A study of maternal deaths from preeclampsia and eclampsia in a tertiary care centre

Background: Hypertensive disorders of pregnancy (HDPs) affect about 10% of all pregnant women around the world and are an important cause of maternal and perinatal mortality and morbidity. In Asia and Africa, nearly one tenth of all maternal deaths are associated with hypertensive disorders of pregnancy. Predicting the onset of these complications could aid in timely interventions such as increased surveillance, treatment of symptoms, transfer to higher care facility and delivery when necessary, which could reduce morbidity and mortality from the HDPs. Aim: It was to calculate the total number of women admitted with hypertensive disorders and eclampsia in the labor room and their case fatality rate, to calculate the number of mothers died from preeclampsia and eclampsia, to critically analyze all the mothers who died from preeclampsia in order to identify the root causes of substandard care leading to maternal deaths. Materials and methods: This prospective study was carried out in the labor room, Department of Obstetrics and Gynecology, King George Hospital, Andhra Medical College for a period of twelve months from November 2016 to October 2017. All the mothers who died from severe preeclampsia and eclampsia were included in the study and they were all analyzed modeled on the United Kingdom Confidential Enquiries into maternal deaths. Results: In one year there were 530 women admitted with hypertensive disorders and 144 with Chuppana Ragasudha, Atluri Phani Madhavi, Pulidindi Sanjana Sharon, Satyala Satya Priya, Syed Shehnaz. A study of maternal deaths from preeclampsia and eclampsia in a tertiary care centre. IAIM, 2018; 5(1): 6-10. Page 7 eclampsia giving a prevalence of 9.04% and 2.45% respectively. Case fatality rate of preeclampsia was 2.26% and eclampsia was 4.1%. During the study period there were 44 total maternal deaths. Out of 44 maternal deaths, 12 were from severe preeclampsia and eclampsia making it the second leading cause of maternal mortality in our institute. Conclusion: The majority of deaths related to hypertensive disorders can be avoided by providing timely and effective care to women presenting with complications. Thus, optimization of health care for women during pregnancy to prevent and treat hypertensive disorders of pregnancy is a necessary step towards achievement of the Millennium Development Goals

Critical analysis of maternal deaths from sepsis in a tertiary care center and lessons learned

Background: Maternal mortality in India is reported to be 300 to 500 per 100,000 births in the Bulletin of World Health Organisation. It is far away from Millennium development goal 5 where it is required to reduce MMR to 109 per 100, 000 live births. Sepsis in pregnancy continues to be the third leading cause of preventable maternal deaths in India, still accounts for up to 10 to 50% of maternal deaths in our country. Aim: It was to critically analyze all the mothers who died due to sepsis in order to identify factors associated with deaths. Materials and methods: This prospective study was carried out in the labor room, Department of Obstetrics and Gynecology, King George hospital, Andhra Medical College for a period of twelve months from November 2016 to October 2017. All the mothers who died due to sepsis were included in the study and they were all analyzed modelled on the United Kingdom Confidential Enquiries into maternal deaths. Results: During the study period there were 44 total maternal deaths out of 5863 births giving maternal mortality ratio of 641 per 100,000 maternities. Out of 44 maternal deaths, 14 were due to sepsis making it the leading cause of maternal mortality in our institute. Out of fourteen deaths due to Chuppana Ragasudha, Atluri Phani Madhavi, Pulidindi Sanjana Sharon, Hyma, Sirisha, Syamala, Sravanthi, Sagarika. Critical analysis of maternal deaths from sepsis in a tertiary care center and lessons learned. IAIM, 2017; 4(12): 5-9. Page 6 sepsis nine were due to direct causes and the remaining five were due to indirect causes such as pneumonia, sickle cell disease with malaria, and pancytopenia. The ages of the women who died ranged from 19 to 38 years with a median age of 26 years. All had normal body mass index. Five women who died were tribals, six from rural areas and the remaining three from slums of urban areas. Eight women were primigravid. Eight women died from sepsis in the antenatal period, two deaths were in the first trimester after criminal abortion, three due to pneumonia, one had intrauterine dead fetus infected and the other was due to pancytopenia. Four deaths were due to genital tract sepsis after cesarean section and two were due to genital tract sepsis after normal delivery. These six had risk factors such as anemia, prolonged rupture of membranes etc. Conclusion: In few cases, the outcome was inevitable, but for majority it might have been different had the infection been diagnosed and treated more promptly. There are lessons learned from the deaths of these women to improve the survival of mothers and to achieve millennium development goal 5.

Management of severe sepsis and septic shock in pregnancy to improve the survival

Background: The thymus is a central lymphoid organ that plays a vital role in the development and maturation of the immune system during childhood, the thymus appears as a bilobed triangular structure located in the anterior mediastinum. Aim and objectives: To provide radiologists a comprehensive understanding of Recognition of the variable appearance of thymic lesions and evaluation of thymic lesions on different radiological modalities like X-Rays and CT-scan for early diagnosis as well as management. Materials and methods: 10 cases of either strong suspicion or symptoms related to thymic lesion were evaluated who came to Dhiraj Hospital with different radiological modalities (X-ray, CT-scan). Results: Out of total no. of 10 patients who were diagnosed and evaluated with thymic lesion on Xrays and CT-scan are: Thymic Hyperplasia, Thymic Cyst, Thymic Lymphoma, Thymoma, Benign Teratoma, Malignant Teratoma. Conclusion: CT Imaging remains the ideal scanning modality to evaluate Radiologists play a major role in differentiating normal thymus from its variants, various thymic lesions and tumor. But common associated radiological modality used along with CT scan done is X-ray.