Obstetric Causes Research Articles

Our Experience in Using the Endovascular Therapy in the Management of Hemorrhages in Obstetrics and Gynecology.

(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management of significant bleeding in Obstetrics and Gynecology. The aim of this study was to evaluate the effect and the complications of PAE in patients with significant vaginal bleeding with different obstetrical and gynecological pathologies. (2) Methods: We conducted an observational, retrospective study on 1135 patients who presented to the University Emergency Hospital of Bucharest with vaginal bleeding of various etiology treated with endovascular therapy. All the patients included in the study presented vaginal hemorrhage that was caused by: uterine leiomyomas, genital tract malignancies, ectopic pregnancy, arterio-venous mal-formations and other obstetrical causes. We excluded patients with uncontrolled high blood pressure, severe hepatic impairment, congestive heart failure, renal failure or ventricular arrhythmias. (3) Results: Bleeding was caused in 88.19% of cases by uterine leiomyomas (n = 1001), 7.84% (n = 89) by cervical cancer, 2.29% by ectopic pregnancy (n = 26), 1.23% by arteriovenous malformation (n = 14) and 0.52% by major hemorrhage of obstetrical causes. Endovascular procedures were used in all the cases. In patients with uterine leiomyomas, supra-selective uterine arteries embolization was used. In 97% (n = 1101) of patients, bleeding was stopped after the first attempt of PAE. 3% (n = 34) needed a second embolization. In 12 of 14 cases of AVM, PAE was successful, two other cases needed reintervention; (4) Conclusions: Endovascular procedures represent a major therapy method for both acute and chronic hemorrhage in Obstetrics and Gynecology. It can be used in post-partum or post-traumatic causes of vaginal bleeding, but also in patients with chronic hemorrhage from uterine leiomyomas or inoperable genital malignancies or even as a preoperative adjuvant in cases of voluminous uterine fibroids or invasive malignant tumors, aiming to reduce intraoperative hemorrhage.

Causes of health inequities.

A renewed focus on U.S. racial and ethnic maternal health disparities has arisen following high-profile incidents of police violence and antiracism protests which coincided with the coronavirus disease 2019 pandemic, which has exerted a disproportionate effect on minority communities. Understanding the causes of disparities is pivotal for developing solutions. Social determinants of health must be addressed during clinical care; however, race must be used with caution in clinical decision-making. Medicaid expansion has been associated with a decrease in severe maternal morbidity and mortality, especially for racial and ethnic minority women. Indirect obstetric causes are the leading cause of maternal death. Policy-level changes and investment in marginalized communities are required to improve access to quality maternity care at all stages, including preconception, interconception, prenatal, intrapartum and postpartum for 12 months after delivery. Improvements in hospital quality and implementation of evidence-based bundles of care are crucial. Clinicians should receive training regarding susceptibility to implicit bias. To support the research agenda, better collection of race and ethnicity data and anesthesia care indicators is a priority (see Video, Supplemental Digital Content 1 {Video abstract that provides an overview of the causes racial and ethnic disparities in maternal health outcomes.} http://links.lww.com/COAN/A85).

Hubungan pengetahuan ibu nifas dengan perawatan luka perinium di PMB Aan Dyah Tahun 2020/2021

The cause of maternal death in Indonesia is still dominated by bleeding (32%) and hypertension in pregnancy (25%), followed by infection (5%), old partus (5%), and abortion (1%) in addition to obstetric causes, maternal mortality is also caused by other causes (non obstetric) of 32%. As a result of improper perineal care can result in perineal conditions affected by lokchea and moisture will greatly support the proliferation of bacteria that can cause infections in the perineum. The purpose of this study to determine the relationship of maternal knowledge with perineal wound at PMB Aan Dyah.
 This research use analytical method by using primary data and secondary data. The population in this study is the number of mothers in the last 3 months totaling 65 respondents in June - August 2017. Sampling technique is total sampling.
 The result of the research was obtained, good postpartum mother as many as 25 people (38,5%), bad woman with bad knowledge about 40 people (61,5%), postpartum who do perineal wound care 15 respondents (23,1%), and postpartum mothers who did not perform perineal wound care as much as 50 respondents (76.9%). In chi square test to see the correlation between knowledge of postpartum mother and perineal wound care, p-value value of0.000 (p <0,05) was obtained, meaning that there was a significant correlation between maternal knowledge with perineal wound care. It is suggested to health officer to give counseling about perineal wound care on postpartum so that postpartum mother can know the importance of perineum wound care benefit.

Study of Impact of Covid-19 on Pregnancy Outcome

Background: This is a prospective, observational study done amongst the covid positive pregnant patients who are admitted and undergone intervention during the duration of SARS-CoV- between April 2020 and April 2021, and who delivered within the next 14 days at the government medical hospital Bhavnagar were included and an observational prospective study conducted for their severity, maternal outcome and neonatal outcome.
 Result: This study included a total of 74 patients diagnosed with covid positive status by RT-PCR method, 55 (73.33%) patients had mild-moderate covid symptoms while 19 (26.7%) patients has severe covid symptoms which required either oxygen support or ICU admission. Out of these 55 patients,34 (61.82%) patients had a normal vaginal delivery and out of this,7 (20.6%) had condition deterioration and required subsequent oxygen support, and 21(38.2%) patients had to undergo caesarean section for some obstetric indication and out of this 8 (38.1%) patients had condition deterioration with subsequent oxygen support requirement. in the mild-moderate symptoms group, 8.83% of patients had neonatal ICU admission after normal delivery while it was 19% after caesarean section. In the severe covid group all those with spontaneous delivery still required ICU care with increased oxygen support. Of those who underwent CS due to obstetric cause, 33.34% of patients had increased oxygen requirements while 16.67% had to be admitted in ICU care.
 Conclusion: Covid 19 infection posed a significant risk to a small proportion of pregnant women including an increased risk for critical diseases requiring ventilation support..COVID-19 is not an indication for caesarean section or induction of labour, the however second stage should be assisted in those with severe disease and caesarean section may be indicated to allow for proper ventilation supports or resuscitation.
 Keywords: pregnancy, covid positive severity, caesarean section, vaginal delivery.

Association Of Vesico-Vaginal Fistula to The Congenital Ureter Abnormality: About Two Cases in Two African Countries

A significant number of preventable deaths occur during pregnancy and childbirth in developing countries where maternal mortality ranges from 500 to 1000 per 100,000 live births; for every woman who dies, an estimated 16 to 30 more survive with preventable complications. Obstetric fistula can be considered the most tragic complication during childbirth. WHO estimates that there are about 2 million cases of VVF worldwide and 50,000 to 100,000 new cases each year. [5, 6] The vast majority of cases are reported in sub-Saharan Africa and Southeast Asia where qualified obstetric assistance is random. Obstetric fistulas are thus a major public health problem in poor countries. Obstetric fistula is an abnormal communication between the urinary tract (the ureter, bladder and urethra) and/or digestive (rectum), on the other hand the genitals (the uterus and vagina) occurring during delivery. Various types of fistula are distinguished: uretero-vaginal fistulas, vesico-uterine fistulas and vesico-vaginal fistulas (VVFs). These take into account uretro- vaginal fistulas. RVF, associated or not with a VVF, is a communication between the rectum and the vagina. The most common are VVFs. Many etiologies are recognized in VVFs, but studies in Africa have shown that in the majority of cases, are of obstetric cause. Obstetric Fistula occurs as a result of obstructed labor characterized by prolonged delivery without the possibility of caesarean section. Uretero-vaginal fistula is characterized by the ectopic drainage of the ureter in the vagina causing a permanent flow of urine through the vagina. Although the congenital origin is rare, iatrogenic etiology remains common during a caesarean section or poorly performed hysterectomy. It results from a ligation or damage of the ureter at its crossing with the uterine artery. The ureter attached to the vaginal wall eventually drains urine into the vagina within a few hours or days of the procedure. Duplicity and uretero-pyelic bifidity are rare abnormal uropathies whose surgical discovery is the most common diagnostic method in developing countries where high-tech diagnostic method is not affordable. The rarity of the pathology and the non-systematic prescription of certain analysis (as IVU) for the preoperative assessment of urogenital fistulas justify the paucity of the literature on this subject.

Cardiac disease in pregnancy.

In the developed world, cardiovascular disease has become the most frequent cause of death during pregnancy and postpartum, outnumbering by far obstetric causes of death such as bleeding or thromboembolism. Many factors contribute to this phenomenon, including an increasing age of pregnant women, co-morbidities, and an unhealthy lifestyle. The cardiovascular system is not only significantly challenged by physiological alterations in pregnancy but also by obstetric medication. Depending upon the severity of the underlying condition, pregnant women with cardiovascular disease should be managed by a multidisciplinary heart team in which anaesthesiologists play an important role. Profound knowledge of the cardiac pathophysiology is a prerequisite for the successful anaesthesiologic management of pregnant patients with cardiovascular disease. As there is no difference in general and regional anaesthesia regarding maternal outcomes, neuraxial anaesthesia using incremental techniques should be preferred for labour and (caesarean) delivery if not contraindicated by non-cardiac issues.

TRANSVAGINAL REPAIR OF VESICOVAGINAL FISTULA: EXPERIENCE AT A TERTIARY CARE CENTRE.

Aim: to highlight the transvaginal route as an effective approach for repair of simple vesico-vaginal and urethro-vaginal stulae without compromising patient outcomes. Materials and Methods: A retrospective analysis was carried out on 45 patients with simple trigonal, supra trigonal and urethrovaginal stula who underwent transvaginal repair in the last 3 years. Simple stulas were dened as stula less than 3 cm in size or recurrent stulae less than 1.5–2 cm in size and located either supra-trigonally (above the bar of mercier) or sub-trigonally (below the bar of mercier) as determined by cystoscopy. Results: Obstetric cause, due to obstructed labour, was the most common cause of stula formation (68.96%), while remaining (29.31%) were attributed to hysterectomy. Primary stulae were found in 68.9% of patients and recurrent stulae in 31.1% patients. The mean age of patients was 34.30 years. Average stula size was 1.5 cm. The success rate of primary operation was 84.12%. On using a multivariate regression model, the underlying aetiology (OR 2.2), stula location (OR 2.5) and history of previous repair (OR 2.4) were found to be signicant factors affecting outcome. Conclusion: The transvaginal approach is less invasive and achieved comparable success rates as compared to other methods of vesico-vaginal stula repair. We postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible vesico vaginal stulae, both of obstetrical and gynaecological origin.

Estimating the Risk of Maternal Death at Admission: A Predictive Model from a 5-Year Case Reference Study in Northern Uganda.

Background Uganda is one of the countries in the Sub-Saharan Africa with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births. We aimed at exploring the main factors affecting maternal death and designing a predictive model for estimation of the risk of dying at admission at a major referral hospital in northern Uganda. Methods This was a retrospective matched case-control study, carried out at Lacor Hospital in northern Uganda, including 130 cases and 336 controls, from January 2015 to December 2019. Multivariate logistic regression was used to estimate the net effect of the associated factors. A cumulative risk score for each woman based on the unstandardised canonical coefficients was obtained by the discriminant equation. Results The average maternal mortality ratio was 328 per 100,000 live births. Direct obstetric causes contributed to 73.8% of maternal deaths; the most common were haemorrhage (42.7%), sepsis (24.0%), hypertensive disorders (18.7%) and complications of abortion (2.1%), whereas malaria (23.5%) and HIV/AIDS (20.6%) were the leading indirect causes. The odds of dying were higher among women who were aged 30 years or more (OR 1.12; 95% CI, 1.04–1.19), did not attend antenatal care (OR 3.11; 95% CI, 1.36–7.09), were HIV positive (OR 3.13; 95% CI, 1.41–6.95), had a caesarean delivery (OR 2.22; 95% CI 1.13–4.37), and were referred from other facilities (OR 5.57; 95% CI 2.83–10.99). Conclusion Mortality is high among mothers referred late from other facilities who are HIV positive, aged more than 30 years, lack antenatal care attendance, and are delivered by caesarean section. This calls for prompt and better assessment of referred mothers and specific attention to antibiotic therapy before and after caesarean section, especially among HIV-positive women.

Community-acquired AKI and its management

Acute Kidney Injury (AKI) is defined as an abrupt decrease in kidney function within hours to days and is caused by multiple factors. Community-acquired AKI (CA-AKI) is common in developing countries, and it is crucial to bring awareness about its epidemiology and simple preventive strategies that can tackle this potentially serious complication. Infections, use of over-the-counter medicines, traditional herbal remedies, animal (and insect) bites, and pregnancy-related complications are common causes of CA-AKI in developing countries. The incidence of vector-borne disease-related AKI and obstetric causes of AKI have decreased following better public health policies in most developing countries. Appropriate fluid management is critical in AKI, both in terms of prevention of development and progression of AKI. Timely initiation and de-escalation of fluid therapy are both equally important. Kidney replacement therapy (KRT) is indicated when AKI progresses to stage 3 and/or patients develop refractory fluid overload or electrolyte imbalances and/or uremic complications. Hemodialysis is the most common modality of KRT in adults, whereas peritoneal dialysis is the dominant modality in small children. Convective renal replacement therapy, such as hemofiltration, is increasingly used in critically sick patients with AKI and hemodynamic instability. To summarize, CA-AKI is a common, serious, and often preventable complication of certain conditions acquired in the community, and is, therefore, a matter of utmost concern from the public health perspective.

Pregnancy, childbirth and neonatal outcomes in women with inherited bleeding disorders: A retrospective analysis.

AbstractObjectiveTo describe the characteristics and outcomes of women with inherited bleeding disorder during pregnancy and birth.DesignRetrospective cohort study.SettingTertiary care hospitals, New South Wales and Victoria, Australia.PopulationOne hundred women with inherited bleeding disorders, who birthed 134 live infants from 132 pregnancies.MethodsData were retrospectively obtained from the patient and neonatal medical records. Descriptive analysis was used to report maternal and pregnancy characteristics and birth and neonatal outcomes.Main outcome measuresFactor replacement, neuraxial analgesia use and complications, postpartum haemorrhage (PPH) and neonatal complications.ResultsPPH occurred in 22% of deliveries with primary PPH occurring in 20% and secondary PPH in 2% of births; 48% of PPH were classified as major. PPH occurred across the spectrum of inherited bleeding disorders and was evenly distributed between women who had ‘normalised’ (46%) their factor levels in pregnancy compared with those requiring factor at the time of birth (50%). An obstetric cause was identified in almost half of PPH (46%). Neuraxial analgesia was administered in 40% of births without complication and refused in 3% of births despite documented adequate haemostatic potential.ConclusionsWomen with inherited bleeding disorders can deliver safely and receive neuraxial analgesia without complication when best practices are adhered to. PPH appears to occur at higher rates than in the general population despite adequate factor levels or planned replacement. Although an obstetric cause was demonstrable in the many cases, these findings raise concern over the current definition of ‘adequate’ factor levels at the time of birth.Tweetable abstractWomen with inherited bleeding disorders can deliver without complication when best practices are maintained.

REVIEW OF MATERNAL MORTALITY AT A TERTIARY CENTRE

Introduction: World Health Organization (WHO) denes maternal mortality as “the death of women while being pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy, from any cause related or aggravated by the pregnancy but not from accidental or incidental cause”. Reduction of Maternal Mortality Rate (MMR) (Ensure healthy lives and promote well-being for all at all ages) is also one of the Sustainable Development Goals adopted by United Nations. Hence, it is very important to study the factors affecting maternal mortality in order to devise a comprehensive strategy for its reduction. Aim:The study aims to analyze the cause and incidence of maternal mortality in Patna Medical College and Hospital, Patna. Type Of Study:Retrospective study Study Period: 1 year (November 2020 to October 2021) Materials And Methods: This study is conducted in department of Obstetrics and Gynaecology of Patna Medical College and Hospital, Patna. Demographic data and other data are collected from record section, admission registers and ICU Registers. Result: Out of 6,658 admissions and 5,370 deliveries during the study period, there were 63 maternal deaths. 57 maternal deaths reviewed were due to obstetric causes. Eclampsia was the leading direct cause of death (26.98%). Conclusion: The study helps in identifying the preventable factors contributing to maternal mortality. The review exercise yielded useful information on factors contributing to preventable causes of maternal mortality in Patna Medical College and Hospital, Patna.

FETOMATERNAL OUTCOME IN OBSTETRIC PATIENTS REQUIRING CRITICAL CARE IN A TERTIARY CARE HOSPITAL.

This retrospective observational study was conducted at the Department of Obstetrics & Gynecology at LTMMC & LTMGH Sion, Mumbai for a duration of 12 months (from January 2020 till December 2020). Aim: To study fetomaternal outcome in obstetric patients requiring critical care in tertiary care hospitals. Inclusion criteria: All the patients admitted and delivered or operated and transferred to the surgical ICU ward. Methodology: Data collected from case records and medical record books of hospitals. Result: In this study, a total of 139 obstetric patients were admitted in ICU which constituted 1.98 % of total deliveries and 1.1 % of ICU admissions. Major obstetric causes of ICU admission were hypertensive disorder of pregnancy(35.9%), haemorrhage(28%), ectopic pregnancy( 11.5%). There were 11 maternal deaths.

Due casi di frattura depressa del cranio o frattura “ping pong”

The paper presents two cases of depressed skull fracture or “ping pong” fracture. This type of fracture is typical of neonatal age or toddlers, ages in which cranial bones are still malleable and not very resistant. Obstetrical causes are more frequent in neonates and traumatic causes in toddlers, abuse should be ruled out in older children. These two cases offer the opportunity to discuss about the possible complications of this type of fracture and about the diagnostic and therapeutic management.

Parturient with Acute Abdomen.

Management of a parturient with an acute abdomen presents unique challenges. We aim to review the common obstetric and nonobstetric causes for acute abdomen in pregnancy, approach to diagnosis, the role of imaging, and management including the scope and timing of operative intervention.How to cite this articleKundu R, Srinivasan S. Parturient with Acute Abdomen. Indian J Crit Care Med 2021;25(Suppl 3):S223–S229.

Blood Transfusion in Obstetrics and Gynecology: A Retrospective Analysis in Government Naseerullah Babar Hospital Peshawar

OBJECTIVES: To evaluate the indications of blood transfusion in the Obstetrics and Gynecology Department of Government NaseerUllah Khan Babar Memorial Hospital. METHODOLOGY: This retrospective observational study was performed on indoor gynecology and obstetrics patients for the period of one year, a total of 100 patients were included in this study that received blood transfusion. Samples were collected by non-random convenience sampling after getting approval from the hospital ethical committee. Data was analyzed by using SPSS version 20. RESULTS: In this study a total of 100 patients who received blood transfusion were analyzed, out of 100 patients 78% of patients received transfusion due to obstetrical causes and 22% patients got transfused for gynecological causes. Most common blood group transfused was B+ and O+ and mean hemoglobin level at which patients received blood transfusion was 9.7g/dl. Blood components preparation can provide components to treat two to three patients from a single donor. The use of packed cell transfusion should be promoted instead of whole blood transfusion that is not even needed in most of the cases. CONCLUSION: Blood transfusion practice has been used aggressively in gynecology and obstetrics in some cases even without proper indications. There is a need to modify this practice by correcting anemia through drugs to avoid the inappropriate use of blood. Use of blood components should be encouraged.

Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010-2019.

To estimate the prevalence of pregnancy-associated deaths due to drugs, suicide, and homicide nationwide from 2010 to 2019. Using U.S. death certificate records from 2010 to 2019 for 33 states plus the District of Columbia, we identified pregnancy-associated deaths using the pregnancy checkbox and International Classification of Diseases, Tenth Revision codes, calculated pregnancy-associated death ratios, and categorized deaths by cause, timing relative to pregnancy, race or ethnicity, and age. Of 11,782 pregnancy-associated deaths identified between 2010 and 2019, 11.4% were due to drugs, 5.4% were due to suicide, and 5.4% were due to homicide, whereas 59.3% were due to obstetric causes and the remaining 18.5% were due to other causes. Drug-related deaths, suicide, and homicide accounted for 22.2% of pregnancy-associated deaths. All three causes of death increased over the study period, with drug-related pregnancy-associated deaths increasing 190%. Homicide during pregnancy and drug-related deaths, suicides, and homicide in the late postpartum period (43-365 days) accounted for a larger proportion of all deaths in these time periods than the contribution of these causes to all deaths among females of reproductive age. Pregnant and postpartum people identified as non-Hispanic American Indian or Alaska Native were at highest risk of drug-related and suicide death, and people identified as non-Hispanic Black were at highest risk of homicide. Deaths due to drug use, suicide, and homicide constitute more than one fifth of all deaths during pregnancy and the first year postpartum. Drug-related deaths and homicides have increased over the past decade. Substantial racial and ethnic inequities in these deaths exist.

Causes of Maternal Mortality in 2020 in the Kara Region (Togo)

Objective: Determine the maternal mortality rate, the epidemiological profile, the causes of death and the dysfunctions noted. Patients and method: This was a cross-sectional and descriptive study from January 1 to December 31, 2020. All maternal deaths during pregnancy or within 42 days after its termination fitting the World Health Organisation definition criteria that occurred in the seven districts of Kara region were included. The data were processed using Excel microsoft. Results: A total of 41 maternal deaths occurred among 23,456 live births, accounting for a maternal mortality ratio of 174.8 deaths per 100,000 live births. The followings were observed: the average age of 30 years; 88% married; 39% multiparous; 78% housewives without income; 5% students. Hemorrhage, preeclampsia, and complications of abortion were the main direct obstetric causes, while anemia was the main indirect obstetric cause. Factors related to deaths were inadequate quality of health care and lack of universal health insurance. The various maternal death audit reports found that 94.4% of deaths were preventable. Conclusion: Most maternal deaths would be prevented in the Kara region if women during pregnancy and the postpartum period received quality health care and the community was involved in decision-making about their health.

Changing Trends of Maternal Mortality in a Rural Medical College in Eastern India: A 23-Year Retrospective Study

Introduction: Maternal mortality in a region is a measure of reproductive health of women in that area. The direct causes of maternal deaths are largely preventable. A new era of more comprehensive, international development agenda-the Sustainable Development Goals (SDG 3.1) was launched by the United Nations General Assembly 2015, New York for ending preventable maternal deaths. Aim: To determine the causes and changing trends of maternal mortality in this rural centre. Materials and Methods: A retrospective observational study was carried out in the Department of Obstetrics and Gynaecology of Bankura Sammilani Medical College in West Bengal in Eastern India. Individual hospital records of all the maternal deaths, from January 1998 to December 2020 were collected. Data regarding demographic profile and reproductive parameters like gravida, parity, antenatal care and cause of death were collected. The records were divided into two four yearly periods, to compare the changing trends (1998-2001) vs (2017-2020) and three five yearly (2002-2006), (2007-2011), (2012-2016) periods. The first term (1998-2001) was taken as the reference period. Results: Comparison between first (1998-2001) and last term (2017-2020) shows significant declining trend of Maternal Mortality Ratio (MMR) (364 vs 148)/100000 live birth (p-value <0.00001). Majority of deaths occurred in primigravida (57.5% vs 60.6%). Direct obstetric causes accounted for majority of the deaths, but with a declining trend (74.7% vs 66.7%). Eclampsia remained the leading direct cause (35.5% vs 32.2%) followed by haemorrhage (20.4% vs 18.8%) and sepsis (18.8% vs 15.7%) in the first term (1998-2001) vs last term (2017-2020). Jaundice 6.45% vs 10.3%, heart disease 2.15% vs 7.1%, embolism 4.3% vs 0.8%, anaemia 6.45% vs 1.6% and other diseases 5.91% vs 13.4% in the first vs last term were the indirect causes of maternal mortality. Conclusion: There is a declining trend of maternal mortality since 1998, which can be attributed to improvement at all levels of healthcare. Eclampsia/preeclampsia and its complications remain the leading cause of maternal mortality. Majority of these maternal deaths can be prevented by regular screening of highrisk cases, integrated antenatal and postnatal care, institutional deliveries, timely referral, and proper implementation of national health programmes.

Hospital-Based Retrospective Cross-sectional Study to Analyse the Causes of Maternal Deaths at a Tertiary Health Care Facility.

Maternal mortality is considered a key health indicator of Maternal and Child Health. Considering the fact that complications are preventable and most of them are modifiable, the study has been planned to analyse maternal deaths in order to suggest recommendations for preventing it. There are various delays according to the three-delay model at primary and secondary level; therefore, interventions are needed at those levels to prevent maternal deaths. To determine the various direct and indirect causes of maternal deaths, analyse the association of medical and social factors with maternal deaths and ^to determine the predictors of maternal deaths. Hospital-based retrospective cross-sectional study of all the maternal deaths occurring in the last 4 years at a tertiary health care facility. Data were collected from the Facility Based Maternal Death Review forms. Data were entered and analysed by IBM SPSS version 25.0 software. For maternal deaths, direct obstetric causes were responsible in 128 (74.4%) and indirect causes in 45 (26.2%) cases followed by unspecified causes in 78 (45.3%) and 1 (0.6%) coincidental cause. Statistically significant associations were observed between maternal death and period of gestation, mode of delivery and outcome of delivery (P = 0.12, P = 0.04 and P < 0.001, respectively). The health professionals of primary and secondary level should be well equipped to diagnose the complications and to manage it as early as possible. Thus, maternal mortality rates can be decreased to significant level.

Критические акушерские состояния в Дальневосточном федеральном округе в пандемию COVID-19 и до эпидемии

Study Objective. To assess the structure and indicators of critical obstetric conditions and maternal deaths in the Far East Federal District of Russia before (2019) and during (2020) the COVID-19 pandemic. Study Design: Retrospective comparative analysis. Material and methods. We have reviewed medical records on near misses (NM) and maternal deaths (MD) for 2019 (194 and 17, respectively) and 2020 (207 and 19, respectively). Descriptive statistics, cross tables analysis with evaluation of the Pearson’s chi-square and p-value, odds ratio calculation at 95%CI were used for mathematic data processing. Study Results. In 2019 and 2020, maternal death rate was 18.7 and 21.1 per 100,000 live births, respectively. Obstetric causes of maternal deaths demonstrated statistically significant reduction during the COVID-19 pandemic (2020) (26.3% vs 76.5% in 2019, р &lt; 0.05); the ratio of life-threatening conditions (NMs and MDs) grew from 2.3 to 2.5; and COC (NM) coefficient soared from 2.1 to 2.3 per 100,000 life births. Reduction in the survival index from 11.4 to 10.9 and increase in the death index from 8.1% to 8.4% can evidence poorer quality of medical care. Conclusion. Analysis of trends and indicators of the critical obstetric conditions allows evaluating the system of organisational and medical measures, revealing issues with obstetrics services and finding additional resources to reduce maternal morbidity and mortality during the emergency situation caused by COVID-19. Кeywords: critical obstetric conditions, near miss, maternal deaths, COVID-19.