This document discusses maternal near miss (MNM), which refers to women who survive severe life-threatening complications during pregnancy, childbirth, or postpartum. MNM is presented as an important tool for evaluating obstetric healthcare beyond just maternal mortality. The document outlines criteria for identifying MNM cases, indicators for assessing healthcare quality using MNM data, advantages of MNM reviews for reducing maternal mortality, and findings from studies on MNM in various hospitals that identified leading complications and opportunities for improvement. MNM reviews are described as complementary to maternal death reviews for gaining insights to reduce preventable morbidity and mortality.
Near miss maternal mortality (Dr Amenda Ann Davis)Amenda Ann Davis
The Geller Criteria proposes a scoring system to identify women with near-miss maternal morbidity by assigning points for clinical factors like organ failure, extended intubation, ICU admission, surgical intervention, and significant transfusion. The scoring system was developed and tested at a large tertiary care hospital serving an urban population. The total score on the proposed scoring systems could help differentiate near-miss cases from those with only severe but not life-threatening conditions.
This document discusses severe maternal morbidity, also known as near-misses, which are life-threatening complications during pregnancy, childbirth, or postpartum that women survive only through medical intervention. It notes that over 50 million women experience maternal health issues annually. The document then provides definitions of near-miss cases and discusses risk factors. It presents statistics on near-miss cases from a private hospital in India compared to a rural hospital, finding higher rates in the rural hospital. The leading causes of near-misses are identified as pre-eclampsia/eclampsia and hemorrhage. The conclusion emphasizes the need for improved management of near-miss cases to reduce maternal mortality.
This document summarizes presentations on maternal near miss in Sudan. It defines maternal near miss as a severe life-threatening complication during pregnancy, childbirth, or postpartum that requires urgent intervention to prevent death. The document discusses how analyzing near miss cases can provide insights into health system failures in obstetric care. It notes that the leading causes of near miss in Sudan are hemorrhage, infection, hypertensive disorders, and anemia. The document also outlines Sudan's policy on identifying near miss criteria and qualitative research examining determinants of maternal morbidity and mortality in post-conflict areas.
This document discusses maternal morbidity and near-misses, which are defined as life-threatening complications during pregnancy, childbirth, or postpartum that are survived due to medical intervention. It notes that while maternal mortality has declined, morbidity remains high. The document then presents statistics on near-misses from a private and rural hospital in India, finding higher rates in the rural hospital. The most common causes of near-misses were pre-eclampsia/HELLP syndrome and hemorrhage. Improved management of severe complications, emergency protocols, training, and access to care are needed to further reduce maternal mortality and morbidity.
In India, roughly one maternal death occurs every five minutes. Maternal mortality is defined as the death of a woman during or within 42 days of pregnancy termination from pregnancy-related causes. The highest maternal mortality rates in 2010 were in Chad, Somalia, Central African Republic, Sierra Leone and Burundi, while the lowest were in Estonia and Singapore. Though India's maternal mortality ratio has declined from 400 in 1997 to 212 per 100,000 live births in 2007-2009, it still has a long way to go to meet its Millennium Development Goal of 109 by 2015. Anemia and unsafe abortion are significant causes of maternal death in India. National initiatives aim to strengthen antenatal, intranatal and
Benzathine penicillin is the only recommended treatment for syphilis during pregnancy to prevent mother-to-child transmission. However, global supplies of benzathine penicillin have been inadequate in recent years due to shortages. An estimated 5.6 million doses are needed annually to treat all syphilis cases, with 930,000 doses needed during pregnancy to prevent congenital syphilis. WHO is conducting analyses of benzathine penicillin production, demand, supply and procurement practices to address shortages and ensure availability for eliminating mother-to-child transmission of syphilis.
This study reviewed 92 pregnant women with acute brucellosis at a Saudi Arabian hospital between 1983-1995. The incidence of spontaneous abortion in the first and second trimesters was 43%, and the incidence of intrauterine fetal death in the third trimester was 2%. Antepartum antimicrobial therapy with cotrimoxazole or cotrimoxazole/rifampin was protective against spontaneous abortion, with a relative risk of 0.14. Treatment was most beneficial for women presenting with febrile illness; vaginal bleeding at presentation usually led to spontaneous abortion. This demonstrates that brucellosis increases the risk of spontaneous abortion in pregnant women and prompt antimicrobial treatment is important.
This document discusses maternal near miss (MNM), which refers to women who survive severe life-threatening complications during pregnancy, childbirth, or postpartum. MNM is presented as an important tool for evaluating obstetric healthcare beyond just maternal mortality. The document outlines criteria for identifying MNM cases, indicators for assessing healthcare quality using MNM data, advantages of MNM reviews for reducing maternal mortality, and findings from studies on MNM in various hospitals that identified leading complications and opportunities for improvement. MNM reviews are described as complementary to maternal death reviews for gaining insights to reduce preventable morbidity and mortality.
Near miss maternal mortality (Dr Amenda Ann Davis)Amenda Ann Davis
The Geller Criteria proposes a scoring system to identify women with near-miss maternal morbidity by assigning points for clinical factors like organ failure, extended intubation, ICU admission, surgical intervention, and significant transfusion. The scoring system was developed and tested at a large tertiary care hospital serving an urban population. The total score on the proposed scoring systems could help differentiate near-miss cases from those with only severe but not life-threatening conditions.
This document discusses severe maternal morbidity, also known as near-misses, which are life-threatening complications during pregnancy, childbirth, or postpartum that women survive only through medical intervention. It notes that over 50 million women experience maternal health issues annually. The document then provides definitions of near-miss cases and discusses risk factors. It presents statistics on near-miss cases from a private hospital in India compared to a rural hospital, finding higher rates in the rural hospital. The leading causes of near-misses are identified as pre-eclampsia/eclampsia and hemorrhage. The conclusion emphasizes the need for improved management of near-miss cases to reduce maternal mortality.
This document summarizes presentations on maternal near miss in Sudan. It defines maternal near miss as a severe life-threatening complication during pregnancy, childbirth, or postpartum that requires urgent intervention to prevent death. The document discusses how analyzing near miss cases can provide insights into health system failures in obstetric care. It notes that the leading causes of near miss in Sudan are hemorrhage, infection, hypertensive disorders, and anemia. The document also outlines Sudan's policy on identifying near miss criteria and qualitative research examining determinants of maternal morbidity and mortality in post-conflict areas.
This document discusses maternal morbidity and near-misses, which are defined as life-threatening complications during pregnancy, childbirth, or postpartum that are survived due to medical intervention. It notes that while maternal mortality has declined, morbidity remains high. The document then presents statistics on near-misses from a private and rural hospital in India, finding higher rates in the rural hospital. The most common causes of near-misses were pre-eclampsia/HELLP syndrome and hemorrhage. Improved management of severe complications, emergency protocols, training, and access to care are needed to further reduce maternal mortality and morbidity.
In India, roughly one maternal death occurs every five minutes. Maternal mortality is defined as the death of a woman during or within 42 days of pregnancy termination from pregnancy-related causes. The highest maternal mortality rates in 2010 were in Chad, Somalia, Central African Republic, Sierra Leone and Burundi, while the lowest were in Estonia and Singapore. Though India's maternal mortality ratio has declined from 400 in 1997 to 212 per 100,000 live births in 2007-2009, it still has a long way to go to meet its Millennium Development Goal of 109 by 2015. Anemia and unsafe abortion are significant causes of maternal death in India. National initiatives aim to strengthen antenatal, intranatal and
Benzathine penicillin is the only recommended treatment for syphilis during pregnancy to prevent mother-to-child transmission. However, global supplies of benzathine penicillin have been inadequate in recent years due to shortages. An estimated 5.6 million doses are needed annually to treat all syphilis cases, with 930,000 doses needed during pregnancy to prevent congenital syphilis. WHO is conducting analyses of benzathine penicillin production, demand, supply and procurement practices to address shortages and ensure availability for eliminating mother-to-child transmission of syphilis.
This study reviewed 92 pregnant women with acute brucellosis at a Saudi Arabian hospital between 1983-1995. The incidence of spontaneous abortion in the first and second trimesters was 43%, and the incidence of intrauterine fetal death in the third trimester was 2%. Antepartum antimicrobial therapy with cotrimoxazole or cotrimoxazole/rifampin was protective against spontaneous abortion, with a relative risk of 0.14. Treatment was most beneficial for women presenting with febrile illness; vaginal bleeding at presentation usually led to spontaneous abortion. This demonstrates that brucellosis increases the risk of spontaneous abortion in pregnant women and prompt antimicrobial treatment is important.
This study analyzed perinatal mortality trends at Kathmandu Medical College Teaching Hospital from 2002-2007. It found that the perinatal mortality rate decreased from 30.7 in 2002-2003 to 19.1 in 2003-2005 but slightly increased to 25.5 in 2007. The main causes of perinatal deaths were prematurity (33.3%), intrapartum asphyxia (25%), and congenital anomalies (8.3%). Improving antenatal care, preventing preterm births, better monitoring during delivery, and intensive care for low birth weight infants could help reduce the perinatal mortality rate further.
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses: the basic principles of mortality audit, maternal and perinatal mortality, managing mortality meetings, ways of reducing maternal and perinatal mortality rates, This book should be used together with the Perinatal Problem Identification Programme (PPIP).
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Pregnant women are at an increased risk from influenza due to physiological changes during pregnancy. The document recommends that all women who will be pregnant during flu season (October through May) receive the inactivated influenza vaccine. Studies have not found any adverse effects to the mother or baby from the inactivated flu vaccine. Vaccination provides benefits to both mother and infant by preventing flu and reducing respiratory illnesses. Despite these recommendations and safety evidence, vaccination rates among pregnant women remain low. Healthcare providers play an important role in educating pregnant women about the importance of receiving the flu vaccine.
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
Infant Mortality Rate, perinatal mortalityRoselin V
This document discusses infant and perinatal mortality. It defines key terms like live birth, fetal death, stillbirth and provides current global and national magnitudes for perinatal mortality rate, neonatal mortality rate and infant mortality rate. The major causes of infant and perinatal deaths are discussed along with the various determinants. Prevention strategies are highlighted including improvements to antenatal, natal and postnatal care. Investigation of infant deaths and methods for surveying to estimate infant mortality rate are also summarized.
This document discusses neonatal mortality measurement and summarizes recent developments. It covers:
1) Neonatal mortality rates can now be estimated annually through improved surveys, though data reliability remains a concern. Pregnancy history modules may better capture neonatal deaths.
2) Estimates of neonatal causes of death have been improved through increased country data, especially for large countries like India and China. Rates of infections and tetanus appear to be declining in some areas.
3) Surveys can be improved by modifying questions to better capture neonatal mortality and stillbirths, and through follow up verbal autopsies to obtain cause of death data for over 75% of neonatal deaths dependent on surveys.
Saving Mothers and Babies: Introduction to maternal and perinatal mortalitySaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses: the basic principles of mortality audit, maternal and perinatal mortality, managing mortality meetings, ways of reducing maternal and perinatal mortality rates, This book should be used together with the Perinatal Problem Identification Programme (PPIP).
Maternal mortality is defined as the death of a woman during pregnancy or within 42 days of termination of pregnancy from pregnancy-related causes. The three main causes of maternal death globally are hemorrhage, sepsis, and hypertensive disorders. In India, maternal mortality rates are highest in rural areas where access to healthcare is limited. The three delay model explains that maternal deaths are often due to delays in seeking care, reaching care, and receiving adequate care. Reducing maternal mortality requires improving access to emergency obstetric care, family planning services, and addressing social determinants like gender inequality and poverty.
This document defines various mortality rates used to measure child mortality and provides statistics for Canada in 2007. It defines perinatal mortality as deaths from 22 weeks of gestation to 7 days after birth. Neonatal mortality is defined as deaths from birth to 28 days. Infant mortality is deaths under 1 year of age. The under-5 mortality rate measures the probability of a child dying before age 5.
Understanding Maternal Mortality using the medical and social contexts. In explaining the social contexts, the presentation will present a case of the Zuellig Family Foundation on Maternal Death Reviews.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
1) Maternal mortality in India remains a significant problem, with 212 deaths per 100,000 live births according to 2009 data.
2) The main medical causes of maternal death are postpartum hemorrhage (24%), hypertension/eclampsia (12%), and infection (15%).
3) Addressing the "three delays" - delay in deciding to seek care, reaching a facility, and receiving care at the facility - is critical to reducing maternal mortality through strategies like community education, improving transportation and emergency services, and upgrading health facilities.
Hospital based study on perinatal mortality in RIMS,Manipuriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
WOMEN AND IMMUNISATION PROMOTING ADOLESCENT / ADULT WOMEN IMMUNIZATION DR....Lifecare Centre
This document discusses promoting immunization for women and adolescent/adult women. It notes that missed opportunities to vaccinate occur in an estimated 30% of children and women globally. For vaccinating women, emphasis should be placed on health worker knowledge, access and availability of vaccine services, cost and service quality, and using all opportunities. Guidelines are provided for vaccinating pregnant women and breastfeeding women against various diseases. Specific vaccines discussed include chickenpox, MMR, and HPV vaccines. Recommendations are given for vaccination schedules and the importance of immunizing women is emphasized.
This presentation is all about the epidemiology of stillbirths, in India. It talks about the different challenges in controlling the stillbirths and the strategies of controlling it. The INAP guideline of Government of India, which is a stepping stone for controlling stillbirths in India, is also discussed here.
1) The document discusses the history and epidemiology of the HIV/AIDS epidemic from its earliest known cases in 1981 to modern day. It describes key events like the identification of HIV as the cause and the development of antiretroviral treatments.
2) Surveillance methods for HIV are discussed, including case reporting systems and sentinel surveillance at specific sites. Three types of epidemics - generalized, concentrated, and low-level - are also summarized.
3) Statistics and maps show the current global status of the HIV epidemic, with parts of sub-Saharan Africa most severely affected. Resources for further information are listed.
Mission Down’s Syndrome
we are running
Mission Down Syndrome and
congenital heart defetcts detecion Program
in pregnant mothers in antenatal period.
Now we wish more Gynaecologists to join hands and extend this noble facility to larger section of INDIAN society .
Breastfeeding in Women with Covid19 infection-Expert group meeting for develo...Niranjan Chavan
Breastfeeding in Women with Covid19 infection-Expert group meeting for development of standard treatment protocols for clinical management of covid- 19 complicating pregnancy at New Delhi 8th December 2021
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Indications and Outcomes of Emergency Caesarean Section at St Paul’s HospitalMedical College, Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study) by Bizuneh Ayano in Womens Health Journal
Pregnancy outcomes in women with mechanical prosthetic heart valves a prospe...oswaldo aguilar molina
This study analyzed data on 58 pregnant women in the UK with mechanical prosthetic heart valves between 2013-2015 to describe outcomes. It found:
1. There was a high rate of maternal complications, with 5 maternal deaths (9%) and 24 women (41%) suffering serious morbidity.
2. There was also a high rate of poor fetal outcomes, with complications or loss of pregnancy in 26 cases (47%).
3. Only 16 women (28%) had good outcomes for both mother and fetus.
4. Low molecular weight heparin was the most common anticoagulation regimen at 71% of cases, but 83% required increased dosing in the first trimester and 89% at 20
This study analyzed perinatal mortality trends at Kathmandu Medical College Teaching Hospital from 2002-2007. It found that the perinatal mortality rate decreased from 30.7 in 2002-2003 to 19.1 in 2003-2005 but slightly increased to 25.5 in 2007. The main causes of perinatal deaths were prematurity (33.3%), intrapartum asphyxia (25%), and congenital anomalies (8.3%). Improving antenatal care, preventing preterm births, better monitoring during delivery, and intensive care for low birth weight infants could help reduce the perinatal mortality rate further.
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses: the basic principles of mortality audit, maternal and perinatal mortality, managing mortality meetings, ways of reducing maternal and perinatal mortality rates, This book should be used together with the Perinatal Problem Identification Programme (PPIP).
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Pregnant women are at an increased risk from influenza due to physiological changes during pregnancy. The document recommends that all women who will be pregnant during flu season (October through May) receive the inactivated influenza vaccine. Studies have not found any adverse effects to the mother or baby from the inactivated flu vaccine. Vaccination provides benefits to both mother and infant by preventing flu and reducing respiratory illnesses. Despite these recommendations and safety evidence, vaccination rates among pregnant women remain low. Healthcare providers play an important role in educating pregnant women about the importance of receiving the flu vaccine.
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
Infant Mortality Rate, perinatal mortalityRoselin V
This document discusses infant and perinatal mortality. It defines key terms like live birth, fetal death, stillbirth and provides current global and national magnitudes for perinatal mortality rate, neonatal mortality rate and infant mortality rate. The major causes of infant and perinatal deaths are discussed along with the various determinants. Prevention strategies are highlighted including improvements to antenatal, natal and postnatal care. Investigation of infant deaths and methods for surveying to estimate infant mortality rate are also summarized.
This document discusses neonatal mortality measurement and summarizes recent developments. It covers:
1) Neonatal mortality rates can now be estimated annually through improved surveys, though data reliability remains a concern. Pregnancy history modules may better capture neonatal deaths.
2) Estimates of neonatal causes of death have been improved through increased country data, especially for large countries like India and China. Rates of infections and tetanus appear to be declining in some areas.
3) Surveys can be improved by modifying questions to better capture neonatal mortality and stillbirths, and through follow up verbal autopsies to obtain cause of death data for over 75% of neonatal deaths dependent on surveys.
Saving Mothers and Babies: Introduction to maternal and perinatal mortalitySaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses: the basic principles of mortality audit, maternal and perinatal mortality, managing mortality meetings, ways of reducing maternal and perinatal mortality rates, This book should be used together with the Perinatal Problem Identification Programme (PPIP).
Maternal mortality is defined as the death of a woman during pregnancy or within 42 days of termination of pregnancy from pregnancy-related causes. The three main causes of maternal death globally are hemorrhage, sepsis, and hypertensive disorders. In India, maternal mortality rates are highest in rural areas where access to healthcare is limited. The three delay model explains that maternal deaths are often due to delays in seeking care, reaching care, and receiving adequate care. Reducing maternal mortality requires improving access to emergency obstetric care, family planning services, and addressing social determinants like gender inequality and poverty.
This document defines various mortality rates used to measure child mortality and provides statistics for Canada in 2007. It defines perinatal mortality as deaths from 22 weeks of gestation to 7 days after birth. Neonatal mortality is defined as deaths from birth to 28 days. Infant mortality is deaths under 1 year of age. The under-5 mortality rate measures the probability of a child dying before age 5.
Understanding Maternal Mortality using the medical and social contexts. In explaining the social contexts, the presentation will present a case of the Zuellig Family Foundation on Maternal Death Reviews.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
1) Maternal mortality in India remains a significant problem, with 212 deaths per 100,000 live births according to 2009 data.
2) The main medical causes of maternal death are postpartum hemorrhage (24%), hypertension/eclampsia (12%), and infection (15%).
3) Addressing the "three delays" - delay in deciding to seek care, reaching a facility, and receiving care at the facility - is critical to reducing maternal mortality through strategies like community education, improving transportation and emergency services, and upgrading health facilities.
Hospital based study on perinatal mortality in RIMS,Manipuriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
WOMEN AND IMMUNISATION PROMOTING ADOLESCENT / ADULT WOMEN IMMUNIZATION DR....Lifecare Centre
This document discusses promoting immunization for women and adolescent/adult women. It notes that missed opportunities to vaccinate occur in an estimated 30% of children and women globally. For vaccinating women, emphasis should be placed on health worker knowledge, access and availability of vaccine services, cost and service quality, and using all opportunities. Guidelines are provided for vaccinating pregnant women and breastfeeding women against various diseases. Specific vaccines discussed include chickenpox, MMR, and HPV vaccines. Recommendations are given for vaccination schedules and the importance of immunizing women is emphasized.
This presentation is all about the epidemiology of stillbirths, in India. It talks about the different challenges in controlling the stillbirths and the strategies of controlling it. The INAP guideline of Government of India, which is a stepping stone for controlling stillbirths in India, is also discussed here.
1) The document discusses the history and epidemiology of the HIV/AIDS epidemic from its earliest known cases in 1981 to modern day. It describes key events like the identification of HIV as the cause and the development of antiretroviral treatments.
2) Surveillance methods for HIV are discussed, including case reporting systems and sentinel surveillance at specific sites. Three types of epidemics - generalized, concentrated, and low-level - are also summarized.
3) Statistics and maps show the current global status of the HIV epidemic, with parts of sub-Saharan Africa most severely affected. Resources for further information are listed.
Mission Down’s Syndrome
we are running
Mission Down Syndrome and
congenital heart defetcts detecion Program
in pregnant mothers in antenatal period.
Now we wish more Gynaecologists to join hands and extend this noble facility to larger section of INDIAN society .
Breastfeeding in Women with Covid19 infection-Expert group meeting for develo...Niranjan Chavan
Breastfeeding in Women with Covid19 infection-Expert group meeting for development of standard treatment protocols for clinical management of covid- 19 complicating pregnancy at New Delhi 8th December 2021
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Indications and Outcomes of Emergency Caesarean Section at St Paul’s HospitalMedical College, Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study) by Bizuneh Ayano in Womens Health Journal
Pregnancy outcomes in women with mechanical prosthetic heart valves a prospe...oswaldo aguilar molina
This study analyzed data on 58 pregnant women in the UK with mechanical prosthetic heart valves between 2013-2015 to describe outcomes. It found:
1. There was a high rate of maternal complications, with 5 maternal deaths (9%) and 24 women (41%) suffering serious morbidity.
2. There was also a high rate of poor fetal outcomes, with complications or loss of pregnancy in 26 cases (47%).
3. Only 16 women (28%) had good outcomes for both mother and fetus.
4. Low molecular weight heparin was the most common anticoagulation regimen at 71% of cases, but 83% required increased dosing in the first trimester and 89% at 20
Background: We conducted this study to identify outcomes of pregnancies complicated by pre-eclampsia and eclampsia in
Cameroon.
Methods: This was a cohort study at the Regional Hospital, Maroua-Cameroon between June 2005 and May 2007. The outcome of pre-eclamptic and ecliptic patients were compared. The level of significance was 0.05.
This study examined pregnancy outcomes for 152 women in Cameroon with pre-eclampsia or eclampsia. It found that eclampsia was associated with higher rates of cesarean delivery (27% vs 9%) and maternal death (9% vs 1%) compared to pre-eclampsia. The overall maternal mortality rate was 4% and fetal mortality rate was 27%. Among women with eclampsia, induction of labor was linked to greater risk of fetal death (50% vs 13%). The study concludes that outcomes of hypertensive disorders in pregnancy in this region of Cameroon remain serious, and improved national guidelines, education, training and drug availability are needed.
This study evaluated the clinical and perinatal outcomes of 100 teenage pregnancies at a tertiary referral center in South India. The study found that teenage pregnancies had higher rates of complications like anemia (43%), preeclampsia (21%), preterm labor (21%), and emergency c-sections (33%) compared to adult pregnancies. Neonatal outcomes were also worse, with 38% of babies being low birth weight (<2.5 kg) and 21% being preterm. The study concluded that teenage pregnancy poses significant health risks to both mother and baby due to the biological immaturity of teenage mothers.
Intensive Care Management of Severe Pre-eclampsia and EclampsiaApollo Hospitals
Pregnancy induced hypertension is a common medical complication of pregnancy and is a significant contribution to maternal and perinatal morbidity and mortality. Early diagnosis, increased patient awareness and appropriate medical intervention, especially intensive care management of severe preeclampsia and eclampsia have led to marked fall in mortality in this group of patients. In this review article, the pathophysiology, effect on different organ systems, choice of drugs (anticonvulsants and antihpertensives), support of a critically ill patient in the intensive care, monitoring, anaesthetic considerations and management of the neonate are discussed.
This study examined maternal and fetal outcomes in term premature rupture of membranes (PROM) using medical records from a hospital in Ethiopia between 2011-2013. The study found that 22.2% of women experienced unfavorable maternal outcomes like puerperal sepsis. 33.5% of neonates experienced unfavorable outcomes like stillbirth. Factors associated with unfavorable outcomes included residing in a rural area, duration of PROM over 12 hours, latency over 24 hours, and birth weight under 2500g. The study aims to identify factors that can help reduce complications from term PROM and improve outcomes.
A prospective observational study was conducted in the Neonatal Unit of Indraprastha Apollo Hospital over a period of 10 months. A total of 86 high-risk newborns were included to study the mortality and morbidity patterns. Majority of these (68%) were outborn male babies: 65% were pre-term and 36% were low birth weight. Overall survival was 77.2% and was better in inborn babies. Survival was directly proportional to gestation and birth weight. Systemic infection was associated with higher mortality and morbidity. Klebsiella was the commonest organism cultured followed by Candida. Hyaline membrane disease was the commonest respiratory morbidity. Sixty-seven percent required ventilatory support, and mortality was directly proportional to the duration of ventilation. Only 6% of the survivors had neurodevelopmental delay at 6 months and one baby had hearing impairment requiring cochlear implant. They continue to be on long-term follow-up.
A prospective observational study was conducted in the Neonatal Unit of Indraprastha Apollo Hospital over a period of 10 months. A total of 86 high risk newborns were included to study the mortality and morbidity pattern. Majority of these (68%) were outborn male babies. Sixty five percent were preterm and 36% low birth weight. Overall survival was 77.2% and was better in inborn babies. Survival was directly proportional to gestation and birth weight. Systemic infection was associated with higher mortality and morbidity. Klebsiella was the commonest organism cultured followed by Candida. Hyaline membrane disease was the commonest Respiratory morbidity. Sixty Seven pecent required ventilatory support and mortality was directly proportional to the duration of ventilation. Only six percent of the survivors had Neurodevelopmental delay at 6 months and 1 baby had hearing impairment requiring Cochlear implant. They continue to be on long term follow up.
This study examined 73 pregnant patients in Pakistan who presented with signs of liver disease. Laboratory testing found that 50 (68.5%) patients had acute hepatitis E virus (HEV) infection. The study aimed to evaluate maternal and fetal outcomes. It found that acute HEV during pregnancy predicted poor outcomes. 10% of HEV-infected mothers developed fulminant hepatic failure and did not survive. There were also high rates of fetal complications, including 8% intrauterine death, 10% neonatal death, and 12% preterm delivery due to maternal or fetal distress. The study concludes that acute HEV infection during pregnancy carries significant health risks for both mother and baby.
Preterm Premature Rupture of Membranes and Neonatal and Maternal Outcomesremedypublications2
The management of Preterm Premature Rupture of Membranes (PPROM) remains
controversial. PPROM may lead significant maternal and neonatal complications.
Methods: Retrospective data of PPROM cases managed in Suleymaniye Maternity Research and
Training Hospital between 2008 and 2012 were collected and analyzed using SPSS.
MATERNAL AND FETAL OUTCOME AMONG OBSTETRIC REFERRALS: A CASE STUDY OF THE BA...GABRIEL JEREMIAH ORUIKOR
Abstract: Background: maternal/foetal mortality and morbidity could be reduced by making use of timely
consultations, an efficient referral system, basic and comprehensive emergency obstetric care to pregnant women
and their new-borns. This study was carried out in other to compare maternofoetal outcome and to evaluate the
types of delays experienced by women.
The main objective was to evaluate maternal and foetal outcome of obstetric referrals.
Method: A case control study was carried out. All pregnant women that were referred, consented and met with the
inclusion criteria were recruited as cases, while those who came to deliver on their own were recruited as the controls.
Data were collected on pretested questionnaires. The chi square test was used as nonparametric test.
Result: Most of the participants 75.4% (n=49) were found between 15-30 years. The majority (n=35, 53.8%) of
pregnant women were referred from health centres. Cases with at least one delay was twice that of the controls (cases
42, 64.6% controls 22, 33.8% p value =0.00). 6.2 %and 9.8 %babies delivered from cases and control group
respectively were born dead. Admission in the Neonatal intensive care unit was in greater proportion for the babies
delivered from cases than the controls (cases 15, 23.1% controls 9, 13.8% p value=0.175). Most of the women
delivered through ceserian section (cases 27, 41.5% controls 32, 49.2% p value =0.378). No maternal mortality was
recorded. 60% of the women spent 7-14days in the hospital.
Conclusion: for non-referred pregnant women, maternal outcome is poor but foetal outcome is better.
MATERNAL AND FETAL OUTCOME AMONG OBSTETRIC REFERRALS: A CASE STUDY OF THE BA...GABRIEL JEREMIAH ORUIKOR
Background: maternal/foetal mortality and morbidity could be reduced by making use of timely
consultations, an efficient referral system, basic and comprehensive emergency obstetric care to pregnant women
and their new-borns. This study was carried out in other to compare maternofoetal outcome and to evaluate the
types of delays experienced by women.
The main objective was to evaluate maternal and foetal outcome of obstetric referrals.
Method: A case control study was carried out. All pregnant women that were referred, consented and met with the
inclusion criteria were recruited as cases, while those who came to deliver on their own were recruited as the controls.
Data were collected on pretested questionnaires. The chi square test was used as nonparametric test.
Result: Most of the participants 75.4% (n=49) were found between 15-30 years. The majority (n=35, 53.8%) of
pregnant women were referred from health centres. Cases with at least one delay was twice that of the controls (cases
42, 64.6% controls 22, 33.8% p value =0.00). 6.2 %and 9.8 %babies delivered from cases and control group
respectively were born dead. Admission in the Neonatal intensive care unit was in greater proportion for the babies
delivered from cases than the controls (cases 15, 23.1% controls 9, 13.8% p value=0.175). Most of the women
delivered through ceserian section (cases 27, 41.5% controls 32, 49.2% p value =0.378). No maternal mortality was
recorded. 60% of the women spent 7-14days in the hospital.
Conclusion: for non-referred pregnant women, maternal outcome is poor but foetal outcome is better.
Keywords: Obstetrics, Referrals, Haemorrhage, Infection, Outcome.
Clinical study of Eclampsia and outcome in a tertiary care centreiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study analyzed maternal and perinatal outcomes of 150 patients referred to a tertiary hospital in India over 24 months. The most common reasons for referral were previous cesarean section (28.7%) and premature rupture of membranes (16%). Majority of referrals came from private hospitals (48.7%) and primary health centers (44%), indicating gaps in emergency obstetric care. Most common maternal complications were anemia requiring blood transfusion (10%) and cesarean delivery (92.7%). There was 1 maternal death (0.7%) and 12 near miss cases (8%). For neonates, 42.9% had respiratory distress and 42.7% required NICU admission. Neonatal
This document discusses postpartum haemorrhage (PPH) as a major cause of maternal mortality in Malaysia. It summarizes the key findings and recommendations from seven confidential enquiry reports into maternal deaths published between 1991-2005. While PPH rates have declined over this period, it remains one of the leading causes of maternal death. The reports have made recommendations to strengthen protocols, training, infrastructure and access to care to further reduce PPH deaths, but implementation has been inconsistent. Continued efforts are needed to address risk factors like high parity births, lack of family planning and delays in seeking and receiving appropriate emergency care.
Maternal mortality remains a significant issue worldwide, with over 500,000 deaths annually. Through initiatives like the Confidential Enquiries into Maternal Deaths system, Malaysia has significantly reduced its maternal mortality rate from 540/100,000 live births in 1950 to 28.1/100,000 in 2000. Postpartum hemorrhage is a leading cause of death in Malaysia, while medical conditions, sepsis, and hypertensive disorders also contribute substantially. Recommendations focus on increasing access to emergency care and transportation, improving provider training, and expanding family planning programs.
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
The document describes a case study of a 25-year-old unmarried woman who presented with heavy menstrual bleeding and was diagnosed with septic incomplete abortion and severe anemia. She was treated surgically and received blood transfusions and antibiotics. The document then provides background information on unsafe abortion, its prevalence in Nepal, and the country's abortion law which legalized abortion in certain conditions. It discusses methods of surgical and medical abortion and challenges to accessing safe abortion services in Nepal.
This document discusses sonographic criteria for uterine curettage when endometrial neoplasia is suspected. Eight premenopausal and perimenopausal women underwent transvaginal ultrasounds and uterine curettage due to abnormal bleeding or discharge. Histopathology found hyperplasia in polycystic ovary syndrome patients and cancer in a patient on tamoxifen therapy. Key ultrasound findings associated with hyperplasia or cancer included thick irregular endometrium, ill-defined endometrial-myometrial junction, intrauterine fluid collections, adnexal masses, and cystic endometrial areas. The document concludes that endometrial stripe abnormalities on ultrasound, in addition to thickness, are important
This letter discusses the importance of ultrasound in evaluating adnexal masses, which are common but can sometimes indicate ovarian cancer. The letter outlines several ultrasound features suggestive of malignancy, such as thick septations, solid components, bilaterality, and ascites. It emphasizes that while most adnexal masses are benign, ultrasound is essential for timely diagnosis of potential ovarian cancers. The letter concludes by stating that grayscale ultrasound combined with Doppler can reliably diagnose functional, benign, and malignant adnexal masses to guide appropriate clinical management.
Iatrogenic injuries are common in gynecologic surgery and can involve the bowel, urinary tract, or blood vessels. The document presents simplified algorithms to guide gynecologists in managing common intraoperative injuries to these systems. The algorithms describe approaches such as suture repair, ligation, consultation of other specialists, and conservative management depending on the type and severity of the injury. Prevention techniques are also discussed, such as dissecting the ureter prior to dealing with pelvic masses.
The document discusses the role of omentectomy in early ovarian cancer surgery based on the gross appearance of the omentum. It notes that a healthy fatty omentum can act as a barrier against cancer spread, while a thin omentum with low fat content is more susceptible to early metastasis. Early signs of microscopic metastasis in a thin omentum include omental panniculitis. The document concludes that infracolic omentectomy is usually sufficient for staging early cancers when the omentum appears healthy, while supracolic procedures may be needed if the infracolic region shows signs of panniculitis. The gross appearance of the omentum and signs of invasion or inflammation can help determine the
This document summarizes a paper on endosalpingiosis, a rare benign condition where fallopian tube-like epithelium grows outside the fallopian tubes. It can mimic cancers. The paper presents two case studies of endosalpingiosis found in patients' uteri and fallopian tubes. Endosalpingiosis is thought to be related to the development of serous tumors and some evidence suggests it may be a precursor to low-grade serous carcinoma. Accurate diagnosis is important to avoid overtreatment or undertreatment of patients.
This case report describes a 47-year-old woman who presented with lower abdominal pain and distension. Imaging revealed a large multilobulated cystic lesion in her cervix, measuring up to 3 cm, as well as an adnexal mass. She underwent a hysterectomy which found multiple cervical cystic spaces consistent with large nabothian cysts, as well as a granulosa cell ovarian tumor. The report discusses how large nabothian cysts can sometimes be misdiagnosed as malignancy based on imaging alone, and emphasizes the importance of histopathological examination to differentiate between benign and malignant cystic cervical lesions.
There is an increasing incidence of cesarean scar defect. This article will discuss and show different and variable sonographic presentations of scar niches and uterine postpartum ultrasonography with vaginal birth after cesarean section that can be confusing and many should be unaware of. This brief review aims to help practitioners to avoid confusion and be aware and acquainted with the different sonographic findings encountered in practice related to cesarean scar. It can lead to uterine rupture I labour, dehiscence in pregnancy and placenta accreta in the future pregnancy, but this is not evidence-based and not even a contraindication for pregnancy. It is neither an indication of repair for the presenting patient nor an indication to screen these patients for such complications. It is treated if associated with infertility or bleeding and not in asymptomatic ones.
This document discusses three cases of postpartum uterine dehiscence treated conservatively. Each case involved a woman who had undergone a cesarean section and later presented with abdominal pain and vaginal discharge. Ultrasound revealed uterine dehiscence and fluid collections in each case. The women were treated with intravenous and then oral antibiotics and monitored weekly with ultrasound and clinical parameters. In each case, the collections resolved and the dehiscence healed over 1-3 weeks without need for surgery. The document concludes that for uterine dehiscence cases without active bleeding or severe infection, conservative treatment with antibiotics can be an appropriate approach.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. El‑Agwany: Severe maternal outcomes
Apollo Medicine ¦ Volume 16 ¦ Issue 2 ¦ April-June 2019 75
Methods
This was a retrospective cohort study that included women
who were admitted for delivery, pregnancy or labor‑related
complications in the intensive care unit (ICU) and who
sustained severe acute maternal morbidity or mortality at
the Shatby maternity tertiary hospital in Alexandria, Egypt,
between January 2015 and December 2016. The Shatby
Hospital acts as a provincial referral hospital for high‑risk
obstetric cases from health centers and other district
hospitals in Alexandria and three nearby provinces serving
ten million population. Annually, 14,455 deliveries were
conducted at the facility. Eligibility for the study was not
restricted by gestational age, including abortion, ectopic
pregnancy, postpartum complications, and those who met
the WHO criteria excluding other cases in the ICU whether
gynecological cases or patients on follow‑up with no single
criteria.[15‑19]
Women with complications >42 days after
termination of pregnancy were not eligible. We gathered
the data from the ICU medical records. Severe maternal
outcome (SMO) as our goal was defined as MNMs and
maternal deaths. We tried to apply the WHO criteria on all
cases, but some were not applied due to lack of laboratory
tests. For every case, information was collected regarding
sociodemographic characteristics, gestational age, maternal
outcome, main causes of MNM, and death and medical
condition associated.
Results
During the 24‑month study period, there were
28,877 deliveries, 185 women suffered SMO: 171 MNMs
and 14 deaths. SMO ratio is 6.5/1000 live birth, MNM
incidence ratio of 5.9/1000 live births, maternal death
incidence ratio 0.5/1000 live birth, maternal mortality
ratio of 48.48/100,000 live births, MNM mortality ratio is
12:1, and a mortality index of 7.5% (known figures of our
institution). Hemorrhage (n = 107, 62.5%) and hypertensive
disorders, including fits and hemolytic anemia, elevated
liver enzymes, and low platelet count syndrome (n = 44,
25.5%) were the most till common MNM conditions.
Hemorrhage (n = 8, 57%) was the leading cause of maternal
mortality and then cardiac diseases (n = 3, 21.5%). All cases
were not receiving antenatal care in the Shatby Hospital and
were referred at time of delivery or after delivery with the
complication encountered or were not compliant to hospital
ANC visits and policy. Nearly 71.5% of the died cases were
younger than 30 years and 21.5% of the died cases were
primigravida. The main WHO criteria encountered were the
ones related to hemorrhage. Young age pregnant females
can sustain hemoglobin <3 gm% after hemorrhage till blood
replacement. The ICU admission rate was 1.66% among
all delivering women, whereas ICU cases with SMO were
38.5% [Tables 1‑4].
Table 2: Medical disease associated
Maternal
near‑miss cases
Deceased
cases
Paraplegia 1 0
Deep venous thrombosis 1 0
Idiopathic thrombocytopenic purpura 1 0
Pregestational diabetes mellitus 2 0
Cardiac disease 4 1
Chronic renal failure 1 0
Aplastic anemia 1 0
Chronic hypertension 0 1
Table 1: Demography of patients
Parameter Number
Duration of study Two years from January 2015 to December 2016
Maternal near‑miss cases 171
Mortality cases 14
Total ICU cases 480
Total number of cases admitted to hospital for delivery 28877
Duration of stay in ICU Maternal near miss 1‑12 days
Dead cases 1 h‑4 days
Age of patients (years) 18‑38 years
10 cases died before 30 years age
Patient residence in Egypt Alexandria 109 patients then Behara, Kafr Elsheikh, and Matrouh
Gravidity 1‑10
Three cases died at first pregnancy
Parity 0‑6
Number of cesarean section 0‑6
Number of cases with cesarean section as mode of
delivery weather previous or current
Near near‑miss cases: 97
Died cases: 4
Not received in our hospital
Referral center and antenatal care 95%
ICU: Intensive care unit
[Downloaded free from http://www.apollomedicine.org on Monday, January 20, 2020, IP: 10.232.74.23]
3. El‑Agwany: Severe maternal outcomes
Apollo Medicine ¦ Volume 16 ¦ Issue 2 ¦ April-June 201976
Shock is defined as a persistent severe hypotension, defined as a
systolicbloodpressure <90 mmHgfor60 minwithapulserateof
≥120/min despite aggressive fluid replacement (>2 L). Oliguria
is defined as a urinary output <30 mL/h for 4 h or <400 ml/24 h.
Coagulation disorder defined as the absence of clotting from the
IV site after 7–10 min. Unconsciousness/coma lasting >12 h is
defined as a profound alteration of mental state that involves
complete or near‑complete lack of responsiveness to external
stimuli or Glasgow Coma Scale <10. Cardiac arrest is defined
as the loss of consciousness and absence of pulse or heartbeat.
Stroke is defined as a neurological deficit of cerebrovascular
cause that persists ≥24 h or is interrupted by death within 24 h.
Uncontrollable fit is a condition in which the brain is in state of
continuous seizure. Preeclampsia: the presence of hypertension
associated with proteinuria. Hypertension is defined as a blood
pressure ≥140 mmHg (systolic) or ≥90 mmHg (diastolic).
Proteinuriais defined as the excretion of ≥300 mg protein/24 h or
300 mg protein/l urine or ≥1+ on a dipstick. Eclampsia is defined
as the presence of hypertension associated with proteinuria and
fits. Sepsis is defined as a clinical sign of infection and three
of the following: temperature >38°C or <36°C, respiration
rate >20/min, pulse rate >90/min, white blood cell count
>12,000/cmm, clinical signs of peritonitis. Uterine rupture is
defined as the complete rupture of a uterus during labor.[13‑18]
Discussion
The high‑MNM in our study may be explained by delayed
referral of SMO cases or the high proportion of women
without medical insurance which led to delay in seeking
for financial reasons care and limited experience and skills
in private sector, doctors` 1st
money earning and practicing
safe obstetrics in the form of cesarean section with poor
implementation of guidelines increasing placenta accreta
and previa in high fertility society.[8,13,14]
We serve a large
number of critically ill women in the low‑resource settings
with limited facilities that contributes to our facility mortality
and MNM rates as we are a tertiary hospital. The main direct
causes of SMO were obstetric hemorrhage and hypertensive
disorders comparable to other studies in the low‑resource
countries.[11‑14]
Mortality indices were lower than in other
studies, probably due to the wide availability of blood for
transfusion and magnesium sulfate in our setting with more
doctors`clinical experience and better care of patients.
Particular attention is needed for conditions with high
mortality as hemorrhage, sepsis, preeclampsia and cardiac
diseases.[14]
The relative inexperience from medical officers
working in district hospitals (generally recent medical school
graduates) may compound this problem,[20]
with improper
use of antibiotics and poor sterilization. Along with poor
ANC management audit of cesarean section indications.[21]
Is needed in every facility dealing with pregnant patient 95%
percent of SMO cases were referred in critical condition
from other facilities or home. Even came directly from home
taking time in transportation from district areas and even
without ambulance by relatives.[19]
It is essential to separate
referred near miss cases from those developing in the
hospital.[17,18]
95% percent of SMO cases were on admission.
This highlights potential interventions such as educating
pregnant women and caretakers on obstetric danger signs[21]
and training health‑care workers on emergency obstetric
care, improving resources of hospital and implementing
a medical insurance covering all patients.[22]
Poor use of
evidence‑based practices explains SMO cases as use of
oxytocin better than carbetocin in the emergency cesarean
section. That increase PPH as not using the routine first
line syntocinon infusion in vaginal delivery and emergency
section reserving carbetocin to elective section. The high
patient load at the facility might have a negative impact
on the quality of care as it deals with all cases of obstetrics
and gynecology even antenatal care is which should be
managed by primary facilities.[22]
It is easy to underestimate
severe morbidity in the absence of laboratory diagnostics
and shortage of nurse‑midwives and clinicians to identify
clinical signs of deteriorating patients.[12,13]
Studies have
shown maternal morbidity and mortality can be significantly
reduced by improving maternal health care when health
workers use audit to identify and analyze deficiencies and
apply the findings to improve obstetric care practices.[3]
Our
study assess SMO using the new WHO MNM criteria. The
advantage of this approach is its standardized methodology,
which may allow for a comparison of health facilities and
systems. The limitations were the lack of follow‑up after
discharge that may lead to underestimation of MNM and
maternal deaths, and the quality of medical records was
Table 3: Predisposing factor
Maternal
near miss
Deceased
cases
Placenta accreta 26 0
Accidental hemorrhage 19 1
Antepartum seizures 24 1
Disturbed ectopic pregnancy 14 0
Rupture uterus 11 1
Allergic reaction to antibiotics 1 0
Postpartum seizures 6 0
Hemolytic anemia, elevated liver
enzymes, and low platelet syndrome
14 0
Atonic postpartum hemorrhage 30 6
Anesthesia complication 2 0
Peripartum cardiomyopathy 1 2
Vulvar hematoma 1 0
Septic abortion 2 0
Pulmonary embolism 2 0
Acute pyelonephritis 1 0
Cardiac disease 1 1
Puerperal sepsis 2 1
Abortion 4 0
Placenta previa 2 0
Swine flu influenza 0 1
Diabetic ketoacidosis 10 0
Dehydration ketosis 8 0
[Downloaded free from http://www.apollomedicine.org on Monday, January 20, 2020, IP: 10.232.74.23]
4. El‑Agwany: Severe maternal outcomes
Apollo Medicine ¦ Volume 16 ¦ Issue 2 ¦ April-June 2019 77
sometimes poor. We could not apply all the WHO criteria
due to limited resources at our hospital.[15‑19]
Conclusions
MNM is high at Egypt. Our study highlights some pitfalls in the
clinical practice and the referral system; improvements could
lead to further reductions in maternal mortality and morbidity.
The WHO MNM criteria are important for the evaluation of
care. Hemorrhage and preeclampsia and cardiac diseases are
still the main causes of death and MNM. The private sector
needs regulation. MNM is more important now as maternal
mortality is low and hence these patients are important as they
are living with long‑term disabilities and morbidities.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al.
Global causes of maternal death: A WHO systematic analysis. Lancet
Glob Health 2014;2:e323‑33.
2. World Health Organization. Evaluating the Quality of Care for Severe
Pregnancy Complications: The WHO Near‑Miss Approach for Maternal
Health. Geneva: World Health Organization; 2011.
3. van den Akker T, van Rhenen J, Mwagomba B, Lommerse K,
Vinkhumbo S, van Roosmalen J, et al. Reduction of severe acute
maternal morbidity and maternal mortality in Thyolo district, Malawi:
The impact of obstetric audit. PLoS One 2011;6:e20776.
4. Tunçalp O, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of
maternal near miss: A systematic review. BJOG 2012;119:653‑61.
5. Maternal Health Division. Maternal Near Miss Review: Operational
Guidelines. Ministry of Health & Family Welfare. New Delhi:
Government of India; 2014.
6. Souza JP, Cecatti JG, Haddad SM, Parpinelli MA, Costa ML, Katz L,
et al. The WHO maternal near‑miss approach and the maternal severity
index model (MSI): Tools for assessing the management of severe
maternal morbidity. PLoS One 2012;7:e44129.
7. Tunçalp Ö, Hindin MJ, Adu‑Bonsaffoh K, Adanu RM. Assessment
of maternal near‑miss and quality of care in a hospital‑based study in
Accra, Ghana. Int J Gynaecol Obstet 2013;123:58‑63.
8. Say L, Souza JP, Pattinson RC; WHO working group on Maternal
Mortality and Morbidity Classifications. Maternal near miss – Towards
a standard tool for monitoring quality of maternal health care. Best Pract
Res Clin Obstet Gynaecol 2009;23:287‑96.
9. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM,
et al. Maternal mortality for 181 countries, 1980‑2008: A systematic
analysis of progress towards millennium development goal 5. Lancet
Table 4: The World Health Organization criteria
MNM (171) Deceased
patients (14)
Clinical criteria
Acute cyanosis 0 4
Gasping 1 3
Respiratory rate >40 or <6/min 47 3
Shock 47 3
Oliguria nonresponsive to fluids or diuretics 4 3
Coagulation disorders 63 5
Loss of consciousness lasting >12 h 13 5
Cardiac arrest 2 14
Stroke 12 0
Uncontrollable fit/total paralysis 0 1
Jaundice in the presence of preeclampsia 5 0
Laboratory‑based criteria
Oxygen saturation <90% for ≥60 min 47 14
PaO2/FiO2 ratio (the ratio of arterial oxygen partial pressure to fractional inspired oxygen) ≤200 mmHg Not available
Serum creatinine ≥3.5 mg/dL 19 4
Serum bilirubin 6.0 mg/dL 5 0
pH <7.1 60 10
Serum lactate >5 mEq/mL Not available
Acute thrombocytopenia (<50,000 platelets/ml) 62 9
Ketoacidosis in urine 18 0
Management‑based criteria
Admission to ICU 171 14
Use of continuous vasoactive drugs 30 14
Hysterectomy following infection or hemorrhage 40 6
Transfusion of ≥5 units of blood 90 10
Intubation and ventilation for ≥60 min 33 14
Dialysis for acute renal failure 9 0
Cardio‑pulmonary resuscitation 3 14
ICU: Intensive care unit
[Downloaded free from http://www.apollomedicine.org on Monday, January 20, 2020, IP: 10.232.74.23]
5. El‑Agwany: Severe maternal outcomes
Apollo Medicine ¦ Volume 16 ¦ Issue 2 ¦ April-June 201978
2010;375:1609‑23.
10. Ali AA, Khojali A, Okud A, Adam GK, Adam I. Maternal near‑miss in
a rural hospital in Sudan. BMC Pregnancy Childbirth 2011;11:48.
11. van den Akker T, Beltman J, Leyten J, Mwagomba B, Meguid T,
Stekelenburg J, et al. The WHO maternal near miss approach:
Consequences at Malawian district level. PLoS One 2013;8:e54805.
12. Nelissen E, Mduma E, Broerse J, Ersdal H, Evjen‑Olsen B,
van Roosmalen J, et al. Applicability of the WHO maternal near miss
criteria in a low‑resource setting. PLoS One 2013;8:e61248.
13. Abdel Ghani RM, Berggren V. Parturient needs during labor: Egyptian
women’s perspective toward childbirth experience. J Basic Appl Sci Res
2011;1:2935‑43.
14. Ministry of Health and Population Egypt, Partnership for Maternal,
Newborn and Child Health, World Health Organization, World Bank and
Alliance for Health Policy and Systems Research. Success Factors for
Woman’s and Children’s: Egypt. Geneva: World Health Organization;
2014.
15. Saleh WF, Ragab WS, Aboulgheit SS. Audit of maternal mortality ratio
and causes of maternal deaths in the largest maternity hospital in Cairo,
Egypt (Kasr Al Aini) in 2008 and 2009: Lessons learned. Afr J Reprod
Health 2013;17:105‑9.
16. El‑Nemer A, Mosbah A. Maternal near – Misses in a university hospital.
IOSR J Nurs Health Sci 2015;4:48‑53.
17. Bashour H, Saad‑Haddad G, DeJong J, Ramadan MC, Hassan S,
Breebaart M, et al. A cross sectional study of maternal ‘near‑miss’cases
in major public hospitals in Egypt, Lebanon, Palestine and Syria. BMC
Pregnancy Childbirth 2015;15:296.
18. David E, Machungo F, Zanconato G, Cavaliere E, Fiosse S, Sululu C,
et al. Maternal near miss and maternal deaths in Mozambique:
A cross‑sectional, region‑wide study of 635 consecutive cases assisted
in health facilities of Maputo Province. BMC Pregnancy Childbirth
2014;14:401.
19. Mivumbi VN, Little SE, Rulisa S, Greenberg JA. Prophylactic ampicillin
versus cefazolin for the prevention of post‑cesarean infectious morbidity
in Rwanda. Int J Gynaecol Obstet 2014;124:244‑7.
20. Rijken MJ, Meguid T, van den Akker T, van Roosmalen J,
Stekelenburg J; Dutch Working Party for International Safe Motherhood
and Reproductive Health. Global surgery and the dilemma for
obstetricians. Lancet 2015;386:1941‑2.
21. Nyamtema AS, de Jong AB, Urassa DP, van Roosmalen J. Using audit
to enhance quality of maternity care in resource limited countries:
Lessons learnt from rural Tanzania. BMC Pregnancy Childbirth
2011;11:94.
22. Borchert M, Goufodji S, Alihonou E, Delvaux T, Saizonou J,
Kanhonou L, et al. Can hospital audit teams identify case management
problems, analyse their causes, identify and implement improvements?
A cross‑sectional process evaluation of obstetric near‑miss case reviews
in Benin. BMC Pregnancy Childbirth 2012;12:109.
[Downloaded free from http://www.apollomedicine.org on Monday, January 20, 2020, IP: 10.232.74.23]