Near-miss obstetrical events and maternal deaths

To determine the frequency of near-miss cases, nature of near-miss events and mortality among obstetric patients. Cross-sectional, observational study. The study was conducted in the Obstetric Unit of Fatima Hospital, Baqai Medical University, from January 2006 to December 2006. Near-miss case definition was based on validated specific criteria comprising of five diagnostic features: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anemia. The main outcome measures were frequency and characteristics of near-miss cases, total hospital stay, high dependency unit/ICU stay and development of multiple organ dysfunction. Near-miss events and maternal deaths were described with respect to disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for near-miss cases. The maternal death to near-miss ratio was calculated. There were 868 deliveries in the year 2006, 44 near-miss cases, 47 near-miss events and 6 maternal deaths. The maternal death to near-miss ratio was 1:7. The most common type of near-miss events were obstetrical haemorrhage, anemia and dystocia responsible for 51%, 21.2% and 14.8% respectively. Severe hypertensive disorders in pregnancy and infections accounted for 8.5% and 4.2% of near-miss events. Postpartum haemorrhage was responsible for 83.3% and infection for 16.6% of the maternal deaths. The mortality index was higher for infections [33.3%] than for haemorrhage [17.2%]. Organ system dysfunction/failure was diagnosed in 18.1% of near-miss cases. This study showed that for every 7 women who survived life threatening complications, one died. However, the underlying disease processes for near-miss and mortalities were almost same. Evaluation of the circumstances surrounding near miss cases could act as proxy for maternal deaths in the studied population

Complications of induced abortions

To determine the complications developed due to induced abortions. Descriptive case series. Department of Obstetrics and Gynecology, Fatima hospital, Baqai medical University Karachi, from January to December 2005. Records of patients admitted with induced abortion were analyzed retrospectively. Their presentation and complications were noted. Patients presented within 40 days of induced abortion were included in the study. While patients with spontaneous abortions or who were admitted after 40 days of induced abortion were excluded. During study period, total number of patients admitted was 124. Out of them 96 spontaneous abortions, 13 induced and 15 were threatened. The frequency of induced abortion was 10.4%. Out of 13 cases, 9 [69.2%] were married and 4[30.7%] were unmarried under the age of 20 years. Regarding parity 7[53.8%] were having >5 children. Traditional Birth Attendants performed abortions in 11[84.6%] of patients. Sepsis was the main complication developed in 7[53.8%] patients followed by uterine perforation found in 3 [23%] patients. Hemorrhage occurred in 2[15.3%] patients. Induced abortion caused mortality in 1[7.60%] patient. Induced abortions are a major cause of maternal complications. Education of traditional birth attendants to recognize the severity of complications and availability of family planning services can help to reduces morbidities and mortalities

Maternal mortality in a community based hospital

To determine the maternal mortality ratio, frequency of obstetrical causes and disease process leading to maternal mortalities over five years maternity services 2002-06 in a community based hospital. The study was conducted at Fatima Hospital, a tertiary care community based hospital, situated 20km away from Karachi city, covering the population of Gadap Area. The duration of study was from January 2002 - December 2006. All direct and indirect maternal deaths during pregnancy labor and perpeurium were included. The patients who expired after arrival were analyzed from their records. The reason for admission, disease process, cause of death and possible factors responsible for death were identified. The other information included age, parity, booking status, gestational age and relevant features of index pregnancy, along with the distance from hospital was recoded on proforma and analyzed by SPSS Version-11.0. There were total 3,287 deliveries and 2965 live births with 322 perinatal mortalities. Total 37 maternal deaths during five years reveals MMR = 1248 per 100,000 live births. The highest MMR = 2569 was recorded during the year 2004. Majority of the women who died [89.2%] were unbooked. The highest maternal mortality age group was 21-30 years in which 19 [51.4%] mortalities were observed during the entire study period except the year 2004. Out of 37 maternal deaths, 10 [27%] were primigravidas. Obstetrical hemorrhage was the most frequent cause followed by hypertensive disorders, sepsis and suspected pulmonary embolism. On arrival at hospital 4 [10.8%] of patients were dead. SIRS and MODS diagnosed in 14 [37.8%] and 17 [45.9%] of patients. Majority of maternal deaths 25 [67.5%] occurred within 24 hours after delivery. Obstetrical hemorrhage was the leading cause of maternal deaths. Community awareness, training of traditional birth attendants to recognize the seriousness of the disease and improving the referral system can reduce the maternal mortality

Effectiveness of admission test

To find out the effectiveness of Admission Test [AT] in detecting fetal hypoxia already present at admission to predict hypoxia in labor and to correlate the results of the AT with the perinatal outcome. Descriptive study. A total of 100 women in labor both high and low risk groups were selected in the study. All of them were subjected to an admission test [AT] which is a 15-20 minutes recording of fetal heart rate and uterine contractions on cardiotocograph machine at the time of admission in labor. The results of AT were not revealed to the concerned obstetrician in labor room and the test were evaluated after delivery so as not to influence the clinical management. The results of the AT were 'reactive' in 75 [75%], 'equivocal' in 22 [22%] and 'ominous' in 3 [3%] women. Women with the reactive AT had low risk of intrapartum fetal distress, 1.3% as compared to 4.5% in the equivocal and 66.6% in the ominous group. Operative delivery for fetal distress was required in only 1 [1.3%] woman of the reactive group, in 1 [4.5%] woman of the equivocal group and in 2 [66.6%] women of the ominous AT group. Resuscitation was required in 2 [2.6%] babies of the reactive group, in 4 [18.1%] babies of the equivocal group and in 1 [33.3%] baby of the ominous AT group. Nine babies required neonatal unit and NICU admission for neonatal sepsis 5 [6.6%] were from the reactive, 2 [4.5%] were from the equivocal and 2 [66.6%] were from the ominous AT group. The test was useful to detect fetal distress already present at admission and had the ability to propose fetal well being for the next few hours of labor. It is simple, convenient, non invasive and economical for screening purpose