RESUMO
Missed abortion is one of the most important reproductive problem in obstetrics and family.According to the WHO annually 20-30 million abortions are developed in the world. The specialvplace has missed abortion, i.e. a condition in which a dead immature embryo or fetus is not expelled from the uterus for 2 months or more. When embryo died in uterus ‘’the dead fetus syndrome’’ develop in pregnant body. In the case of fetal demise that coagulopathy is caused most frequently by a combination of disseminated intravascular coagulation and subsequent hyperfibrinolysis. Therefore missed abortion influence to the women’s health, reproductive functions. Researchers on problem of abortion reported that frequency of missed miscarriage is equal 10-20% (Dobrokhotova). Of the total population 46.8% live in capacity Ulaanbaatar (2013). According to 2011-2013 health statistics of Maternity hospitals of UB city the incidence of missed abortion was 1032 (1.84) in 2001, 1034 (1.63) in 2012, 1644 in 2013. From this health statistics the missed abortion ratio is not decreasing.The research included 435 pregnant women, who attended Amgalan Maternity hospital in 2014. All pregnant women with missed miscarriage. We studied of obstetric history to mature research card with 17 group questions. Data were analyzed using SPSS 19 for Windows. Values were expressed as percentage. Clinical data were obtained retrospectively to conduct a baseline analysis for the variables of patient age, number of pregnancies, number of miscarriages, having work, work condition, ultrasound and hemostatic tests.According by our research has shown unigravida (gravida I)14.03, gravida II-88.7%, previous abortion 61%, miscarriage 25%, missed miscarriage 14%. From the study has shown the incidence of missed miscarriage according to number of pregnancy found that is increased with number of pregnancy and previous abortion were influencing of missed miscarriage. Diagnosis of missed miscarriage was established by ultrasound examination at the 6-7th weeks of pregnancy. By ultrasound examination absence embryo was 70%, 30% having embryo. All patients had coagulation tests performed. 58% patients had prolonged protrombin time. Partial thromboplastin time prolonged in 24% patients, of the 18% patients developed hypofibrinogenemia. Histological examination of the placenta was found the decidual inflammatory 56%, necrosis 40%, chronic inflammatory of endometrium 3%, oedematus of villii, chrion, decidual tissue 1%. Above inflammatory and circulation changes are the cause of missed miscarriage by our study. In summary, the results of this study show that a employment, season, a number of pregnancy, previous abortion were associated with increased risk of missed abortion.
RESUMO
To study some direct fees paid by a household of a hospitalized patient during the treatment at secondary or tertiary care hospitals.The study was conducted using cross-sectional design. The data was collected from 6 specialized clinical centers, 7 hospitals of provincial and regional diagnostic and treatments centers, and 6 district hospitals using the data of 1335 in-patients hospitalized during 2012-2013. The in- patients’ medical histories were processed using descriptive research methods by using specially designed cards to register the costs for medications and medical equipment. In addition, the questionnaire was used to collect the data on direct and indirect costs associated with hospitalization paid by individuals. Statistical data was analyzed using SPSS 21.0 software. 96% (1282) of total hospitalized patients were covered by health insurance. However, 28.4% of them paid for their drug treatment out-of-pocket. 62% of in-patients who paid for their own medicines responded that the medicines were written in their medical history but the hospitals were out of stock and therefore did not provide them to the patients. 3% of in-patients who paid for their medicines were reimbursed the costs of medicines. When comparing the informal costs associated with a hospital stay to the total household income, 23% of respondents said that those expenditures were high. While 54% of total costs spent by hospitals on diagnosis and treatment of in-patients were used for medicines, the in-patients’ out-of-pocket expenditures were higher in secondary care hospitals.Due to drug supply in secondary and tertiary care hospitals is insufficient to meet the needs for drug treatment; in-patients are required to spend a part of their household income to pay for drug treatment during their hospital stay.
