Cases Of Maternal Death Research Articles

Are There Maternal Deaths Related to Hemorrhagic Stroke Due to Hypertensive Disorder of Pregnancy That Could Be Potentially Preventable by Tight Hypertension Management in Antepartum? A Retrospective Study from the Maternal Death Exploratory Committee in Japan.

Unlike Europe and the United States, Japan has seen numerous maternal deaths from hemorrhagic strokes related to hypertensive disorders of pregnancy (HDP). This study retrospectively analyzed deaths associated with HDP-related hemorrhagic stroke in Japan to determine the number of deaths that may have been prevented with blood pressure control during pregnancy. This study included maternal deaths related to hemorrhagic stroke cases. The proportion of patients without proteinuria whose blood pressure exceeded 140/90 mmHg between 14+0 and 33+6 weeks of gestation were determined. Lastly, the application of tight antihypertensive management was evaluated. Among 34 HDP-related maternal deaths, 4 cases involved patients without proteinuria whose blood pressures exceeded 140/90 mmHg between 14+0 and 33+6 weeks of gestation. These included two chronic hypertension and two gestational hypertension cases. None of the patients received antihypertensive agents, and their blood pressures were managed leniently. Among HDP-related hemorrhagic stroke deaths in Japan, only a few cases of maternal death could have been prevented with tight blood pressure management, as described in the CHIPS randomized controlled trial. Therefore, to prevent HDP-related hemorrhagic stroke in Japan, new preventive strategies during pregnancy should be established.

Retrospective analysis of causes of death in severe PIH, Preeclampsia & Eclampsia cases in a tertiary medical care centre from January 2015 to December 2016

: PIH, preeclampsia and eclampsia cases are one of the leading cause of maternal death especially in underdeveloped countries. Substandard maternity care is thought to be the reason behind it. Hypertensive disorders in pregnancy is a multi-organ involving disease of unknown etiology. Early detection, timely intervention, strict vigilance and intensive monitoring is needed to prevent maternal mortality and morbidity.: Our aim was to detect the cause of death among pregnant women admitted with hypertensive disorders so that measures can be taken to improve the maternity service.: It was a Retrospective analytical study of causes of maternal death among hypertensive disorders in pregnancy cases admitted in our institution from 1 January 2015 to 31 December 2016.Data were collected from case sheets, death certificates and review report on maternal death cases and were analysed and presented. It was found that pulmonary oedema was the most common (75%) cause of maternal death in PIH cases. Improper antepartum care and delay in seeking medical help, moreover, lack of proper utilization of maternity services was the main cause behind the high maternal mortality in PIH cases (89.6%).: Substandard maternity care was found to be responsible for so high maternal death in PIH cases. This result was similar to the other studies in this context. These deaths are preventable to a large extent.

Desenlaces maternos según el tipo de placenta previa en un hospital de alta complejidad en Cali, Colombia. Estudio de cohorte retrospectivo

To describe the frequency of maternal complications in pregnant women with major or minor placenta previa (PP), and to assess a potential association between PP type and the presence of severe maternal bleeding and other associated outcomes. Retrospective descriptive cohort. The study included pregnant women with 20 weeks of gestation or more and a confirmed diagnosis of placenta previa who were seen in a high complexity hospital in Cali (Colombia), between January 2011 and December 2020. Women with a diagnosis of placenta previa and concomitant placenta accreta were excluded. The collected variables were maternal age, body mass index, smoking, obesity, parity, presence of bleeding, postpartum hemorrhage, management of postpartum hemorrhage, transfusion, and maternal ICU admission. A descriptive analysis was performed. The protocol was approved by the ethics committee of Fundaciónn Valle de Lili. A total of 146 patients met the inclusion criteria. The population consisted of women with a mean age of 32 years, with no history of prior surgery, with a prenatal diagnosis of placente previa at week 22; 70 % were major placenta previa cases. The most frequent complications were postpartum hemorrhage (37.9 % vs. 16.3 % for patients with major and minor placenta previa, respectively), transfusion requirement (23.3 and 9.3 %, respectively), and maternal ICU admission (40.8 % vs. 18.6 %, respectively). There were no cases of maternal death. There is a high frequency of complications in women with placenta previa, and it is probably higher in cases of major placenta previa. Further studies are needed to compare the frequency of maternal complications according to the type of placenta previa.

Perbandingan Pengaruh Senam Yoga Dan Senam Hamil Terhadap Lama Kala I Persalinan Di Puskesmas Cimanggu Kabupaten Pandeglang Banten Tahun 2022

Introduction: Long labor as one of the causes of maternal death also tends to be quite high. Cimanggu Health Center 2021 found 1 case of maternal death caused by bleeding the cause, namely due to prolonged labor. Various efforts have been made to reduce the number of long labors, one of which is by doing yoga and pregnancy exercises. The purpose of the study was to compare the effect of yoga and pregnancy exercises on the length of the first stage of labor at the Cimanggu Public Health Center, Pandeglang Regency, Banten in 2022. Methods: The research method was a quasi-experimental design with a post-test-only design with control groups, the number of samples was 60 respondents, and the total sampling technique was total sampling, data analysis using an Independent T-test test. Result: The results of the study on the length of the first stage of labor in the yoga exercise group obtained an average value = of 8,13; the length of the first stage of labor in the pregnant exercise group obtained an average value = 10,63. The results of the bivariate analysis showed that there was a difference in the effect of yoga and pregnancy exercises on the length of the first stage of labor with a significance level of 0,000. Discussion: The conclusion of the research is that there is a difference in the effect of yoga and pregnancy exercises on the length of the first stage of labor. Suggestions for health workers, especially midwives, can consider implementing yoga and pregnancy exercises in classes for pregnant women as care to prepare for a safe, and comfortable delivery. It is also recommended to open yoga and pregnancy exercise classes with trained instructors or midwives who have been officially certified in participating in pregnancy exercise training.

Effect of Perineal Massage on The Spontaneous Perineal Rupture in Maternity Mothers

Background: Perineal rupture is the main cause of postpartum maternal bleeding. Postpartum bleeding is the main cause of 40% of maternal deaths in Indonesia. The number of cases of maternal deaths decreased from 4,999 in 2015 to 4912 in 2016. Perineal rupture is caused by parity, birth spacing, infant weight, labor delivery, cunam extraction, vacuum extraction, tool trauma and episiotomy. Purpose: The aim was to examine the effect of perineal massage on spontaneous perineal rupture among labor mother at the Paramitra Medika 1 Clinic in intervention and control groups. Methods: This research was used pre-experiment by using static group comparison. The sample size was 30 labor mother who consisted of 15 in the experimental group and 15 in the control group. Observation form as an instrument. Univariat and bivariate variable were used and used paired t-test with alpha 0,05. Result: The results showed that 60.0% of mothers given perineal massage did not experience perineal rupture, the average rupture was 1.47 with a standard deviation of 0.64 and as many as 46.7% of mothers who were not given perineal massage had a secon degree rupture, on average rupture is 1.40 with a standard deviation of 0.986. Perineal massage has an effect on the spontaneous perineal rupture in maternal (p value 0.008). Conclusion: It was expected that further study, such as sample are pregnant women so that the massage results are not different.

Causes of death, three delays, and factors associated with Delay 1 among maternal deaths in Myanmar: The maternal death surveillance in 2019

ObjectiveThe maternal mortality ratio (MMR) in Myanmar was the highest in Southeast Asia in 2017. The Three Delay Model is used to evaluate delays that contribute to maternal deaths. This study aims to identify MMR, causes of death, the three delays related to maternal deaths, and the factors associated with Delay 1, which is the time of delay in deciding to seek health care (from the start of the woman's illness to the time when the problem is recognized to be requiring care), in Myanmar. Study designA cross-sectional study. ParticipantThis study included 934 cases of maternal deaths reported from all states and regions throughout Myanmar in 2019 that were not caused by accidents and injuries. Materials and methodsSocio-demographic factors, obstetrical factors, information about deaths, and assessment of delays were obtained from the Maternal Death Surveillance and Response System, the database of maternal deaths. Distribution of maternal deaths by states and regions, causes of maternal death, and types of delay that contributed to maternal deaths were descriptively summarized. Logistic regression analysis was performed to identify factors associated with Delay 1 among 567 maternal deaths without any missing data and unknown information on delays. FindingsIn 2019, the MMR was 106 (95% confidence interval, 99–112) per 100,000 live births. Of the 934 maternal deaths, 80.5% of deaths had at least one delay, and Delay 1 was the major delay (72.9%). Eclampsia/pre-eclampsia (21.6%), postpartum hemorrhage (18.2%), and abortion-related complications (13.2%) were the major causes of maternal death. The husband's low education, low household income, unplanned pregnancy, and no antenatal care were associated with Delay 1. Key conclusions and implication for practiceThe MMR was lower in 2019 than that in 2017 but remained high. Moreover, we demonstrate that most maternal deaths had at least one delay, mostly Delay 1. To prevent maternal deaths caused by Delay 1, the family planning should be promoted to prevent unplanned pregnancies. Educational training for healthcare providers who deliver antenatal care should be strengthened. Furthermore, education on the danger signs of pregnancy and during childbirth should be provided not only to pregnant women and their husbands in communities at health facilities.

Progressive detachment of the normally located placenta: the clinical case of failed maternal death in massive blood loss

Introduction. Despite the global achievements of obstetric science and practice, massive bleeding with premature progressive detachment of the normally located placenta, as well as in placenta previa and ingrowth, hypotonic bleeding, occupy one of the leading positions in the structure of obstetric bleeding and are associated with high rates of nearly dead women (near miss), with maternal and perinatal morbidity and mortality. The purpose of the study was to demonstrate the effectiveness of organizational methodology of emergency care in a 24-hour hospital using the clinical example of PPCR with atypical clinical picture, massive obstetric hemorrhage, and favorable outcome for the patient. Materials and methods. Material for the analysis of the clinical case was an exchange and notification card of a pregnant woman and a parturient and a labor history. Methods: anamnestic data analysis based on the study of official documentation of pregnancy and its outcome, peculiarities of delivery and labor outcome. Results. The analysis demonstrates the possibility of a rapid diagnosis of PPDNLP, which proceeded without the classical triad of symptoms, with a severe course, massive obstetric hemorrhage and timely specialized care, which led to a favorable outcome for the patient. Discussion. The speed of care on admission to the hospital, the timeliness of the correct diagnosis even in the absence of the classical clinical picture of PPDNLP, the equipment of the maternity hospital, the timely and adequate obstetric tactics allowed to avoid maternal mortality in massive blood loss and the presence of the disseminated internal coagulation (DIC) syndrome, complicating PPDNLP. Further study of mechanisms of formation, determination of the most significant predictors and triggers of PPDNLP, improvement of organization of care and planned trainings should make a certain contribution to the improvement of maternal and perinatal morbidity and mortality. Conclusion. In the maternal mortality rate reduction vector, an effective organizational technology of care is demonstrated in a case of PPONR with an atypical clinical picture, the presence of massive obstetric hemorrhage, which ended favorably for the patient.

Haemophagocytic lymphohistiocytosis in pregnancy and the postpartum period: A retrospective case series analysis.

Haemophagocytic lymphohistiocytosis (HLH) is an extremely rare condition characterised by excessive immune activation leading to haemophagocytic activity and has seldom been reported in pregnancy. HLH manifests as relapsing fevers with features of multi- organ failure and has a high mortality. A retrospective case series analysis using national data from MBRRACE-UK maternal death reports (n=5) and case notes from patients diagnosed with HLH during pregnancy at New Cross Hospital, Wolverhampton (n=2) between 2012 and 2021. A total of seven cases were included. Cases uniformly presented with fever and experienced prodromal illnesses consisting of lymphadenopathy, fevers, and malaise. Gestation at presentation ranged from 9/40 to 11 months postpartum. All patients had multiple cytopaenias. Other common features included elevated liver enzymes (n=5), hyperferritinaemia (n=5), splenomegaly (n=4), hypofibrinogenemia (n=4) and elevated soluble interleukin-2 receptor α (CD25) levels (n=3). Underlying causes were identified in four cases. Median time from presentation to diagnosis was 35 days. Bone marrow biopsy was diagnostic in a majority of cases. Corticosteroids and ciclosporin were the most frequently used treatments. In some cases early delivery by caesarean section or termination of pregnancy was necessary to permit maternal treatment. Progression to multi-organ failure resulting in maternal death occurred in five cases: two cases survived. Pregnancy outcomes were: livebirth at term (n=2), preterm livebirth (n=3), termination of pregnancy (n=1), and miscarriage (n=1). Of the surviving infants, one had bone marrow suppression with anaemia at birth and sensorineural deafness. Due to the rarity of the condition, diagnosis is often delayed. In view of the high mortality, clinicians should consider HLH early when reviewing pregnant patients with unexplained pyrexia and multi-organ dysfunction. Early involvement of haematology should be sought, as prompt diagnosis is crucial for meaningful attempts at curative therapy. Important treatment considerations include fetal viability, maternal condition and treatment toxicity.

Efektivitas Pemberian Metode Pijat Oksitosin Dan Pijat Akupresur Terhadap Lama Persalinan Kala I Fase Aktif

Introduction: In Banten, in 2019 the cause of maternal death was recorded at 22,5% caused by other causes, one of which was due to prolonged labor, as well as Cimanggu Health Center in 2021 found 1 case of maternal death caused by bleeding the cause was due to prolonged parturition. One way to speed up the progress of labor is by giving oxytocin massage and acupressure massage. The purpose of the study was to determine the effectiveness of giving oxytocin massage and acupressure massage for the duration of the active phase of the first stage of labor at the Cimanggu Health Center, Pandeglang Regency, Banten in 2022. Methods: The research method was a quasi-experimental design with a post-test-only design with control groups, the number of samples was 60 respondents, the sampling technique was purposive sampling, and data analysis using the Independent T-test. Result: The results of the study showed that the duration of the first stage of active labor in the oxytocin massage group obtained an average of = 6,84 hours, the duration of the active phase of the first stage of labor in the acupressure massage group obtained an average of 5,34 hours. The results of the bivariate analysis showed that there was an average difference between oxytocin massage and acupressure massage on the duration of the active phase of the first stage of labor with a p-value of 0,000. Discussion: The conclusion of the study was that there was an average difference between oxytocin massage and acupressure massage on the duration of the active phase of the first stage of labor. Suggestions are expected for health workers, are expected to always be updated, especially in helping mothers give birth to meet the mother's need for comfort in non-pharmacological pain control, one of which is using acupressure or oxytocin massage techniques.

Pregnancy Outcomes in SARS-CoV-2-Positive Patients: A 20-Month Retrospective Analysis of Delivery Cases

Background and Objectives: The SARS-CoV-2 infection brings supplemental risks for pregnant women. Due to controversial hesitancy, their vaccination rate was lower in 2021 compared to the general population. In addition, access to maternal care was reduced during the pandemic. We conducted a retrospective cross-sectional analysis of the health records data over 20 months (1 April 2020 to 20 November 2021) aiming to explore the outcomes in SARS-CoV-2-positive cases referred for delivery to a tertiary public hospital in Western Romania. Materials and Methods: Women with SARS-CoV-2 infection diagnosed for the first time at the moment of birth who delivered singletons after 24 weeks of gestation, and had a clear immunization status were included in the analysis. Results: Out of the 97 patients included in the study, 35 (36%) had undergone ARN-based vaccination. Five cases of maternal death were recorded (all unvaccinated). Our retrospective exploratory analysis showed that the presence of COVID-19 symptoms in the SARS-CoV-2-positive patients made a significant impact on the delivery hospitalization, with a median hospital stay increase from 5 to 9 days (Mann-Whitney test, p = 0.014): longer hospitalization was recorded in the symptomatic cases irrespective of their vaccination status. No other adverse outcomes, such as gestational age at delivery, C-section rate, 5 min Apgar index, or birth weight were associated with the presence of symptoms. Conclusions: Our clinic maintained safe maternal care for the COVID-19 patients during the analyzed period. Vaccination of the expectant women was beneficial in SARS-CoV-2-positive patients by lowering the risk of COVID-19 symptoms, with subsequent implications on the newborns' health and maternal attachment.

Ruptured interstitial pregnancy: a case report of a sudden maternal death in the late second trimester from a rare cause

Introduction: Interstitial pregnancy is a rare type of tubal ectopic pregnancy that occurs when implantation takes place in the interstitial segment of the fallopian tube. It remains one of the most difficult gestations to diagnose clinically and sonographically, hence a higher risk of rupture and catastrophic haemorrhage because of delayed diagnosis as the gestation progresses. We report a case of sudden maternal death from a ruptured interstitial pregnancy involving a woman at 27 weeks of pregnancy who was mistakenly thought to have a normal intrauterine pregnancy antenatally. Case description: A 40-year-old woman, normally conceived gravida 7, para 4, abortus 2 at 25 weeks of pregnancy by date, was dead on arrival at the hospital after experiencing sudden abdominal pain. A forensic autopsy revealed more than 2100 ml of hemoperitoneum. The uterine cavity was empty, and the right uterine fundus had an asymmetric cystic bulge found to be a ruptured interstitial pregnancy with a 27-week-old male fetus. Discussion and conclusion: The pathology of interstitial pregnancy and the distinction between this entity and the similar but distinct angular and cornual pregnancies will be described. This case report highlights a type of ectopic pregnancy rarely encountered in forensic pathology practice.

Analysis of Causes of Maternal Death in East Java Province, Indonesia

BACKGROUND: The maternal mortality rate is an indicator that reflects the mother’s health status, especially the risk of death for the mother during pregnancy and childbirth. Measles, Mumps, and Rubella (MMR) has a close relationship with efforts to increase human development. Therefore, efforts are needed to reduce MMR by identifying the factors that influence MMR. AIM: The aim of the study was to analyze the factors causing the incidence of Maternal Death in East Java Province. METHODS: The research design used in this research is a quantitative research using descriptive-analytical. The population of this research is districts/cities in East Java Province, with a sample of 38 districts/cities. The research period starts from August to September 2021. Data analysis using grouping and percentage of cases. RESULTS: The results of the study found that cases of maternal death in East Java due to postpartum hemorrhage in 2021 were 131 cases. Cases due to hypertension as many as 115 cases. Cases due to infection as many as 25 cases. The incidence of maternal death due to abortion is 1 case. There were 13 cases of maternal death due to blood disorders. There were 6 cases of maternal death due to metabolic disorders — cases of maternal death due to Heart as many as 54 cases. Maternal deaths due to COVID-19 were 793 cases. CONCLUSION: Factors causing maternal death in East Java Province, namely, hypertension bleeding, infection, abortion, blood disorders, heart metabolic disorders, and COVID-19. The most influential factor in maternal mortality in 2021 is COVID-19.

Expectant treatment for angular pregnancy after assisted reproduction technology: a safe and patient-friendly treatment strategy.

Currently, the treatment strategies for angular pregnancy in the first trimester after assisted reproduction technology (ART) are unclear. Improper treatment will cause unnecessary losses to patients, especially infertile patients, after ART. The purpose of this study was to clarify the pregnancy outcomes of expectant treatment for angular pregnancy post-ART and to provide a basis for the formulation of clinical treatment strategies. This retrospective case series study was performed at the Reproductive Medicine Center of a university hospital. Maternal data and pregnancy outcomes were collected and analyzed for all patients diagnosed with angular pregnancies after ART between January 2016 and August 2021. The outcomes included live birth, term birth, premature birth, early pregnancy loss, fetal death, placental abruption, uterine rupture, maternal death, and hysterectomy. A total of 78 patients were analyzed in this study, of whom 54 (69.2%) had live births, 44 (56.4%) had term births, 21 (26.9%) had an early pregnancy loss, 1 (1.3%) had mid-trimester missed abortion, 1 (1.3%) underwent mid-trimester labor induction due to fetal malformation, and 1 (1.3%) underwent uterine rupture. There were no cases of maternal death, placental abruption, or hysterectomies. Angular pregnancy after ART is not as dangerous as that described in previous studies; most cases could be treated expectantly under close-interval follow-up and obtain live birth.

Residency Experience With Physical Examination- and Ultrasound-Indicated Cerclage: A Single Center Retrospective Study.

Background: Cervical insufficiency, the dilation of the cervix in the absence of contractions or labor, can cause second-trimester pregnancy loss or preterm birth. Cervical cerclage is a common treatment for cervical insufficiency and has 3 indications for placement: history, physical examination, and ultrasound. The purpose of this study was to compare pregnancy and birth outcomes for physical examination- and ultrasound-indicated cerclage. Methods: We conducted a retrospective observational descriptive review of second-trimester obstetric patients with transcervical cerclage performed by residents at a single tertiary care medical center from January 1, 2006, to January 1, 2020. We present data on all patients and compare outcomes between the 2 study groups: patients who received physical examination-indicated cerclage vs those who received ultrasound-indicated cerclage. Results: Cervical cerclage was placed on 43 patients at a mean gestational age of 20.4 ± 2.4 weeks (range, 14 to 25 weeks) and with a mean cervical length of 1.53 ± 0.5 cm (range, 0.4 to 2.5 cm). With a latency period of 11.8 ± 5.7 weeks, mean gestational age at delivery was 32.1 ± 6.2 weeks. Fetal/neonatal survival rates were comparable: 80% (16/20) for the physical examination group compared to 82.6% (19/23) for the ultrasound group. No differences were found between groups for gestational age at delivery-31.5 ± 6.8 in the physical examination group vs 32.6 ± 5.8 in the ultrasound group (P=0.581)-or for preterm birth <37 weeks-65.0% (13/20) in the physical examination group vs 65.2% (15/23) in the ultrasound group (P=1.000). Rates of maternal morbidity and neonatal intensive care unit morbidity were similar between the groups. No cases of immediate operative complications or maternal deaths occurred. Conclusion: Pregnancy outcomes for physical examination- and ultrasound-indicated cerclage placed by residents at a tertiary academic medical center were similar. Fetal/neonatal survival and preterm birth rates were favorable for physical examination-indicated cerclage when compared to other published studies.

Risk of uterine rupture among women in a trial of labor after prior cesarean delivery

Uterine rupture during a trial of labor after prior cesarean (TOLAC) delivery is an obstetrical emergency with potentially severe adverse outcomes. The aim of this study was to assess the incidence of uterine rupture and adverse maternal and perinatal outcomes. We conducted a population-based, retrospective cohort analysis with data from all women who gave birth after one prior cesarean delivery at a single tertiary center from 2009 through 2019. Maternal and perinatal outcomes were compared between women who underwent a successful or failed TOLAC and elective repeated cesarean delivery (ERCD) without labor. Out of 95,552 deliveries, TOLAC was attempted by 5,619 (63.35%), while 3,250 (36.64%) women underwent ERCD. The rate of successful TOLAC - vaginal birth after cesarean (VBAC) was 81.92%. Symptomatic uterine rupture occurred in 55 (0.98%) women who underwent TOLAC and asymptomatic rupture in five (0.153%) who underwent ERCD. Compared with women with spontaneous onset of labor, a greater risk, albeit not significant, for uterine rupture was observed among women with induction of labor using prostaglandins (OR 2.44; CI 0.86-6.92), oxytocin (OR 2.16 CI 0.84-5.54), and lower when external amniotic balloon was used (OR 0.52; CI 0.07-3.86). Women who failed in TOLAC needed more blood transfusions (OR 6.06; CI 3.61-10.16, p< 0.011). Neonatal hypoxic–ischemic encephalopathy occurred in a single case of successful TOLAC but in none of the other groups. There were no cases of cesarean hysterectomy, maternal or neonatal death in any group. Our data confirm the relatively small risk of uterine rupture during TOLAC. In a tertiary well-trained center, with close maternal and fetal monitoring, uterine rupture is rare and does not result in severe maternal and neonatal morbidity or mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal Deaths after Obstetrical Referral and/or Evacuation to the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center, Togo

Introduction: Maternal death or maternal mortality is “the death of a woman occurring during pregnancy or within 42 days of termination, regardless of duration or location, for any specific cause or aggravated by pregnancy or its management, but neither accidental nor fortuitous. Methods: This was a descriptive and analytical cross-sectional study carried out from January 1st, 2021 to April 30th, 2022 at the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center (SOUHC). Results: we noted 86 cases of maternal deaths after referral/evacuation i.e. a maternal mortality rate hospital of 555 maternal deaths per 100,000 LB. The average age of the patients was 31.1 ± 6.3 years with extremes of 15 and 45 years. In 33.7% of cases our patients were resellers. Multiparas represented 33.7% of the sample, they had performed less than three antenatal consultations. Postpartum hemorrhage was the reference reason in 33.7%. In 74.4% of cases, the patients referred had arrived by taxi. In 87.9% of cases, the patients had died of direct obstetric causes. Immediate postpartum hemorrhage accounted for 44.6% of cases and anemia, 36.4%. There is a statistically significant association between the availability of blood product and the avoidability of maternal death after obstetrical referral and/or evacuation (p value = 0.0188 0.05). Conclusion: Determining responsibility for maternal death is not always easy. There is an urgent need to strengthen the policy of reducing maternal mortality in Togo. This remains possible by developing communication strategies and a solid referral/counter-referral system.

Treating mild chronic hypertension during pregnancy: a cost-effectiveness analysis of the CHAP trial

The CHAP trial, a recently published large randomized controlled trial, found improved outcomes with treating chronic hypertension (cHTN) during pregnancy at a lower threshold than the current standard. However, the cost-effectiveness of this strategy has not been examined. A decision-analytic model was constructed to compare treatment of cHTN once above a systolic blood pressure (SBP) of 140 mmHg and/or diastolic blood pressure (DBP) of 90 mmHg, to treatment of cHTN once above a SBP of 160 mmHg and/or DBP of 110 mmHg in a theoretical cohort of 200,000 patients with mild cHTN. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analysis. Primary outcomes included incremental cost per quality-adjusted life year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth (PTB), maternal death, neonatal death (NND), and neurodevelopmental delay (NDD). The cost-effectiveness threshold was $100,000/QALY. Treating cHTN at a lower threshold resulted in 15,752 fewer cases of preeclampsia, 13,149 of which were cases of preeclampsia with severe features. This led to 910 fewer cases of SMM, and 19 fewer cases of maternal death. Treating at a lower threshold also resulted in 8,976 fewer cases of preterm birth, which led to 228 fewer neonatal deaths and 175 fewer cases of neurodevelopmental delay. Overall, treating cHTN at a lower threshold was a dominant strategy resulting in lower costs ($704 million) and increased effectiveness (16,073 QALYs). Treating cHTN at a reduced threshold is a dominant, cost-effective strategy resulting in fewer neonatal and maternal deaths compared to the standard treatment of treating at higher BP.

Associated Factors with Vaginal Delivery on a Uni- or Bi-Scar Uterus in a Low-Resource Setting

Introduction: Delivery in a scar uterus is one of the most debated topics in obstetrics. The objective was to determine the uterine test and the maternal-fetal outcome in patients with uni- and bi-scared uterus who received the uterine test at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of patients who delivered on a uni- or bi-scareduterus at Panzi Hospital, between January 1, 2021 and August 1, 2022. Results: The average age of the patients was 27.09 years, with an age range of 25 - 34 years, they were mostly married (88.3%), with secondary educational level (60.4%). Pauciparous women, with a history of previous caesarean delivery once, represented respectively 52.2%; 7.2% of parturients with an intergenital space equal to 18 months. 63.9% were overweight, 58.6% had undergone more than three ANC sessions. We noted statistically significant associations between modes of admission, water sac, type of membranes rupture, uterine height and success of uterine test (p 0.05). We did not find significant associations between parturient age, gestational age, intergestational interval, pregnancy term, surgical history, number of ANC performed, number of previous caesarean sections, number of newborns. We did not record any cases of maternal death but one case of perinatal death with 0.9% in this study. Conclusion: A good selection of patients with uni- or bi-scared uterus would allow the reduction of the fetomaternal morbidity during the uterine test.

Analysis of the Factors leading to Severe Acute Maternal Morbidity and Maternal Mortality during COVID 19 Pandemic

Aims: To determine prevalence, causes and factors leading to severe acute maternal morbidity and mortality during COVID 19 pandemic.&#x0D; Methods: The was a cross sectional observational study conducted in the department of Obstetrics and Gynaecology of Manipal teaching hospital from March 2020 to February 2022 amid COVID 19 pandemic. Women who sustained severe acute maternal morbidity (according to World health organization organ system criteria) and maternal deaths during pregnancy, labour and six weeks postpartum were included. Maternal characteristics, total live births, pregnancy outcome, causes and factors leading to morbidity and mortality were noted. The acquisitioned data was analyzed using Statistical Package for Social Sciences version 21.&#x0D; Results: There were 37 cases of severe acute maternal morbidity and 2 cases of maternal deaths. The severe acute maternal morbidity ratio was 9.4 per 1000 live births and maternal mortality ratio was 51 per 100,000 live births. Therefore, severe acute maternal morbidity mortality ratio was 18.5:1 and mortality index 5.1%. Haematological and coagulation system (45.9%) and neurological system (29.7%) were the common organ systems involved. Hypertensive disorders (40.5%) and haemorrhage (32.4%) were the main causes of severe acute morbidity. Both maternal deaths occurred due to eclampsia. There was no severe acute maternal morbidity or mortality due to COVID infection in pregnancy. Delay in seeking and reaching to the health centre (65%) was major delay leading to severe morbidity and mortality.&#x0D; Conclusions: Indices and causes of severe acute maternal morbidity and mortality during COVID 19 pandemic was not worse compared to those prior to COVID 19 pandemic. Primary delay in seeking and reaching health care was the main factor leading to severe morbidity and mortality.&#x0D;

PENGARUH LATIHAN BIRTH BALL TERHADAP PENGURANGAN RASA NYERI PERSALINAN

Maternal mortality is still high. The maternal mortality rate (MMR) in Indonesia was recorded at 177 deaths per 100 thousand live births in 2017. This ratio is already better than the previous dozen years, which was more than 200 deaths per 100 thousand live births. However, Indonesia's MMR is still the third highest in Southeast Asia. (World Bank, (Lidwina, 2021). The Maternal Mortality Rate (MMR) based on the 2015 SUPAS report was 305 per 100,000 live births. This figure shows a decrease compared to the 2012 IDHS, which was 359 per 100,000 live births (Profile Lampung, 2020).In Lampung Province, there was an increase in 2020 that the number of cases of maternal death increased compared to 2019, from 110 cases to 115 cases (Profile Lampung, 2020).Based on the Health and Nutrition Section of the Lampung Provincial Health Office in 2020 that MMR occurred in Central Lampangg Regency. as many as 22 cases. Pain during labor arises as a result of the mother's physical and psychological reflexes. Emotional tension due to anxiety will worsen the mother's perception of the pain felt during childbirth. Pain that arises during labor requires proper pain management and this should be a concern for women, families and health workers. Pain in labor during the I m is pain with a scale of weight felt by the mother in labor for a l onger time. Non-pharmacological (complementary) methods are proven to reduce labor pain, one of which is by using Birth Ball exercises.To analyze the effectiveness of birth ball exercises in the first stage of labor to reduce labor pain in the Independent Midwife Practice (PMB) "E" in Central Lampung Regency.Experimental research with Pre and Post-Test Control Group Design approach. The population was primigravida maternity mothers in the active phase of the first phase with a total of 15 samples. The research was conducted at the Independent Midwife Practice (PMB) "E" in Central Lampung Regency. The instrument used was an observation sheet on the intensity of labor pain using the Faces Pain Rating Scale. Results: Statistical tests were carried out using the Wilcoxon test, the p-value (0.001 &lt;0.05) was obtained, so it can be concluded that there is a significant difference in the intensity of labor pain before and after being given Birth Ball exercises to women giving birth. Birth Ball exercise is one of the complementary midwifery care that can be given easily, cheaply, simple, effective, and without adverse effects for maternity mothers and can significantly reduce labor pain in first-stage primigravida mothers.