ABSTRACT
Introduction: The women who survive serious complications of pregnancy are referred to as “near miss.” For every maternaldeath, there are many others who suffer serious life-threatening complications of pregnancy, referred to as “near miss” morbidity.In fact, for the over 500,000 mothers who die annually worldwide, and mostly in developing countries, there are more than 8million who suffer severe maternal morbidity (WHO 2004). There is currently no standard definition of “near miss” such as thereis for a maternal death because it is difficult to determine exactly at which point a woman becomes a “near miss.” WHO definesmaternal “near miss” as a woman who nearly died but survived complications that occurred during pregnancy, childbirth, orwithin 42 days of termination of pregnancy.Aims and Objectives: The aim of the study was to determine the magnitude and types of life-threatening maternal complicationsin pregnant and recently delivered women, timing and management, blood transfusion and major surgery, and inpatient durationof stay of patients with “near miss” morbidity.Materials and Methods: The prospective cohort study was done by the Department of Obstetrics and Gynaecology, KamlaRaja Hospital, Gwalior, study period from 1 year, November 2014 to October 2015. Inclusion Criteria: Acute cyanosis, Gasping,Respiratory rate >40 or <6/min, shock, oliguria, clotting failure, loss of consciousness lasting >12 h, stroke, uncontrolled fit/totalparalysis, and jaundice in the presence of pre-eclampsia were included in the study. Exclusion Criteria: Morbidity resulting fromcauses not related to pregnancy or its complication or management, for example, malignancies, ca breast, and liver rupture.Morbidity from accidental or incidental causes no way related to pregnancy, for example, morbidity from automobile accident/suicide. Women who develop these conditions unrelated to pregnancy.Results: Near miss to maternal death ratio as 3.69:1 which means out of five women with severe morbidity we are savingfour cases. Near miss cases are 97 (61%) war multigravida and only 61 (39%) war primigravida. Referred cases were 102to which means 66.1% of near miss were referred to our institute from various center. Only 57 cases (33.9%) came directly.Fifty-four patients (33.9%) have 4 days intensive care unit (ICU) stay followed by 50 cases (31.44%) having 3 days ICU stayand maximum stay was of 6 days in 11 cases.Conclusion: Still, it needs improvement, which can be achieved by ongoing training and simulation sessions for obstetricalstaff in early recognition and management of severe obstetric morbidity and also by resource allocation that is required in themanagement of the near miss cases.
ABSTRACT
Background: Several generations of antidepressant medication which act by distinct pharmacological mechanisms have been introduced for the treatment of depression; tricyclic antidepressants (TCAs) were first line of treatment for many years. However, over the last decade, selective serotonin reuptake inhibitors (SSRIs) have displaced TCAs, mainly because of better side effect profile. There are no references in literature on comparison of efficacy of TCAs and SSRIs in Nepalese population. This study attempted to compare the efficacy of amitriptyline, a reference standard TCA with escitalopram, a newer SSRI in Nepalese population.Methods: An open level, randomised, prospective study was conducted for one year duration. Eighty outpatients suffering from major depression who met inclusion and exclusion criteria were randomly assigned to either amitriptyline or escitalopram group for four week study. Seventy one patients (amitriptyline N: 36, escitalopram N: 35) completed the study. Hamilton Depression Rating Scale (HDRS) was used to measure the antidepressant effect. Antidepressant efficacy was evaluated on reduction of HDRS score before and after therapy (End of four weeks).Results: In amitriptyline group, mean percentage reduction in HDRS score was 58.29% (13.5 points), while in escitalopram group was 60.78% (14.03 points). Both the drugs significantly improved the HDRS score at the end of the study (p<0.05). On intergroup comparison, antidepressant efficacy of amitriptyline and escitalopram did not differ significantly from each other (p>0.05).Conclusions: This study suggests that escitalopram is effective in the treatment of depression and its efficacy appears to be comparable to amitriptyline at the end of four weeks.