Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Uterine Ruptures in Rural Zaire
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patients with high risk pregnancies. The use of partographs will be encouraged.
2. The Institute Panafricain de Santé Communautaire (IPASC), in collaboration
with the Obstetric department of Nyankunde Hospital will conduct 6
monthly workshops for midwives responsible for rural health programmes
within the Nyankunde Health Districts as well as other neighbouring districts.
3. A survey will be made of the communication system between health centres
and their district hospital, and with Nyankunde through the ‘Flying
Doctor Service’. Necessary improvements will be made where possible.
4. Each case of ruptured uterus will be used as a case study to see where the
weaknesses in the system are and how they can be avoided in the future.
Particular attention will be given to constraints expressed by patients in
reaching adequate medical care.
5. Family planning advice and follow-up will be combined with maternal and
child health programmes, using an awareness-raising approach.
Grande-multiparous women will be encouraged to deliver in hospital.
6. A prospective study will be done by nurses who have studied at IPASC of
the outcome of all women with high risk pregnancies, with special reference
to the time interval between the detection of a complication and the
transfer of the patient to a referral centre.
We would like to anticipate that the problem of ruptured uterus will disappear
in the years to come, but we cannot be confident while the constraints abound.
Awareness-raising and addressing problems caused by inadequate care and poor communications
should reduce the incidence of ruptured uterus in the area.
References
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