Trends of maternal mortality at a tertiary health care centre in India

Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy from any cause, related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.Methods: A retrospective study was conducted by reviewing the hospital records to study the maternal deaths and complication leading to maternal death over the period of one year from January 2019 to December 2019 in the department of obstetrics and gynecology, LTMMC and Sion Hospital.Results: The maternal mortality ratio in the present study 548/100000 live births and corrected MMR’s 190/live births. There were 49 deaths of 8093 live birth during the study period. The majority of deaths occurred in the 20-30 age group. Hemorrhage (22.4%) and hypertensive disorder (14.2%) are two most common direct cause of maternal deaths. 46.9% of maternal deaths occurred after 72 hours of death. Indirect cause accounts for 73.5%. Of these deaths and DIC with sepsis was the leading indirect cause of maternal deaths.Conclusions: Hemorrhage, hypertensive disorder, anemia and DIC with sepsis remain major cause of maternal deaths. Delay at primary level, by the patient and family contributed to higher maternal mortality. This requires more effort to educate, impart knowledge to recognize danger signs and seek urgent medical help and create awareness about the easy accessibility and availability of nearby health care facilities amongst the society.

Comparative analysis of maternal and fetal outcome in meconium stained amniotic fluid and clear liquor in primigravida

Background: The present study was undertaken to evaluate the significance of MSAF and its fetal outcome in parturients.Methods: A total of 121 pregnant women who had completed more than 37 weeks of gestation with live singleton pregnancy, spontaneous onset of labor and at term with adequate pelvis were included in the study. All (121) low risk primigravida with MSAF were studied to identify maternal and fetal outcome and compared with equal number of cases with clear amniotic fluid. Meconium stained cases were clinically classified into two groups- thin (54 cases) and thick (67 cases). MSAF on spontaneous or artificial rupture of membranes were monitored with fetal heart rate abnormality, 1- and 5-minutes Apgar score, NICU admissions and neonatal complications as outcome variables.Results: Overall incidence of meconium staining of AF during labour was 7.71%. The common fetal heart rate abnormalities i.e. bradycardia was seen in 36% in MSG. Apgar score of less than 7 was observed in MSG at 5 minutes in 5% of cases, in thick group. Major neonatal complication was birth asphyxia in MSG (18.18%) that was more in thick MSG (14.87%). MAS were observed in 6 cases in thick and 4 cases in thin meconium stained cases. NICU care was required in 18% cases in MSG and in control group it was required in 7% cases. Neonatal morbidity was more in newborn with thick meconium group (52%) compared to thin meconium group (20%).Conclusions: The present study confirmed that meconium staining of amniotic fluid adversely influences the fetal outcome.

A randomized controlled trial on lactoferrin versus ferrous sulphate for the treatment of mild to moderate iron deficiency anaemia in pregnancy

Background: One of the important factors associated with maternal and foetal complications during pregnancy is Anaemia. Various oral preparations of iron are available, and each has different bioavailability, efficacy and adverse effects. Lactoferrin is a naturally existing iron-binding multifunctional glycoprotein, and a member of a transferrin family, thus belonging to those proteins capable of binding and transferring iron. Lactoferrin has considerably less gastrointestinal side effects than ferrous sulfate and is very useful as well as promising alternative to ferrous sulphate.Methods: Prospective randomized controlled study. Total 100 females with 24 to 36 weeks of pregnancy with haemoglobin between 8 to 10 grams were included out of which 50 patients were given ferrous sulphate 200 mg BD and 50 patients were given lactoferrin 250 mg BD daily for 8 weeks. Various haematological parameters and the adverse effects of both the drugs were studied at registration, 4 weeks and 8 weeks and compared.Results: Thus, after this study authors can say that the rise in haemoglobin with lactoferrin was 1.58 g/dl while with ferrous sulphate it was 1.67 g/dl at 8 weeks. Adverse effects were much lesser in Group A taking lactoferrin compared to Group B.Conclusions: Thus, lactoferrin has the advantage over ferrous sulphate in having   less side effects and increasing the compliance and thus the efficacy of the drug compared to ferrous sulphate.

Budd Chiari syndrome due to inferior vena cava web complicating pregnancy in patient with bad obstetric history: an interesting case

Presenting an unusual case of 27 years old female who presented at 18 weeks of pregnancy with second trimester bleeding per vaginum. Patient had history of recurrent abortions on examination was found to have hypertension and thrombocytopenia. Usg done revealed severe oligohydramnios. Patient was managed conservatively but aborted spontaneously at 22 weeks of gestation. Post-abortionl on day 2 patient developed abdominal distension and liver function tests were found to be deranged. USG and CT abdomen and pelvis was done, which revealed Budd chiari syndrome due to inferior vena cava (IVC) web. This extremely rare condition is characterized by obstruction of inferior vena cava by membrane or fibrous band. This condition is diagnosed by radiological techniques which in our patient revealed classical findings of caudate lobe hypertrophy, non-visualization of hepatic veins, moderate hepatomegaly and spleenomegaly and multiple collaterals. Esophagogastroduodenoscopy done which revealed large varieces for which endoscopic variceal ligation was done. IVCgram and IVC plasty was done by interventional radiology department 6 weeks after abortion. The aim of this case report is to highlight an extremely rare cause of Budd Chiari syndrome and IVC web in patient with recurrent abortion with spleenomegly leading to thrombocytopenia. It is important to rule out other differential diagnosis in these patients like APLA, ITP.