Fifteen Uninterrupted Years of Maternal Mortality Findings from a Tertiary Care Centre

Introduction Maternal mortality reflects reproductive health status and availability of good health care facilities at different levels of the healthcare system at a given period, influenced by globally adopted safe motherhood policies. The leading causes of maternal death in Nepal mainly comprise of hemorrhage, eclampsia, abortion-related complications, gastroenteritis and anemia. Although a declining trend has been noted in Nepal it has yet to meet the target set by the Sustainable Development Goal (SDG) 3.1 of reducing the global MMR to less than 70 maternal deaths per 100,000 live births by 2030. MethodsA cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH) from 1st Baisakh 2055- 30th Chaitra 2069 (15th April 1998- 14th April 2013). The study period of 15 years was divided into three parts, five years each: 2055-59 (14th April 1998-April 13th 2003) ; 2060-64 (14th April 2003- April 12th 2008) and 2065-69 (April 13th 2008 –April 12th 2013). MM was filled in Performa, discussed in morning conference and MM audit, computerized, analyzed, presented quarterly and yearly. Annual Maternal Mortality Ratio (MMR) expressed as MMR per 100,000 live births is calculated by dividing recorded (or estimated) maternal deaths by total recorded (or estimated) live births in the same period and multiplying by 100,000. ResultsTotal MM/maternal mortality ratio (MMR) in the first, mid and last five years were 39 (270 %); 37 (212% ) and 37 (188%) respectively giving overall total MM/MMR 113 (223.5%) attributing to Direct: 55 ( 48.6%), Indirect: 44 (38.9%) and Non maternal deaths: 14 (12.3%). Predominating cause of MM in the first/mid/last five years were sepsis and infective hepatitis each (17.6%) and PPH (18.5 %). While SP/E were almost same over the years, in decreasing trend were hepatitis and puerperal sepsis but in rising trend was PPH and criminally induced abortion (10.6%). Thenumber of maternal death has not changed much, the median age in each five years is surprisingly similar, set at 25 years and the adolescents who died were not very different in every five years. It’s unfortunate that many primigravida died during this period which is a matter of concern. ConclusionsMaternal mortality stresses the impact of timely health seeking behaviour and health providers making provision of prompt adequate services and referral to help so that all Nepalese mothers, especially the young and first-time pregnant thrive. Keywords: infective hepatitis, maternal mortality, maternal mortality ratio, PPH, sepsis.

A comparative study of lipid profile in patients with and without infective hepatitis

Background: Liver plays a central role in lipid metabolism. Liver carries out some important functions in lipid metabolism like liver facilitates the digestion and absorption of lipids by the production of bile, which contains cholesterol and bile salts synthesized within the liver de novo or from uptake of lipoprotein cholesterol, the liver has active enzyme system for synthesizing and oxidizing fatty acids and for synthesizing triacylglycerols and phospholipids, synthesis of the ketone bodies, it plays an integral part in the synthesis and metabolism of plasma lipoproteins. The objective was to compare lipid profile in patients with and without infective hepatitis.Methods: Hospital based cross sectional comparative study was carried out among 112 cases. The patients were divided as having infective hepatitis (69) called cases and not having infective hepatitis (43) called controls. Concentration of serum total cholesterol was determined by Carr and Drekter method. Concentration of serum HDL cholesterol was determined by Carr and Drekter method. Concentration of serum triglyceride level was determined by enzymatic end point peroxidase coupled method.Results: Total cholesterol, VLDL, LDL and triglycerides have been found to be significantly higher in cases of infective hepatitis compared to control. The HDL value was also significantly deranged i.e. significantly lower in cases compared to controls (p <0.05). Thus, it was clear that infective hepatitis deranges the lipid profile of the patients.Conclusions: Lipid profile can be used as sensitive indicators of hepatic function and may have diagnostic and prognostic importance in infective hepatitis.

Evaluation of maternal mortality and their factors in GMCH, Aurangabad, India

Background: Analysing the factors related to maternal mortality is very important as they reflect the socioeconomic status and health care facility availabilities of the country. This study is aimed to analyse the epidemiological aspects and different causes of maternal death and evaluation of preventable factors and unavoidable factors if any causing maternal death.Methods: The retrospective study was carried out at GMCH, Aurangabad during the period from February 2002 to January 2004. All the data related to epidemiological factors and causes of maternal mortality was recorded and analyzed.Results: There were 33 maternal deaths during the study period. The mean maternal mortality rate was 211 per 1,00,000 total births. Maximum maternal deaths were reported at the age group of 26-30 years (36.1%), in primiparous women (46.8%) and from rural areas (78.38%). Most of the deaths (37.5%) were reported within first 24 hours of hospital admission at postpartum stage (87.5%). 84.37% of maternal deaths were due to direct causes. And toxemia of pregnancy (39.5%) was major direct cause. Anaemia and infective hepatitis constitutes for 9.3% each for the indirect causes maternal death.Conclusion: Most maternal deaths can be preventable by multidisciplinary approaches involving mass community education, improving sanitation, early referrals to tertiary care centres and by providing health care facilities in rural areas.

Study of abnormal liver function tests in pregnancy in a tertiary centre in North Kerala

Background: Abnormal liver function tests in pregnancy require proper evaluation and diagnosis. The underlying disorder can have a significant effect on the outcome of both mother and fetus. The present study was done with the objective to study the clinical profile, incidence and possible causes of derangements of liver function tests.Methods: The pregnant women with abnormal liver function were studied prospectively. All the liver function tests values were studied along with other required tests to identify the cause. The fetal and maternal outcome were also noted.Results: The incidence of abnormal liver function tests was 6.7%. Among these 96% were due to pregnancy specific liver dysfunction mainly due to hypertensive disorders. The mean value of bilirubin was more in infective hepatitis. There were 4 cases of intra uterine deaths and no maternal death.Conclusions: Pregnancy specific disorders are the major cause of abnormal liver function tests in pregnancy especially in the third trimester.

Clinical profile of leptospirosis with focus on inflammatory biomarkers

Background: In the last few decades leptospirosis has re-emerged and is on the rise. Infectious diseases like malaria, dengue, infective hepatitis which simulate leptospirosis being rampant, so there is a need to know the clinical profile and biomarkers of leptospirosis. Study aimed to understand the clinical profile, laboratory findings and complications of leptospirosis with focus on inflammatory biomarkers.Methods: All consecutive inpatients of J.S.S medical college hospital with clinical suspicion of leptospirosis were screened for IgM anti-leptospiral antibody. Twenty-five patients who were positive for IgM antileptospiral antibodies were considered as cases and twenty-five patients who were admitted for fever other than leptospirosis were taken as controls and subjected to detailed history, clinical examination, investigations and followed up till discharge or death.Results: The age group commonly involved was 18-55 years (84%). Most of the patients were males (76%), with occupation involving outdoor activity (66%). Common symptoms were fever (100%), musculoskeletal pain (92%), headache (80%) and jaundice (64%). Less commonly seen were respiratory symptoms (36%), bleeding (24%), and gastrointestinal symptoms (16%). Important signs seen were conjunctival suffusion, hepatomegaly, splenomegaly and hypotension. Hyperbilirubinemia was predominantly of conjugated type and elevation of transaminases and alkaline phosphatase were mild to moderate. Mean bilirubin was 4.67mg/dl, Mean SGOT and SGPT were 99.23U/L and 96.97U/L respectively. ARF was seen in 48% and six of them needed haemodialysis. Thrombocytopenia was seen in 76% patients. 28% had multi-organ failure (MOF), 8% had aseptic meningitis, 8% had ARDS and 4% had GI haemorrhage.Conclusions: Musculoskeletal symptoms are most common next to fever. Conjunctival suffusion is a common finding. Liver and kidney are more commonly involved organs. MOF was significantly associated with mortality (p<.05). Thrombocytopenia was significantly related to clinical bleeding (p<.001). TNF-alpha and Interleukin-12 were significantly elevated in leptospirosis and may correlate with severity.