Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 15
Basic Obstetrics and Obstetric Surgery
in a Mission Setting
F. L. Dutton and Glenn W. Geelhoed
Introduction
In this chapter a rather narrow focus will be placed upon surgical interventions
in pregnancy. We begin therefore with the reminder that obstetrics generally deals
with the care of the mother throughout her pregnancy, labor and the puerperium
(by convention, up to six weeks postpartum). In a still larger sense, as pointed out in
Williams Obstetrics (20th Edition), obstetrics is actually “concerned with the reproduction
of a nation, because it is concerned with all the physiological, pathological,
psychological, and social factors that profoundly influence both the quantity and
the quality of new generations of citizens.”
Most issues related to prenatal care and pediatric health need to be addressed in
the community during the prenatal period, if not preconception, and should be
entrusted to community health workers and midwives (the word “ obstetrix” is in
fact Latin for “midwife”). Although development of community health programs,
pregnancy education, and prenatal surveillance is outside the scope of this chapter,
midwives also provide essential services at operative deliveries, both as surgical assistants
and in performing neonatal assessment and resuscitation. Their training and
education may be one of your greatest responsibilities and most significant contribution
to the health of the community.
Phases of Obstetric Management
Medical actions aimed at maximizing obstetric outcomes can be organized chronologically:
A. Prepregnancy measures.
These target safety, nutrition, sanitation.
B. Prenatal care.
Includes surveillance for infection, identification of risk factors for preterm
labor, pregnancy-induced hypertensive disorders, potential for cephalopelvic
disproportion and dystocia. One also aims to detect multiple gestations,
malpresentations, ectopics, and abortions or fetal demise.
C. Labor: First stage (onset of active labor through full dilatation).
This includes the diagnosis of labor, the subsequent identification of dysfunctional
labor, and indications for operative delivery.
D. Second stage (from full dilatation through delivery).
Proper management requires recognition of secondary arrest disorders, and
indications for operative delivery.
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.