A Retrospective Study to find out Factors Affecting Maternal Mortality in a Tertiary Care Hospital in Ahmedabad City, Gujarat

Background : Data pertaining to preventable causes of maternal mortality are valuable in each set up to design interventional steps for the significant reduction of the maternal mortality ratio. Objectives : (1) To study the trend on Maternal Mortality Rate (MMR); (2) To find out the factors for the Maternal Mortality. Material and Methods : A retrospective cross-sectional study of maternal death was conducted in the Obstetrics Department of Tertiary Care Hospital of Ahmedabad city. The data of total 9 years from 1st April 2013 to 31st January 2021 were taken in the study. Epidemiological factors and causes affecting maternal mortality were assessed through pretested questionnaire that includes parity, duration between admission and mortality etc. Results: Maternal Mortality Rate (MMR) was 180.2 per 1 lac live births during the study period. Young mothersaged 20 to 30 years (78.5%), and rural residence (76.6%), multiparous mothers (66.7%)were at risk for Maternal Mortality. Obstetric haemorrhage (25.8%) was the most common cause whereas COVID-19 pandemic later on were indirect causes contributing to Maternal Mortality. Conclusion: Great Care should be taken for high-risk pregnancy like young age, multiparous women and also of postpartum women. Postpartum haemorrhage was the commonest direct cause of Maternal Mortality. Strengthening of existing obstetric care facilities, facility for easy transport, appropriate referral linkages are keys to reduce Maternal Mortality to further extent

A comparative study of perinatal outcome in primary caesarean in multiparous women to that in nulliparous women

Background: To compare indication, incidence, complication, fetal and maternal morbidity and mortality in primary caesarean section in multiparous women and nulliparous women. Objective of this study was to compare perinatal outcome of caesarean section in multiparous women to that in nulliparous women.Methods: It is a prospective observational study conducted in a tertiary care centre during April 2017 to April 2018. All patients who delivered vaginally and abdominally were noted during study period. All patients undergoing primary caesarean section were noted. Their indication, incidence and complication throughout stay were noted. Statistics were calculated separately for multiparous women and primiparous women. Statistical analysis was done using chi square test.Results: Total 150 primary caesarean section in primiparous women and 100 primary caesarean section in multiparous women were done.  Fetal distress and meconium stained amniotic fluid forms the most common indication in study. Birth weight of babies was more in multiparous women. Need of blood and blood products was more in multiparous women compared to nulliparous women. Complications like postpartum fever and wound gape was more in multiparous women.Conclusions: In the study population significant difference was seen between the indication and complication between multiparous and nulliparous women.

Serum proteinogram and biochemistry of Holstein cows in the peripartum period / Proteinograma e bioquímica séricas de vacas da raça Holandesa no período periparto

In face of the few reports found in national literature analyzing the potential influence of parturition number in serum proteinogram and biochemical profile in the peripartum period of high yielding dairy cows, the aim of the present study was to comparatively evaluate the dynamics of these serum constituents' concentrations in blood samples obtained from primiparous and multiparous Holstein cows, 60 and 30 days prepartum and in the day of parturition. Data were analyzed by repeated measures variance analysis (ANOVA) and differences between groups and moments were analyzed by Tukey's test. Results were considered significant when P<0.05. Parity influenced levels of total protein, albumin, globulins, magnesium, cholesterol, which were higher in multiparous cows, as well as concentrations of ceruloplasmin, total calcium, chloride and alkaline phosphatase activity, which were higher in primiparous cows. Parturition influenced serum concentrations of ceruloplasmin (+58%), transferrin (-25%), haptoglobin (+33%), total protein (-17%), globulins (-25%), immunoglobulin A (-43%), immunoglobulin G (-24%), total calcium (-12%), inorganic phosphorus (-10%), chloride (+5%), sodium (+4%), cholesterol (-23%), triglycerides (-38.6%), as well as activities of aspartate aminotransferase (+14%) and alkaline phosphatase (+28%). A decrease in serum levels of total calcium, inorganic phosphorus, cholesterol and triglycerides was more pronounced in multiparous than in primiparous cows. These results demonstrate that the interpretation of proteinogram and serum constituents should take into consideration lactation number and the moment of parturition as relevant factors in high yielding dairy cows in the transition period.(AU)

Diante da escassez de relatos encontrados na literatura nacional quanto à potencial influência do número de parições sobre o proteinograma sérico e perfil bioquímico no período periparto de vacas leiteiras de alta produção, o objetivo do presente estudo foi avaliar comparativamente a dinâmica de constituintes séricos em amostras de sangue obtidas de vacas da raça Holandesa primíparas e pluríparas, 60 e 30 dias pré-parto e no dia do parto. Os resultados foram avaliados por análise de variância (ANOVA) com medidas repetidas no tempo e as diferenças entre grupos e entre momentos foram analisadas pelo teste de Tukey, sendo os resultados considerados significativos quando P<0,05. O número de parições influenciou os teores de proteína total, albumina, globulinas, magnésio e colesterol, que foram maiores em vacas pluríparas, bem como as concentrações de ceruloplasmina, cálcio total, cloreto e atividade de fosfatase alcalina, que foram maiores em vacas primíparas. O número de parições influenciou as concentrações séricas de ceruloplasmina (+58%), transferrina (-25%), haptoglobina (+33%), proteína total (-17%), globulinas (-25%), imunoglobulina A (-43%), imunoglobulina G (-24%), cálcio total (-12%), fósforo (-10%), cloretos (+5%), sódio (+4%), colesterol (-23%), triglicérides (-38.6%), bem como as atividades de aspartato aminotransferase (+14%) e fosfatase alcalina (+28%). A diminuição do teor sérico de cálcio total, fósforo, colesterol e triglicérides foi mais acentuada em vacas pluríparas do que em vacas primíparas. Esses resultados mostram que a interpretação do proteinograma e dos constituintes séricos deve levar em consideração o número de lactações e a ocorrência do parto como fatores relevantes em vacas leiteiras de alta produção no período de transição.(AU)

Comparison of Low Urinary Tract Symptoms during Pregnancy between Primiparous and Multiparous Women

Low urinary tract symptoms (LUTS) are a common problem during pregnancy. This study aimed to compare changes in the prevalence of LUTS during pregnancy between primiparous and multiparous women. A chart review of consecutive pregnant women who attended our antenatal clinic from August 2015 to December 2016 was performed. All of the women were asked to respond to a LUTS questionnaire in either of the three trimesters. Of the 270 women included, 164 were nullipara and 106 were multipara. The most common LUTS during pregnancy were frequency (77%), followed by nocturia (75.6%), stress urinary incontinence (SUI) (51.1%), incomplete emptying (43.7%), dysuria (17.8%), and urgency incontinence (10.4%). There was a significantly higher prevalence of SUI (P < 0.001) and urgency incontinence (P= 0.005) in the multiparous compared to the nulliparous women. Increasing prevalence rates of frequency, nocturia, SUI, and incomplete emptying were reported with gestational age in both the nulliparous and multiparous women. Frequency and nocturia were the two most common LUTS during pregnancy. The prevalence rates of all LUTS increased with increasing gestational age except for frequency in the nulliparous women during the second trimester. In addition, multipara was a predictor of SUI during Pregnancy.

Variáveis Associadas à Ansiedade Gestacional em Primigestas e Multigestas / Las Variables Asociadas con la Ansiedad Gestacional en el Primigestas y Multigestas / Variables Associated with Gestational Anxiety in Primigravidas and Multigravidas

Resumo Este estudo teve por objetivo descrever e comparar a ansiedade de primigestas e multigestas, no terceiro trimestre gestacional, bem como identificar, dentre as variáveis sociodemográficas e de gestação, as que se associaram para alta ansiedade. Participaram 479 gestantes que responderam a um instrumento de ansiedade (IDATE) e um questionário sobre variáveis sociodemográficas e da gestação. Compararam-se os grupos estatisticamente e montou-se um modelo de regressão logística para avaliar o peso das associações (p<0,05). Os resultados indicaram que 36% das gestantes apresentaram sintomas de alta ansiedade no terceiro trimestre gestacional, com um predomínio das multigestas em relação às primigestas. Para as multigestas, a maior chance para alta ansiedade esteve associada à baixa renda e, para as primigestas, à ameaça de aborto no início da gestação. Tanto para primigestas como para multigestas, desejar o bebê apareceu como fator de proteção para alta ansiedade. A expressiva porcentagem de gestantes com sintomas de ansiedade justifica o oferecimento de serviços voltados à prevenção e promoção de saúde mental das gestantes, com atenção diferenciada às primigestas e multigestas.

Resumen Este estudio tuvo como objetivo describir y comparar la ansiedad en el primigestas y multigestas en tercer trimestre, y para identificar, entre las variables sociodemográficas y el embarazo, que se asocian a mayor ansiedad. Participaron en 479 mujeres embarazadas que respondieron a un instrumento de ansiedad (STAI) y un cuestionario sobre variables sociodemográficas y el embarazo. Los investigadores compararon los grupos estadísticamente y montaron un modelo de regresión logística para evaluar las asociaciones. Los resultados indicaron que el 36% de las mujeres embarazadas tenían síntomas altos de ansiedad en tercer trimestre, con un predominio de multigestas en relación con el primigestas. Para multigestas la mayor oportunidad para alta ansiedad se asoció con bajas ingresos y para el primigestas con un aborto involuntario en el embarazo temprano. Ambos primigestas y multigestas quieren el bebé apareció como un factor protector para alta ansiedad. Un porcentaje significativo de mujeres embarazadas con síntomas de ansiedad justifica los servicios dirigidos a la prevención y promoción de la salud mental de las mujeres embarazadas, con una especial atención a las primigestas y multigestas.

Abstract This study aimed to describe and compare anxiety on primigravidae and multiparous in the third quarter, as well as to identify, among sociodemographic variables and of pregnancy, which ones were associated with high anxiety. There were 479 pregnant women participants who responded to an anxiety instrument (STAI) and a questionnaire on sociodemographic variables and about pregnancy. The groups were statistically compared e a logistic regression model was composed to evaluate associations. The results indicated that 36% of pregnant women presented symptoms of high anxiety on third gestational trimester, with a predominance of the multiparous in relation to the primigravidae. For the multiparous, the highest chance for high anxiety was associated with low income and for the primigravidae to the threat of miscarriage in early pregnancy. For both primigravidae and multiparous, wanting the baby appeared as a protective factor for high anxiety. The expressive percentage of pregnant women with anxiety symptoms justifies the offering of prevention services and promotion of mental health for pregnant women, with a differentiated attention to primigravidae and multiparous.

Gemelos unidos (siameses): descripción de hallazgos anatomopatológicos / Conjoined twins (siamese): description of anatomopathological findings

Resumen OBJETIVO: Describir los hallazgos anatomopatológicos y placentarios en una serie de autopsias de 5 siameses. CASOS CLÍNICOS: Serie de casos de autopsias efectuadas entre 2013 y 2018 de pacientes entre 14 y 30 semanas de embarazo, con diagnóstico de gemelos unidos. RESULTADOS: Se encontraron 5 casos de gemelos unidos, hijos de madres multíparas, 3 tuvieron muerte intrauterina y 2 fallecimiento a los pocos minutos de vida. Tres casos correspondieron a uniones ventrales (2 toracoonfalópagos y 1 cefalópago) y dos a uniones laterales de tipo parápagos, dicéfalos. Hubo corazón único en los gemelos toracoonfalópagos y sistemas cardiacos separados en los tres restantes, donde hubo fusión aórtica distal. En 4 casos el hígado se encontró fusionado, con dos vías biliares independientes. Los cordones umbilicales de los casos de unión ventral tenían 5 vasos sanguíneos. Los de unión lateral tenían cordón umbilical trivascular. Los discos placentarios mostraron grados variables de hipoxia preplacentaria y cambios de malperfusión vascular materna. CONCLUSIONES: Las fusiones ventrales tienen grados variables de estructuras compartidas; entre mayor sea la fusión de los órganos internos, menor es el número de vasos umbilicales. De las teorías etiológicas propuestas, la esférica es la que mejor soporta los grados variables de fusión.

Abstract OBJECTIVE: Description of the anatomopathological and placental findings in a series of autopsies of 5 conjoined twins. MATERIALS AND METHODS: Series of cases of autopsies performed between 2013-2018 of patients between 14-30 weeks of gestation, with diagnosis of conjoined twins. RESULTS: Five cases of conjoined twins, product of multiparous mothers, 3 of these presented intrauterine death and 2 deaths within a few minutes of life. Three cases corresponded to ventral junctions (2 thoracoomphalopagus and 1 cephalopagus) and two to lateral junctions of parapagus type. A single heart was observed in the thoracoomphalopagus twins and separated cardiac systems in the remaining three where there was distal aortic fusion. In 4 cases the liver was found fused with two independent bile ducts. The umbilical cords of the cases of ventral union presented 5 blood vessels; those with lateral junction presented a trivascular umbilical cord. The placentas showed varying degrees of preuterine hypoxic pattern and changes of Maternal Vascular malperfusion of the Placental Bed. CONCLUSIONS: Ventral fusions have varying degrees of shared structures; the greater the fusion of the internal organs, the smaller the number of umbilical vessels will be. Of the proposed etiological theories, it is the so-called spherical theory, which best supports the variable degrees of fusion and how it can be saltatory on the vertical axis.

Reembarazo en la adolescencia: análisis de la población perteneciente a la Red del Hospital Padre Hurtado, entre los años 2005-2015 / Teenage pregnancy: analysis of the population belonging to the Padre Hurtado Hospital Network, between 2005-2015

OBJETIVO PRINCIPAL: Evaluar prevalencia de adolescentes multíparas >2, en la población atendida en Hospital Padre Hurtado. MATERIALES Y MÉTODO: Estudio de cohorte retrospectivo, con información extraída de la ficha electrónica de partos e intervenciones, realizados entre 2005-2015 HPH. Los datos fueron tabulados en Microsoft Excel y luego analizados en el paquete estadístico IBM SPSS versión 22. RESULTADOS: Se atendieron 62.656 partos y hubo 5.770 eventos gestacionales que requirieron alguna intervención, de éstas, 14.030 (20,5%) ocurrieron en pacientes menores de 20 años y 356 (0,52%) en menores de 15 años. El número de multíparas fue de 940 (10,3% de mujeres con embarazo adolescente). En el caso de primigestas <15 años, 68 presentaron más de un embarazo durante su adolescencia (19,3% de embarazadas). El período intergestacional tuvo una mediana en 3 años (rango 1 - 6 años). Cuando una adolescente <15 años se embaraza por primera vez, tiene un OR de 2,25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) de volver a embarazarse durante su adolescencia, en relación a las adolescentes que se embarazan por primera vez después de los 15 años. En cuanto a intervenciones, al comparar ambos grupos, las menores de 15 años tienen un OR 2,75 de que al embarazarse, requieran cirugía. CONCLUSIÓN: La frecuencia de embarazo adolescente evaluada, es superior a la nacional y mundial. Cuando el primer embarazo ocurre <15 años, éstas tienen mayor riesgo de presentar un segundo embarazo durante la adolescencia. Una medida de prevención secundaria, es la utilización de MAC en el puerperio inmediato, idealmente LARCs.

OBJECTIVE: To evaluate the prevalence of multiparous adolescents, in the population that had their births at Hospital Padre Hurtado. METHODS: Retrospective cohort study, with information taken from the electronic database of the center, Birth data and Interventions, between 2005 and 2015. The data was tabulated in Microsoft Excel and the analysis was done with IBM SPSS 22 version. RESULTS: It occurred 62,656 deliveries and 5,770 pregnancies that ended in an intervention, from the total, 14,030 (20.5%) occurred in girls under 20 years and 356 (0.52%) under 15 years old (yo). The number of multiparous was 940 (10.3% of all of the adolescent pregnancies). For first time pregnants under 15 yo, 68 had a reiterative pregnancy among their adolescence (19.3% of pregnant <15 yo). The median time between pregnancies was 3 years (range 1- 6 years). When a girl <15 yo gets pregnant for the first time, she has an OR of 2.25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) of getting pregnant again during adolescence compared to girls that get pregnant between 15-18 yo. About interventions, the group under 15yo had an OR 2.75 (in Chile all forms of abortions are illegal) compared with the group above 15 years, of requiring surgery when pregnant. CONCLUSIONS: The frequency of adolescent pregnancy analized, is above the national and international publications. Plus, if the pregnancy occurs under 15 yo, they have a greater chance of having another teenage pregnancy. An effective secondary prevention could be administration of contraception during immediate postpartum, ideally LARCs.

Caracterización epidemiológica del bajo peso al nacer en Centro de Salud Bárbara años 2014 y 2015

Introducción. Los recién nacidos (RN) con bajo peso al nacer (BPN) tienen 20 veces más riesgo de morir. En Guatemala se reportó 12.9% de los recién nacidos en 2014 como bajo peso al nacer. Objetivo: Determinar las características epidemiológicas y la incidencia de los factores de riesgo maternos, asociados a RN con BPN durante los años 2014 a 2015 en Centro de Salud Bárbara (CSB). Métodos: Se revisaron los expedientes de 506 partos ocurridos en CSB durante el período de tiempo establecido y se identificó a los RN con BPN. Se documentaron los factores de riesgo de cada recién nacido. Resultados: Se encontró una prevalencia de 10.67% de BPN Los factores de riesgo fueron, bajo IMC materno, período intergenésico corto, multiparidad, ocupación ama de casa e inadecuado control prenatal. En su mayoría procedían de las aldeas Comunidad de Ruiz, Cruz Blanca, Montufar y Cerro Alto; 35% eran analfabetas. Conclusión: Los resultados de este estudio ponen en relieve la necesidad de intervención con grupos específicos de mujeres con mayor riesgo de presentar embarazos con resultados adversos, específicamente BPN. Palabras clave: Peso al nacer, bajo peso al nacer, factores de riesgo, incidencia, prevalencia, intergenésico, multiparidad

Introduction. Several studies have demonstrated that new born infants with low birth weight (LBW) have up to 20 times more risk of dying. In Guatemala 12.9% of LBW newborn were reported in 2014. Objective: To determine the incidence of maternal risk factors associated to LBW during the period 2014-2015 in a health care post (CSB). Methods: Medical records of 506 deliveries occurred in CSB during this period were reviewed and LBW infants were identified. Maternal risk factors were documented for each new born. Results: A prevalence of 10.67% low birth weight infants were found. Prevalent risk factors were, maternal low BMI, short intergenesic interval, multiparity, being a housewife as an occupation, and inadequate prenatal care. Thirty-five (35%) of patients were illiterate and mostly came from the out of town villages (Comunidad de Ruiz, Cruz Blanca, Montufar y Cerro Alto). Conclusion: Findings highlight the need of intervention for specific groups of women with higher risk of adverse pregnancy outcomes, specifically low birth weight. Key words: Low Birth Weight, risk factor, incidence, prevalence, intergenesic, multiparous

Aspectos epidemiológicos en citologías con resultados anormales en el hospital boliviano "El Torno" / Epidemiological aspects in cytologies with abnormal results in "El Torno" Bolivian hospital

Se efectuó un estudio observacional, descriptivo, retrospectivo y transversal de 886 mujeres con resultados citológicos positivos, atendidas en la consulta de Ginecología del hospital "El Torno" de Bolivia, desde enero hasta diciembre del 2009, a fin de caracterizar aspectos epidemiológicos en citologías con resultados anormales. La información se obtuvo de la historia clínica individual de cada paciente y una encuesta elaborada al efecto. El procesamiento de los datos se realizó de forma computarizada, a través del sistema Epi Info 6. Se emplearon la prueba estadística Ji al cuadrado y el porcentaje como medida de resumen. En la casuística predominaron el grupo etario de 20-39 años y el diagnóstico de reacciones inflamatorias inespecíficas del cuello uterino. La positividad de los exámenes de papanicolaou mostró una tendencia descendente en relación con años anteriores. Se evidenció que las féminas iniciaron sus relaciones sexuales precozmente y la mayoría tuvo más de una pareja sexual.

An observational, descriptive, retrospective and cross-sectional study of 886 women with positive cytological results, assisted in the Gynecology Department from "El Torno" hospital in Bolivia, was carried out from January to December, 2009, in order to characterize epidemiological aspects in cytologies with abnormal results. The information was obtained from the individual medical record of each patient and a survey elaborated to the effect. The processing of data was carried out in a computerized way, through the system Epi Info 6. Chi square test and the percentage as summary measure were used as statistical tests. The age group 20-39 years and the diagnosis of inespecific inflammatory reactions of the cervix prevailed in the case material. The positivity of the Pap smears showed a descending tendency in relation to previous years. It was evidenced that the patients began their sexual relations in an early stage and most of them had more than one sexual couple.

A Case of Periumbilical Perforating Pseudoxanthoma Elasticum / 대한피부과학회지

Perforating pseudoxanthoma elasticum is a rare disorder. It is an hereditary connective tissue disease involving progressive fragmentation and dystrophic calcification of elastic fibers. The localized lesions usually occur in a periumbilical location in obese, middle-aged, multiparous black women. It is characterized clinically by yellowish, lax, well-circumscribed, reticulated or cobblestoned patches or plaques of the periumbilical region. Herein, we report a case of periumbilical perforating pseudoxanthoma elasticum which occurred in an obese, multiparous woman with no signs of hereditary systemic pseudoxanthoma elasticum.

Procurement of HLA Class I Antisera from Multiparous Blood Donors / 대한임상병리학회지

BACKGROUND: HLA antisera are procured mainly from placental blood or blood of multiparous women. The latter has a merit that a large volume of antisera could be obtained, once the antisera are found to be of good quality. METHODS: A total of 1,437 multiparous blood donors were screened for the presence of anti- HLA antibodies. After the first screening with 20 panel cells, initially reactive sera were re- screened with 30 panel cells. RESULTS: Of 1,437 sera, 50 sera (3.5%) were reactive to both the first and the second screening panel cells. Among 50 sera, 25 (50.0%) sera could be assigned for their antibody specificity with r value of 0.8 or more. Only 14 samples (1.0%) showed reactivity to two or more panels with same antigen specificity and strength index of 80% or more. Four donors repeatedly donated blood with specificities of A24, A26, B7, and B7+B40, respectively. CONCLUSIONS: Screening of HLA class I antibodies in multiparous blood donors showed that HLA antisera of good quality could be obtained in about 1% of the donors in Korea.

Periumbilical Pseudoxanthoma Elasticum

We report a case of periumbilical pseudoxanthoma elasticum in a 73-year-old female. It is characterized by a dark-yellowish plaque present on the periumbilical area of the lower abdomen. The plaque is well-demarcated and its surface is grooved or fissured, atrophic and verrucoid. This localized lesion of the periumbilical area occurs in a multiparous woman with no history of hereditary systemic pseudoxanthoma elasticum.