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Background:A maternal near miss case is defined as a “a woman who nearly died but survived a complication that occurred during pregnancy,child birth or within 42 days of termination of pregnancy”1.MMR is defined as ratio of number of maternal deaths per 1000 live births. All pregnant women deserve a good quality of care especially Emergency Obstetric Care including proper infrastructure, human resources that can detect and manage such complications earliest. The objective of this study was to evaluate the causes of maternal near miss cases, various management modalities performed and maternal and fetal outcome in near miss cases. Material And Methods:A retrospective study was carried out in obstetrics and gynaecology department of SCL municipal general hospital, Ahmedabad for identification of MNM as per MNM-R operational guidelines (2014) in a tertiary care hospital from August 2020 to March 2022. Result:Total deliveries during our study period were 9266 out of which 535 number of patients developed complications, 75 patients ended up becoming near miss cases and 30 maternal mortalities were observed.Hypertensive disorders (38.6%) followed by severe anemia (18.6%) and haemorrhage (13.3%) were the commonest underlying causes leading to MNM. More than one management modality was followed in one case. 25% of patients required blood transfusion. Out of which 11 patients required massive blood transfusion (>5 units of blood) and 16% of patients required blood products along with blood resulting from either severe anemia or altered coagulopathy (DIC). 69.3% of patients required ICU stay of <5 days and majority of patients required hospital stay of 9-14 days.63.6% of patients required ICU stay of 1-4 days.Live birth rate was 82.6%.Conclusion:Maternal health is the direct indicator of prevailing health status in a country. Reduction in maternal mortality is one of the targets of MILLENIUM DEVELOPMENT GOALS13for 2015 but in spite of full efforts by all the health care professionals, it still remains a challenge in developing countries.There should be prompt and proper management of high-risk groups by frequent antenatal visits. Aggressive management of each complication and close monitoring of women in labour, decision making in mode and time of termination of pregnancy are important to prevent further complications.
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Purpose To determine and compare the diagnostic performance of Doppler sonography of fetal umbilical artery (UA) for prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre eclampsia. Materials and Methods 100 women with singleton pregnancy between 26 to 30 weeks of gestation were studied in this prospective study over a period of one and half years with color Doppler. UA flow velocity form was studied. In UA systolic/diastolic (S/D) ratio, pulsatility index (PI) and Resistance index (RI) were studied. In UA absent diastolic flow or reversed diastolic flow is noted. Results Out of 50 clinically suspected pregnancy induced hypertension (PIH) cases, 31 (62%) cases show abnormal PI, 40 (80%) cases show abnormal RI values and 45 (90%) cases show abnormal S/D Ratio's. Sensitivity and specificity of the S/D ratio in predicting PIH are 90% and 88% respectively followed by positive and Negative predictive value (PPV & NPV) of 88% and 89% whereas sensitivity, Specificity, PPV and NPV of RI & PI are lower than S/D ratio. This shows that S/D ratio has more Sensitivity, Specificity and Predictive values. Sensitivity of PI value in predicting fetal outcome is 75%. 22% (11 out of 50 cases) cases show absent/reversal of end diastolic velocities, of these four are reversal of end diastolic velocity (RDEV). All four cases of REDV died before 32 weeks of gestation. Absent diastolic flow is seen in 7 cases, 4 cases died and three cases admitted in NICU with severe respiratory distress. Our study shows absent or reversal of end diastolic velocity is more sensitive in predicting adverse fetal outcome. There was no case of eclampsia or maternal death. Conclusion UA flow velocity waveforms abnormality is more predictive for preeclampsia and IUGR. Hence Doppler is a promising tools in prediction of PIH and IUGR
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Objective To investigate the relationship between intrauterine growth retardation (IUGR) and en docrine parameters so as to assess the effects of the main endocrine factors on IUGR. The concentrations of growth hormone (GH), insulin, T3, T4 and TSH were measured in umbilical cord blood, amniotic fluid and maternal serum. Methods The samples were collected from 23 pregnant women who were diagnosed as the full term IUGR, 42 normal full term pregnant women with normal infants' weight were taken as control. Growth hormone and insulin were mea sured by radioimmunoassay. T3, T4 and TSH were investigated by micro-radioimmunoassay. Results The concentra tions of growth hormone, insulin and T4 in umbilical cord blood were lower in IUGR than that in control group(GH 4. 63μg/L vs 7.01μg/L, insulin 10. 68μIU/ml vs 31.44μIU/ml, T4 87. 39nmol/L vs 138. 10nmol/L. P ＜0. 05, 0. 05 and 0. 05, respectively). The TSH concentration in umbilical cord blood was higher in IUGR than in control group (10. 84μmIU/L vs 5. 75μmIU/L, P ＜0. 01). The concentration of growth hormone in maternal serum and the concen tration of insulin in amniotic fluid were also lower in IUGR group than in control group(GH 1.77μg/L vs 2.74μg/L, P ＜0. 01, insulin 5. 84μIU/mi vs 15. 64μIU/ml, P ＜0. 01). Conclusion This study confirms that full term neonates with IUGR are abnormal in endocrine factors. The inadequacy of growth hormone may be one of the causes of IUGR. The relative scarcity of growth hormone and insulin seems to be a factor to compromise the fetus' metabolism. Be sides, the early hypothyrosis of infants with IUGR might protect them from unfavorable environment in the uterine.
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Objective:To determine levels of insulin and glucose of maternal serum (MS),umbilical venous serum (UVS) and umbilical artery serum (UAS) in normal term pregnancy and intrauterine growth retardation(IUGR).Methods:One hundred and seven cases of normal gestational weeks on induction of labors and spontaneous deliveries and 32 cases of pregnancies complicated with IUGR.Levels of insulin were measured with sensitive radioimmunoassay and levels of glucose were measured by the glucose oxidase-peroxidase method.Results:Level of insulin of maternal serum was not significantly different before 28 gastational weeks and peaked on 28 th gastational week,then it decreased with gestational weeks and peaked again at last term.Levels of insulin increased in UVS and UAS.Levels of glucose in MS,umbilical venous serum and umbilical artery serum were not significantly different.Level of insulin and glucose of MS in IUGR had no change,but it was significantly different in IUGR of UVS and UAS (P<0.01).Conclusion:Our study suggested a decrease of insulin and glucose in UVS and UAS with IUGR.