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.
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
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.
Demographic Profile, anemia status and fetal outcome of the pregnant women at...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.
A Study to Identify the Post Partum Complications among Post Natal Mothers in...ijtsrd
Complications in early post natal periods may lead many issues such as breast engorgement, perineal pain, constipation, and urine incontinence. Postpartum complications contribute to a lot of maternal morbidity. A Descriptive study was conducted to identify the post partum complications among post natal mothers. The study was conducted on 120 post natal mothers who were selected using convenient sampling technique. The study was explained to participants and consent was taken. Data were collected by using structured knowledge questionnaire and self reported practice check list. Homogeneity was maintained for demographic variables. The result showed Identification of post partum complications shows that that in perineal pain, pain in perineal area 45 . In constipation, difficulty to express stool 33.33 , a sense that everything didn’t come out 33.33 , hard or small stool 20.83 . In breast engorgement, 20.83 mothers reported pain and swelling in breast, hardness in breast 20 and flat nipple 15 . In urine incontinence, intense urge of urine 2.5 . Himani Bora | Kanchan Bala | Laxmi Kumar "A Study to Identify the Post-Partum Complications among Post Natal Mothers in Selected Hospital of Dehradun, Uttarakhand" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33524.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/33524/a-study-to-identify-the-postpartum-complications-among-post-natal-mothers-in-selected-hospital-of-dehradun-uttarakhand/himani-bora
This document provides an overview of maternal and newborn care in the Philippines, outlining key challenges like high maternal and infant mortality rates. It introduces the Basic Emergency Obstetric Care (BEmOC) model and the six functions facilities should provide. The Safe Motherhood Policy aims to reduce morbidity and mortality through improving quality and accessibility of services. The Pregnancy, Childbirth, Postpartum and Newborn Care manual guides health workers in essential care practices based on the WHO guide, adapted to the Philippine context.
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.
The presentation can be used for training of Doctors and Staff nurses on Emergency Obstetric care and MMR reduction strategies in Low Resource settings.
The document discusses Emergency Obstetric and Neonatal Care (EmONC) in Zambia. It notes that Zambia's maternal mortality rate of 398 deaths per 100,000 births in 2014 shows the neglect of women's health needs. EmONC aims to combat maternal deaths by providing emergency obstetric care at health centers (basic EmONC) and hospitals (comprehensive EmONC). The principles of EmONC include providing life-saving measures to prevent maternal and neonatal deaths and disabilities through skilled birth attendants trained in basic and comprehensive emergency functions.
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
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.
Demographic Profile, anemia status and fetal outcome of the pregnant women at...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.
A Study to Identify the Post Partum Complications among Post Natal Mothers in...ijtsrd
Complications in early post natal periods may lead many issues such as breast engorgement, perineal pain, constipation, and urine incontinence. Postpartum complications contribute to a lot of maternal morbidity. A Descriptive study was conducted to identify the post partum complications among post natal mothers. The study was conducted on 120 post natal mothers who were selected using convenient sampling technique. The study was explained to participants and consent was taken. Data were collected by using structured knowledge questionnaire and self reported practice check list. Homogeneity was maintained for demographic variables. The result showed Identification of post partum complications shows that that in perineal pain, pain in perineal area 45 . In constipation, difficulty to express stool 33.33 , a sense that everything didn’t come out 33.33 , hard or small stool 20.83 . In breast engorgement, 20.83 mothers reported pain and swelling in breast, hardness in breast 20 and flat nipple 15 . In urine incontinence, intense urge of urine 2.5 . Himani Bora | Kanchan Bala | Laxmi Kumar "A Study to Identify the Post-Partum Complications among Post Natal Mothers in Selected Hospital of Dehradun, Uttarakhand" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33524.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/33524/a-study-to-identify-the-postpartum-complications-among-post-natal-mothers-in-selected-hospital-of-dehradun-uttarakhand/himani-bora
This document provides an overview of maternal and newborn care in the Philippines, outlining key challenges like high maternal and infant mortality rates. It introduces the Basic Emergency Obstetric Care (BEmOC) model and the six functions facilities should provide. The Safe Motherhood Policy aims to reduce morbidity and mortality through improving quality and accessibility of services. The Pregnancy, Childbirth, Postpartum and Newborn Care manual guides health workers in essential care practices based on the WHO guide, adapted to the Philippine context.
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.
The presentation can be used for training of Doctors and Staff nurses on Emergency Obstetric care and MMR reduction strategies in Low Resource settings.
The document discusses Emergency Obstetric and Neonatal Care (EmONC) in Zambia. It notes that Zambia's maternal mortality rate of 398 deaths per 100,000 births in 2014 shows the neglect of women's health needs. EmONC aims to combat maternal deaths by providing emergency obstetric care at health centers (basic EmONC) and hospitals (comprehensive EmONC). The principles of EmONC include providing life-saving measures to prevent maternal and neonatal deaths and disabilities through skilled birth attendants trained in basic and comprehensive emergency functions.
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.
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.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Neonatal Outcome In Pregnancy Induced Hypertensive Mothers – A Tertiary Care ...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.
Gap identification in birth asphyxia management among cmw's in dist rict hafi...Zubia Qureshi
Background: In Pakistan, Neonatal Mortality Rate (NMR) has remained static since 1994 (1). In early neonatal period approximately 82% deaths are attributed to Birth Asphyxia (2, 3). Methodology: A cross sectional study was conducted to assess the CMWs knowledge regarding birth asphyxia in district Hafiz Abad, Pakistan. All the CMWs were included in the study, except those who were on leave in the study duration. Pre-structured questionnaire was used for this purpose. SPSS version 21 was used for analysis. Results: Response rate of this study is about 90%. Results showed that most of the CMWs i.e. 40 (72.7%) were below the age of 30 years, while 24 (40%) were married. Most of them 58.2% (32) had less than 3 years of experince as a community midwife. Regarding the diagnosis of Birth Asphyxia, 35 (63.6%) consider depressed breathing as sign of birth asphyxia. About 55% of the Community midwives took 30 minutes to resuscitate the baby. About 49% of them indicated that they use fetoscope to monitor the fetal heart rate. Age group and marital status of midwives found significantly associated with the proper diagnosis of Birth Asphyxia (P-value = <0.05). Cross tabulation results show that CMW’s age and marital status not significantly associated with time taken to manage the birth asphyxia (P-Value 0.164 and 0.141 respectively), while professional experience is significantly associated with it with p-value <0.001. Recommendations: There is need for continuous training of CMW’s in proper resuscitation and management skills of Birth Asphyxia. In addition, there is also a need to ensure the availability of resuscitating equipment’s and proper resources, so that the quality of proper neonatal care is ensured. Key words: Birth Asphyxia, Neonates, Mortality, Community midwives, Knowledge, Management.
Rate of Different Types of Abortion in Madinah Maternity and Children Hospita...Crimsonpublishers-IGRWH
This document discusses a retrospective study conducted at Madinah Maternity and Children Hospital (MMCH) in Saudi Arabia in 2016 to determine the rates of different types of abortion. The study found that abortion accounted for 95% of early pregnancy bleeding cases at MMCH. The most common type of abortion was incomplete abortion, which was likely due to the advanced age and high parity of many of the patients. Over half of abortion patients were aged 38-45 years old and had 5 or more pregnancies. The second most common type was missed abortion. The study concludes that incomplete abortion is the most frequent type of abortion seen at MMCH, likely due to social norms contributing to older age and high parity among patients in the region.
This study examined newborn care practices in rural Nepal and factors associated with those practices. The study surveyed 296 mothers 4 months postpartum about cord care, breastfeeding, and thermal care of their newborns. The study found that only 25.7% practiced clean cord care while 51.35% initiated breastfeeding within 1 hour and 58.45% delayed bathing babies beyond 24 hours. Most deliveries (53.38%) occurred at home without assistance from skilled birth attendants. The study concluded that community interventions are needed to improve newborn care practices and reduce risks like unsafe cord care and early bathing.
The profile of infants born to mothers with subclinical hypothyroidism in a t...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.
This document profiles Dr. Laxmi Shrikhande, an obstetrician and gynecologist in India. It lists her extensive qualifications and experience, including various leadership roles in Indian medical organizations. It also outlines her achievements, such as numerous awards and over 450 guest lectures delivered. The document highlights her publications, including 13 national and 11 international publications, as well as her work sensitizing over 200,000 adolescents on health issues.
Rate of Different Types of Abortion in Madinah Maternity and Children Hospita...Crimsonpublishers-IGRWH
Rate of Different Types of Abortion in Madinah Maternity and Children Hospital, Madinah, Saudi Arabia by Mohammad Othman in Investigations in Gynecology Research & Womens Health
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.
Health in infants born to mothers who received mefloquine or sulphadoxine pyr...Wendy.J. Seymour
Attention ADF Female Veterans who were administered Mefloquine prior,during and after deployments overseas.
Dr Jane Quinn (Spokesperson for Mefloquine and Tafenoquine (Mef n Taf) Veterans Australia group)
BScu(U Westminister),PhD (Edin) quoted:
This study does show that mefloquine-treated mothers Africa do have babies with some very mild developmental delay in some specific motor skills.
Now I KNOW this is not directly relevant to the Australian veterans experience, but I think this suggests that some of the genetic and epigenetic effects on children that we have had some discussion about cannot (YET) be ruled out.
I'm not being alarmist, there are many studies that have shown no effect, but this is probably one of the largest, most consistently undertaken, and most importantly: is not linked to Roche.
What's sad to see too is the poor outcomes for these babies overall.
Wendy J.Seymour (Me)
Makes me wonder how many Australian female veterans have been affected in this way too with their pregnancy? Were some of them pregnant whilst being administered Mefloquine? Can the ADF or AMI or DVA explain that one to me please? The reason why I ask is our Mef n Taf veterans not only women but men are asking each other if they are experiencing certain symptoms in their special needs child/children and if these antimalarials have caused this. I've seen their posts on social media and I hang my head in shame with a feeling of helplessness.
Please refer to the document attached for further information. This is another matter that GPs and Specialists,Advocates ADF and DVA need to look at closely also.
Screening for and treatment of asymptomatic bacteriuria in high-risk pregnant women reduces the risk of preterm birth. However, routine screening of all pregnant women in the first trimester with urine culture is not currently recommended due to the low prevalence of asymptomatic bacteriuria in the general pregnant population and the costs of universal screening.
Determinants of Maternal mortality in SomaliaOmar Osman Eid
This document analyzes the determinants of maternal mortality in Somalia from 1990-2015. It finds that socioeconomic factors like poverty and lack of education, as well as cultural factors like gender inequality, contribute significantly to maternal deaths in Somalia. Physical barriers like limited transportation and long distances to health facilities also restrict access to prenatal and postnatal care. The document concludes that increasing GDP, lowering fertility rates, reducing HIV prevalence, expanding education for girls, discouraging early pregnancies, and increasing access to healthcare can help reduce Somalia's high maternal mortality ratio.
Dr. Poly Begum discusses strategies to reduce maternal mortality in Bangladesh, which include expanding training of midwives. Bangladesh aims to train 3,000 midwives by 2015 to improve maternal and neonatal health outcomes. Doubling the percentage of births attended by skilled health workers is a key goal. Strengthening emergency obstetric care through upgrading facilities and ensuring round-the-clock midwifery services are also part of the strategy. Cooperation across all sectors is needed to further reduce Bangladesh's maternal mortality ratio.
This document discusses the management of post-partum hypertension. It outlines who is at risk, when to treat elevated blood pressure, how to treat through medication choices, and how to follow up with patients. Treatment involves using anti-hypertensive drugs like hydralazine, labetalol, and nifedipine to effectively lower blood pressure without side effects while allowing for breastfeeding. Patients should be followed closely in the first two weeks after delivery by checking blood pressure every other day and adjusting medications accordingly.
This document summarizes a presentation on improving maternal mortality through policy perspectives. It discusses the high maternal mortality ratio in countries like Sierra Leone compared to low ratios in countries like Grenada. The root causes of maternal mortality are identified as inequality, low socioeconomic status, lack of healthcare access, and cultural practices. Effective policies to reduce mortality ratios include increasing access to skilled healthcare workers, emergency services, transportation, and community health programs.
Low dose aspirin and low molecular weight heparin in recurrent miscarriageDr. Aisha M Elbareg
This study compared the effects of low dose aspirin alone versus low dose aspirin combined with low-molecular-weight heparin in treating 150 Libyan women with a history of recurrent miscarriages. Women received either low dose aspirin daily or low dose aspirin daily plus low-molecular-weight heparin injections. The combination therapy resulted in significantly fewer miscarriages and more live births compared to aspirin alone. There were no significant differences in preterm birth rates or birth weights between the groups. The combination of low dose aspirin and low-molecular-weight heparin was found to be more effective than low dose aspirin alone in maintaining pregnancy for women with a history of recurrent first trimester
This research article examines alterations in reproductive hormones during pregnancy and the risk of preeclampsia. The study followed 79 preeclamptic women and 80 healthy pregnant controls longitudinally from the third trimester through 6 weeks postpartum. Blood samples were taken at each visit and analyzed for beta-hCG, oestriol, progesterone and prolactin levels. Results showed beta-hCG and oestriol levels were significantly altered in the preeclamptic group compared to controls in the first and third trimesters respectively, indicating these hormones may help identify risk of preeclampsia earlier in pregnancy. The study aims to determine the gestational age at which hormonal changes occur that are associated with developing preecl
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
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.
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.
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.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Neonatal Outcome In Pregnancy Induced Hypertensive Mothers – A Tertiary Care ...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.
Gap identification in birth asphyxia management among cmw's in dist rict hafi...Zubia Qureshi
Background: In Pakistan, Neonatal Mortality Rate (NMR) has remained static since 1994 (1). In early neonatal period approximately 82% deaths are attributed to Birth Asphyxia (2, 3). Methodology: A cross sectional study was conducted to assess the CMWs knowledge regarding birth asphyxia in district Hafiz Abad, Pakistan. All the CMWs were included in the study, except those who were on leave in the study duration. Pre-structured questionnaire was used for this purpose. SPSS version 21 was used for analysis. Results: Response rate of this study is about 90%. Results showed that most of the CMWs i.e. 40 (72.7%) were below the age of 30 years, while 24 (40%) were married. Most of them 58.2% (32) had less than 3 years of experince as a community midwife. Regarding the diagnosis of Birth Asphyxia, 35 (63.6%) consider depressed breathing as sign of birth asphyxia. About 55% of the Community midwives took 30 minutes to resuscitate the baby. About 49% of them indicated that they use fetoscope to monitor the fetal heart rate. Age group and marital status of midwives found significantly associated with the proper diagnosis of Birth Asphyxia (P-value = <0.05). Cross tabulation results show that CMW’s age and marital status not significantly associated with time taken to manage the birth asphyxia (P-Value 0.164 and 0.141 respectively), while professional experience is significantly associated with it with p-value <0.001. Recommendations: There is need for continuous training of CMW’s in proper resuscitation and management skills of Birth Asphyxia. In addition, there is also a need to ensure the availability of resuscitating equipment’s and proper resources, so that the quality of proper neonatal care is ensured. Key words: Birth Asphyxia, Neonates, Mortality, Community midwives, Knowledge, Management.
Rate of Different Types of Abortion in Madinah Maternity and Children Hospita...Crimsonpublishers-IGRWH
This document discusses a retrospective study conducted at Madinah Maternity and Children Hospital (MMCH) in Saudi Arabia in 2016 to determine the rates of different types of abortion. The study found that abortion accounted for 95% of early pregnancy bleeding cases at MMCH. The most common type of abortion was incomplete abortion, which was likely due to the advanced age and high parity of many of the patients. Over half of abortion patients were aged 38-45 years old and had 5 or more pregnancies. The second most common type was missed abortion. The study concludes that incomplete abortion is the most frequent type of abortion seen at MMCH, likely due to social norms contributing to older age and high parity among patients in the region.
This study examined newborn care practices in rural Nepal and factors associated with those practices. The study surveyed 296 mothers 4 months postpartum about cord care, breastfeeding, and thermal care of their newborns. The study found that only 25.7% practiced clean cord care while 51.35% initiated breastfeeding within 1 hour and 58.45% delayed bathing babies beyond 24 hours. Most deliveries (53.38%) occurred at home without assistance from skilled birth attendants. The study concluded that community interventions are needed to improve newborn care practices and reduce risks like unsafe cord care and early bathing.
The profile of infants born to mothers with subclinical hypothyroidism in a t...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.
This document profiles Dr. Laxmi Shrikhande, an obstetrician and gynecologist in India. It lists her extensive qualifications and experience, including various leadership roles in Indian medical organizations. It also outlines her achievements, such as numerous awards and over 450 guest lectures delivered. The document highlights her publications, including 13 national and 11 international publications, as well as her work sensitizing over 200,000 adolescents on health issues.
Rate of Different Types of Abortion in Madinah Maternity and Children Hospita...Crimsonpublishers-IGRWH
Rate of Different Types of Abortion in Madinah Maternity and Children Hospital, Madinah, Saudi Arabia by Mohammad Othman in Investigations in Gynecology Research & Womens Health
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.
Health in infants born to mothers who received mefloquine or sulphadoxine pyr...Wendy.J. Seymour
Attention ADF Female Veterans who were administered Mefloquine prior,during and after deployments overseas.
Dr Jane Quinn (Spokesperson for Mefloquine and Tafenoquine (Mef n Taf) Veterans Australia group)
BScu(U Westminister),PhD (Edin) quoted:
This study does show that mefloquine-treated mothers Africa do have babies with some very mild developmental delay in some specific motor skills.
Now I KNOW this is not directly relevant to the Australian veterans experience, but I think this suggests that some of the genetic and epigenetic effects on children that we have had some discussion about cannot (YET) be ruled out.
I'm not being alarmist, there are many studies that have shown no effect, but this is probably one of the largest, most consistently undertaken, and most importantly: is not linked to Roche.
What's sad to see too is the poor outcomes for these babies overall.
Wendy J.Seymour (Me)
Makes me wonder how many Australian female veterans have been affected in this way too with their pregnancy? Were some of them pregnant whilst being administered Mefloquine? Can the ADF or AMI or DVA explain that one to me please? The reason why I ask is our Mef n Taf veterans not only women but men are asking each other if they are experiencing certain symptoms in their special needs child/children and if these antimalarials have caused this. I've seen their posts on social media and I hang my head in shame with a feeling of helplessness.
Please refer to the document attached for further information. This is another matter that GPs and Specialists,Advocates ADF and DVA need to look at closely also.
Screening for and treatment of asymptomatic bacteriuria in high-risk pregnant women reduces the risk of preterm birth. However, routine screening of all pregnant women in the first trimester with urine culture is not currently recommended due to the low prevalence of asymptomatic bacteriuria in the general pregnant population and the costs of universal screening.
Determinants of Maternal mortality in SomaliaOmar Osman Eid
This document analyzes the determinants of maternal mortality in Somalia from 1990-2015. It finds that socioeconomic factors like poverty and lack of education, as well as cultural factors like gender inequality, contribute significantly to maternal deaths in Somalia. Physical barriers like limited transportation and long distances to health facilities also restrict access to prenatal and postnatal care. The document concludes that increasing GDP, lowering fertility rates, reducing HIV prevalence, expanding education for girls, discouraging early pregnancies, and increasing access to healthcare can help reduce Somalia's high maternal mortality ratio.
Dr. Poly Begum discusses strategies to reduce maternal mortality in Bangladesh, which include expanding training of midwives. Bangladesh aims to train 3,000 midwives by 2015 to improve maternal and neonatal health outcomes. Doubling the percentage of births attended by skilled health workers is a key goal. Strengthening emergency obstetric care through upgrading facilities and ensuring round-the-clock midwifery services are also part of the strategy. Cooperation across all sectors is needed to further reduce Bangladesh's maternal mortality ratio.
This document discusses the management of post-partum hypertension. It outlines who is at risk, when to treat elevated blood pressure, how to treat through medication choices, and how to follow up with patients. Treatment involves using anti-hypertensive drugs like hydralazine, labetalol, and nifedipine to effectively lower blood pressure without side effects while allowing for breastfeeding. Patients should be followed closely in the first two weeks after delivery by checking blood pressure every other day and adjusting medications accordingly.
This document summarizes a presentation on improving maternal mortality through policy perspectives. It discusses the high maternal mortality ratio in countries like Sierra Leone compared to low ratios in countries like Grenada. The root causes of maternal mortality are identified as inequality, low socioeconomic status, lack of healthcare access, and cultural practices. Effective policies to reduce mortality ratios include increasing access to skilled healthcare workers, emergency services, transportation, and community health programs.
Low dose aspirin and low molecular weight heparin in recurrent miscarriageDr. Aisha M Elbareg
This study compared the effects of low dose aspirin alone versus low dose aspirin combined with low-molecular-weight heparin in treating 150 Libyan women with a history of recurrent miscarriages. Women received either low dose aspirin daily or low dose aspirin daily plus low-molecular-weight heparin injections. The combination therapy resulted in significantly fewer miscarriages and more live births compared to aspirin alone. There were no significant differences in preterm birth rates or birth weights between the groups. The combination of low dose aspirin and low-molecular-weight heparin was found to be more effective than low dose aspirin alone in maintaining pregnancy for women with a history of recurrent first trimester
This research article examines alterations in reproductive hormones during pregnancy and the risk of preeclampsia. The study followed 79 preeclamptic women and 80 healthy pregnant controls longitudinally from the third trimester through 6 weeks postpartum. Blood samples were taken at each visit and analyzed for beta-hCG, oestriol, progesterone and prolactin levels. Results showed beta-hCG and oestriol levels were significantly altered in the preeclamptic group compared to controls in the first and third trimesters respectively, indicating these hormones may help identify risk of preeclampsia earlier in pregnancy. The study aims to determine the gestational age at which hormonal changes occur that are associated with developing preecl
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
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.
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.
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 document discusses antepartum haemorrhage (APH), defined as bleeding from or into the genital tract occurring from 24 weeks of pregnancy until birth. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. The most important causes of APH are placenta praevia and placental abruption. This guideline aims to provide recommendations for identifying risk factors, assessing and managing APH, and improving outcomes for both mother and baby. It finds that while some risk factors are known, APH cannot be reliably predicted or prevented due to its heterogeneous nature. Clinicians should be aware of complications associated with APH such as preterm birth and still
Community Midwifery and Prevention of Postpartum Hemorrhage_Kate Brickson_5.8.14CORE Group
This document summarizes information from a meeting on preventing postpartum hemorrhage (PPH). It discusses:
1) The leading causes of maternal death globally based on a WHO study, with severe bleeding during and after childbirth accounting for 27% of deaths.
2) MCHIP's comprehensive approach to PPH prevention, which promotes a package of interventions before, during, and after birth to prevent and manage PPH at both health facilities and in the community.
3) New WHO guidelines from 2012 that focus on uterotonic use immediately following birth to prevent PPH and allow misoprostol administration by community health workers.
This document discusses obstetric emergencies and the role of nurses. It begins by defining obstetric emergencies as life-threatening conditions that occur during pregnancy, labor, delivery or postpartum. It then lists some common causes like postpartum hemorrhage, eclampsia, obstructed labor and discusses their management. It emphasizes the importance of recognizing early signs, performing life-saving interventions and timely referral. It outlines essential life-saving skills for nurses including managing hemorrhage, infection prevention and using a partograph. It concludes by stressing the need for nurses to anticipate problems, communicate well with doctors and be prepared for emergencies.
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
A Dissertation To Be Submitted In Partial Fulfillment Of The Requirements For...Bryce Nelson
This document is a dissertation submitted in partial fulfillment of requirements for a Master's degree in Obstetrics and Gynecology. It investigates factors associated with successful trial of labor after cesarean delivery (TOLAC) in low resource settings. The study found that previous vaginal delivery, previous successful VBAC, and advanced cervical dilation on admission were independent predictors of successful VBAC. Half of the women who underwent TOLAC had a successful VBAC. Providers and patients generally believed that vaginal delivery remains an option after cesarean. The study provides insight into improving VBAC rates in low resource settings.
The document outlines key strategies for improving maternal health in India, including using the Mother and Child Tracking System (MCTS) to ensure early registration of pregnancy and full antenatal care, detecting and line listing high-risk pregnancies like severely anemic mothers to ensure management, and equipping delivery points with facilities for basic and comprehensive obstetric and newborn care available 24/7. It also discusses reviews of maternal, perinatal and child deaths to understand gaps in health services and strategies to strengthen health infrastructure for maternal and newborn care.
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.
This document discusses fetal endoscopic surgery, including the indications and anesthetic management. It describes several fetal conditions that may benefit from fetoscopic intervention, including twin-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence (TRAP), and bladder outlet obstruction from conditions like posterior urethral valves. For TTTS and TRAP sequence, fetoscopic techniques like selective fetoscopic laser photocoagulation of placental vessels and umbilical cord ligation are discussed as alternatives to open fetal surgery or other treatments. The document also reviews maternal and fetal considerations for anesthesia during these procedures.
Repeat steroids when is it okay review 2012 ron wapnerAsha Reddy
This document discusses the history and efficacy of antenatal corticosteroids in managing preterm birth. It notes that while antenatal corticosteroids have been shown to significantly reduce neonatal mortality and morbidity rates, questions remain about their efficacy in specific patient populations and safety with repeat courses. The history demonstrates how clinical practices can be adopted before sufficient evidence is available and how arbitrary choices can become standardized. Further research is still needed to determine optimal dosing schedules and administration in special cases.
Ectopic pregnancy refers to the pregnancy occurring outside the uterine cavity, predominantly i.e. 90% of them in the fallopian tube. Ectopic pregnancy affects 11 in 1000 pregnancies and is a significant cause of morbidity and at times mortality in the first trimester of pregnancy. In a 20-year longitudinal study on ectopic pregnancy in a defined
population of women aged 15e39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased
from 5.8 during 1960e4 to 11.1 during 1975e9. The mean annual incidence of ectopic pregnancy per 1000 women
increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed
conceptions increased with increasing age of the women and were 4.1 in the teenage group, 6.9 in women aged
20e29 years, and 12.9 in women aged 30e39.
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.
This document discusses gestational trophoblastic disease (GTD), including classifications, genetics, risk factors, clinical features, investigations, management, and follow up. GTD includes benign, non-neoplastic lesions like molar pregnancies as well as gestational trophoblastic neoplasms. Molar pregnancies are classified as complete or partial moles. Complete moles usually arise from abnormal fertilization, while partial moles are usually triploid. Follow up of molar pregnancies involves monitoring beta-hCG levels to detect persistent trophoblastic disease.
The effect of Metformin on endometrial tumor-regulatory genes and systemic metabolic parameters in polycystic ovarian syndrome – a proof-of-concept study
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.
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
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
1. Med J Malaysia Vol 66 No 1 March 2011 1
Globally, over a half million women die annually from causes
related to pregnancy and childbirth1
. In the developing
world, postpartum haemorrhage (PPH) accounts for up to half
of all maternal deaths2
. The wife of the Moghul Emperor
Shah Jahan of India, Empress Mumtaz, had 14 children and
died after her last childbirth of PPH in 1630. So great was the
Emperor’s love for his wife that he built the world’s most
beautiful tomb in her memory-the Taj Mahal3
.
Malaysia has experienced dramatic improvements in the
provision of Maternal and Child Health (MCH) services
throughout the post-independence era. The Division of
Family Health Development of the Ministry of Health,
Malaysia through various technical committees introduced
Programmes and Management Protocols to reduce maternal
morbidity and mortality. A rigorous confidential system of
enquiry into maternal deaths (CEMD) based on that of the
triennial reports of England and Wales was introduced in
Malaysia since 1991, audited by individual case note review at
hospital, state and national levels. The objective was to
identify shortfalls in care, recommend remedial measures and
thus improve standards of care. Thus far, seven reports have
been published (1991, 1992, 1993, 1994, 1995-96, 1997-2000,
and 2001-05).
The average blood loss during a normal vaginal birth has been
estimated at 500 ml and caesarian delivery at 1,000 ml. A
widely used definition for PPH currently is that proposed by
the World Health Organisation (WHO)4
as any blood loss
from the genital tract during delivery above 500 ml. The first
CEMD alluded to the incidence of PPH maternal death to be
27.2 % of the total 224 maternal deaths then5
. It is gratifying
to note that this figure has declined to 13.6 % of 125 maternal
deaths in the 2001-05 report6
. Almost half of the deaths were
due to atony of the uterus followed by retained products of
conception. This decline is certainly not in pari passu with
the PPH mortality in the United Kingdom (UK) where there
were only five deaths7
compared to 17 deaths in Malaysia6
.
Hence it is important to focus on aggressive measures in the
direction to further reduce PPH maternal deaths. It is of
paramount importance that all efforts are focused in this
direction by the involvement of the MOH, the Malaysian
Medical Association, the Academy of Medicine Malaysia and
the Obstetrics and Gynaecological Society of Malaysia.
However, it has to be acknowledged that these agencies are
already putting in great effort towards this goal. The
measures undertaken to address high rates of “substandard
care” should focus on three critical areas: reduction in delays
in seeking medical care, delay in reaching healthcare facilities
and delay in appropriate care in a health institution. These
are problems encountered mainly in developing and third
world countries.
Risk factors associated with lifestyle changes
Lifestyle changes in recent years have resulted in lower
maternal resilience towards safe reproductive ability. One of
these changes include the prospect of more women seeking
tertiary education leading to delayed child bearing and
increased mean maternal age at child birth. In addition, with
aging, maternal obesity (BMI > 30 kg/m2
), and complex
medical disorders are bound to occur. The increasing number
of multiple pregnancies in the wake of novel reproductive
techniques, with the consequence of increased surgical
interventions, is also a contributory risk factor for PPH.
Furthermore, caesarean section rates are rising due partially to
patient request 8
, fear of medico-legal litigations 9
and recent
adverse reports on anorectal function10
. This will lead to more
placenta praevia and accreta in subsequent pregnancies.
Morbidly adherent placentae are becoming increasingly
frequent; the numbers requiring hysterectomy then rises too.
Strategies for the prevention of PPH
Historically, Crede’s manoeuvre, was the first to introduce the
method for management of third stage of labour. The
introduction of ergometrine and blood transfusion facilities,
emergency obstetric services or “flying squads” came in the
thirties. Modern day policy of “Active management of
labour” pioneered by O’Driscoll in 1969, is a means of
reducing the number of prolonged labours to fewer than 12
hours and operative delivery rates to a minimum. The key to
the management of PPH involves rapid recognition and
diagnosis of the condition, restoration of circulatory blood
volume to maintain tissue perfusion and oxygenation with a
simultaneous search for the cause.
An assessment of vital signs (level of consciousness, pulse,
blood pressure and oxygen saturation, if available) and
amount of blood loss accurately must be made. Immediate
resuscitation measures include inserting two large-bore (14G)
intravenous cannulae. Rapid infusion of warmed crystalloids
Postpartum Haemorrhage: A Continuing Tragedy in
Malaysia
K Siva Achanna, FRCOG
Professor of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences-Tingkat 13, Menara B, Persiaran MPAJ, Jalan
Pandan Utama, Pandan Indah, 55100 Kuala Lumpur, Malaysia
EDITORIAL
Corresponding Author: Siva Achanna, Universiti Sains Islam Malaysia, Department of Obstetrics & Gynaecology, Faculty of Medicine & Health Sciences-
Tingkat 13, Menara B, Persiaran MPAJ, Jalan Pandan Utama, Pandan Indah, 55100 Kuala Lumpur, Malaysia. Email: sivaachanna@gmail.com
2. Editorial
2 Med J Malaysia Vol 66 No 1 March 2011
(0.9% normal saline or Hartmann’s solution) or colloids are
undertaken until cross-matched blood is available. Fluid
resuscitation in obstetric haemorrhage is often conservative
either because of underestimation or as a result of rapid blood
loss. Under-resuscitation may lead to hypovolaemia and the
attendant risks or over-resuscitation leading to pulmonary
oedema.
After detailed evaluation and when medical treatment fails,
various surgical interventions may be attempted. Uterine
packing fell into disfavour initially because of infection,
however, a recent resurgence of interest has shown favourable
outcomes. Bimanual and aortic compression during transfer
of cases to tertiary centres has been discussed in the CEMDs.
In catastrophic PPH, application of compression sutures (B-
Lynch), systematic pelvic devascularisation by ligation of
tubal branches of ovarian and internal iliac arteries have
shown approximately 90% success rates. In situations where
fertility is a premium, services of interventional radiologist
are sought for uterine artery embolization. Attention to
postoperative care in critical care areas, with multidisciplinary
input is equally vital. While subtotal hysterectomy or total
hysterectomy remains a last resort, it should be considered
sooner than later. Availability of senior personnel and
sustained clinical training and retraining junior specialists
and post-graduates is pivotal.
Ensuring vigilant care of critical patients in high dependency
and intensive care units with better monitoring systems and
trained personnel in post-operative care has been consistently
echoed in the peri-operative mortality audits of Malaysia11
.
This issue has also been alluded to in the Peri-Operative Care
Study-Protocol: November 2009 of the National Confidential
Enquiry into Patient Outcome and Death (NCEPOD) in the
UK12
.
Updated management protocols and training in the
management of massive obstetric haemorrhage must be
taught to all levels of healthcare personnel periodically to
account for rapid attrition and retirement of staff.
Infrastructure strengthening has been an ongoing exercise in
all the 5-Year Malaysia Plans. Unlike the situation before
Independence in 1957, geographical remoteness,
inaccessibility to healthcare facilities, rapid transportation of
ill-patients to tertiary centres, availability of blood
transfusion services have all been addressed. There are more
hospitals and primary care health facilities built in all states.
Antenatal risk approach13
study using the four colour codes
denoting the severity of risk had been adopted with practical
guidelines for the nursing personnel at primary care levels.
The colour coding was introduced as a triaging strategy. The
objective of this study was to assess the level of appropriate
management and outcomes in obstetrics in selected districts
with high and low maternal mortality. However, the colour
assignment was found accurate only in 56.1% of cases in low
maternal mortality areas and 55.8% in high maternal
mortality areas.
The Obstetric Red Alert System5
was also established to
facilitate a fast, efficient and coordinated team management
of selected obstetric emergencies such as eclampsia, severe
haemorrhage, disseminated intravascular coagulation and
obstetric shock. Personnel on call out of hours carry mobile
phones to avoid delays in tracking them down through the
hospital switchboard. Despite this recommendation, the
system is not universally practiced in all hospitals due to
implementation problems. Besides, obstetric drills are also
used increasingly in many public units, to test, improve and
maintain clinical awareness and highlight system failures.
Conduct of regular drills enables to test effectiveness,
unfortunately this is not carried out in all centres.
There is a clear need for fertility regulation in high risk
groups. All the seven CEMD reports have been relentlessly
echoing the high maternal mortality in high parity and older
mothers. Family planning is one of the pillars of Safe
Motherhood Initiative (SMI)14
. The initiative is an
international effort to raise awareness of the scope and
dimensions of maternal mortality. The 5th Report on CEMD15
reiterates that generally less than a quarter (25%) practised
contraception. Even the 6th and 7th CEMD Reports reiterates
on the significance of this issue. It was found that the use of
contraception amongst grand multiparae was relatively lower
than in those who were Para 1-5 group. The reason for such
low uptake was due to unawareness and lack of knowledge.
This needs to be urgently addressed.
To address the needs of mothers living in remote,
geographically inaccessible rural areas, who express fear of
distance and unfamiliar atmosphere of hospital labour rooms
with high technology equipment, they are encouraged to
deliver in rural Alternative Birthing Centres (ABCs)16
. All the
seven CEMD Reports have clearly shown that the majority of
these mothers of high parity, with lack of antenatal care,
short birth intervals, and advanced maternal age have a high
preponderance to PPH. ABCs are to be manned by qualified
midwives with availability of facilities for transfer to base
hospitals in emergencies. Many such centres are located in
rural areas of Kelantan and in other states as well.
The Impact of CEMDs made in combating PPH
PPH throughout the last 20 years from the inception of the
first CEMD report in 1991 till today, has remained one of the
leading causes of maternal mortality in Malaysia although it
declined from 27.5% of total maternal deaths in 199415
to
16% of total maternal deaths over 5 years from 2001 to 20056
.
Many guidelines, management protocols on PPH,
recommendations on infrastructure strengthening, training,
improvements in work processes have been recommended.
However, the delay in release of the CEMD reports have
minimized the impact they have in further reducing PPH and
maternal mortality. The 5th CEMD Report (1995-1996)17
echoed that the Malaysian Confidential Enquiries Reports
have been credited in changes in practice (67.7%), training
(66.7%), development of protocols (61.1%), increased staffing
(43.6%), development of facilities (39.8%) and allocation of
increased budget in (29.5%). Although it appears positive
steps are taken, the uptake of contraception, implementation
of the red alert system, colour coding system, obstetric drills
are still not fully implemented in many health care
institutions.
3. Postpartum Haemorrhage: A Continuing Tragedy in Malaysia
Med J Malaysia Vol 66 No 1 March 2011 3
Malaysia today is committed to achieving the Millennium
Development Goals (MDG 5) 18
. The MDG-5 calls for a
reduction of maternal mortality by 75% in 2015 from 1990
levels and this philosophy is yet to be seen. In 1987, health
experts, development professionals and policy makers
gathered in Nairobi to inaugurate the global SMI14
. Malaysia
too adopted this Initiative but has fallen short of the goal it
set almost 20 years ago to reduce maternal deaths by 50 per
cent by the year 2000. Despite the efforts put in by all senior
obstetricians (resource persons), policy makers, stakeholders
and other healthcare providers in the eighties and nineties in
formulation of the CEMD recommendations, PPH continues
to be a leading cause of maternal mortality in Malaysia. This
is partly because of late recognition of the problem, delay to
institute care, delay in implementing policies, inadequate
optimization and inappropriate care rendered.
REFERENCES
1. WHO. World Health Report 2005-Make every mother and child count.
Geneva: World Health Organization; 2005.
2. Chandraharan E, Arulkumaran S. Management Algorithm for Atonic
Postpartum Haemorrhage. J Paediatr Obstet Gynaecol 2005; 31: 106-12.
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