The purpose of this study was to evaluate the meconium staining of amniotic fluid (AF) in term of fetal distress, meconium aspiration syndrome, and perinatal morbidity and mortality. In a prospective study at Princess Badeea Teaching Hospital from April to November 1999, women with a singleton cephalic pregnancy of completed 37-42 weeks and with no pre-defined risk factor were recruited into the study. Study patients comprised 390 (10%) patients with meconium and 400 patients as controls but with clear amniotic fluid. Virtually meconium staining of the amniotic fluid was significantly associated with poor neonatal outcome in all outcomes measures assessed. Perinatal mortality increased from 2 per 1000 births with clear AF to 10 per 1000 with meconium (P<0.001). Other adverse outcomes also increased; e. g., severe fetal acidemia, Apgar score < or = 3 at 1 min and 5 min, and meconium aspiration syndrome. Delivery by cesarean section also increased with meconium from 7-14% (P<0.001). We concluded that meconium in the amniotic fluids associated with an obstetric hazard and significantly increase risks of adverse neonatal outcomes. Women with thin meconium in the presence of normal fetal heart rate can be safely managed at the clinical level. Mod-thick meconium alone should alert the obstetrician to a high risk fetal condition. Continuous fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most significant factors in the reduction of meconium aspiration syndrome.

This randomised prospective study was designed to evaluate the use of transvaginal (TVS) and transabdominal (TAS) ultrasound in the diagnosis of placenta praevia and its effect on length of stay in hospital. One hundred and thirty patients with antepartum haemorrhage (APH) and/or malpresentation with a suspicion of placenta praevia were referred to the scanning department of Aberdeen Maternity Hospital and Princess Badee'a Teaching Hospital from July 1993 to December 1996. Fifty-eight patients had an ultrasound because of antepartum haemorrhage and 72 had a malpresentation and/or unstable lie. All examinations were performed by the same authors. Placenta praevia was diagnosed in 13 (22.4%) out of 58 cases presenting with APH and in five (7%) out of 72 cases presenting with malpresentation. There was a high false positive rate in the detection rate of placenta praevia using TAS (23%) compared with TVS (11.5%) which is higher than other reported figures (2-6%). The mean length of stay in hospital of the group in whom the results were released was 9.2 days compared with those not released where it was 15.7 days. The difference was significant (P <0.05). This study suggests that the traditional transabdominal approach to the diagnosis of placenta praevia can be improved upon. TVS is a safe method and with improved accuracy over TAS can reduce the length of stay in hospital.

A better understanding of the demographics of these diseases has the potential to aid in the more efficient utilization of health care resources and improved planning and provision of health care services.

This study examined the decrease in cesarean section rates in relation to perinatal mortality between 1987 and 1993 at the primary referral hospital in north Jordan. Most of the population is at high risk and of low socioeconomic status. The cesarean section rate decreased from 15.5 percent in 1987 to 8.7 percent in 1993, and has remained at this low rate. During the same period the perinatal mortality dropped from 52 to 20.9 deaths per 1000 live births. These results do not include perinatal morbidity. The successful reduction of the cesarean section rate is attributed to active management of labor, trial of labor for women with a previous cesarean birth, and vaginal breech delivery in selected women. We conclude that the rate of cesarean delivery can be safely reduced in a developing country without adverse effects on birth outcomes.

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