Incidence & factors influencing maternal near miss events in tertiary hospitals of Maharashtra, India

Background & objectives: Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. Methods: This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. Results: The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. Interpretation & conclusions: The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.

Giant angioleiomyoma of uterus masquerading as ovarian tumour: a case report

Angioleiomyoma is a rare benign tumour of uterus. We are presenting an unusual case of 45-year-old female with 11 kg giant angioleiomyoma of uterus which was masquerading as ovarian tumour on imaging. Exploratory laparotomy was done which was suggestive of huge lobulated mass arising from the uterus. Hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination of specimen was suggestive of uterine subserosal and broad ligament angioleiomyoma of cavernous type. This case is being reported because of its rarity and challenges in diagnosis and management.

Intrauterine retention of fetal bones, a cause for secondary infertility

Secondary infertility due to retained products of conception in the form of fetal bones is a rare entity. It is usually associated with a history of abortion, either spontaneous or induced. The bony fragments probably act as an intrauterine contraceptive device to stimulate the secretion of endometrial prostaglandins, resulting in secondary infertility. The common symptoms include menstrual disturbances, pelvic pain, dyspareunia, vaginal discharge, spontaneous passage of fetal bones and infertility. Advanced diagnostic technique like hysteroscopy has helped in the diagnosis.