Cases Of Maternal Death Research Articles

To Study the Incidence & Various Causes of Maternal Mortality in OBGY Dept

Background & Methods: The aim of the study is to study incidence & various causes of maternal mortality in OBGY Dept. All causes of maternal mortality particularly direct causes of maternal mortality for which management usually involves maternity care professional. Convulsion during pregnancy or in the 1st - 10 days postpartum together with at least two of the following features within 24 hrs after convulsion. BP> 170/110 mmHg, proteinuria > 1 + on random dipstick or > 0.3 g in 24 hours, thrombocytopenia <100x109/L increased aspartate aminotransferase > 42 u/I.Results: 37.32% Maternal Death occurred in Primi Patients out of 418 cases of Maternal Death. 50.25% Maternal Death occurred in direct cases out of 400 cases. We found ANC 84.50% & PNC 15.50%. We found maximum mortality in Toxemia (35.25%), followed by Severe Anemia (13.5%).Conclusion: Age wise Mortality is more in 21-30 yrs, i.e. 65.5% & teen age 15-20 yrs mortality is 24.75%. 50.25% cases were Direct & 49.75% cases were referred from peripheral areas. Out of all cases 84.50% cases reported with ANC & 15.50% cases PNC. According to my observation cause of deaths are – 35.25% due to eclampsia/ toxemia/PIH, 27.5% cases due to Severe anemia/APH/PPH & remaining due to septicemia, Abruptio/Ectopic/Hepatic coma/Dengue/HIV/Ruptured Uterus etc.

Uterine rupture: Epidemiology, Risk Factors and Maternal-Fetal Prognosis at the Bougouni Reference Health Center

Introduction: the objective of this study was to study the epidemiological aspects, risk factors and maternal-fetal prognosis of uterine rupture in the Gynecology-Obstetrics Unit of the CSRéf of Bougouni Methodology: We carried out a case-control study from January 1 to December 31, 2019 in the Gynecology-Obstetrics Unit of the Bougouni Reference Health Center. All patients treated in the uterine rupture department were included and two controls (delivery without rupture) for one case (uterine rupture). The data were entered and analyzed on SPSS version 21 software. The significance threshold has been set at 5%. The association between 2 qualitative variables was studied by the Chi². Results: At the end of our study, we had recorded 43 cases of uterine rupture out of a total of 1161 deliveries, i.e. a frequency of 3.7%. The average age of the cases: 30.77 ± 2 years with extremes of 18 and 40 years compared to 26.01 ± 1 years for controls with extremes of 14 and 42 years. Ninety-five percent of our patients for the cases were out of school compared to 86% for the controls, 97% were housewives compared to 82% for the controls. Risk factors were dominated: caesarean section scar (p=0.038); OR=2.99, non-follow-up of pregnancy (p=0.002) and residence in a rural area (p=0.000) and intergenerational interval ≤ 2 years (Chi-square = 9.1735; p = 0.002). The maternal-fetal prognosis is reserved with 1 case of maternal death (2.3%) and 28 cases of perinatal death (65.1%). Keywords: Uterine rupture, Risk factors, maternal-fetal prognosis, case-control study.

The Effectiveness of CATIN Class on Pregnancy Readiness of Prospective Brides in The Working Area of Citangkil 2 Health Center, Cilegon City

Prospective brides and grooms are a strategic target group in efforts to improve their health before pregnancy. Before the wedding, many prospective brides and grooms do not have enough knowledge and information about reproductive health in a family, so that after marriage pregnancies are often not planned well and are not supported by optimal health status. The number of marriages in Indonesia in 2023 will reach 1.58 million and 68,185 will come from Banten Province. Maternal mortality still reaches 127 cases of maternal death per 100,000 births and the incidence of anemia in pregnant women is 9.2% in 2023. The aim of this research is to determine the effectiveness of prospective brides and grooms or CATIN (Calon Pengantin) classes on the pregnancy readiness of prospective brides in the Industrial Area of ​​the Citangkil 2 Community Health Center, Cilegon City. Research methods is qualitative research. Population in this study were prospective brides and grooms who registered at KUA in July 2024 in the Citangkil 2 Health Center Working Area, Cilegon City, totaling 12 informants, consisting of 10 Catins and 2 expert informants from KUA and Health officers. There is an influence of information sources related to the socialization of the catin class program from KUA officers and Community Health Center Health Workers on the pregnancy readiness of the prospective bride and groom and knowing the attitude of the prospective bride and groom, the attitude of the KUA officers and the attitudes of health workers who take part in the catin class. There is a change in attitude after participating in the catin class service.

Analysis of Spatial Distribution of Maternal Death Cases in the Special Region of Yogyakarta Province

Maternal mortality is an important indicator of improving health in a country which is included in the target of achieving the Subtainable Development Goals (SDGs). The Maternal Mortality Rate (MMR) in Indonesia in 2018 was still high at around 305/100,000 KH. Maternal mortality in the Yogyakarta Special Region Province experienced a significant increase in 2021. Objective: to analyze the Maternal Mortality Rate (MMR) in the Yogyakarta Special Region Province and determine the relationship between spatial accessibility of Community Health Centers. Method: This is a quantitative descriptive study to see the pattern of distribution of maternal mortality cases using GIS using ArcGis. Results: Maternal deaths in 2020-2022 have a spreading pattern with the highest cases being in Banguntapan sub-district and the distribution of health centers has been evenly distributed in each sub-district. Conclusion: Maternal death cases occur almost in all sub-districts, with a widespread distribution pattern. The highest case in the last three years occurred in 2021 due to exposure to Covid-19. The distribution of health centers is evenly distributed, but hospitals are still concentrated in Sleman district and Yogyakarta city.

Asuhan Kebidanan Komprehensif pada Ny. M di Puskesmas Slawi Kabupaten Tegal Tahun 2023 (Studi Kasus Anemia Ringan dengan Penerapan Pijat Oksitosin)

The Maternal Mortality Rate (MMR) in Tegal Regency has increased drastically since the Covid-19 pandemic. The number of maternal deaths in Tegal Regency in 2021 and 2022 was recorded at 30 deaths each year. Meanwhile, in 2023 until the end of June, there were 9 cases of maternal deaths. Based on data obtained from the Slawi Health Center in 2023, there were 142 cases, including high-risk pregnant women, with causes of age, pregnancy spacing, maternal height less than 145 cm, grandemultipara, KEK, hypertension, history of CS, gemelli, and fetal abnormalities. For anemia itself, there were 34 cases. The purpose of this case study is to obtain a real picture and experience in providing comprehensive midwifery care to Mrs. M at the Slawi Health Center, Tegal Regency in 2023 (Case Study of Mild Anemia with the Application of Oxytocin Massage). This study uses a case study approach. The subjects of the study were pregnant women Mrs. M is 29 years old with Mild Anemia. Data was taken from September to November 2023. Data was taken using interviews, observations, and documentation, the results during pregnancy the subject accepted to have an Hb check, and the results of the subject at the 3rd visit Hb increased and was normal. Pregnant women with anemia can cause bleeding, premature birth, and death. Suggestion: If the same case is found, collaboration with a doctor is needed during pregnancy until postpartum, in addition it is necessary to involve the family, especially children during pregnancy and after the baby is born.

Maternal Death Due to Lymphocytic Hypophysitis: A Case Report

Lymphocytic hypophysitis is a rare condition characterized by lymphocyte and plasma cell infiltration, leading to fibrosis and functional impairment of the pituitary gland. Although lymphocytic hypophysitis is associated with pregnancy, its diagnosis may be challenging in pregnant women owing to unclear symptoms of pituitary dysfunction. Lymphocytic hypophysitis can lead to serious complications, including a sudden death; however, no case of maternal death has been reported in Korea. This study presents a case of maternal death after childbirth. The deceased had a history of hypertension, obesity, hypothyroidism, and gestational diabetes and died suddenly the day after the emergency cesarean section. Notably, no other pregnancy-related complications were observed. Histopathological examination of the pituitary gland confirmed lymphocytic hypophysitis. This case report emphasizes the requirement of clinical awareness and underscores the significance of examining the pituitary gland during autopsy investigations of maternal deaths.

An Investigation into how Primary Care Nurses Practices affect clinical competence in Emergency Maternal Obstetric and Newborn Care skills in Nakuru County

To reduce the risks of maternal morbidity, mortality and newborn death worldwide, the use of high-quality emergency obstetric and new born care (EMONC) was proposed to ensure women and their babies receive high-quality care. The government of Kenya with non-profit health programs have jointly invested resources with the aim of achieving SDG’s goal of zero rating maternal and neonatal death cases in the country. Despite these efforts, maternal and neonatal death cases have not reduced significantly. Most of the contributing factors to the deaths occur in the lower levels of the health care delivery system. Majority of the health care providers at these levels are the primary care nurses. It is on this background that the study sought to investigate how primary care nurses practice affect clinical competency in emergency maternal, obstetric, and new born care skills in Nakuru county. Madeleine Leininger’s Transcultural Theory of Nursing anchored the study. It deployed correlational cross-sectional survey design, targeting midwives and nurses in 184 KEPH level II and III facilities in all the 11 sub counties in Nakuru County. The study used stratified sampling technique to sample 126 health facilities distributed in every Sub County. A sample size of 196 primary health care nurses from the sampled facilities were involved. Key informant interview and questionnaires were used to collect both qualitative and quantitative data. To analyze data, SPSS version 26 was used to generate inferential and descriptive statistics, correlation analysis was carried using multiple regression model to ascertain the relationship between dependent and independent variables. Results found that Maternal and newborn care practice was found to have a significant positive relationship with competence in EmONC skills. (P<0.05). This was achieved through clean and safe delivery, thermal care and cord care which were carried out in KEPH level II and III facilities. It was concluded that maternal and neonatal care practices had positive significant relationship with competent EmONC. The study advised that the practice of fundamental maternal and newborn care has to be improved. The primary care nurses should be culturally competent in engaging the community members. Through community-based health care efforts, mothers need to be sensitized about delayed bathing, umbilical cord care, feeding, and thermal care for newborns. Further, County Government of Nakuru should support programs that enables primary health care nurses pursue maternal and neonatal care courses. County Government of Nakuru should ensure ambulance services are easily accessible to all, equipment availability at all time, consistent supply of all drugs needed and the need to create awareness among women, family and community members on newborn and early neonatal care

The cost of inaction: a global tool to inform nutrition policy and investment decisions on global nutrition targets.

At present, the world is off-track to meet the World Health Assembly global nutrition targets for 2025. Reducing the prevalence of stunting and low birthweight (LBW) in children, and anaemia in women, and increasing breastfeeding rates are among the prioritized global nutrition targets for all countries. Governments and development partners need evidence-based data to understand the true costs and consequences of policy decisions and investments. Yet there is an evidence gap on the health, human capital, and economic costs of inaction on preventing undernutrition for most countries. The Cost of Inaction tool and expanded Cost of Not Breastfeeding tool provide country-specific data to help address the gaps. Every year undernutrition leads to 1.3 million cases of preventable child and maternal deaths globally. In children, stunting results in the largest economic burden yearly at US$548 billion (0.7% of global gross national income [GNI]), followed by US$507 billion for suboptimal breastfeeding (0.6% of GNI), US$344 billion (0.3% of GNI) for LBW and US$161 billion (0.2% of GNI) for anaemia in children. Anaemia in women of reproductive age (WRA) costs US$113 billion (0.1% of GNI) globally in current income losses. Accounting for overlap in stunting, suboptimal breastfeeding and LBW, the analysis estimates that preventable undernutrition cumulatively costs the world at least US$761 billion per year, or US$2.1 billion per day. The variation in the regional and country-level estimates reflects the contextual drivers of undernutrition. In the lead-up to the renewed World Health Assembly targets and Sustainable Development Goals for 2030, the data generated from these tools are powerful information for advocates, governments and development partners to inform policy decisions and investments into high-impact low-cost nutrition interventions. The costs of inaction on undernutrition continue to be substantial, and serious coordinated action on the global nutrition targets is needed to yield the significant positive human capital and economic benefits from investing in nutrition.

Molecular Docking and Pharmacokinetic Studies of Moringa oleifera As Angiotensin-Converting Enzyme Inhibitors

Background: Hypertension in pregnancy is a vascular disorder that occurs before pregnancy or arises during pregnancy that there were 30% of cases of maternal death. Moringa oleifera's potential to lower blood pressure can be utilized as an alternative antihypertensive during pregnancy, minimizing the risk of preeclampsia. Objective: The purpose of this study was to determine the molecular target of Moringa oleifera is intended to optimize pharmacodynamic activity based on the interaction pattern of the compounds with the ACE inhibitor (PDB ID: 1O86). Methods: Molecular docking is carried out using Autodock 4.0 program (AutoDock Tools). Results: According to the binding energy value and ACE inhibitory interaction, a-Rhamnopyranosyl, b-Sitosterol, and Sinalbin are prospective Moringa oleifera compounds as alternative antihypertensive. These potential compounds can inhibit ACE with binding energy -8.23; -9.27; -9.14 kcal/mol. Pharmacokinetic predictions reported that the potential compounds are absorbed in the intestine and indicates as molecules are tightly bound to plasma proteins and, as well as CYP3A4 and CYP2C9 inhibitors. The prediction of toxicity indicates that the potential compounds are classified as drug-induced acute liver failure with low carcinogens. Conclusion: a-Rhamnopyranosyl, b-Sitosterol and Sinalbin can be suitable lead compounds for synthetic drugs for antihypertensive agents.

MIDWIVES' PERCEPTIONS OF PREECLAMPSIA SCREENING

Background: Preeclampsia-related maternal mortality is a persistent issue globally, including in Indonesia. The International Federation of Gynecology and Obstetrics (FIGO) recommends universal preeclampsia screening in obstetric services. In Indonesia's NTT Province, pregnant women are screened based on guidelines in the MCH book. Sikka Regency mandates midwives to use the KSPR and MCH manuals for risk factor screening In 2022, 154 out of 9,685 screened pregnant women exhibited signs of preeclampsia risk factors. Despite the reduction in maternal deaths in Sikka Regency, the number of deaths directly linked to preeclampsia increased from one in 2021 to four in 2022. Notably, at Watubaing Public Health Center, two cases of maternal death were specifically attributed to preeclampsia. This underscores a significant gap in midwives' perceptions and clinical practices, elevating maternal mortality risk. This study explores midwives' perceptions of preeclampsia screening. Method: Qualitative research with a phenomenological approach at Watubaing Public Health Center involved three informants selected through purposive sampling, meeting the inclusion criteria. Data collection, conducted from April to July 2023, comprised in-depth semi-structured interviews that were subsequently analyzed thematically. Results: Midwives’ expressed divergent opinions on preeclampsia screening, yet a consensus prevailed on its crucial importance. Conclusion: Midwives' perceptions of preeclampsia screening in ANC services are significantly shaped by internal and external factors, including knowledge and experience.

The Need for Gynecological Ultrasound Examination on IUD Acceptors

Maternal Mortality Rate (MMR) signifies the number of women who perish due to pregnancy-related complications or their treatment per 100,000 live births, with septic shock emerging as a notable contributor. One such complication linked to septic shock is the rare but perilous translocation of intrauterine devices (IUDs), leading to potential uterine perforation. A recent case of maternal death underscored the urgency of prompt intervention in intraabdominal IUD translocations, with the delay stemming from the refusal of necessary surgical procedures. This tragic incident emphasizes the critical need for timely detection and management of IUD translocations to avert life-threatening complications. Integrating routine gynecological ultrasound examinations to assess uterine shape for prospective IUD acceptors and promoting informed consent through engagement with family members, community leaders, and policymakers is essential in mitigating the risk of maternal mortality associated with such complications.

Obstetric Evacuations Received At the "Major Moussa Diakite" Referral Health Centre in Kati, Republic of Mali

The organisation of the evacuation referral system is an important strategy for reducing maternal and perinatal mortality in Mali. Objective: To study obstetric evacuations received in the gynaecology and obstetrics department of the "Major Moussa DIAKITE" referral health centre in Kati. Method: We conducted a cross-sectional, descriptive and analytical study. Data were collected retrospectively and prospectively over a 12-month period (from 1 January to 31 December 2020). Sampling was exhaustive and included all cases of obstetric evacuation received and managed on site during the study period. Results: Out of a total of 3050 deliveries, we received and managed 352 cases of obstetric evacuation, representing a frequency of 11.5%. The average age of the patients was 25 years, with extremes of 15 and 44 years, although the 20-34 age group was dominant, accounting for 73.6% of cases. The majority of evacuees were housewives (86.4%), married (92%), nulliparous and primiparous (52%). Dystocic labour was the most common reason for evacuation (51.1%), followed by ante-partum haemorrhage (13.4%). Nearly nine out of ten women evacuated came from Community Health Centres (89.8%) and the most common means of evacuation was by ambulance (52.1%). The average time from admission to the start of care was 26.5 minutes, with extremes of 3 and 50 minutes. Delivery by the vaginal route was carried out in almost eight out of ten cases (79%). Newborns were resuscitated alive (7.9%); stillbirths were fresh (3.7%) and stillbirths were macerated (06%). We recorded 2 cases of maternal death (0.6%) and the causes of maternal death were haemorrhage due to uterine rupture and eclampsia. Conclusion: The improved organisation of the evacuation referral system in our facility has improved the maternal and, above all, foetal prognosis of obstetric evacuations, but more needs to be done.

Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis.

To assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg. A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analyses. Primary outcomes included incremental cost per quality-adjusted life-year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth, maternal death, neonatal death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000 per QALY. Treating chronic hypertension in a population of 180,000 pregnant persons at mild-range blood pressures, compared with severe-range blood pressures, resulted in 14,177 fewer cases of preeclampsia (43,953 vs 58,130), 11,835 of which were cases of preeclampsia with severe features (40,530 vs 52,365). This led to 817 fewer cases of SMM (4,375 vs 5,192), and 18 fewer cases of maternal death (102 vs 120). Treating at a lower threshold also resulted in 8,078 fewer cases of preterm birth (22,000 vs 30,078), which led to 26 fewer neonatal deaths (276 vs 302) and 157 fewer cases of neurodevelopmental delay (661 vs 818). Overall, treating chronic hypertension at a lower threshold was a dominant strategy that resulted in decreased costs of $600 million and increased effectiveness of 12,852 QALYs. Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.

TEMPORARY REMOVAL: Mortalité maternelle et prise en charge par les services d’urgence en France 2016–2018

In France, 272 maternal deaths occurred during the period 2016-2018, of which 131 were initially treated by healthcare professionals not specialized in obstetric. Fifty-six files were excluded because they did not concern emergency services or because there was insufficient data to allow analysis. Seventy-five cases of maternal deaths initially treated by emergency services (in-hospital emergency department (ED) or emergency medical ambulance (SAMU)) were analyzed. Fifty-six cases were treated by the SAMU and 22 by an ED (both in 3 cases). The causes of death were 20 cardiovascular events, 18 pulmonary embolisms, 9 neurological failures and 8 hemorrhagic shocks. The event occurred during pregnancy in 48 cases (64%) and during per or postpartum period in 27 cases (36%). The motivations for consultation at the ED were mainly pain (n = 9), respiratory distress (n = 6) or faintness (n = 3). The reasons for calling emergency dispatching service (SAMU) were cardiorespiratory arrest in 32 cases (57%) and neurological failure (coma or status epilepticus) in 6 cases (11%). Among the 56 patients treated outside the hospital, 17 died on scene and 39 were transported to a resuscitation room (n = 13), a specialized department (n = 13), an obstetrics department (n = 8) and less often in the ED (n =2). This was considered appropriate in 35 out of 39 cases (90%). Concerning the 75 files analyzed (ED and SAMU), death was considered unavoidable in 37 cases (49%) and potentially avoidable in 29 cases (38%) (maybe = 23, probably = 6). Avoidability could not be established in 9 cases. Among the 29 potentially avoidable deaths (38%), one of the criteria of avoidability concerned emergency services in 14 cases (ED = 9, SAMU/SMUR = 5, 18% of the files studied). ED’s cares were considered optimal in 11 cases (50%) and non-optimal in 11 cases (50%). SAMU’s cares were considered optimal in 45 cases (80%).

Perineal Wound Treatment with Wound Healing Process on Knowledge of Post Partum Mothers at the Bissappu Bantaeng Community Health Center

Maternal Mortality Rate is an important indicator in assessing health status. Maternal Mortality can be used in monitoring deaths related to pregnancy. This indicator is influenced by general health status, education and services during pregnancy and childbirth. The sensitivity of MMR to improvements in health services makes it an indicator of the success of health sector development. Cases of maternal death include deaths of pregnant women, giving birth and postpartum women. Perineal tears generally occur in the midline and can become extensive if the fetal head is born too early, the angle of the pubic arch is smaller than normal, the fetal head passes through the pelvic inlet with a size that is larger than the circumferential suboccipitobregmatica. A perineal wound is an injury to the urogenital diaphragm and leftator ani muscle, which occurs during normal delivery, or delivery with an instrument, and can occur without injury to the skin of the perineum or vagina, so it is not visible from the outside. The aim is to prove the relationship between post partum mothers' knowledge about perineal wound care and the wound healing process. This research method is an analytical survey with a cross sectional approach, the research population is all 32 post partum mothers at the Bissappu Community Health Center. The sampling technique in this research was carried out using a total population technique. The results of the study found that of the 32 respondents, the majority of respondents' knowledge about perineal wound care was sufficient, namely 15 people (46.9%) and the minority had good knowledge, namely 8 people (25%), normal wound healing, namely 12 people (37.5%) and the fast minority, namely 9 people (28.1%). Chi-Square test results (person Chi-Square) with a p value of 0.00 < α=0.05 where H0 is rejected and Ha is accepted. The conclusion is that there is a significant relationship between maternal knowledge about perineal wound care and the wound healing process.

Clinical Characteristics, Laboratory, Maternal and Fetal Outcomes in Pregnancy with Covid-19 at RSUP dr. M. Djamil Padang

Introduction : The data obtained from various studies about covid-19 conducted in severalhospitals in the world are currently considered not sufficient to provide a clinical picture thatoccurs in pregnancies with Covid-19 infection. The aims to provide an overview of the clinical,laboratory, maternal and fetal outcomes in pregnancy with Covid-19 infection at dr. M. DjamilPadang.Methods: This study used a descriptive design with data collection starting from March 01,2020 - March 31, 2021 based on medical record data. Carried out in a single center at RSUPdr. M. Djamil Padang in pregnant patients with confirmed Covid-19 by PCR examination.Results: Total 136 pregnant patients confirmed Covid-19 by PCR examination. Most of thesymptoms were asymptomatic (47.1%) and without any comorbidities (76.5%). There were 3patients who experienced critical symptoms (2.2%). Maternal mortality was found at 2.3% andfetal death 4.7%. The values of d-dimer and NLR were found increasing significantly,2025.35±1392.18 for d-dimer and 6.39±4.43 for NLR. Pregnancy terminations done for 77.9%patients with cesarean section is the most method (83%). There were 4 cases (3.8%) of babiesinfected with Covid-19 from mothers who had pregnancy terminations.Conclusions: Most cases had asymptomatic clinical symptoms (47.1%). There are 2.3%cases of maternal death and 4.7% cases of fetal death. Most of the pregnancy terminationswere performed by cesarean section (88%). On laboratory examination, there was a significantincrease in maternal d-dimer (2,025.35±1.392.18) and NLR (6.39±4.43) in pregnancies withCovid-19.

Multi-organ dysfunction and outcomes in pregnancy associated COVID-19 infection – descriptive review of pathological findings

Objective(s)Comparative clinical and morphological characterization of lesions of the vascular and nervous system in cases of maternal death associated with COVID-19.Study designThe study included autopsy in 12 cases of maternal death with a positive intravital result for SARS-CoV-2 by reverse transcription polymerase chain reaction. For histopathology, tissue samples were taken from the internal organs of each patient. Pieces of organs were fixed and stained according to the standard protocol. The relative number of microvessels with vasculitis and fibers of the peripheral nervous system with infiltration by immune cells was studied. All morphological changes were classified depending on the severity of the damage.ResultsThe average age of patients with a fatal outcome was 35 ± 4.4 years. Time to death after onset of symptoms averaged 16 ± 4.4 days. Dystrophic lesions (necrosis and apoptosis) of the villous and extravillous trophoblast and decidual tissue were observed in the studied placentas. Histopathological signs of mild and severe lesions of the peripheral nervous system in the organs of the gastrointestinal tract were detected in 2 (16.7%) and 10 (83.3%) cases, respectively, in the myocardium in 4 (33.3%) and 8 (66.7%) cases. Histopathological signs of severe damage to the microvascular bed in the organs of the gastrointestinal tract were registered in 9 (75%) cases.Conclusion(s)The main clinical feature of this cohort was that death occurred in a long-term period, in most cases with a negative PCR. The histopathological pattern was a non-acute injury with an immune component of the microvascular bed and the autonomic nervous system with predominant damage to the myocardium and intestines.What does this study add to the clinical workThis study makes it possible to even better study the immunopathological profile in organs and tissues in pregnant women with a fatal outcome when affected by a viral infection, in particular Covid-19. This knowledge can be used when humanity encounters other viral pandemics in the future.

Situation Analysis of Health Problems in Depok City in 2021

Based on 2021 data, from the results of problem identification, 16 health problems in Depok City were assessed. Maternal mortality was selected as a priority problem with 65 cases of maternal death or 155.58 per 100,000 live births. COVID-19 infection is the most common cause of maternal death. This study aims to provide an overview of maternal death circumstances in Depok because of prioritization following situation analysis of health problems. This situation analysis was conducted in Depok with a quantitative and qualitative approach analyzed using the PAHO-adapted Hanlon involving the participation of 17 respondents from the Health Office and the Head of the PHC in Depok. Primary and secondary quantitative data were collected using questionnaires, the Ministry of Health's Strategic Plan 2020-2024, Regional Medium-Term Development Plan 2016-2021, and Health Profile 2021. Qualitative data was obtained through interviews with respondents. Maternal mortality got a PAHO score of 42.37. This disease is a priority health problem in Depok. Most pregnant women had a high risk due to a lack of knowledge about pregnancy and a lack of participation in attending pregnancy class programs and pregnancy checks. Lack of family support for the health of pregnant women and there are also challenges in recording and reporting which must be based on an identity card so that cases sometimes do not live in the area but are recorded in the area. There are still some challenges in controlling maternal mortality. Promotive, preventive efforts such as conducting refresher training for health workers and volunteers, counseling, and presenting exciting material in pregnant women's classes to increase pregnant women's knowledge and family support. Cross-sector coordination and community leaders must be concerned with all parties to support and assist in screening pregnant women.

Danger Signs and 4T Risk Factors of Pregnant Women

The number of cases of maternal death in 2020 was 122, an increase of 25 cases compared to 2019, which was 97 cases of maternal death. The highest number of maternal death cases was in West Lombok district with 43 cases. The maternal mortality rate in NTB Province has increased from 93.92 per 100,000 live births to 119.05 per 100,000 live births. When compared with the performance achievements in the RPJMN, the NTB province is still below the national target. The 4T factors (too old, too young, too closely spaced between pregnancies and too many children) can increase cases of complications in the mother. Birth interval between one child and another child of less than 2 years can increase the risk of maternal death. Delivery at intervals of less than 24 months (too often) is a high-risk group for postpartum hemorrhage. This research aimed to determine the risk factors experienced by pregnant women so that prevention can be taken to prevent maternal death during childbirth. The research method used a quantitative analytical observational with a Focus Group Discussion (FGD) approach. The research results showed that pregnant women did not understand the danger signs and risk factors for 4T, so that pregnant women are able to take preventive measures. Apart from that, this research also provides anticipatory solutions so that pregnant women and their husbands can avoid further complications related to the risks of 4T. This research concludes that the understanding of pregnant women and their husbands regarding the danger signs and risks of 4T has increased so that they are able to know the mother's condition during pregnancy and are able to plan and have a healthy pregnancy.

Causes of Maternal Mortality Based on The Three-Delays Model: A Retrospective Observational Study

Reducing maternal mortality is one of the targets for achieving global health Sustainable Development Goals (SDGs). The cause of maternal death is still a major problem. The breadth of the territory and the variety of demographic, economic, social, and cultural conditions of the Indonesian people are important to investigate regarding the causes of maternal death in the community. The purpose of this study was to find out the causes of maternal death in one of the districts in the province which is in the eastern part of Indonesia. a retrospective observational study was conducted on 23 cases of maternal death. Data collection has been carried out using the three-delay model approach. the majority of maternal deaths were caused by two delays, 1) being late in deciding to seek care at a health facility due to lack of awareness of complications (78.%), low-income families (74%), and the culture of visiting traditional healers to help with deliveries (57%), and 2 ) were late reaching health facilities due to cost and availability of transportation (52%), poor road conditions (43%), and travel time > 1 hour (39%). awareness of mothers and families about the dangers of perinatal complications is an important point that must be addressed early so as not to affect delays in making decisions to seek care at health facilities, which ultimately results in delays in reaching health facilities, and delays in receiving treatment from health workers.