Unfavorable Maternal Outcomes Research Articles

Indications for Caesarean Section and its Fetal and Maternal Outcome in a Teaching Hospital, Province Five, Nepal

Introduction: Cesarean section (CS) is an operative technique by which a fetus is delivered through an abdominal and uterine incision and is effective in saving maternal and infant lives but caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates. The objective of the study was to find out the indications for caesarean section and its fetal and maternal outcomes in a Teaching Hospital, Province Five, Nepal.
 Methods: A descriptive, cross-sectional study was conducted in a teaching hospital, Nepal. A total of 150 purposively selected postnatal mothers after caesarean section were interviewed by face to face technique using a structured interview schedule. Analysis and interpretation of the findings were done with the help of descriptive and inferential statistics.
 Results: The study shows that the majority (93.3%) of mothers had undergone an emergency caesarean section and the majority (92%) had maternal indications for caesarean section. Among them, one third had a previous caesarean section followed by 14.5% obstructed labor. Fetal indications include breach (44.4%), fetal distress (29.6%), big baby (11.1) and twins and triplets (3.7%). Only (10.7%) had an unfavorable fetal outcome which includes the need for Neonatal Intensive Care Unit (NICU) (31.2%) followed by neonatal death (25%). Only three mothers (2%) had an unfavorable maternal outcome which includes Post-Partum Hemorrhage (PPH); need for blood transfusion and fever respectively. There is no statistically significant association between sociodemographic characteristics and type of caesarean section. There is a statistically significant association between the previous history of caesarean section and type of caesarean section (P= .005).
 Conclusions: Previous caesarean section was the most common indication for caesarean section. Unfavorable outcome after caesarean section was considerably present which needs to be addressed.

Association between serum beta-human chorionic gonadotropin and preeclampsia and its effects on perinatal and maternal outcomes: a case control study.

The aim of this study was to evaluate the relationship between serum beta-human chorionic gonadotropin (β-hCG) and preeclampsia (PE) and the effects of βhCG on maternal and perinatal outcomes. This case-control study included 125 pregnant women who were admitted to the labor ward of the Maternity Teaching Hospital, Erbil City, Kurdistan, Iraq between January and December 2016. Participants included 50 women with severe PE, 25 with mild PE, and 50 who were normotensive. Serum β-hCG concentrations during labor were compared between groups and maternal and perinatal outcomes were recorded. There were no significant differences in maternal age or parity distribution between the three groups. Gestational age was less than 37weeks in 34% of the women with severe PE and in 12% of women in the mild PE and normotensive groups (p = 0.012). Mean β-hCG concentration was 37,520.56 mIU/mL in women with severe PE, 16,487 mIU/mL in those with mild PE, and 11,699.82 mIU/mL in those who were normotensive (p < 0.001). There were no significant differences in perinatal outcomes between groups; however, those with β-hCG concentrations ≥ 40,000 mIU/mL had worse neonatal outcomes (lower Apgar scores, higher rate of NICU admission, and lower survival rate) and unfavorable maternal outcomes (seizures, abruption, post-partum hemorrhage, and deep vein thrombosis). There was a significant difference in β-hCG concentrations between women with PE and normotensive women. There were no significant differences in perinatal or maternal outcomes between groups, except in patients with β-hCG ≥ 40,000 mIU/mL.

Maternal outcome following uterine rupture and its associated factors among mothers who delivered at Felege-Hiwot referral hospital, Amhara-Ethiopia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ruptured uterus is one of the major causes of maternal and prenatal morbidities and mortalities in developing countries, particularly in Africa. Ethiopia is one of developing countries where maternal and prenatal mortalities are still high. The major objective of this study was to determine maternal outcomes of uterine rupture and its associated factors.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study design was facility based retrospective cross-sectional study from all mothers who visit from 01 September 2011 to 31 August 2015 at Felege-Hiwot referral hospital delivery room for delivery service with ruptured uterus was conducted in the study. A total of 312 cases were enrolled in the study&lt;em&gt;. &lt;/em&gt;The table, graph and binary logistic regression was found to be more appropriate for analyzing the data. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; More than&lt;em&gt; &lt;/em&gt;39% mothers had severe complication. The common complication was severe anemia 24.4% followed by severe shock 14.7%. There were also 2.7% maternal deaths. The binary logistic regression model showed that incidence and its complication of uterine rupture in this study were remarkably high. Antenatal care visit, duration of labor and admission to laparotomy time and hospital stay had strong association with maternal outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Improving access to antenatal care, proper monitoring of labor and early referral of high risk patients will contribute to the reduction of unfavorable maternal outcome.&lt;/p&gt;

Management of Severe Traumatic Brain Injury in Pregnancy: A Body with Two Lives.

Traumatic brain injury is the major contributing factor in non-obstetric mortality in developing countries. Approximately 20% of maternal mortality is directly correlated to injuries. Road traffic accidents and domestic violence are the most common nonlethal injuries that can threaten either the maternal or foetal life, and such events occur in one out of every 12 pregnancies. The treatment of severe traumatic brain injury in pregnancy requires a multidisciplinary team approach. The management of a pregnant trauma patient warrants consideration of several issues specific to pregnancy, such as the alterations in the maternal physiology and anatomy. In the case of maternal cardiac arrest with amniotic fluid embolism, intact neonatal survival is linked with the timing of caesarean section after maternal cardiac arrest. Moreover, the decision for perimortem caesarean section is clear after maternal cardiac arrest. The foetal survival rate is 67% if the operation is done before 15 min of cardiopulmonary compromise has occurred, and it drops to 40% at the duration range of 16–25 min. Whether minor or severe, traumatic brain injury during pregnancy is associated with unfavourable maternal outcomes. Injuries considered minor for the general population are not minor for pregnant women. Therefore, these patients should be intensively monitored, and multidisciplinary approaches should always be involved.

Maternal and fetal outcomes in term premature rupture of membrane.

Premature rupture of membrane (PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia. A retrospective cross sectional study was conducted using data available at Mizan-Aman General Hospital during a period of 3 years (January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically significant. Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours (AOR=5.6, 95%CI 1.3-24.1) latency >24 hours (AOR=2.8, 95%CI 1.7-11.8), residing in rural areas (AOR=4.2, 95%CI 3.96-29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes. Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.

Atrial Fibrillation or Flutter During Pregnancy in Patients With Structural Heart Disease: Data From the ROPAC (Registry on Pregnancy and Cardiac Disease)

ObjectivesAtrial fibrillation (AF)/atrial flutter (AFL) during pregnancy in these women is associated with adverse outcome of pregnancy. BackgroundThe incidence, timing, and consequences of AF or AFL during pregnancy in patients with heart disease are not well known. MethodsBetween January 2008 to June 2011, 60 hospitals in 28 countries prospectively enrolled 1,321 pregnant women with congenital heart disease, valvular heart disease, ischemic heart disease, or cardiomyopathy in the ROPAC (Registry of Pregnancy and Cardiac Disease). We studied the incidence, onset, and predictors of AF/AFL during pregnancy and assessed the pregnancy outcome. An overview of the existing literature is provided. ResultsSeventeen women (1.3%) developed AF/AFL during pregnancy, mainly in the second trimester (61.5%). Univariable analysis identified the following pre-pregnancy risk factors for AF/AFL in pregnancy: AF/AFL before pregnancy (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 1.5 to 32.8); mitral valvular heart disease (OR: 6.9, 95% CI: 2.6 to 18.3); beta-blocker use (OR: 3.3, 95% CI: 1.2 to 9.0); and left-sided lesions (OR: 2.9, 95% CI: 1.0 to 8.3). Maternal mortality was higher in women with than in women without AF/AFL (11.8% vs. 0.9%; p = 0.01), although heart failure was not seen more often. Low birth weight (<2,500 g) occurred more often in women with than in women without AF/AFL (35% vs. 14%; p = 0.02). ConclusionsAF/AFL occurs in 1.3% of pregnant patients with structural heart disease with a peak at the end of the second trimester. AF/AFL during pregnancy in cardiac patients is associated with unfavorable maternal outcome and also has an impact on fetal birth weight.

Trauma during Pregnancy: A Population‐based Analysis of Maternal Outcome

Serious injury during pregnancy is known to cause adverse maternal outcomes. However, the significance of minor injuries in adverse maternal outcomes requires clarification because most injuries sustained during pregnancy are minor ones. Two population-based databases (inpatient and ambulatory care) were used to identify pregnant women who had severe (required hospitalization) or minor injuries (required ambulatory care only) prenatally. ICD-9-CM coding was used to categorize the types of prenatal injury and complications during delivery. The patient demographics, types and timing of the injuries, and their association with adverse maternal outcomes were compared among the uninjured, those with minor injury, and those with severe injury. Odds ratios were calculated to estimate the risks of having adverse outcomes in injured pregnant women compared with those who are uninjured. The severely injured women tended to be younger (<20 years old), lived in less urbanized regions, and had lower income levels than those who were uninjured or had minor injury. Motor vehicle crash was the most common mechanism of injury. While minor injuries were associated with preterm labor [odds ratio (OR)=1.25], a severe injury was strongly associated with increased risks of preterm labor, placental abruption, uterine rupture, and maternal death, especially during the third trimester (OR=2.71, 6.12, 7.79, and 20.15, respectively). Injuries away from the trunk could also lead to adverse maternal outcomes. Trauma during pregnancy, whether minor or severe, is associated with unfavorable maternal outcomes. Injuries considered minor for the general population are not minor for pregnant women. Therefore, these patients should be monitored carefully.

Mitral balloon valvuloplasty during pregnancy:The long term up to 17 years obstetric outcome and childhood development.

Background & Objectives : We report 17 years outcome of subsequent pregnancies of women with severe Mitral Stenosis (MS) who underwent Mitral Balloon Valvuloplasty (MBV) during pregnancy and the follow up of the children born of such pregnancies. Methods: Twenty three pregnant patients suffering from severe MS (NYHA-New York Heart Association class III/IV) who underwent MBV by Inoue balloon catheter technique during second trimester were enrolled. The study was performed between January 1992 and December 2008 at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, during which time, details about the obstetric outcome and childhood development were recorded. Mean follow up period was 10± 5.5 years (range 1-17 years). Results: MBV was successful in all patients with improvement in their NYHA class to I/II. All patients were followed until term and had uneventful course after MBV. Twenty two (95.6%) patients delivered 23 babies including a twin birth. These children exhibited normal growth and development according to their age. Nineteen patients had further pregnancies and gave birth to 38 live & healthy babies with one still birth and no unfavorable maternal outcome. Of these, 97.4% were singleton pregnancies while 2.6% were twin pregnancies. Spontaneous abortions were recorded in 21.5% and there was one still birth (2.5%) and one ectopic pregnancy (2.5%). Conclusion : Mitral Balloon Valvuloplasty is a safe and useful procedure during pregnancy, with no short or long term adverse affects on the mothers and their obstetric future. The children born of subsequent pregnancies exhibited normal physical and mental development.