Background and objective: Maternal deaths are still leading problems in many developing countries, including Iraq. Iraq is, in fact, far away to reach the Millennium Development Goal declared to reduce the maternal mortality ratio by three quarters between 1990 and 2015. The aim of this study was to highlight the main causes of avoidable deaths that lead to maternal mortality among those admitted to Maternity Teaching Hospital in Erbil. Methods: This survey was carried out in the Maternity Teaching Hospital in Erbil city, Kurdistan region, Iraq. Variables included in this study were those related to patient's age, number of parity and mode of delivery of the last baby. Data were collected from patient's records. In addition, some clinical data were included related to causes leading to death and underlying condition of death. Results: Of the total 75000 live birth recorded in the hospital during the study period (2011)(2012)(2013), 33 maternal deaths were recorded which gives an overall maternal mortality ratio of 44 per 100,000 live births. Pre-eclampsia and eclampsia were among the top causes of maternal deaths in this study (42.4%) followed by obstetrical bleeding and rapture uterus (30.3%). Conclusion: Maternal mortality rate in Maternity Teaching Hospital was 44/100,000 total live births. The main cause of the maternal deaths was pre-eclampsia and its complications. Most of those died were residents of rural areas and were illiterate women.
Background The term morbidly adherent placenta characterized by abnormally implanted, invasive, or adhered placenta, which is increasing in obstetrical practice mainly due to increasing rate of cesarean section associated with increasing mortality and morbidity which can be avoidable by good assessment by ultrasound before operation. Objectives The aim of this study was to assess the diagnostic accuracy of pre-natal ultrasound in detecting morbidly adherent placenta in patients at risk. Materials and Methods Prospective observational study, case sheets of 125 women reviewed having placenta previa and previous uterine surgery (CS, myomectomy or curettage) from May 2018 to May 2019, population included 38 pregnant women. All cases of complete placenta previa or low-lying placenta, scans performed through either trans abdominal ultrasonography or transvaginal ultrasonography in their second and third trimesters of pregnancy, signs were loss of clear zone, placental lacunae, myometrial thinning, placental bulge, focal exophytic mass, and bladder wall interruption with the availability of more than three finding regarded as highly suspicious and final diagnosis made during cesarean section. Results Among 38 patients with risks, there was a significant correlation between increasing age and extend of morbidly adherent placenta. The average gestational age of the patients was 36.2 weeks, ranging from 20-39.3 weeks. All cases at least underwent prior caesarean delivery. There was increasing incidence of MAP with increasing number in C/S. In women with risk of MAP along with highly suspicious ultrasound findings, fourteen cases underwent hysterectomy, uterus-sparing alternatives to manage this condition can be an option in selected cases, the most reliable signs for suspecting percreta were placental bulge, focal exophytic mass, and bladder wall interruption, the sensitivity and positive predictive value was 70% and 90% respectively. Conclusion Management with prediction of MAP by ultrasonography is useful for obtaining permissible morbidity.
Background Anti-Mullerian hormone (AMH), produced by growing pre-antral and early antral ovarian follicles, has been shown to be a useful marker for ovarian ageing. Serum AMH concentrations are elevated during reproductive life in anovulatory women, especially in those patients exhibiting polycystic ovaries (PCO) and have been implicated in the pathogenesis of polycystic ovary syndrome (PCOS). Objectives The aim of our study is to compare the AMH concentrations in anovulatory women with normoovulatory women of similar age.
Background Incidence of premalignant and malignant endometrial diseases increase in postmenopausal women. Objectives to identify at which endometrial thickness in symptomatic and asymptomatic postmenopausal women endometrial sampling is optimal and cost effective. Besides, use of ultrasound as a screening tool for detection of endometrial pathology. Materials and Methods A cross-sectional study was conducted in Sulaymaniyah Maternity Teaching Hospital during April 2018 to April 2019. 100 postmenopausal women with thick endometrium were recruited; 61 women with bleeding and 39 women without symptoms. All women subjected to endometrial biopsy. The results were recorded, T Test and Chi-Squared Test was used to identify statistical differences between the two groups at a P-value of 0.05 and Receiver Operating Characteristic (ROC) curve of endometrial thickness measurement for prediction of endometrial cancer were analyzed. Results Endometrial cancer was detected in 16.5% symptomatic women and 5% asymptomatic women. Best cutoff point of endometrial thickness in predicting endometrial carcinoma in symptomatic women was 14.5 mm, which provided 70% sensitivity and 66.7% specificity. Area under curve (AUC) was 0.71, and P-value was 0.32. While in asymptomatic women, cutoff point of endometrial thickness in predicting cancer was 17.25 mm which provided 50% sensitivity and 86.5% specificity. Besides, AUC was 0.49, and P-value was 0.97. Conclusion Ultrasound measurement alone for endometrial thickness has no diagnostic value in asymptomatic women at cutoff point of 17.5 mm. Therefore, it is not a good predictor for endometrial cancer; we should consider other ultrasound features and risk factors while assessing symptomatic and asymptomatic postmenopausal women.
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