Maternal Mortality in a Tertiary Care Hospital: A 10-year Review.

BACKGROUND: Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. METHODS: This was a 10 year retrospective study. Epidemiological data was collected from the hospital register and maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed. RESULTS: A total of 120 maternal deaths occurred. Most maternal deaths occurred in the age group of 20-24 years, multiparous women (56.66%), women from rural areas (69.16%), illiterate women (65%), unbooked patients (83.33%), and patients of low socioeconomic status (83.33%). Direct causes accounted for 72.5% of maternal deaths where as 27.5% of maternal deaths were due to indirect causes. CONCLUSION: There is a wide scope for improvement as a large proportion of the observed deaths are preventable.

Comparison of safety and efficacy of papaya dressing with hydrogen peroxide solution on wound bed preparation in patients with wound gape.

OBJECTIVE: Indian papaya or Carica papaya is known to have de-sloughing and wound-healing properties due to the presence of protease enzymes. The present study was done to compare the efficacy and safety of papaya dressing with hydrogen peroxide solution for preparation of wound bed in patients of postoperative wound gape. MATERIALS AND METHODS: A randomized, open-labeled interventional study was carried out over a period of 8 months at a tertiary care hospital on post-caesarean section patients with wound gape. The efficacy parameters studied were duration of time required to induce development of healthy granulation tissue and total duration of hospitalization. Safety parameters studied were adverse effects reported by patients and development of hypersensitivity reaction. RESULTS: A total of 64 patients were enrolled, of which 32 patients received hydrogen peroxide dressing and 31 patients received papaya dressing (one patient withdrew after randomization). Time required to induce the development of healthy granulation tissue and total duration of hospitalization were 6.2±1.6 days vs 2.5±0.5 days and 19.2±5.8 days vs 12.92±4.6 days in papaya and hydrogen peroxide dressing groups, respectively. Both primary efficacy parameters were significantly shorter in papaya dressing group. The incidence of adverse effects like local irritation and itching were comparable in both groups and the difference was not statistically significant. CONCLUSION: Papaya dressing is more efficacious and equally safe as compared to hydrogen peroxide dressing when used for wound bed preparation in patients with postoperative wound gape.

Comparison of the efficacy and tolerability of telmisartan and enalapril in patients of mild to moderate essential hypertension.

BACKGROUND: Theoretically, angiotensin II receptor blockers (ARBs) have certain advantages over angiotensin-converting enzyme inhibitors, but the contribution of these advantages to the clinical effect of ARBs is not known. OBJECTIVE: To compare the efficacy and tolerability of telmisartan with enalapril in patients of essential hypertension. MATERIALS AND METHODS: Patients of mild to moderate hypertension were randomized to receive either 40 mg of telmisartan or enalapril 10 mg once a day orally for 12 weeks. At each visit, the systolic blood pressure (BP), diastolic BP and heart rate of each patient were recorded. Investigations such as hemogram hemoglobin, total leucocytes count (Hb, TLC), serum creatinine, serum glutamic oxaloacetic transaminase, serum glutamic pyruric transaminase (SGOT, SGPT) random blood sugar and urine examination were performed at baseline and after 12 weeks of the treatment period. RESULTS: The mean reduction in systolic BP in the telmisartan/enalapril group was 26.38 ± 10.98/26.74 ± 8.24 mmHg while the mean reduction in diastolic BP in the telmisartan/enalapril group was 14 ± 2.98/9.71 ± 4.23 mmHg, respectively, at 12 weeks. When the reduction in systolic BP in the two groups was compared, there was no significant difference between the groups (P > 0.05). However, the mean reduction in diastolic BP achieved with telmisartan at 12 weeks was significantly higher (P < 0.001) than that achieved with enalapril after the corresponding period. The overall frequency of adverse-effects was similar. However, in the enalapril group, the incidence of dry cough was higher as compared to that in the telmisartan group (11.43% vs. 0%, respectively; P < 0.05). CONCLUSION: Telmisartan produces a greater reduction in diastolic BP than enalapril and is free from the adverse-effect of dry cough that is commonly encountered with enalapril.