Risk factors predisposing to abruption placentae. Maternal and Fetal outcome

Abruptio placentae is one of the leading causes of perinatal deaths. Abruptio placentae increase the neonatal morbidity and mortality. It is one of the recognized causes of low birth weight. The purpose of this study was to examine the risk factors for abruptio placentae together with the maternal and fetal outcome in a large population based data set. All cases of abruptio placentae presented to the Department of Obstetrics, Wad Medani Teaching Hospital, Sudan during the period January 1997 through to December 2002 were collected. All infants born to those cases were also collected and analyzed as live birth or stillbirth. The live born infants were followed for one month to detect the neonatal deaths. The study also aimed to determine the predisposing factors for abruptio placentae. The study was designed as a case control study from live, singleton births and singleton fetal death. The total number of abruptio placentae collected during this period was 1028, while the total number of births during the same period was 15620 giving and incidence of 1028/15620 [6.5%] for abruptio placentae. The combined stillbirths and first month deaths were 20.2%. Abruptio placentae was associated with pre-eclampsia, diabetes, polyhydramnios and hypertension. Parity and maternal age were not associated with an increased incidence of abruption placentae. This study had the advantage of complete ascertainment of all reported cases of abruptio placentae during a period of 6-years. We found an increased risk for abruptio placentae associated with maternal diabetes, hypertension, pre-eclampsia and polyhydramnios. We found that infants born after abruptio placentae were small for gestational age and had lower Apgar scores than the control infants. The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers were there is advanced maternal and neonatal facilities

comparative study of twin and triplet pregnancy

Multiple pregnancy now warrants special attention from the obstetrician. The incidence of multiple pregnancy had increased during the last 15 years. Multiple pregnancy is a high-risk pregnancy since it is associated with increased perinatal morbidity and mortality. In addition, almost every maternal and obstetrical problem occurs more frequently in multiple than in singleton pregnancies. In view of the above we designed our study. This was a comparative and descriptive retrospective study conducted during the period January 1985 to December 1999 at Wad Medani Teaching Hospital, Wad Medani, Sudan. The study included the follow up of 597 twin pregnancies and 30 triplet pregnancies. The variables used were the age, the parity, the incidence, the sex of neonates and their weights. The study also concentrated on the mode of delivery, and it highly considered the maternal and perinatal complications. During the period of the study the total number of pregnancies received was 44605. Twin pregnancies accounted for 597/44605 [1.3%], while triplet gestation showed an incidence of 30/44605 [0.1%]. In twin pregnancy ovulation occurred spontaneously in 43/597 [7.2%] and it was induced in 167/597 [28%]. On the other hand, ovulation occurred spontaneously in triplets 19/30 [63.3%] and it was induced in 11/30 [36.7%]. The common maternal complication was pre-term labor, which affected 35.5% in twins and 76.7% in triplets. The rate of cesarean section was 53.1% in twins while in triplet it was 83.3%. The mean birth weight in twin pregnancy was 1890 gm for males and 1780 gm for females. In triplet gestation, the mean birth weight was 1760 gm for males and 1720 gm for females. The maternal mortality rate was 35.8/100.000 live births in twin pregnancies while it was 99/100000 in triplet gestation. The perinatal mortality rate was 115/1000 for twin and 223/1000 for triplet pregnancy. Multiple pregnancy is a high-risk pregnancy, and to decrease its maternal and fetal complications it must be diagnosed early. It should also receive almost antenatal care and care at delivery. Early hospitalization plays an important role of reducing these complications. It must be treated by one obstetrician

Obstructed labor in a teaching hospital in Sudan

This study was aimed to deal with a serious obstetrical problem in Wad Medani Teaching Hospital, Medani, Sudan. The study reviewed the incidence of obstructed labor, its clinical presentation and methods of diagnosis. The study also includes the methods of treatment and its complications. A prospective and descriptive study was carried out in Wad Medani Teaching Hospital, Medani, Sudan. Case notes were studied for all cases with obstructed labor received during the period 1 January 1997 to 31 December 1999. The data was analyzed. The literature was reviewed for similar studies. During the period 207 cases of obstructed labor were diagnosed. The total number of deliveries during the same period was 16221, giving an incidence of 1.27%. The most striking symptoms are tachycardia and low blood pressure, while the common sign is the non-engagement of the presenting part. The most common complication is septicemia, Obstructed labor remains a major obstetrical problem. Adequate antenatal care and proper care at delivery could prevent it. The obstructed labor should always be anticipated and the attendant should not wait for the advanced classical signs to make the diagnosis. Early intervention is associated with an excellent outcome

Maternal mortality in a teaching hospital in Sudan

Although there is a great advances in obstetrics in recent years, a hard core of maternal mortality still lingers and is considered to be an irreducible minimum. Nevertheless there has been worldwide decline in maternal mortality over the past decades. Yet maternal mortality is still the major public health problem throughout the world. A retrospective study carried out at the Medani Teaching Hospital, Medani City, Sudan. Case notes were reviewed for all the 877 women died during the period 1985-1999. All parturients were followed for at least 6 weeks after delivery so that deaths due to sequel of delivery and puerperium were also included. The data was analyzed and the literature was reviewed to compare the results of similar studies. Out of the total number of deliveries in that period [N = 44,605], 877 women died with a rate of 1,966 per 100,000. This rate showed a decline each year, being 2,661 per 100,000 during the period 1985-1989. The mortality rate during 1990-1994 was 2,021 per 100,000 and 1,363 per 100,000 during the last period of 1995-1999. Sepsis was the cause of death in almost one third of cases, while malaria accounted for 37.2%. The number of preventable deaths had decreased steadily. The study highlighted the existence of a serious and preventable obstetrical problem. Sepsis, malaria hemorrhage and hypertensive disorders are the main contributory factors. Poor antenatal care, poor intranatal care, and poor provision of health services add more to the problem. Research into the problem of malaria, sterilization, anesthesia, vascular accidents, and indication for cesarean section together with social and medical improvements will definitely reduce the maternal morbidity and mortality