Poor Maternal Prognosis Research Articles

Postpartum Hemorrhage; Incidence and Prognosis

During the study period a total of 1000 deliveries; 74 parturients presented with PPH, an incidence of 7.4% [95% CI 6.3-6.5] with that of severe PPH at 2.7% [95% CI 1.6-1.8]. maternal age varied between 30 and 42 years. The average age in our sample was: 34.33 ± 6.030 years. Mean term: 38.69 ± 1.25 weeks gestation mean was 3.8 ± 1.6. The oldest parity was 3.2 ± 2 with extremes of 1 and 8. 73.7% were multiparous (2 deliveries and more). RBC transfusion was done in 97.5%. Oxytocics were administered in 95.8%. Uterine inertia following a placentation anomaly (accreta, increta and percreta) remains the most frequent etiology in 79.8%, and coagulation disorders 15.2% (congenital or acquired) and 5% of entangled causes (ATCD from Covid19, death in utero, help ). As for the mode of delivery, the upper route is the most frequent with 70% of cases RBC transfusion was done in 97.5%. Oxytocics were administered in 95.8%. Uterine revision was performed in 80.6%. , artificial delivery was done in 26.4%. Vascular ligation was done in 20.8%. Hemostatic hysterectomy was required in 19.4%. Hospitalization in the maternal intensive care unit was necessary in 70.9% with an average duration of 3.5 days. There were 73% cases of disseminated intravascular coagulation (DIC), 50% renal failure (IR) of which two were hemodialysis. The death rate was 18%. Three risk factors associated with a poor maternal prognosis: severe hypovolaemia (p = 0.0001), disseminated intravascular coagulation abnormalities (p = 0.006) and organic renal failure (p = 0.0013).

Severe Preeclampsia Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects at the Thies Regional Hospital Center about 443 Cases

Objectives: Are to study the epidemiological, diagnostic, therapeutic and prognostic aspects of severe pre-eclampsia in the Obstetrics Gynecology Department of the Regional Hospital of THIES. Materials and Methods: This were a prospective, descriptive and analytical study of patients received for PES at the Maternity Department of the Regional Hospital of Thies between June 20, 2015 and June 20, 2017. We studied the diagnostic, epidemiological, therapeutic and prognostic aspects. The data were entered and analyzed by the EPINFO software version 6.04dfr. In order to study the influence of certain prognostic factors, we used the comparison of proportions and the Chi-square test with a significance level of 0.05. Results: We recorded 443 cases of Severe Peclampsia (SEP) out of 15,744 pregnant women, i.e. a frequency of 2.81%. It represented 52.05% of all hypertensive states associated with pregnancy during the study and a frequency of 3.12% of deliveries. The typical epidemiological profile found was that of a young woman aged 20-24 (25.05%), married (91.19%), housewife (80.8%) from the commune of Thies (50.56 %), primiparous (52.37%), carrier of a single pregnancy (96.4%), followed in a health post (97.21%) and evacuated in 89.4% of cases. The time between admission and delivery was on average 3.85 ± 3.91 days with extremities ranging from 0 to 42 days. The main signs found were: headache (96.61%), hypertension with SBP ≥160/110mmHg (93.90%), edematous syndrome (90.29%), proteinuria on the test strip ≥ ++ (95.48%), hyper uricemia >60mg/l (66.13%). Therapeutically, calcium channel blockers were the main antihypertensive agent used (99.32%). Magnesium sulfate was administered to almost all patients (97.29%). Corticosteroids were administered to 223 patients (50.23%). The blood transfusion had been done in 45 patients or 10.08%, and 05 of our patients had presented an acute renal failure requiring a transfer to Dakar for dialysis. Fetal evacuation was performed by Caesarean section in 49.88% of cases. Maternal complications were dominated by: eclampsia (24.78%), retro-placental hematoma (3.61%) and Hellp syndrome (3.61%). We recorded 18 cases of maternal death, i.e. a specific lethality of 4.06% and 69 cases of neonatal death, or a perinatal mortality rate of 4.87 per 1000 live births. On the fetal side, the main complications were fetal hypotrophy (51.46%) and prematurity (41.08%). The main factors of poor maternal prognosis were young age (20-24 years), primi gestity and primiparity. The fetal risk factors included prematurity and the low Apgar score.

Anesthesiological Management of Eclampsia in Tropical Africa: Experience of the University Hospital Center of Bouake

Introduction: Eclampsia is a common cause of maternal mortality in developing countries. The objective of this study is to evaluate the practice of anesthesia for eclampsia in tropical Africa. Patients and Methods: Retrospective descriptive study on the parturients who benefited from eclampsia anesthesia in the operating theaters of the gynecology and obstetrics department, the University Hospital Center (CHU) of Bouake over a two-year period (January 2015 to December 2016). The parameters studied were: anesthetic risk assessment, anesthetic management, immediate anesthetic and post-anesthetic accidents and incidents. Results: Out of a total of 3831 emergency cesarean sections, 65 were for eclampsia, or 1.69% of obstetrical surgical activity. The mean age of the patients was 20.30 ± 3.34 years (range: 14 years and 39 years). Prenatal consultation was not performed in 70% of cases and 85% of patients were primiparous. Patients classified as ASA IIIU accounted for 75% of the population and in 62% of cases, the Glasgow score was between 9 and 12. Induction was achieved with thiopental in 98% of patients and vecuronium was the only muscle relaxant used. The most common fetal complications were hypotrophy (50%), prematurity (30%) and respiratory distress (40%). Postoperative anesthetic complications were agitation (70%) and wake delay (15%). Maternal mortality was 5% and the neonatal death rate was around 7.69%. The elements of poor maternal prognosis were the ASA IVU class (P = 0.015) and the Aldrete awakening score between 3 and 5 awakening (P = 0.001). Conclusion: Anesthesia for eclampsia at CHU of Bouake is difficult. It needs to be improved thanks to better equipment of the health structures.

Thrombocytopenia, hypertension and seizures in eclampsia

Objective: Mortality by eclampsia most likely relies on factors that are associated with seizures, but not directly related to them. The objective of the current study is to analyze these probable factors. Method: This study evaluates patients with eclampsia only. Age, parity, weeks of gestation, blood pressure, platelet counts and cause of death were analysed. The groups of survivors and fatalities were compared using relative risk (RR) with 95% confidence intervals (CI), χ 2 and Student's t-test. Results: A total of 446 cases of eclampsia were studied, of which there were 371 survivors and 75 deaths. The incidence was 14.2 10000 births with mortality of 14.4%. Mortality was more frequent in patients over 25 years of age ( P < 0.005). The diastolic blood pressure showed significant difference between the survivor and fatality group ( P < 0.05). Before convulsion, thrombocytopenia was present in 148 patients (33.2%) of which 95 survived and 53 died (RR = 2.76; 95% CI 2.20–3.46; P < 0.0000001). Conclusions: Mortality by eclampsia is directly related to age, diastolic blood pressure ≥110 mmHg, seizure and thrombocytopenia. Our findings suggest poor maternal prognosis if seizures occur associated with thrombocytopenia.

Atraumatic Subdural Hematoma Associated with Pre-Eclampsia

A patient with pre-eclampsia at 31.7 weeks' gestation developed focal neurologic signs. Computerized tomography revealed a large cranial subdural hematoma. A subdural hematoma should be considered in any pre-eclamptic patient demonstrating lateralizing neurologic symptoms. Despite adequate treatment, an atraumatic subdural hematoma associated with pre-eclampsia carries a poor maternal prognosis.