Maternal mortality in Bahrain 1987-2004: an audit of causes of avoidable death

The aim of this report was to establish the national maternal mortality rate in Bahrain over the period 1987-2004, to identify preventable factors in maternal deaths and to make recommendations for safe motherhood. There were 60 maternal deaths out of 243 232 deliveries giving an average maternal mortality rate of 24.7 per 100 000 total births. The main causes of death were sickle-cell disease [25.0%], hypertension [18.3%], embolism [13.3%], haemorrhage [13.3%], heart disease [11.7%], infection [8.3%] and other [10.0%]. In an audit of care, 17 [28.3%] out of 60 deaths were judged to be avoidable, nearly half of which were due to a shortage of intensive care beds. We recommend that a confidential enquiry of maternal deaths be conducted at the national level every 3 to 5 years

[Evaluation of the maternal death system in public facilities in the Tunis [1999-2004]]

We report the performance indicators in 2004 of a follow-up on the system for recording maternal deaths which was established in 1999. The system was operating in 69.8% of public hospitals, and 96% of maternal deaths investigations were completed. In 69.8% of maternal deaths there was a direct obstetric cause. Haemorrhage was the major cause of maternal death [30.8%], followed by eclampsia [11%]. The proportion of avoidable [certain or possible] deaths was 75.3%. There were problems in evaluation of risk presented by women and inadequate follow-up during the postpartum period and delay in appropriate treatment. Incomplete documentation and difficulty in ascertaining avoidability were problems faced by the regional follow-up committee

Study on glucose tolerance in pregnancy as a screening test and diagnostic tool for gestational diabetes mellitus

GDM is a common medical problem that results from an increased severity of insulin resistance as well as an impairment of compensatory increase in insulin secretion. GDM is associated with a variety of maternal and fetal complications. Controversy surrounds the ideal approach for detecting GDM, and the approaches recommended for screening and diagnosis are largely based on expert opinion. This study enrolled 51 pregnant women aged between 20 and 39 years old. All women were invited to do fasting and two hours postprandial blood glucose every two weeks, 2 hr. 75g OGTT every trimester. Plasma glucose measurements were performed with glucose oxidase method using semi-automated spectrophotometer [Biosystems 310]. Both normal and GDM cases have normal glucose tolerance in early weeks of pregnancy. However, after 24 weeks of gestation progressive increment of hyperglycemia was obviously observed in GDM cases. Suitable cutoffs in diagnosis of GDM in third trimester are 97 mg/dl for fasting; 174 mg/dl for 1 hour; and 141 mg/dl for 2 hour

[Determination of effectvie factors on preeclampsia severity; the application of classification and regression trees]

Despite advances in medical sciences, preeclampsia and eclampsia are still among chief causes of maternal mortality worldwide. In this study, we used classification and regression trees to investigate the role of certain inherent and maternity care factors in severe preeclampsia. This study was done on 1643 pregnant women admitted at 4 hospitals in Iran with one of the 53 maternity complaints were enrolled in this study during 2005. Variables of socioeconomic status, history of pregnancy and diseases, health care visits numbers awareness of warning signs, and the body mass index before pregnancy were recorded in the analysis model as predictors, and preeclampsia severity was entered as the dependent variable. A non-parametric method, known as the classification and regression tree was used to predict the studied consequence. Model validation was done using subsets of the study sample. The results were compared with logistic regression analysis. The incidence of preeclampsia among the studied patients was 5.2%. In model 1, variables of frequent headaches and epigastric pain during pregnancy, the number of previous pregnancies, and the amount of maternal care received were predictive of severe preeclampsia. In model 2, only frequent headaches and the number of previous pregnancies were found predictive. Sensitivity for model 1 and 2 was 47.8% and 39.1%, respectively, and specificity was 96.8% and 93.6%, respectively. In logistic regression analysis, only frequent headache was related to severe preeclampsia [OR=2.5, CI 95%: 1.3-5.0]. This study showed that using of variables that can be measured during maternity care visits to predict severe preeclampsia. Regarding the simple interpretation of tree models and their application in clinical decision making, which can be used in different levels of the health care system

Maternal and foetal complications in neglected transverse lie

To see the frequency of foetal and maternal complications of neglected transverse lie at a tertiary care hospital. This prospective study was conducted at Gynae B Unit Department of Gynaecology and Obstetrics Lady Reading Hospital Peshawar, Pakistan, from 1st January I997, to 31st December I997. Eighty-seven Patients presenting with neglected transverse lie were included in this study. Detail information regarding name, age, address, parity, past history, physical, abdominal and vaginal examination findings, general management and specific managements like internal podalic version, caesarean section, foetal complications and maternal complications of neglected transverse lie were entered into a predesigned proforma for the purpose. The maternal complications in order of frequency were dehydration 86.5% [n=77], pyrexia 41.37% [n=36], wound sepsis 31.03% [n=27], antepartum haemorrhage [APH] 16.09% [n=14] and postpartum haemorrhage [PPH] 14.94% [n=13] and maternal death 1.14% [n=1]. The foetal complications of neglected transverse lie were fresh stillbirth 55.17% [n=48], prematurity 14.94% [n=13], alive with poor Apgar score 10.34% [n=9], macerated stillbirth 8.04% [n=7], neonatal death 3.44% [n=3], post mature and alive 2.29% [n=2] and congenital malformation 2.29% [n=2]. Emergency lower segment caesarean section was done in 58 [66.7%] cases, while internal podalic version followed by breech extraction was done in 21 [24.1%] cases. Neglected transverse lie is associated with various maternal and foetal complications. Prenatal examinations are essential to reduce the unfortunate complications of transverse lie

Maternal mortality: a 10-year study at Nishtar-Hospital Multan

To analyse causes of maternal deaths and to identify preventable causes leading to this tragedy in our setup. An analytical, hospital-based study. Department of Obstetric and Gynaecology, Nishter Hospital Multan from June-August 2005. During the study period retrospective data was collected for period of 10 year from January 1995 to December 2004. This data was analyzed in order to determine the Maternal Mortality Rate [MMR], causes of death and characteristics of the mothers who died including her age, parity and whether they were booked or unbooked. A total numbers of 30031 deliveries took place during the study period and there were 178 maternal deaths with maternal mortality rate of 593/100,000 LB [live births]. 7[3.9%] patients were below the age of 20, 74[41.5%] were in the age group of 21-30 and 82[46%] in 31-40 years age range. 15[8.42%] were above the age of 40. Most of them [69%] were grand multiparas [Parity >5]. The major causative factors were haemorrhage 63[35.4%], eclampsia 41[23.03%], sepsis 25[14.04%], anaemia 18[10.1%], hepatic encephalopathy 14[7.9%], abortion 11[6.2%]. Majority of the patients were unbooked and presented in the hospital very late. A high proportion of potentially preventable maternal deaths indicate the need for improvements in education for both patient and health care provider. The provision of skilled care and timely management of complications can lower maternal mortality in our setup

Maternal mortality in a tertiary care teaching hospital

Every women can experience sudden and unexpected complications during pregnancy, child birth and just after delivery. Although high quality accessible health care has made maternal death a rare event in developed countries, these complications can often be fatal in the developing world. Safe motherhood as a priority for action can not be identified without properly assessing maternal mortality. The aims of this study were toanalyse the causes of maternal mortality and thus determine the preventable factors responsible for maternal deaths. Descriptive study. This study was carried out at DHQ Hospital Faisalabad from June 2002 to December 2004. Patients were admitted through emergency and Obstetrics and Gynaecology out-patient department. Patient age, parity, education, socio-economic status, antenatal booking level of care, whether come from rural or urban area, and distance from hospital were noted. Contributing and causative factors leading to maternal mortality were evaluated. All these information were recorded on a specially design Performa. Results: Total number of maternal deaths recorded during 2 V[2] years study period were 70. The causative factors of maternal mortality were sepsis 19[27%], post partum hemorrhage 18 [25.7%], eclan‡sia 11[15.7%], pulmonary embolism 7[10%], liver disease 6[8.5%] heart disease 5[7.1%], anaesthetic complications [3][4.2%] and one death [1.4%] due to miss match] blood transfusion in a private hospital. Patient's age ranged between 18-45 years. 40[57.1%] patients were <31 years old. 15[21.4%] patients were prmigravida or Para one and 55 [78.5%] were multigravida or multi para. All patients were unbooked, uneducated and belonged to poor socio-economic setup. Majority of them came from distance between 20-60 km. 40[57.1%] were attended by traditional birth attendant, 18 [25.7%] by lady health visitors, [3][4.2%] by doctors in private clinics and 9[12.8%] received no level of care. Sepsis, obstetrical hemorrhage, eclampsia and pulmonary embolism are major causative factors of maternal mortality

Diagnostic evaluation of [pregnant] patient with acute abdominal pain. The role of imaging modalities

Assess the pregnant patient with other causes of pain not related to pregnancy presenting to emergency department, using different imaging modalities and to review the basic principles of radiation safety. During 18 months, 55 pregnant patients were referred randomly from emergency department for evaluation of abdominal pain prospectively enrolled into our study. Pregnant with pregnancy-related causes such as premature contractions and other related causes were excluded. US evaluation for all patients including a careful search for gall bladder, kidneys, pancreas and appendix related causes. Clinical, surgical, and/or imaging follow-up data were obtained in some patients. Out of 55 patients, 28[50.90%] were confirmed to have an eight with gall-bladder stones [14.54%] five with hydronephrosis related to pregnancy [9.08%], two of renal calculi [3.63%] one had bowel obstruction and pancreatitis [1.81%],seven with pyelonephritis[12.72%], and four with appendicitis [7.27%]. There is an increased incidence of acute abdomen during pregnancy though clinical pictures sometimes get blunted due to gravid uterus. Early diagnosis followed by surgical intervention if needed decrease morbidity for both mother and fetus, also enhances our knowledge of the principles of radiation safety

Reasons for Zahedan's women for not referring to delivery ward for child delivery

Maternal and infantile mortality are important health indicators of every society due to pregnancy incidents. Maternal and infant mortality and also neonatal tetanus incidents have direct relation with delivery condition. Neonatal tetanus and mortality among mothers and newborns have direct relation with delivery in non-hygienic condition. Non-hygienic delivery rate is very high in Sistan and Baluchestan province. Even in the city of Zahedan with a population of 450000, where as access to maternity hospital is possible for all residents of this city, 50-60% deliveries take place at home. In this study, the reasons of women were investigated for not referring to maternity hospital for delivery. The method of research was case control. Case group was selected from those women whose last deliveries had not taken place in maternity hospital and referred to health centers to vaccinate their children [no. 482]. Control group was selected randomly among women who referred to hospital to give birth [no. 198]. Hospital's high fee [38%], easy delivery at home [19%], fear from cesarean and drugs adverse reaction [13%] were the most prevalent reason for not giving birth at hospital. Employment and literacy rates of those women who had given birth at home were lower than control group. They were mainly from Suni and Baluch ethnic. In order to minimize the cultural barriers of referring to maternal hospital, we advise the respectful officers, to make insurance public, lower the treatments fee, held training programs and provide hygienic conditions with low cost for out of hospital deliveries

Comparison between the effect of glycopyrrolate and atropine with and without cimetidine on gastric volume and pH in emergency cesarean section

The most common cause of maternal mortality is aspiration of gastric contents. So, many methods have been advocated to decrease or prevent this risk. This study was designed to compare the effects of intramuscular atropine or glycopyrrolate either alone or in combination with oral cimetidine on the pH and volume of gastric contents at the time of induction of general anesthesia in 50 obstetric patients undergoing emergency cesarean section. They were classified into five groups, 10 each. Each group received different combinations of atropine, glycopyrrolate and cimetidine. The fifth group was used as control. It was found that atropine alone elevated the pH to the alkaline side with no effect on gastric volume compared to the control group. Adding cimetidine raised the pH with no significant effect on gastric volume. Glycopyrrolate alone caused a significant reduction in the volume of gastric contents compared to the control group without affecting the gastric pH significantly. Cimetidine combined with glycopyrrolate resulted in significant elevation in the pH value and significant reduction in the gastric contents volume. So, this study confirmed the importance of premedication with drugs that raise the pH and reduce the gastric volume in susceptible obstetric females and the most effective combination in this respect was premedication with intramuscular glycopyrrolate and oral cimetidine