Pulmonary hypertension and pregnancy: The experience of a tertiary institution over 15 years.

Background: Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%. Aim: To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses. Materials and Methods: A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were identified from the high-risk pregnancy database within the department of anesthesia and from the hospital medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary team and management planned accordingly. Results: 19 eligible patients were identified. Patients who were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor and operatively delivery seem to be the ideal choice. Conclusion: Multidisciplinary approach is a key to the successful management of these patients. Secondary PH results in higher morbidity and mortality, in particular, older the age higher the maternal morbidity and mortality.

Study of septic abortion cases at a tertiary centre of Uttarakhand.

Aim of this study was to evaluate the incidence, maternal morbidity & mortality, clinical features, management in cases of septic abortion in a tertiary centre. This study included 37 cases of septic abortion admitted during 5 years from January 2007 to January 2012 in the Department of obstetrics & Gynaecology in Government Medical College, Haldwani. All patients were evaluated with special reference to incidence, etiological factors, clinical features, surgery & maternal morbidity & mortality. The incidence of septic abortion was 1.08%. Common age group was between 26-30 years. Most of the cases were from lower socioeconomic status. Septic abortion following spontaneous abortion was present in 5 cases. Unwanted pregnancy was the indication for termination of pregnancy in 32 cases. 4 women were admitted in state of septic shock. 12 cases required lapratomy for drainage of pus, 3 had hysterectomy, 3 had resection anastomosis & uterus repair was done in 4 cases. Overall maternal mortality was 5 (13.5%).The incidence of illegal and septic abortion can be reduced by increasing awareness about family planning services and making legal abortion services easily available to the women and that too at a cheaper cost.

Burns during pregnancy: a socio-cultural disease.

Burns during pregnancy poses a serious threat to the life of baby, as well as to the mother. More severely it is associated with various social and economical problems, as well as associated with illiteracy and poverty which many cases complicate its prevention. Burns during pregnancy influence maternal as well as foetal outcome. Keeping this in view a comprehensive task was undertaken to assess the maternal and foetal outcome in relation to burn extent and gestational age of foetus. A total of thirty two cases of burn females with pregnancy were analyzed. There were 23 maternal and 26 foetal deaths. Percentage of abortion during the third trimester was highest. Rate of maternal mortality increased with percentage of Total Body Surface Area (TBSA) burnt. Maximum incidence of maternal mortality rate was with cases of burns involving more than 50% TBSA.

Pregnancy-related deaths: A three-year retrospective study.

Over 600000 maternal deaths occur each year worldwide. In India, many women die due to pregnancy-related complications. The present study was undertaken with a view to determine factors causing maternal deaths, to recognize cause of death and to discuss the utility of autopsy record as a useful and adjunct data source for ascertainment of maternal deaths. A total 21 pregnancy-related deaths occurring during 2004 to 2006 were studied and their age ranged from 21 year to 35 year. It was observed that maximum numbers of deaths were recorded in the age group of 21-25 years (52.38%). Analyzing the pregnancy outcome, live birth to child were given by 9 females and 1 died during abortion. Hemorrhage remains leading cause of death (38.09%) followed by indirect causes (23.80%), undetermined (19.04%), sepsis (9.52%) and postpartum pre-eclamptic shock (9.52%). Death records remain an important source of maternal deaths however, using only death certificate suffers from drawback because many times cause of death is not mentioned, especially if death incurred medicolegal autopsy. Under such circumstances review of autopsy reports may prove useful in the ascertainment of maternal deaths and elucidating the emerging trends.

[Evaluation of the maternal death system in public facilities in the Tunis [1999-2004]]

We report the performance indicators in 2004 of a follow-up on the system for recording maternal deaths which was established in 1999. The system was operating in 69.8% of public hospitals, and 96% of maternal deaths investigations were completed. In 69.8% of maternal deaths there was a direct obstetric cause. Haemorrhage was the major cause of maternal death [30.8%], followed by eclampsia [11%]. The proportion of avoidable [certain or possible] deaths was 75.3%. There were problems in evaluation of risk presented by women and inadequate follow-up during the postpartum period and delay in appropriate treatment. Incomplete documentation and difficulty in ascertaining avoidability were problems faced by the regional follow-up committee

Is treatment with oral or rectal misoprostol effective to prevent postpartum hemorrhage?

To compare the efficacy of 400 mg of oral or rectal misoprostol with 0.2 mg intramuscular methylergometrine to prevent postpartum hemorrhage [PPH]. 672 women were randomized into three groups: Group 1 received 400 mg misoprostol orally [n =240], Group 2 received 400 mg misoprostol rectally [n = 222], and Group 3 received 0.2 mg methylergometrine IM [n =210]. The mean blood loss, PPH >/= 500 ml, needs for additional oxytocic drugs, and decrease in hemoglobin concentration were the main outcomes measured. The demographic characteristics were comparable. There were no significant differences among the three groups in mean blood loss [P = 0.112], incidence of PPH >/= 500 ml [P=0.334], need for additional oxytocic agents [P=0.574], and decrease in mean hemoglobin concentration [P=0.613]. Significant differences detected with the use of misoprostol whether given orally or rectally, were elevated temperature >/= 38°C [P= 0.002] and shivering [P=0.001]. Oral or rectal misoprostol is as effective as conventional, intramuscular methylergometrine in preventing postpartum hemorrhage, and the drug has the advantages of stability at room temperature and ease of administration. It can be recommended for routine use anywhere for prevention of PPH

Advanced abdominal pregnancy- a diagnostic and management dilemma

Advanced abdominal pregnancy is a complex condition demanding challenging management. High index of suspicion may reduce the diagnostic error. Management varies from patient to patient. Expectant management is a feasible option in a well-equipped tertiary care hospital in case of alive viable fetuses. This evidence-based report describes the author's experience of managing a series of advanced abdominal pregnancies at 24 weeks or more of gestation

Comparison of intravenous hydralazine - bolus dose versus continuous infusion drip in eclampsia

The leading cause of maternal death from eclampsia is cerebral hemorrhage, which is presumably the consequence of severe hypertension, so the acute elevations in blood pressure above 160/100 mm Hg should be brought under control. A study of forty diagnosed cases of eclampsia was carried out in Lady Willingdon Hospital, Lahore to determine the time and quantity of drug required to control high blood pressure levels by intravenous hydralazine bolus dose versus continuous infusion drip. Patients were divided into control and case group. In control group continuous infusion was given and in cases bolus dose was given. Mean time taken to control blood pressure by continuous infusion was 124.75 minutes and drug quantity was 23.50 mg while it was 52 minutes and 12.25 mg in case of bolus method. The study showed that 60-70% less time was required and 37.5-50% less drug quantity was used in bolus method versus continuous infusion of intravenous hydralazine. Regarding efficacy of intravenous hydralazine, it was fou nd to be statistically superior in this study [P<0.05] so that management strategy should be changed in favour of bolus dose as compared to continuous infusion of intravenous hydralazine

Reasons for Zahedan's women for not referring to delivery ward for child delivery

Maternal and infantile mortality are important health indicators of every society due to pregnancy incidents. Maternal and infant mortality and also neonatal tetanus incidents have direct relation with delivery condition. Neonatal tetanus and mortality among mothers and newborns have direct relation with delivery in non-hygienic condition. Non-hygienic delivery rate is very high in Sistan and Baluchestan province. Even in the city of Zahedan with a population of 450000, where as access to maternity hospital is possible for all residents of this city, 50-60% deliveries take place at home. In this study, the reasons of women were investigated for not referring to maternity hospital for delivery. The method of research was case control. Case group was selected from those women whose last deliveries had not taken place in maternity hospital and referred to health centers to vaccinate their children [no. 482]. Control group was selected randomly among women who referred to hospital to give birth [no. 198]. Hospital's high fee [38%], easy delivery at home [19%], fear from cesarean and drugs adverse reaction [13%] were the most prevalent reason for not giving birth at hospital. Employment and literacy rates of those women who had given birth at home were lower than control group. They were mainly from Suni and Baluch ethnic. In order to minimize the cultural barriers of referring to maternal hospital, we advise the respectful officers, to make insurance public, lower the treatments fee, held training programs and provide hygienic conditions with low cost for out of hospital deliveries

Evaluation of the role of craniotomy in developing countries

A review of 32 cases of craniotomy performed at the Jinnah Postgraduate Medical Centre Karachi, over a period of 6 years from January, 1984 to December, 1989 is presented. Total number of deliveries during this period were 37,682. Frequency of craniotomy was 0.08% i.e., 1 in 1177 deliveries. Of these 32 craniotomies, 28 were done on non-deformed dead fetus, 16 because of obstructed labour, 7 in cases of after coming head of breech and 5 in failure to progress in second stage of labour. Four cases were of live hydrocephalic fetus in whom cephalocentesis was done followed by craniotomy due to failure to progress in labour. Maternal morbidity was 12.5% with no maternal death. We conclude that it is safe and quicker than caesarean section in selected cases. Though unpleasant to perform, is of great relief to the patient and her family

Maternal mortality at Mount Hope Women's Hospital, Trinidad

A ten-year survey of the magnitude and causes of obstetrical deaths at Mount Hope revealed a maternal mortality rate of 33.3 per 100,000 live births. The leading causes of death were the hypertensive disorders, and the most common identifiable factors were inadequate antenatal care and substandard clinical management.

21 years statistic of perinatal mortality in a private hospital

21 years statistics of perinatal mortality at Baqai Medical College Hospital along with maternal and foetal factors are discussed. A comparison of booked and non-booked cases is also done. In conclusion some recommendations to reduce perinatal mortality in the community are suggested