Sleep quality and new onset postpartum hypertension

Background: Chronic sleep deficiency is a stressful situation which has an association with high blood pressure. After delivery, mothers have disrupted sleep due to frequent awakenings by their infants. What is not known is how significant this relationship is in women during the postpartum period as well as other factors that may affect their Sleep quality. Sleep quality is a measure of duration and disruption. Aim and Objectives: Study is aimed at determining the relationship between Sleep quality and new onset postpartum hypertension. The specific objectives are; to determine the Sleep quality of mothers in the postpartum period using the Pittsburgh Sleep quality index (PSQI), identify factors that affect Sleep quality of mothers in the post-partum period and determine blood pressure patterns of mothers in the postpartum period. Materials and Methods: This was a longitudinal study. Using systematic random sampling, a sample size of 126 women were recruited between June and August 2016 in the Postnatal clinic of the 37 Military Hospital. Written consent was obtained from participants. Sitting blood pressure was checked and recorded and a modified form of the Pittsburgh Sleep quality index (PSQI) was used to assign a global score for Sleep quality. A global score of more than 5 indicated poor Sleep quality in that mother. Clients were first recruited at the 1st postnatal visit with follow-up at the 2nd routine postnatal visit (6weeks). Only mothers whose blood pressures were normal during pregnancy and upon discharge from hospital were included. For categorical data, Pearson's chisquare test was used for comparisons and logistic regression as used to determine significant factors that contribute to new onset hypertension in postpartum women. A P-value less than 0.05 was considered significant. Results: Majority of mothers (92.1% and 90.5% at first and second visits respectively) had poor Sleep quality. Mothers who slept away from their babies at the sixth week visit had better sleep. Mean global Sleep quality scores had no significant association with new onset hypertension but mean scores of some Age , p=0.001, OR =1.20 (C.I: 1.09-1.32) and some sleep components sleep disturbance, p=0.041, OR =1.86(C.I: 1.02-3.37), and use of sleep medicine, p=0.031, OR =1.54 (C.I:1.04- 2.29) were significantly associated with new onset postpartum hypertension. Conclusion: Global poor Sleep quality is not associated with increased odds of new onset hypertension but the Sleep quality components, sleep disturbance and increased use of sleep medicine, were significantly associated with new onset hypertension in mothers

Labor, delivery and postpartum complications in nulliparous women with female genital mutilation admitted to Karamara hospital

Objectives:To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM.Methods:A prospective hospital based study using structured questionnaire was conducted between January to March 2015 at Karamara hospital, Jijiga, Ethiopia. All nulliparous women admitted for labor and delivery were included. Data were collected regarding circumcision status, events of labor, delivery; postpartum and neonatal outcomes as well as attitude of mothers towards elimination of FGM/C. Results:Two hundred sixty four (92.0%) of the women had FGM/C with most (93.0%) undergoing Type III FGM. The mean age of the women was 22 yr. Failure to progress in 1st stage and prolonged 2nd stage of labor occurred in 165 (57.0%) and189 (65.6%) of the cases respectively. Caesarean section was performed in 17.0% and instrumental delivery in 23.0%. 64.5% required episiotomies, 83.3% had an anterior episiotomy, 29 % had perineal tears, 25.7%% experienced post-partum hemorrhage and 24% postpartum infection. Among the newborns, there were 6.4% perinatal deaths; 18.8 % low birth weight and 1.5% birth injuries. Almost all complications were more frequently seen in circumcised compared to non-circumcised women. Conclusions: The prevalence of FGM is high and it substantially increases the risk of many maternal complications. Health professionals should be aware of these complications and support/care of women with FGM should be integrated at all levels of reproductive health care provision. Capacity building of responsible health professional should be initiated in the area with intensification of FGM eradication activities

Postpartum eclampsia is defined as eclampsia that occurs after delivery within 48 h. Now-a-days, the incidence of antenatal and intrapartum.

Postpartum eclampsia is defined as eclampsia that occurs after delivery within 48 h. Now-a-days, the incidence of antenatal and intrapartum eclampsia is reduced considerably due to good antenatal care, and preeclampsia diagnosed early and treated well. However, postpartum cases nowadays show a unique pattern occurring too late, which can be nearly missed and difficult to diagnose. Postpartum eclampsia has to be differentiated from other causes such as cerebral malaria, cerebral tumor, cerebral hemorrhage, cerebral venous thrombosis, cerebral aneurysm, brainstem syndrome, posterior reversible encephalopathy syndrome, epilepsy, thrombotic thrombocytopenic purpura, strychnine poisoning, chronic hypertension, chronic renal disease and hemolytic uremic syndrome. Postpartum eclampsia requires prompt treatment. Left untreated can result in seizures and other serious complications. Here, we present a unique and interesting case of atypical delayed onset postpartum eclampsia. Hence that such unique cases should not be missed in the diagnosis and management.

Peripartum hysterectomy

To find out the frequency, indication and its associated morbidity in our setup. Prospective cross-sectional observational study for the period one year [from June 2003 - May 2004] carried out in the Department of Obs / Gynae, Lahore General Hospital Lahore. During the study there were 26 cases of peripartum hysterectomy, of which 14 case were of caesarean hysterectomy, while 10 cases were following normal vaginal delivery and 2 cases followed by instrumental delivery. Uterine atony was the most common indication for peripartum hysterectomy in 12 cases [46.15%]. Uterine rupture including instrumental delivery tear was 2nd most frequent cause in 4 +2=6[23.07%] of cases. In 19.2% [5] of cases abnormal placentation was the cause. In 2[7.6%] of cases sepsis was the cause leading to secondary PPH followed by hysterectomy. A subtotal hysterectomy was carried out in 10 [38.46%] and total hysterectomy was performed in 16 [61.53%] cases. there were 4 maternal deaths. Urinary tract injuries occurred in 3[11.53%] cases, fever, chest infection and wound infection were common morbidity. Anemia was found in almost every case. Intra and post operative Blood transfusion s were given in all cases. Reloparotomy was done in one patient for continues vaginal bleeding. Despite its morbidity and mortality emergency Obstetric hysterectomy remains an essential life saving tool. Uterine atony, uterine rupture and abnormal placentation were mast common indications, reflecting under utilization of existing antenatal, family planning services. Injudicious use of oxytocin, lack of transportation facilities, poverty and delayed referral all contribute to morbidity and mortality associated with emergency Obstetric hysterectomy