ABSTRACT
Background: Pregnancy, although being considered a physiological state, carries the risk of serious maternal morbidity and at times mortality, due to various complications that may arise during pregnancy, labour or thereafter. The existing medical condition, infection, and surgical condition which is collectively called as non- obstetric cause pre disposes a women for more complication than a non-pregnant women, so much so that it can lead to maternal mortality. Thus, Pregnancy is more vulnerable state and present study was carried out to study, analyse and review various non-obstetrics causes of death of women during pregnancy or within 42 days of termination of pregnancy in Tertiary care centre.Methods: This was an Observational study, conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached with medical college, from October 2016 to October 2018. The details of maternal deaths were collected from various departments with non- obstetric causes and analyzed.Results: The total number of deliveries in my study period was 15,208. There were 197 maternal mortality in our study period, of which 51 women died of non-obstetric causes. The most common cause of maternal mortality in our study was hepatic cause i.e. 33.33% amongst which viral hepatitis was the most common cause followed by respiratory (19.60%), infectious (15.18%), heamoglobinopathy (13.72%), cardiac (5.88%), neurological (5.88%), surgical (5.88%) causes.Conclusions: Looking into our study, maternal mortality can be reduced by identifying various different indirect medical causes which are preventable by proper pre-pregnancy evaluation for pre-existing comorbid conditions.
ABSTRACT
HELLP syndrome is a serious complication in pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count. This case demonstrated the importance of rapid and early diagnosis and treatment of HELLP syndrome to reduce maternal and perinatal mortality and morbidity. 26 years old, 2nd gravida with 31 weeks of gestation with severe pre-eclampsia was admitted to Department of Obstetrics and Gynecology at Civil Hospital, Ahmedabad. Patient suddenly developed epigastric pain, blood tinge urine (not frank hematuria)and decrease urine output within 24 hours of admission. Investigations revealed platelet count 44,300, serum bilirubin 12, direct bilirubin 3.44, and indirect bilirubin 8.56, SGPT 193.5 and was diagnosed as a HELLP syndrome class 1 She underwent cesarean section and there was dramatic improvement of her symptoms and all blood investigations (S. bilirubin, Platelet count) were declined to normal limit within 48 hours post operatively. HELLP syndrome, a variant of severe pre-eclampasia, if diagnosed and manage timely ensure favorable maternal and perinatal outcome.
ABSTRACT
Background: Total 0.2% to 4% of all pregnancies are complicated by cardiac diseases. In non western countries, rheumatic heart diseases (RHD) constitute 56-89% of the cases and congenital heart diseases only 9-19%. Aim and objectives: To review all obstetric patients with co-existing cardiac diseases admitted to a tertiary care center over a period of one year and ascertain the causes of admissions and the maternal and perinatal morbidity and mortality. Material and methods: A retrospective, analytical study of all patients with cardiac diseases who delivered over a period of January 2013 to December 2013 was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according to their severity, NYHA category, type of pathology, the maternal and perinatal outcome was assessed and maternal mortality and perinatal mortality was recorded. Conclusion: Total 69% cardiac lesions in pregnancy were rheumatic in origin and 15% belonged to high risk category while 13.1% were NYHA type IV. Total 69% deliveries were by vaginal route Epidural analgesia preferred in LSCS of cardiac patients. Perinatal and maternal complications were observed to increase with increase in NYHA class.