FM3THE CAESAREAN SECTION: Indications, Techniques, Complications and Alternatives with Notes on Obstetric Practice in the Tropics
Erik Domini MD FCOG (Padova)
Consultant Obstetrician and Gynaecologist (R) Ospedale St. Spirito, Nizza Monferrato, Italy Father Ambrosoli Memorial Hospital, Kalongo, Uganda St Kizito Hospital,
Matany, Uganda
Sara Guazzini MD FCOG (Florence)
Registrar Department of Obstetrics and Gynaecology Ospedale di Cittadella,
Padova, Italy
Former Registrar Department of Obstetrics St Kizito Hospital,
Matany, Uganda
Monica Guidi MD FCOG (Florence)
Registrar and Referee for Obstetrics Department of Obstetrics and Gynaecology Ospedale di Cittadella,
Padova, Italy
Former Registrar Department of Obstetrics St Kizito Hospital,
Matany, Uganda
Stefano Vicentini MD
Medical Superintendent (R) St Kizito Hospital,
Matany, Uganda
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The Caesarean Section
First Edition: 2017
9789352700196
FM5Dedicated to
Our parents.
To the women of Uganda
we had the privilege to serve and admire
A Demetria, non infrequentemente nei miei pensieri, sempre nel mio affetto e nella mia amicizia.
FM7Preface
Experience comes from critical analysis of the therapeutic conducts and outcomes of the cases entrusted to our care. Some of these have a favourable outcomes, others do not have.
Events that develop in a positive way fade very soon from the memory; those with an ominous outcome leave the deepest trace, along with the nagging question: “Should I have managed it differently? Could it have been managed differently?”
These cases with unfavourable outcomes and the human suffering which we have witnessed and for which we were, perhaps, in part, responsible, albeit unwittingly, along with the wish that this suffering shall not have been in vain, have spurred us to write this book and the forthcoming Treatise on Obstetric Surgery.
In these two works, we have tried to make available to our younger colleagues what little we have learned over the course of our professional lives. Our aim is to reduce for them the number of nagging doubts that will inevitably accompany their professional lives, especially if conducted in the tropics.
There is a saying that “The first thing a doctor wants to be is rich, then famous, and lastly to be good at his job”. We advise our youthful colleagues to stand this order on its head, and to strive first and foremost for mastery, which is attained through sacrifice and study, which brings to mind a favourite maxim of our teacher,
TNA Jeffcoate of Liverpool: Presumption of knowledge is the major obstacle to knowledge.
Wealth and fame will follow in due course.
Erik Domini
Sara Guazzini
Monica Guidi
FM9Acknowledgements
Every acknowledgement closes with expressions of thanks and this one is no exception with the sole difference that there is nothing perfunctory about these words, as they express a need felt by the heart that I should acknowledge all those who have contributed either directly or indirectly to the present work.
To M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India for publishing this monograph: It is a source of great pride to me that such a prestigious publishing house has accepted my text. Thank you!
To the co-authors of this book, who have accompanied me throughout and supported me with their enthusiasm and friendship. Thank you!
To my Ugandan colleagues, my partners during the years I spent in Uganda, goes all my admiration for their dedication to work and their technical skill.
The latter is the fruit of training provided by Uganda's faculties of medicine, among which the Medical Faculty at Makerere is the most outstanding. May I be permitted to mention here Eminton Odong, James Lemukol and Richard Edmund Sanya, John Bosco Nsubuga, Myango Patient?
I worked for years in close collaboration with Ugandan midwives, many of whom were trained at the Father Ambrosoli Midwifery School of Kalongo, one of the best in Uganda. The excellence of the training given there, and at other Schools of Obstetrics in Uganda, is well attested by the ability to resolve complex obstetric challenges, even when working in outlying medical centres.
I spent some intensive years in Kalongo and in Matany, and forged friendships there that remain in my memory and in my heart. I ask leave to call to mind the Sisters (Carmel et al.) and Tutors (Polly et al.) who run the Midwifery School of Kalongo, Sr. Paska, Alphonse Ayepa “Sir Alphonse” the anaesthetist who enabled me to operate on extremely complex cases in safety, Mary Annunciata Longole, Daniel Irusi, Betty Agan, Lilian Adwar and Hellen.
Two colleagues have left a deep mark on my professional life; even though they are of my generation, I consider them my masters: Thomas Raassen, President of the International Society of Obstetric Fistula Surgeons and Carlo Alberto Bonini, an extraordinary surgeon and gentleman.
I judge a publication, apart from by its conceptual content, also by its typographical attire, which facilitates both reading and understanding. My thanks for this are due to Giovanni Durando and to his wife, Ada Giaretto, for their skill, passion and patience.
The life of a physician, as that of any human being, is made up of more than just its professional side. I am privileged here to be able to thank Rita Prudenzano, my Ward Sister, Nizza Monferrato (Italy) Hospital, whose gifts of human understanding and professional ability have been indispensable for the proper running and harmony of the ward.
My memory and my friendship to: Adriana Platone, Giovanna Riva du Lac Capet, Lisa Corti Santini, Commander Giancarlo Basile and Crew of I.N. Training Ship “Stella Polare” Asti, 7th August 2016.
Erik Domini