Advanced extrauterine pregnancy with a successful outcome is a rare event. A case is presented of a 34-year-old woman at 35 weeks gestation whose abdominal pregnancy was successfully managed. The diagnostic and management problems associated with abdominal pregnancy are discussed, and especially the controversial issues of the treatment of the placenta after delivery. The reasons for the high maternal and perinatal mortality associated with the condition are analyzed.
Cesarean Section - methods ; Female ; Magnetic Resonance Imaging ; Postnatal Care - methods ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Third

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

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 ;

A retrospective study of 432 consecutive singleton low birthweight babies and 432 unmatched controls was carried out at the Port Moresby General Hospital from January to December 1988. Of the 432 low birthweight babies 65% were preterm, 27% were light for gestational age, 6% were both preterm and light for gestational age and 2.5% could not be classified. The results of the analysis showed low birthweight to be significantly associated with the past delivery of a low birthweight infant, very young and elderly mothers, lack of antenatal care, poor family planning, hypertensive disease in pregnancy and intrauterine death. This study reveals that maternal education and improved antenatal care and family planning would ultimately reduce the incidence of low birthweight babies and perinatal mortality in Papua New Guinea.
Analysis of Variance ; Case-Control Studies ; Developing Countries ; Gestational Age ; Infant, Low Birth Weight

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*

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