Retrospective analysis of maternal mortality at tertiary care hospital, during 2012- 2014

Background: The Maternal Mortality Ratio [MMR] of a country is indicative of its health and developmental status. The aim of the study is to determine the frequency of maternal mortality and identify the causes with different age groups, parity and gestational in 4 campuses of Ziauddin University and Hospitals, during the period 2012- 2014

Methods: A descriptive study conducted at the Gynecology and Obstetrics units of Ziauddin university hospitals with retrospective review of validated records of hospital registers in the last 3 years during January 2012 to December 2014. Convenience sampling used to access the records. A self-structured proforma designed to collect data on variables like age, parity, gestational age, cause of death, condition at the time of admission, duration of stay in hospital before death, cause of delay were part of the questionare

Results: In the three years period from January 2012 to December 2014 there were 32 maternal deaths. Total number of births was 14219 out of which 14184 were live births. MMR [Maternal Mortality Ratio] was 226 per 100000 live births. Eclampsia and haemorrhage were the leading cause of maternal mortality. Seven [21.8%] patients died due to postpartum haemorrhage and 7 [21.8%] from eclampsia and its complications, while 4 [12.5%] patients had puerperal sepsis

Conclusion: Maternal mortality was high with leading causes as, eclampsia, haemorrhage, and sepsis in the age of 20-30 years and parity 1-4. Mostly, deaths were due to delay in getting full term females to the health facility in time

Birth of quintuplets a great challenge

Different names have been used for multiple births depending on the number of offspring of which common multiples are 2 and 3, in our case we have 5. They are associated with high rates of complications like: preterm labor, pre eclampsia, low birth weight and significant perinatal mortality and morbidity. Quintuplets occur rarely making the survival of infants even rarer. We here report a case of non-booked woman who presented in her third trimester of gestation. Who on ultrasound was found to be having 4 babies but surprisingly at the time of delivery,5 babies were delivered by caesarean section, of which one was IUD [intrauterine death] and another baby expired on the second day of operation due to interventricular hemorrhage as the infant was of low birth weight and premature. The remaining infants were kept in NICU. This is a very precious pregnancy and since we found out that the frequency of multiple pregnancies with more than two fetuses has increased considerably since the introduction of methods of ovulation induction the case was looked on carefully according to the requirements

Undiagnosed cervical ectopic pregnancy is a threat to life

Cervical ectopic pregnancy implants in the lining of endocervical canal. Cervical ectopic is rare form of ectopic pregnancy and incidence of cervical ectopic pregnancy is 1:9000 pregnancies .We are reporting a case report of a 35 years old female P1+0 was presented in OPD with continuous per vaginal bleeding since 3 months. MRI pelvis showed 4.8x4.5x4.2 cm lesion involving the entire cervix including stroma with partial obstruction of endocervical canal. Growth was removed digitally with difficulty and was sent for frozen section and biopsy. Hemostasis was secured with great difficulty by taking sutures and cervix was packed. Report of frozen section showed products of conception. Injection Methotrexate was given intramuscularly. Cervical ectopic pregnancy was associated with significant hemorrhage which led to hysterectomy in the past. Mortality is limited and fertility is preserved by improved ultrasound resolution, MRI and earlier detection of these pregnancies which has led to the development of more conservative treatments

Postpartum infection can be a disaster

Endometritis is the most common infection that occurs postpartum. Postpartum endometritis is tenfold to 20-fold more common among women who delivered by cesarean section than women who delivered vaginally. It can present with puerperal pyrexia, abscess formation and rarely rupture of uterus. Reported risk factors for dehiscence of the lower segment uterine scar following CS are multiparty, infection, and an incision placed too low in the lower uterine segment. The case presents a report of a 34 year old female Para 3+0 who was presented in emergency with high grade fever and abdominal pain. She undergone a caesarean delivery 9 days prior to presentation in a private clinic. Due to infection her uterus was found to be ruptured on exploratory laparotomy which is reported very rarely. Uterus was irreparable so obstetrical hysterectomy was done and patient was kept in ICU

Molar ectopic pregnancy; an unusal presentation. A case report

Ectopic molar pregnancy is a rare occurrence. Clinical diagnosis of a molar pregnancy is difficult but histopathology is the gold standard for diagnosis. The management of ectopic molar pregnancies consists of surgically removing the conceptus, follow up and chemotherapy, if required. We are reporting a case report of a 35-year-old married, nulliparous woman, admitted in emergency with a 6-week history of amenorrhea, severe abdominal pain and an episode of fainting at home. Per abdominal examination revealed tenderness over the right iliac fossa, with guarding and rigidity. Diagnosis of ruptured ectopic pregnancy was made.Emergency laparotomy was done. Histopathological examination, showed tubal ectopic pregnancy with partial hydatidiform mole and a separate corpus luteal cyst. She was followed up with serial beta hCG which became normal within 1 month. Although ectopic molar pregnancy is a rare entity but all ectopic pregnancies should be examined histologically to rule out presence of gestational trophoblastic disease to plan follow-up accordingly in order to avoid persistent gestational trophoblastic disease which has a chance of malignant conversion.The prognosis of ectopic molar pregnancies is the same as for other forms of gestational trophoblastic disease

Peritoneal tuberculosis - a gynecologist's dilemma

Tuberculosis [TB] can involve the entire gastrointestinal tract [GI] including the peritoneum and the pancreatobiliary system. Tuberculous infection of the peritoneum is rare in developed, countries but significant in countries with a high prevalence of TB. It is commonly seen in individuals less than 40 years of age with female predominance. It can be found in pulmonary and extra pulmonary sites. The case reported here is of tuberculous peritonitis in a 30 years old female which was diagnosed incidentally during caesarean section and was kept on antitubercular treatment [ATT]. She did not respond to ATT. Laparotomy was performed because of increasing pain, abdominal distension and multicystic lesions in ovaries. ATT alone may be an effective treatment in pelvic-peritoneal tuberculosis, obviating the need for invasive methods. Indications for surgery may include persistence of pelvic mass and recurrence of pain or bleeding after 9 months of ATT

Hypertension in pregnancy: a review of preecamplesia, its effects and management

Hypertension complicates 5% to 7% of all pregnancies. Pre-eclampsia is a major contributor to maternal mortality worldwide. In Africa and Asia they contribute to 9% of deaths. A subset of preeclampsia, characterized by new-onset hypertension, proteinuria, and multisystem involvement, is responsible for substantial maternal and fetal morbidity and is a marker for future cardiac and metabolic disease. It is a pregnancy-specific disease characterized by de-nova development of concurrent hypertension and proteinuria, sometimes progressing into a multi organ cluster of varying clinical features. Poor early placentation is especially associated with early onset disease. Symptomatic clinical management should be mainly directed to prevent maternal morbidity [e.g. eclampsia] and mortality. Expectant management of women with early onset disease to improve perinatal outcome should not preclude timely delivery - the only definitive cure

Complete heart block in pregnancy: a curable entity

Pregnancy complicated complete heart block is a high-risk situation. Maternal complete heart block [CHB], which manifests for the first time during pregnancy and peurperium, poses a challenge to treating physicians. Pace maker insertion is recommended early in case the patient is symptomatic or has a prolonged Q-T interval or left atrial enlargement on ECG. We are reporting a case of a pregnant woman G 2 para1+O with 31 weeks of pregnancy with complete heart block. She presented complains of sudden onset of localized epigastric pain which was accompanied with shortness of breath and non-projectile vomiting. Apart from these symptoms, she did not feel any palpitation. She was conscious and oriented with a pulse rate 44-bpm and BP 151/71mmHg. ECG confirmed the diagnosis of complete heart block. A permanent pacemaker was placed. She delivered at 37 weeks of gestation with an alive and healthy baby by. Caesarean section due to ruptured membranes. When a multidisciplinary approach is used, both maternal and neonatal outcomes are good

Ruptured uterus in primi para

Rupture of a gravid uterus is a surgical emergency. Spontaneous rupture of the uterus in a primipara is very rare. Furthermore, uterine rupture prior to the onset of active labor is extremely uncommon in a primipara, with very few reported cases. We present a case of antepartum uterine rupture in a 23-year-old gravida 2 para 0+1 with 26 weeks pregnancy in whom the clinical features resembled those of abruption placentae. She had past history of one uterine curettage and now presented with 26 weeks pregnancy and abdominal pain of sudden onset. After ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy done. The entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus

large chorioangioma can result in adverse perinatal outcome

Chorangioma of the placenta is a common benign vascular tumor of the placenta with a frequency of about 1%. It is threatening as it often goes unnoticed and presents potentially serious fetal risks and making it necessary to keep the pregnancy under surveillance. It usually presents as a solitary nodule or, less frequently, as multiple nodules, consisting of blood vessels and stroma. Most of these tumors are small and have no adverse effects on the fetus. Large tumors are associated with complications affecting mother and the fetus which may cause sudden intrauterine fetal death. Chorangiomas act as peripheral shunts between arteries and veins, leading to progressive heart failure of the fetus. In the case prenatal diagnosis is achieved by ultrasonography and Doppler studies are used confirm the highly vascular nature of the mass. As the tumor is associated with unfavorable side-effects on the mother and fetus like polyhydroamnios, prematurity, toxemia, hydrops, fetal heart failure and, intra uterine death, regular monitoring is required to detect and manage complications early on in the pregnancy. A large size of the tumor is indicative of a higher probability of complications. The case presented is that of a large chorioangioma in a primigravida without any serious complications and a successful outcome

Acute pancreatitis in pregnancy a rare presentation

Acute pancreatitis during pregnancy is rarely encountered and can have a high maternal mortality and fetal loss. We report here a case of a 35-year-old woman para 1+0 previous 1LSCS at 32 weeks of gestation. She had laparotomy at 29 weeks of gestation due to torsion of dermoid cyst in this pregnancy. Now she was presented with, severe epigastric pain, vomiting and pedal edema. Investigation revealed hyperamylasemia and leukocytosis, hypokalemia, hypocalcaemia. The patient was kept on conservative management, antibiotics, analgesics and intravenous fluids.Pancreatitis resolved and she delivered at 38 weeks by caesarean section