Toxic metals in maternal blood, cord blood and meconium of newborn infants in Pakistan.

Toxic metals and deficiency/excess of trace elements can have adverse effects on health. The aim of this study was to quantify toxic metals lead, cadmium and trace elements zinc, copper, aluminium (Al) and Iron (Fe) levels in pregnant women, cord blood and meconium of new-born infants from industrial zones of Karachi, Pakistan. Analytical research was performed from 2011-2012 in low socio-economic pregnant mothers and newborn infants from 20 towns near Sindh Industrial Trading Estates, Federal B industrial area and Korangi industrial areas, Karachi, where environmental pollution was anticipated. Blood samples of pregnant women (n = 416), cord blood (n = 309) and meconium (n = 309) were analyzed quantitatively for metals and trace elements. Results indicated that mothers residing in steel towns were found to have the highest levels of lead. Meconium contained high levels of toxic heavy metals and trace elements compared to cord blood and maternal blood. Maternal blood toxic metals were present in high quantities. Therefore, safety measures should be taken when industrial waste is disposed of in order to prevent population contamination.

Risk factors for perinatal deaths in Pakistan.

AIM: The aim of this study was to identify the risk factors for perinatal deaths in Pakistan, where perinatal mortality is still very high. MATERIALS AND METHODS: This prospective cohort study was conducted in Sindh Government Lyari General Hospital, Karachi from 1 May 2006 to 30 April 2008. During this period, all perinatal deaths and each live infant delivered following every perinatal death (which were taken as controls) were enrolled. Demographic information, birthweight, booking status, associated obstetric risk factors, stillbirth or neonatal death and the cause of death were recorded. Univariate logistic regression was used to determine the effect of categorized weight, booking status, sex and the obstetric risk factors on perinatal death. RESULTS: A total of 1103 deliveries were conducted during this period with 119 perinatal deaths. Stillbirths constituted 68.9% while there were early neonatal deaths in 31.1% cases. Booking status, gestational age, weight of fetus and the presence of obstetric risk factors were found to have significant (P-value < 0.05) association with perinatal deaths. Among the obstetric risk factors, abruptio placentae was the commonest (13.4%) and the commonest cause of death was identified as birth asphyxia (44.5%). There was a strong association between birthweight and perinatal death. CONCLUSIONS: The high perinatal death rate in this study is comparable to other hospital-based studies and indicates the poor health status, inadequate prenatal and intranatal care and lack of services in our setup. In order to achieve the Millennium Development Goals-4, much work is needed to improve the quality of care, to identify high-risk cases and to carry out their proper management.

Control of postpartum and post abortal haemorrhage with uterine packing.

OBJECTIVE: To determine safety and effectiveness of uterine packing to stop hemorrhage in postpartum and post abortal cases. METHODS: Patients who delivered either vaginally or via Caesarian section who developed primary post partum haemorrhage and post abortal patients developing primary post partum haemorrhage refractory to conventional medical treatment, were included in the study. Packing was done using 8-10 meters sterilized gauze from the fundus to cervix and was left for 12-24 hours or removed earlier in cases of failure to control hemorrhage. Morbidity and effectiveness was assessed. RESULTS: Intractable primary hemorrhage was encountered in 20 patients of whom 2 had bleeding after caesarian section, 14 after vaginal delivery and 4 patients had post abortal haemorrhage. Uterine atony was the commonest cause. Failure of packing to control haemorrhage was seen in 3 cases. It was successful in 17 cases. CONCLUSION: Whether used early or late in the management of post partum haemorrhage, uterine packing is a safe, quick and effective procedure.