of highland origin, were unemployed, or had partners who were unemployed; significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned this pregnancy. PIP: This study aims to identify factors (explanatory variables) which are associated with the risk of an adolescent becoming pregnant. From July 1992 to August 1993, 330 18 year old primigravidas (cases) and 330 randomly selected 20-29 year old primigravidas (controls), who were delivered at the Port Moresby General Hospital in Papua New Guinea, were sequentially studied. Trained research assistants administered a standard, pretested, precoded questionnaire. By using stepwise logistic regression analysis, it was revealed that significantly more of the cases had menarche at 15 years of age (81% vs. 49%), learned before menarche that sex causes pregnancy (51% vs. 32%), were of highland origin, were unemployed, or had partners who were unemployed. Moreover, significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned their pregnancy.
Adult ; Analysis of Variance ; Case-Control Studies ; Female ; Health Knowledge, Attitudes, Practice ; Mothers - education ; Mothers - psychology ; Papua New Guinea ; Pregnancy ; Pregnancy in Adolescence - psychology*

Factor V deficiency is a rare hereditary disorder. We report a patient with factor V deficiency who presented with menorrhagia and pelvic haematoma. The Haematology Department at the Royal Brisbane Hospital performed the definitive factor assays leading to the diagnosis. The challenges of her management were obtaining adequate supplies of factor V and her socioeconomic circumstances. The main future challenge will be the supervision of her pregnancies.
Blood Coagulation Factors - analysis ; Factor V Deficiency - complications ; Factor V Deficiency - diagnosis ; Female ; Genital Diseases, Female - etiology ; Hematoma - etiology ; Humans ; Menorrhagia - etiology

A retrospective study of 274 consecutive primary caesarean sections and 274 unmatched controls was carried out at Port Moresby General Hospital from January to December 1992. The primary caesarean section rate was 3.5%. Stepwise logistic regression analysis showed that primary caesarean section was significantly associated with maternal height of less than 150 cm; nulliparity; symphysis-fundal height of more than 38 cm at admission in labour; cervical dilatation of less than 4 cm at admission in labour; and the level of fetal head at admission in labour of 3/5 or higher.
Analysis of Variance ; Case-Control Studies ; Cesarean Section - statistics & ; numerical data ; Confidence Intervals ; Developing Countries ; Logistic Models ; Natural Childbirth - statistics & ; numerical data

We studied 510 patients in a retrospective, nonrandomized, comparative survey of vaginal births and repeat caesarean section after one primary caesarean section at the Port Moresby General Hospital. 478 (94%) were allowed a trial of scar (TOS). The most common indications for elective caesarean section in the other 32 patients were cephalopelvic disproportion (CPD) 31%, contracted pelvis 19% and preeclampsia 12.5%. In 41% of patients TOS was terminated by emergency caesarean section. Logistic regression analysis showed that the following were significantly associated with repeat caesarean section after TOS: parity of one, no vaginal birth after the primary caesarean section, narrow obstetric conjugate, birthweight of 2500 g or greater, short stature, high level of the head at admission to the labour ward and region of origin.
Cesarean Section / statistics & ; numerical data Data Collection Delivery, Obstetric - methods Delivery, Obstetric - statistics & ; numerical data ;