RESUMO
Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.
RESUMO
A 14 years old girl presented to the gynecology OPD with pain abdomen and huge abdominal lump since 2 months. On clinical examination, a large mass of 20x15 cm size was found extended upto the xiphoid process. Serum studies showed rise of CA-125 up to 406.9U/mL and LDH up to 310U/L. USG shows right ovarian cyst of 14.8x14.1x12.8 cm with internal calcification. MRI revealed a well encapsulated mass of 21x19x17cm with solid and cystic mass and upward peritoneal extension. Exploratory laparotomy was performed with right sided salpingo- ophorectomy with infracolic omentectomy, as the omentum appeared granular. She had an uneventful post-operative recovery. Subsequently HPE showed immature teratoma NORRIS grade 3 with co-existent peritoneal gliomatosis (grade 0). She is under regular follow-up and decided to give six cycles of combination chemotherapy with BEP at regional cancer hospital.
RESUMO
The rarest form of ectopic pregnancy is bilateral tubal ectopic pregnancy in which twining occurs with pregnancy in both the tubes. The fates of two pregnancies are independent of each other. We report a 28 years woman with out any high risk factor of ectopic pregnancy had spontaneous right sided un-ruptured tubal ectopic and left sided ruptured tubal ectopic pregnancy. The diagnosis of ectopic pregnancy was made on clinical suspicion and ultrasonography. The diagnosis of bilateral tubal ectopic was made during surgery and confirmed on histopathological examination. To avoid missing ectopic pregnancy a high index of suspicion is required and close examination of both tubes at the time of surgery even in presence of significant adhesion.