Background: Complications of pregnancy and childbirth are the leading cause of death and disability among women of reproductive age in developing countries. In Mozambique, there were 1000 maternal deaths for every 100,000 live births in the year 2000, compared to 20/100,000 in developed nations. Little is known of Mozambican women's beliefs about pregnancy, childbirth, and postpartum. The aim of this research project was to gain an understanding of the perceptions of pregnancy complications among women in the Sofala province of Mozambique. This research sought to discern some of the sociocultural reasons that contribute to primary delays in women seeking and receiving care. Methods: A triangulation of methodology was used: the information was gathered through general observation, a combined questionnaire and open-ended interview questions with 60 informants, as well as chart review. Research took place at two rural health clinics that provided basic emergency obstetric care (EmOC) and one rural maternal hospital that provided comprehensive EmOC in the Sofala province of Mozambique. The sample included women who were either pregnant, or had been pregnant in the previous 2 years. Results: Initial findings point to strong cultural barriers, mainly witchcraft, which deter the sharing of reproductive health knowledge among women. Additionally, women frequently described concurrent use of both the traditional and biomedical health care systems. Conclusions: How women learn about the risk of pregnancy complications and treatment for those complications are critical questions to be answered amidst the context of cultural barriers in Mozambique. Additionally, this study found that the use of traditional herbal preparations was pervasive, if not universal.

No abstract

OBJECTIVE:We present the surgical anatomy and steps to perform the uterosacral ligament vaginal vault suspension. METHODS: Video taping of cadaver dissection, laparoscopic surgery, and vaginal surgery is combined to demonstrate the surgical anatomy and steps of suspending the apex of the vaginal to the uterosacral ligaments for treatment of uterine or apical prolapse. The relationship of the uterosacral ligament and the ureter is presented. Color illustrations and animation compliment the presentation of the procedure. RESULTS: The uterosacral ligament vaginal vault procedure provides a vaginal approach to achieving bilateral apical support directed in the normal axis of the vagina. CONCLUSION: This video presents a detailed description of the surgical anatomy and steps of the uterosacral ligament vaginal vault procedure. OBJECTIVE:To demonstrate the purpose and technique of the Extended (colpo-) Perineorrhaphy (EP), a minimally invasive operation for severe prolapse in elderly acoital women. METHODS: A modification of the old Martius Labhardt vulvoplasty was developed to offer a definitive, albeit obliterative, option to treat grades 3 and 4 pelvic organ prolapse (Baden-Walker system) in surgically at risk acoital patients. Patients were offered this operation after having failed or refused pessary care. The technique was designed to accomplish marked narrowing of the genital hiatus, tightening of the distended introitus, and creation of an exaggerated perineum; thus preventing prolapse exteriorization. The steps included: 1) excision of perineal and distal posterior vaginal skin, 2) levator plication, 3) deep connective tissue closure, 4) running closure of posterior vaginal and labial skin, and 5) wide crown stitches to create an exaggerated perineum. The EP was performed in 24 patients and their intra and postoperative courses were observed for subjective and objective cure or improvement and complications. A video was made to demonstrate the detailed technique of this procedure. RESULTS: The operation was successful in curing prolapse symptoms either alone or with the aide of an easily maintained pessary. In a review of 24 at risk acoital patients at a mean of 17 months (range, 3-75), in 16 (67%) their prolapse remained intra-vaginal, in 6 (25%) the prolapse was exteriorized but improved and they were now able to hold a pessary, and the remaining 2 cases (8%) were failures. Postop complications included 1-anemia with transfusion, 2 (8.3%) cellulitis and 3 (12.5%) partial breakdowns. Two of these 5 local healing problems required re-closure. Success defined by prolapse intra-vaginal with or without a pessary and no symptoms was 92%. CONCLUSION: The EP alone is a safe and effective operation for the cure of exteriorized prolapse in acoital women. Because of the inherent superficial nature of this procedure, it can be expected to have a shorter operative time, blood loss, hospital stay and recuperation when compared with the standard full reconstructive operation. The acoital patient formally relinquishes her v...