Important Cause Of Maternal Death Research Articles

Role of prophylactic use of tranexamic acid in reducing blood loss during caesarean section in a tertiary care hospital

Postpartum Haemorrhage (PPH) is an important cause of maternal death and severe maternal morbidity. Compared to vaginal delivery, women undergoing caesarean delivery incur the highest risk of PPH and haemorrhage related morbidity. Furthermore, evidence suggests that PPH during caesarean delivery is occurring more frequently. To study the effect of low dose intravenous tranexamic acid in reducing blood loss during Caesarean section.: This randomized control trial among 50 antenatal women aged >18 years undergoing Lower segment caesarean section in tertiary care centre. They were divided into Study group and control group. Study group received 1gm iv tranexamic acid and the Control group did not receive tranexamic acid. Data was entered in Microsoft Excel data sheet (MS-Excel) and analysed using commercially available SPSS 23 software package. MS Excel and MS word was used to obtain various types of graphs such as bar diagram. : Among the study population who underwent Lower section caesarean section in our study, we found that the requirement of additional oxytocin was nil with tranexamic acid group (p value<0.02). There were no side effects observed with the group administered tranexamic acid (p value<0.01). The difference in mean of bleeding from placental delivery to end of Caesarean Section, End of Caesarean Section to 2 hrs Postpartum was statistically significant (p value <0.05). The fall in Hb% between the two groups was significant, thereby showing the benefits of Tranexamic acid.: Tranexamic acid significantly reduces the amount of blood loss during and after lower segment caesarean section. It was not associated with any significant side effects and complications. It can be used effectively in all women undergoing caesarean section to reduce the postpartum Haemorrhage thereby reducing the maternal morbidity and mortality.

Perioperative Anesthesia Management of a Patient with Triplet Pregnancy Who Developed Hemorrhage Due to Uterine Atony during Cesarean Section: A Case Report

The incidence of postpartum hemorrhage (PPH) is increased in multiple pregnancies and is an important cause of maternal death. Controlling bleeding and correct anesthesia management during this period are essential.
 In our 35-year-old patient with triple pregnancy, hemorrhage due to uterine atony developed during C/S surgery. We aimed to discuss the anesthesia management of PPH in our patient who underwent a total abdominal hysterectomy and bilateral salpingectomy (TAH BS) due to continued bleeding during and after C/S, with literature.
 We think that morbidity and mortality rates can be reduced in the perioperative period for PPHs with the help of multidisciplinary approach, rapid action, and close follow-up.

Epidemiological Features of Spontaneous Abortion in the North Africa and the Middle East From 1990 to 2019: Results From the Global Burden of Disease Study 2019.

Objective: Spontaneous abortion is one of the most common problems which a woman may encounter during her pregnancy which is one of the most important causes of maternal death. Therefore, the aim of this study was to report the epidemiological features of spontaneous abortion in North Africa and the Middle East (NAME) countries. Materials and methods: The study population included 21 countries in the NAME region with a population of more than 600 million. The Global Burden of Disease (GBD) 2019 database was used. Incidence rates, the prevalence rates, death rates, the disability adjusted life years (DALYs) rates by age-standardized rate (ASR) per 100,000 people were measured. Also, the attributed burden to iron deficiency was reported. Results: In 2019, the highest prevalence 39.44 (95% CI, 24.58_ 59.26) and incidence 4794.16 (95% CI, 3491.77_ 6353.03) rates of spontaneous abortion were in Afghanistan. In 2019, the highest spontaneous abortion related-death 5.88 (95% CI, 3.23_ 8.97) and DALYs 339.12 (95% CI, 184.29_ 516.95) rates by ASR were in Yemen. In MENA, average prevalence (44.7 to 19.82) and incidence (5434.95 to 2409.61) rates have decreased by nearly 56%, and also average death (1990 4.51 to 2019 0.48) and DALYs (263.15 to 29.37) rates have decreased by nearly 89% between 1990 and 2019. The highest spontaneous abortion-related DALYs rate was attributed to iron deficiency. In 2019, Yemen (29%) had the highest attributed burden to iron deficiency. Conclusion: This study on 21 countries in the NAME region with a population of more than 600 million showed that average prevalence and incidence rates of spontaneous abortion have decreased by nearly 56%, and also average and the disability adjusted life years (DALYs) rates have decreased by nearly 89% between 1990 and 2019.

Descriptive study of Feto maternal outcomes of obstructed labour in a tertiary care hospital

Introduction: Labour is considered abnormal when the presenting part of the foetus cannot progress in to the birth canal, despite strong uterine contractions which leads to various maternal or foetal complications. Obstructed labour accounts for about 8% of all maternal deaths in developing countries like India. Obstructed labour is the single most important cause of maternal death and is one of the leading causes of perinatal mortality. Materials and methods: This prospective study of obstructed labour was conducted from September 2021 to May 2022 (9 months) in the Department of obstetrics and Gynaecology of M.G.M Medical College, Jamshedpur. All patients admitted with obstructed labour were included in the study. Detailed history regarding age, socioeconomic status, parity, previous obstetric history, past history, antenatal care, duration of labour, details of referral and management were recorded. During admission, the general condition of mother was assessed as well as fetal lie, presentation, position and heart sounds were recorded. Results: During the 9 months study period, there were total of 5845 deliveries of which 100 cases were diagnosed to have obstructed labour, incidence being 1.71%.

Complex and Successful Management of a Symptomatic Isolated Abdominal Aortic Aneurysm in a Pregnant Woman with Marfan Syndrome.

Aortopathies associated to Marfan syndrome (MFS) are important causes of maternal death during pregnancy. We present a 27-year-old and 24-week pregnant MFS woman who arrived to the emergency department with increasing abdominal pain; an obstetric ultrasound showed an Abdominal Aortic Aneurysm (AAA), a multislice computed tomography angiography (CTA) confirmed and demonstrated a 7.3centimeter (cm) infrarenal AAA without evidence of dissection. A multidisciplinary committee determined that an open repair would lead to a significantly high maternal-fetal morbidity and mortality. Although endovascular repair (EVAR) in MFS patients remains controversial, an urgent bridge therapy was considered to be the best option. She was transferred to the angiography suite for EVAR to prevent AAA rupture and ensure a satisfactory pregnancy. The patient and fetus presented no complications during the procedure and were discharged 3days later. She continued her pregnancy without eventualities and an elective C-section was performed on week 36. A CTA imaging at 12months revealed type 1A and 3 endoleaks, we decided to perform endograft explant and a definitive open repair, there were no complications during the procedure, the patient is currently asymptomatic. Our case illustrates a complex decision and management that successfully avoid morbidity and mortality of a MFS mother and her product; additionally, this experience reinforces the need for lifelong and close surveillance in these patients.

Emergency peripartum hysterectomy: Five-year experience in a university hospital

Background/Aim: Postpartum hemorrhage (PPH) is an important cause of maternal death and morbidity worldwide. Its incidence is still increasing in some countries. This study aimed to evaluate the incidence, indications, risk factors, complications, maternal and fetal outcomes, mortality rates and management strategies of emergency peripartum hysterectomy (EPH) in women with life-threatening postpartum hemorrhage. Methods: This retrospective cohort study included 94 cases of EPH performed at tertiary obstetric center between January 2016-January 2021. The demographic data, current pregnancy and delivery mode, hysterectomy indications, operative complications, postoperative conditions, and maternal and fetal outcomes were analyzed. EPH was performed for hemorrhage which cannot be controlled with other conventional treatments within 24 hours of delivery. Results: The incidence of EPH was 1.71 per 1000 deliveries. In our study, the indications of hysterectomy were placenta previa in 47 cases (50%), placental insertion anomalies in 23 cases (24.5%), uterine atony in 22 cases (23.4%), and uterine rupture in 2 cases (2.1%). Hysterectomy was performed after vaginal delivery in 7 patients (7.4%) and during cesarean section in 87 cases (92.6%). Total and subtotal hysterectomy were performed in 88 (93.6%) and 6 cases (6.4%), respectively. Major complications occurred in 40 patients (42.6%). In total, 97.9% of the patients required a transfusion of blood and blood products. The mean postoperative hospital stay was 8.1 (6.1) days. There were two (2.2 %) maternal deaths due to pulmonary embolism and coagulopathy. Conclusion: EPH operation has high maternal morbidity and mortality but is lifesaving when performed at the appropriate time. The most common indication for EPH was placental abnormality (74.5%), followed by uterine atony (23.4%). Together with a significant increase in cesarean rates, significant increases in the frequency of placental abnormalities are remarkable. Limiting the number of cesarean deliveries will have a significant impact on reducing the risk of EPH.

Correlation analysis of stress and family function and coping modes in pregnant women with pregnancy-induced hypertension syndrome.

Pregnancy-induced hypertension is a common complication in obstetrics and an important cause of maternal death. We explored the correlations among stress, family function and coping mode in women with pregnancy-induced hypertension syndrome. A total of 58 pregnant women with pregnancy-induced hypertension syndrome were included in the study. The perceived stress scale (PSS), family assessment device (FAD), and medical coping modes questionnaire (MCMQ) were used to assess stress level, family function, and coping mode, respectively. The PSS score was 28 (interquartile range: 20-43). The total FAD score was 128.1±27.1. The subscale scores were problem-solving, affective responsiveness, communication, roles, behavior control, affective involvement, and general function, in order of decreasing score. Significant correlations were noted between PSS score and total FAD score, affective responsiveness, problem-solving, communication, roles, affective involvement, and behavior control (all P<0.05). PSS score was significantly correlated with "Escape" (P=0.016) and "Yield" (P<0.001) in the MCMQ. Single-factor analysis showed that education level, average household income, and FAD total score were significantly different in those with a low or high PSS score. Logistic regression indicated the FAD total score as an independent factor for the PSS score. Women with pregnancy-induced hypertension syndrome with a high PSS score tended to adopt the "Escape" and "Yield" coping modes. Family function integrity is essential for reducing PSS scores.

The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

BackgroundMaternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures.MethodsBased on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters.ResultsAlthough incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions.ConclusionThese findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.

The association between postpartum hemorrhage and postpartum depression: A Swedish national register-based study.

BackgroundPostpartum hemorrhage is an important cause of maternal death and morbidity. However, it is unclear whether women who experience postpartum hemorrhage are at an increased risk of postpartum depression.ObjectivesTo examine whether postpartum hemorrhage is associated with postpartum depression.MethodsWe conducted a national register-based cohort study of 486,476 Swedish-born women who had a singleton livebirth between 2007 and 2014. We excluded women with pre-existing depression or who filled a prescription for an antidepressant before childbirth. We classified postpartum depression up to 12 months after giving birth by the presence of an International Classification of Diseases, version 10 (ICD-10) diagnosis code for depression or a filled outpatient prescription for an antidepressant. We used Cox proportional hazard models, adjusting for maternal sociodemographic and obstetric factors.ResultsPostpartum depression was identified in 2.0% (630/31,663) of women with postpartum hemorrhage and 1.9% (8601/455,059) of women without postpartum hemorrhage. In our unadjusted analysis, postpartum hemorrhage was not associated with postpartum depression (unadjusted hazard ratio (HR) = 1.06, 95% confidence interval (CI) 0.97–1.15). After adjusting for maternal age, parity, education, cohabitation status, maternal smoking status, and early pregnancy maternal BMI, gestational age, and birthweight, the association did not appreciably change, with confidence intervals overlapping the null (adjusted HR = 1.08, 95% CI 0.99, 1.17).ConclusionsWithin a population-based cohort of singleton women in Sweden with no prior history of depression, postpartum hemorrhage was not associated with postpartum depression.

Upregulation of elafin expression in the fallopian tube of ectopic tubal pregnancies compared to the normal tubes

BackgroundEctopic pregnancy is one of the most important causes of maternal deaths and fallopian tubes are the location of 95% of ectopic pregnancies. Elafin is a natural antimicrobial molecule that plays an important role as an anti-inflammatory agent in mucosal surfaces and has been found in the female reproductive tract. ObjectivesThe aim of this study was to investigate elafin expression, in the fallopian tube mucosa of ectopic pregnancies compared to the normal tubes using immunohistochemistry (IHC) techniques and quantitative reverse transcription (qRT)-PCR. MethodsIn this case-control study, uterine tube samples were obtained from patients with an indication for surgical removal of the tubes. The case group (n = 20) consisted of patients who were undergoing salpingectomy due to an ectopic pregnancy, the control group (n = 20) included patients who had a salpingectomy and hysterectomy. Using qRT-PCR and IHC, the expression of elafin was investigated in both study groups. ResultsImmunohistochemical expression of elafin in the epithelium and connective tissue was significantly increased in the implantation site of the patients in comparison with the control group (P < 0.001). The level of elafin mRNA increased in the mucous membrane of the fallopian tube from patients with the ectopic pregnancy compared to the normal mucosa (P < 0.001). ConclusionIncreasing expression of elafin during an ectopic pregnancy may be a mechanism for enhancing innate immune response and be involved in related pathological conditions such as infection and ectopic implantation.

Risk factors for postpartum sepsis: a nested case-control study

BackgroundThe Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.MethodsA case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC).ResultsMultivariable analysis revealed that 1–4 antenatal visits (95% CI 0.01–0.62)., 3 or more vaginal examinations (95% CI 1.21–3.65), home delivery (95% CI 1.72–50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93–20.23), lower abdominal pain (95% CI 1.15–3.42)) vaginal discharge (95% CI 2.97–20.21), SpO2 < 93% (95% CI 4.80–37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80–0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis.ConclusionThis study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.

Cardiovascular Programming by Preeclampsia Sensitizes Mother Rats to Hemodynamic and Cardiac Autonomic Depressant Effects of Postpartum Endotoxemia

Preeclampsia is a pregnancy related disorder with serious maternal and fetal consequences. Considering that postpartum infection and endotoxemia are important causes of maternal death, we investigated whether preeclamptic maternal programming alters cardiovascular and cardiac autonomic consequences of endotoxemia in rats. Preeclampsia was induced by daily oral administration of 50 mg/kg of L‐NAME for 7 days starting from day 14 of conception. Changes in blood pressure (BP), heart rate (HR), and cardiac sympathovagal balance caused by i.v. administration of lipopolysaccharide (LPS) were assessed in conscious mothers pre‐instrumented with femoral indwelling catheters at 3 weeks (weaning time) and 9 weeks postpartum. At weaning, LPS caused significantly greater falls in BP and rises in HR and LV contractility (dP/dtmax) in PE rats compared with their non‐PE counterparts. Additionally, more apparent reductions in time and frequency domain indices of heart rate variability and shifts in cardiac sympathovagal balance (low‐frequency/high‐frequency ratio, LF/HF) towards parasympathetic dominance were observed after treatment of weaning PE mothers with LPS. Measurement of arterial baroreflex activity by the vasoactive method revealed that LPS attenuated reflex bradycardic responses to phenylephrine in endotoxic PE, but not non‐PE, weaning rats. Remarkably, the intensified cardiovascular effects of endotoxemia in weaning PE rats were found to subside after 9 weeks of delivery. In conclusion, maternal programming by preeclampsia elicits short‐term exacerbation of cardiovascular and autonomic derangements caused by endotoxemia in rats.Support or Funding InformationSupported by the Science and Technology Development Fund, Egypt (STDF Grants No. 14895)

Venous Thrombosis could be Gender Specific, Women Beware!

Venous thrombosis (VT) is the third major cause of mortality in the world after heart attack and stroke. Its two major clinical manifestations are deep vein thrombosis (DVT) and pulmonary embolism (PE) which are serious medical conditions but often remain under-diagnosed. Although rate of occurrence of venous thrombosis in men is slightly higher, a number of studies have pointed out that woman poses higher risk of venous thromboembolism (VTE) compared to men at various stages of life. Risk of VTE increases in women’s life particularly with use of oral contraceptives, during pregnancy and with exogenous administration of hormones like in post-menopausal hormone therapy. Various reports show that these factors increase risk of DVT and PE by several folds. DVT is considered as an important cause of maternal death in western countries. It is often asymptomatic and its signs and symptoms are similar to those of normal pregnancy. The hormonal changes at various stages of life and less physical activity increase the risk of VTE by blood flow stasis. It is extremely important for women to know the stages of life when they are prone to develop VTE, about its prevention and treatment. Detailed studies on differences in clinical manifestations of VTE between men and women are lacking. This review focusses on assessing the increased risk of VTE and its prognosis in women based on available literature.

Maternal near-miss and death among women with rupture of the gravid uterus: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

To investigate the burden of maternal near-miss and death due to rupture of the gravid uterus, the indicators of quality of care, and avoidable factors associated with care deficiencies for ruptured uterus in Nigerian tertiary hospitals. Secondary analysis of a nationwide cross-sectional study. Forty-two tertiary hospitals. Women admitted for pregnancy, childbirth or puerperal complications. Cases of severe maternal outcome [SMO: maternal near-miss (MNM) or maternal death (MD)] following uterine rupture were prospectively identified over 1year. Incidence of SMO, indicators of quality of care, and avoidable factors associated with deficiencies in care. There were 91724 live births and 3285 women with SMO during the study period. SMO due to uterine rupture occurred in 392 women: 305MNM and 87 MD. Uterine rupture accounted for 11.9, 13.3, and 8.7% of all SMO, MNM, and MD, respectively. SMO, MNM, and intra-hospital maternal mortality ratios due to uterine rupture were 4.3/1000 live births, 3.3/1000 live births, and 94.8/100000 live births, respectively. Mortality index (% of MD/SMO) was 22.2%, and MNM:MD ratio was 3.5. Avoidable factors contributing to deaths were related to patient-orientated problems, especially late hospital presentation and lack of insurance to cover life-saving interventions. Medical personnel problems contributed to care deficiencies in one-third of women who died. Uterine rupture significantly contributes to SMO in Nigerian tertiary hospitals. Strategies to improve maternal survival should address avoidable institutional factors and include community-based interventions to encourage skilled attendance at birth and early referral of complications. Uterine rupture remains an important cause of maternal death in Nigerian tertiary hospitals.

Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999\u20132015

BackgroundThe available literature suggests that there are significant differences in maternal mortality according to maternal origin in high income countries. The objective of this study was to quantify the risk of maternal death by maternal origin and region of Spain where the birth occurred and to identify the most important causes of maternal death in our country.MethodsAn ecological cross-sectional study was conducted that included all deliveries that resulted in maternal survival and cases of maternal death during 1999–2015 in Spain. A descriptive analysis of the maternal mortality rate by maternal origin, region and year of birth was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analysis, with adjustment for the variables included in the descriptive analysis.ResultsThere were 272 maternal deaths during this period, most of which were due to haemorrhage (63 cases, 23.16%).Women whose continent of origin was South America had the highest adjusted risk of maternal death, with an OR of 3.92 (95% CI 2.75–5.58). The region of Spain with the highest risk of maternal death was Ceuta, with an OR of 12.11 (95% CI 2.02–72.68).ConclusionsThis study shows that there are inequalities in maternal mortality according to maternal origin and region where labour occurred. These findings highlight the need to establish strategies at the national and European levels to analyse the most relevant causes and risk factors associated with maternal mortality in order to reduce it and pay closer attention in identifying and carefully managing pregnant women from this at risk groups.

Prophylactic antibiotics for the prevention of infection following operative vaginal delivery (ANODE): study protocol for a randomised controlled trial

BackgroundSepsis is one of the most important causes of maternal death and severe morbidity worldwide. Studies conducted both in the UK and US have documented an additional risk associated with operative vaginal delivery. However, a Cochrane review, updated in 2017, identified only one small trial of prophylactic antibiotics following operative vaginal delivery, which included a total of 393 women. Given the small size of that trial, it recommended that further robust evidence is needed. Operative vaginal delivery rates vary worldwide, but typically 5–10% of women have operative vaginal births. A conservative estimated incidence of maternal infection following operative vaginal delivery is 4%, based on the one previous trial. There is, therefore, considerable scope for direct patient benefit from an effective preventive strategy.Methods/DesignThis protocol describes a multicentre, randomised, blinded, placebo-controlled trial aiming to recruit 3424 participants from over 20 hospital sites in the UK. Women who have undergone an operative vaginal delivery at 36+0 weeks or greater gestation with no indication for ongoing antibiotics in the postpartum period and no contra-indications to prophylactic co-amoxiclav, will be randomised to receive a single intravenous dose of co-amoxiclav or placebo.The primary outcome will be confirmed or suspected maternal infection within 6 weeks of delivery, as defined by one of (a) a new prescription of antibiotics for presumed perineal wound-related infection, endometritis or uterine infection, urinary tract infection with systemic features or other systemic infection, (b) systemic infection confirmed with a culture or (c) endometritis as defined by the US Centers for Disease Control and Prevention. Outcome information will be collected by a single telephone interview and questionnaire, with clinical data collected from medical records or the hospital laboratory if necessary, at 6 weeks post-delivery.DiscussionThis randomised trial will investigate whether a prophylactic dose of antibiotic following operative vaginal delivery can reduce the incidence of infection and sepsis. If shown to be effective, this could lead to a change in recommended practice and the prevention of infection. Conversely, if there is no significant difference between the two arms, then this could contribute to a reduction in antibiotic use and improved antimicrobial stewardship.Trial registrationISRCTN11166984. Registered on 23 September 2015.

Secondary Postpartum Hemorrhage Following Cesarean Section

Background : Complications of pregnancy and childbirth have always been one of the leading causes of death and disability among women of reproductive age in developing countries .Globally, postpartum haemorrhage is the single most important cause of maternal death, accounting for about 25% of the total and claiming an estimated 1,50,000 lives annually. Among the postpartum hemorrhage, the primary postpartum hemorrhage is more prevalent, but sufferings from secondary postpartum hemorrhage have been emerging. With the rising trend of cesarean section rate, the incidence of secondary postpartum hemorrhage is also rising.Objective: The objectives of this study is to evaluate secondary postpartum hemorrhage cases following cesarean section and vaginal delivery with the aim of reducing the maternal mortality at child bearing age.Methods: This is a cross sectional observational study in the department of Obstetrics and Gynaecology, DMCH , by purposive sampling method. Total 100 cases of secondary PPH were observed during 1st January 2013 to 31 December 2013.Result: In this study, among the cases 67% were following cesarean section and 33% were following vaginal delivery, mean age of the patients were 29 year, parity ranges from 1 to 5. Regarding the outcome of secondary PPH, severe anaemia, anaemic heartfailure, renal failure and DIC were common in cesarean sections along with hazards of massive blood transfusion and jaundice. 7 patients were died in post cesarean cases and 2 died in post vaginal delivery cases. Causes of death were due to hemorrhagic shock &amp; septicemia.Conclusion: In this is study, the rate of secondary PPH is 67% following cesarean section which is very much alarming . The outcome of secondary PPH following cesarean section is worse than vaginal delivery.J Shaheed Suhrawardy Med Coll, June 2017, Vol.9(1); 23-25

Postpartum hemorrhage: new insights for definition and diagnosis

The current definition of is inadequate for early recognition of this important cause of maternal death that is responsible for >80,000 deaths worldwide in 2015. A stronger definition of postpartum hemorrhage should include both blood loss and clinical signs of cardiovascular changes after delivery, which would help providers to identify postpartum hemorrhage more promptly and accurately. Along with the amount of blood loss, clinical signs, and specifically the shock index (heart rate divided by systolic blood pressure) appear to aid in more accurate diagnosis of postpartum hemorrhage.

Venous Thromboembolism and Route of Delivery - Review of the Literature.

Venous thromboembolism events are important causes of maternal death during pregnancy and the postpartum period worldwide. A review of the literature with the objective of evaluating venous thromboembolism events in the puerperium according to the route of delivery was performed through a bibliographic survey in the Medline, LILACS and Scielo databases. We observed that patients submitted to cesarean sections present a significantly higher risk of developing venous thromboembolism when compared with those who undergo spontaneous vaginal delivery. The pathophysiological bases for this difference were explored and described in this review, as well as the indications of prophylaxis and treatment. Doctors and health professionals must be continuously vigilant regarding this condition, since it is associated with high morbidity and mortality.

A study of the diagnostic value of Inhibin A Tests for occurrence of preeclampsia in pregnant women.

BackgroundHypertensive disorders are common during pregnancy, and are among 3 important causes of maternal death. Preeclampsia occurs in 3 to 5% of pregnancies. Early diagnosis of this disorder can lead to better pregnancy outcomes.ObjectiveThe aim of this study was to determine the relationship between inhibin A serum levels during second stage pregnancy screening tests, and incidence and severity of preeclampsia.MethodsIn this study, 300 pregnant women who referred to Kowsar Hospital and carried out second stage pregnancy screening tests from September 2014 to March 2015 in Urmia city, Iran, were enrolled. Five ml venous blood samples were obtained from each participant, and inhibin A serum levels were evaluated in all cases. Finally, all the necessary information was obtained from the pregnancy files of participants after delivery, and gathered in a questionnaire. The data were analyzed using SPSS software version 18 and independent t-test, ANOVA and descriptive statistics were used. P-values less than 0.05 were considered significant.ResultsAmong the 300 pregnant women who were studied, the gestational age at the time of acquiring blood samples was as follows: 169 cases (56.3%) at 16–17 weeks, 77 cases (25.7%) at 18–19 weeks and 14 cases at 20 weeks (4.7%). In this study, MOM of inhibin A was more than 1.25 in 12 cases that finally, preeclampsia occurred in them. This relationship was statistically significant (p=0.001). The relationship between MOM of inhibin A and severe preeclampsia was evaluated, and the relationship was significant (p=0.004). The relationship between MOM of inhibin A and pregnancy hypertension was not significant (p=0.643).ConclusionConsidering the results of this study, we can conclude that MOM of inhibin A levels in maternal serum during second stage pregnancy screening tests can predict incidence and severity of developing preeclampsia in pregnant women. This is not true in cases of pregnancy hypertension.