RESUMO
Background Anemia is one of the most common conditions that affect pregnancies, with dietary iron deficiency being its most common cause. Maternal anemia has been associated with increased risks of both maternal and neonatal adverse outcomes. This study aimed to analyze the maternal and neonatal outcomes in women with third-trimester anemia. Methods This was a retrospective report from a Pakistani public hospital. It included data records of the childbirths in the hospital, with at least one record that documented the hemoglobin (Hb) level in women in the first or second trimester and one in the third trimester. The duration of the study was from January 1, 2019 to June 30, 2019. Women with Hb level of <10mg/dL in the third trimester were categorized as anemic, and those with Hb level of >10mg/dL were categorized as non-anemic. Pregnancy outcomes were assessed for both mothers and babies. All data were processed through SPSS version 21.0 for Windows (IBM Corp., Armonk, NY). Results The study evaluated 235 (37.8%) anemic and 387 (62.2%) non-anemic women. Adverse maternal outcomes were compared between the two groups. In anemic women, gestational hypertension (56% vs. 27%; p: <0.0001), preeclampsia (65% vs. 25%; p: <0.0001), antepartum hemorrhage (32% vs. 19%; p: =0.0001), postpartum hemorrhage (79% vs. 28%; p: <0.0001), transfusions (94% vs. 5%; p: <0.0001), prolonged/obstructed labor (49% vs. 20%; p: <0.000), urgent induction of labor (24% vs. 2%; p: <0.0001), and urgent caesarean section (CS) (45% vs. 29%; p: 0.0001) were significantly more common as compared to non-anemic women. Adverse neonatal outcomes such as low birth weight (LBW) (59% vs. 29%; p: <0.0001), small-for-gestational-age (SGA) (73% vs. 23%; p: <0.0001), preterm delivery (39% vs. 15%; p: <0.0001), stillbirth (8% vs. 3%; p: 0.01), and early neonatal death (9% vs. 2%; p: 0.000) were associated more with anemia. There was no report of maternal mortality in either group. Conclusion: Anemia in the third trimester of pregnancy is associated with adverse maternal and neonatal outcomes including neonatal death. Efforts are required to ensure adequate maternal nutritional status in order to prevent poor outcomes.
RESUMO
Introduction Patients with congestive heart failure (CHF) readily present with electrolyte imbalance which commonly includes deficiencies of sodium, potassium, and magnesium. Hyponatremia occurs in advanced stages of CHF and is associated with adverse disease outcome-longer hospital stay, severity of CHF, and increased risk of mortality. Methods In this observational, single-center, prospective, case-control study adult patients admitted with clinical diagnosis of CHF were included after informed consent. Their demographic, clinical, and biochemical profile was attained. Patients with low serum sodium (hyponatremia) were grouped as "cases" and patients with normal serum sodium profile (normonatremia) were grouped as "controls". Factors associated with both groups and their hospital outcome were compared. SPSS for Windows version 16 (SPSS Inc., Chicago, IL, USA) was utilized. Results Hyponatremia (serum sodium <135 mmol/L) was present in 58/189 (30.7%) patients admitted with CHF. Younger patients with non-ischemic CHF, and history of previous diagnosis, treatment, and hospitalization due to CHF were more likely to be affected. Diabetic nephropathy, chronic kidney disease, salt-restricted diet, drugs including furosemide, spironolactone, and angiotensin-converting enzyme inhibitors, low serum potassium, and reduced GFR were also related to hyponatremia. Hyponatremic CHF patients showed adverse hospital outcome on all parameters including higher death rate (12% vs. 0.8%), longer duration of hospital day, and deranged blood pressures and severe CHF at the time of discharge. Conclusion Hyponatremic CHF patients are associated with prolonged hospital stay, more severe form of CHF, and deranged blood pressures. Overall, hyponatremia is an indirect clinical indicator of circulatory dysfunction and should guide a clinician for closer observation as outcomes could be poor. These patients also have higher in-hospital mortality risk.
