A study of maternal mortality in a teritiary care hospital in North Coastal Andhra

Background: Pregnancy, although being considered a physiological state, carries risk of morbidity and at times death. Maternal mortality is an indicator for health care provided to the women. The major causes of maternal mortality are preventable through regular antenatal check-ups, early diagnosis and management of complications. Aim: The aim of this study was to focus on incidence of various causes of maternal mortality, and about avoidable factors that can prevent maternal deaths. Materials and methods: A hospital record based study of maternal deaths over a period of 2 years from January 2017 to December 2018 was done. The information regarding demographic profile and reproductive parameters were collected and results were analyzed. Results: MMR over a period of 2 years (2017 and 2018) was 962 per 100000 live births. Most maternal deaths occurred in the age group 20-24years. Majority were multi parous and unbooked cases. Hypertension, hemorrhage, sepsis are major direct causes. Febrile illness, respiratory disorders, cardiovascular disorders, anemia being indirect causes. Conclusion: Majority of maternal deaths were preventable by proper antenatal care, early detection of high risk pregnancies and their timely referral to tertiary care centre.

A comprehensive study on jaundice in pregnancy with emphasis on fetomaternal outcome

Background: Jaundice affects a small percentage (1-4 per 1000) of pregnant women, yet it is an important medical disorder especially in developing countries like India. Jaundice in pregnancy carries adverse outcomes for both the fetus and the mother. It accounts for 60% perinatal and 14% of maternal deaths. The aim of the study is to know the incidence of jaundice, to evaluate the causes of jaundice and to know the effect of jaundice during pregnancy on maternal and fetal outcome. Materials and methods: All pregnant women with jaundice admitted in the Department of Obstetrics and Gynecology, King George Hospital, Visakhapatnam between September 2015 and August 2017 were taken up for study. Results: The incidence of jaundice was 7.22 per 1000 deliveries. Since 92.54% of patients were between 20-35 years of age, maximum number of cases was Primi gravidae. The most common cause of jaundice was HELLP syndrome, hepatitis being the second most common cause. Maternal mortality was 12.74%, the perinatal mortality was 35.71%, prematurity being the commonest cause. Conclusions: Jaundice in pregnancy has adverse fetomaternal outcome. It should be managed as a team in collaboration of obstetrician, physician, gastroenterologist, anesthetist and neonatologist. Improvement in health education, regular antenatal check-ups and early referrals result in early diagnosis and treatment of jaundice during pregnancy thus reducing maternal and fetal morbidity and mortality.

Endogenous strychnine, nicotine, and morphine--description of hypo and hyper-strychninergic, nicotinergic and morphinergic state in relation to neuropsychiatric diseases.

Previous work from this laboratory had demonstrated the presence of endogenous morphine, strychnine and nicotine in the mammalian brain and human serum samples. Morphine is synthesised from tyrosine and strychnine and nicotine from tryptophan. This study examines the role of strychnine, nicotine and morphine in neuropsychiatric disorders. The blood levels of tyrosine, tryptophan, strychnine, nicotine and morphine were studied as also RBC membrane Na(+)-K+ ATPase activity. It was found that serum tyrosine levels were reduced and tryptophan levels elevated in all neuropsychiatric disorders studied with a reduction in RBC Na(+)-K+ ATPase activity. Nicotine was present in significant amounts in serum of patients with schizophrenia, CNS glioma and syndrome X with multiple lacunar state. Morphine was present in significant amounts only in the serum of patients with multiple sclerosis and MDP. Strychnine was present in significant amounts in the serum of patients with epilepsy, Parkinson's disease and MDP. The presence of nicotine and strychnine in significant amounts could be related to elevated tryptophan levels suggesting the synthesis of these alkaloids from tryptophan. Morphine was not detected in most of the disorders owing to low tyrosine levels noted in them. Na(+)-K+ ATPase inhibition noticed in most of the disorders could be related to decreased hyperpolarising morphinergic transmission and increased depolarising nicotinergic and strychinergic transmission. The role of morphine, strychnine and nicotine in the pathogenesis of these disorders in the setting of membrane Na(+)-K+ ATPase inhibition is discussed.

Isoprenoid pathway and free radical generation and damage in neuropsychiatric disorders.

Two substances which are products of the isoprenoid pathway, can participate in lipid peroxidation. One is digoxin, which by inhibiting membrane Na(+)-K+ ATPase, causes increase in intracellular Ca2+ and depletion of intracellular Mg2+, both effects contributing to increase in lipid peroxidation. Ubiquinone, another products of the pathway is a powerful membrane antioxidant and its deficiency can also result in defective electron transport and generation of reactive oxygen species. In view of this and also in the light of some preliminary reports on alteration in lipid peroxidation in neuropsychiatric disorders, a study was undertaken on the following aspects in some of these disorders (primary generalised epilepsy, schizophrenia, multiple sclerosis, Parkinson's disease and CNS glioma)--1) concentration of digoxin, ubiquinone, activity of HMG CoA reductase and RBC membrane Na(+)-K+ ATPase 2) activity of enzymes involved in free radical scavenging 3) parameters of lipid peroxidation and 4) antioxidant status. The result obtained indicates an increase in the concentration of digoxin and activity of HMG CoA reductase, decrease in ubiquinone levels and in the activity of membrane Na(+)-K+ ATPase. There is increased lipid peroxidation as evidenced from the increase in the concentration of MDA, conjugated dienes, hydroperoxides and NO with decreased antioxidant protection as indicated by decrease in ubiquinone, vit E and reduced glutathione in schizophrenia, Parkinson's disease and CNS glioma. The activity of enzymes involved in free radical scavenging like SOD, catalase, glutathione peroxidase and glutathione reductase is decreased in the above diseases. However, there is no evidence of any increase in lipid peroxidation in epilepsy or MS. The role of increased operation of the isoprenoid pathway as evidenced by alteration in the concentration of digoxin and ubiquinone in the generation of free radicals and protection against them in these disorders is discussed.