INTRODUCTION: A peripartum near-miss event occurs when a woman nearly dies, but survives a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. As maternal deaths are rare occurrences, near-miss cases can be used instead to elucidate the events leading to complications and the obstacles that must be overcome to treat complications, hence providing valuable information on obstetric care. This study aimed to assess maternal near miss at Ayder Referral Hospital (ARH). METHODS: Our study was a retrospective chart review of near miss cases seen at ARH between July 1, 2016 and June 30, 2017. WHO near miss criteria was used to select cases. RESULTS: Over the study period, there were 3,899 deliveries, 236 near miss, and 13 maternal deaths at ARH. The leading causes of near miss were hemorrhage (41.9%), hypertensive disorders of pregnancy (41.1%), sepsis (9.3%), labor abnormality (4.6%), and medical disorders of pregnancy (3.6%). In terms of timing of near miss diagnosis, 37.7% occurred antenatally, 25% intrapartum, 32% postpartum, and 5.1% post abortion. 86% of cases were referred from other health facilities. Majority of the patients (80%) arrived to our hospital in critical condition. Ninety percent of the near miss cases had antenatal care (ANC) at health center. CONCLUSION: Near miss is substantial problem in North Ethiopia. Most referred patients arrived in critical condition, suggesting support and transportation from referring institutions should be improved. Additional research is need to assess the quality ANC given that 90% of the near miss cases had ANC.
INTRODUCTION: Preeclampsia is a common pregnancy disorder with potential adverse maternal and neonatal outcome. Ayder Referral Hospital (ARH), a tertiary hospital in northern Ethiopia where most preeclamptic patients are treated. This study aimed to assess the prevalence and determinants of maternal and perinatal outcome of preeclampsia at ARH. METHODS: Our study was a retrospective chart review of preeclamptic patients treated at ARH between September 1, 2016 and September 30, 2018. This study was approved by IRB. RESULTS: Over the study period, the total number of deliveries recorded was 8,502. There were 362 patients with preeclampsia. Most (77.3%) patients had preeclampsia with severity features. Poor maternal outcome was present in 40% of cases while 25% of cases had poor perinatal outcome. The top three poor maternal outcomes reported in this study were, eclampsia (6.6%), maternal death (2.8%), and renal failure (1.1%). Headache (AOR 32.26 95% CI 0.003-0.326 P=.004) and low hemoglobin value (AOR 3.44 95% CI 1.772-6.761 P=.005) were associated with poor maternal outcome. The poor perinatal outcomes were low APGAR score (18.8%), still births (5.8%), and early neonatal deaths (1.1%). Earlier gestational age at diagnosis (AOR 3.19 95% CI 1.762-5.766 P=.0001) was associated with poor perinatal outcome. CONCLUSION: Preeclampsia is a significant problem in Ethiopia. In a resource limited setting where tools are scarce, clinical profile should be taken into consideration for prediction of poor outcome. Owing to the association found in between maternal outcome and hemoglobin, further prospective research is required to identify if anemia was the cause or effect of preeclampsia.
INTRODUCTION: Post-partum hemorrhage (PPH) remains the leading cause of maternal mortality in Ethiopia; the country experiences 412 maternal deaths per 100,000 births, exceeding the global average. Delays in-transit time and inefficient blood transfusions are linked to maternal death. This study aims to evaluate the effects of centralized Ethiopian blood banks on timely blood transfusion and the impact of comprehensive patient education on transfusion refusal. METHODS: As part of a mixed-method study, blood transfusion log books at Ayder Comprehensive Specialized Hospital were analyzed to assess the common reasons for transfusions at tertiary care centers. Focus groups of residents from the Tigray region were conducted to explore the social acceptance of blood transfusions. RESULTS: Focus group data illuminates that women are receptive to receiving blood transfusions, especially in the context of delivery. Hospital transfusion log books show a transfusion rate of 3% for PPH; comprising of 1.95% of total transfusions recorded during our 3-month preliminary data collection period. CONCLUSION: Despite research indicating the average rate of blood transfusions during PPH is 1.4%; Ayder Comprehensive Specialized Hospital has a transfusion rate of 3.0%. Women should be fully counseled on blood transfusions risks and benefits; our data indicates that comprehensive education does not influence women’s transfusion decisions. High transfusion rates may indicate that women are suffering from complications and are being transferred instead of stabilized at general hospitals. Research should focus on exploring the effectiveness of blood distribution and storage in the general hospitals after screening, eliminating the need to transfer women during obstetric emergencies.
INTRODUCTION: Pulmonary hypertension (PH) is a rare disease that is infrequently associated with pregnancy. However, when present in the parturient, it can be devastating. In the developed world, mortality from PH during pregnancy and postpartum decreased from 50% in the 1970s to 16% in 2014. Proper management requires a multidisciplinary team approach and close follow up. In the developing world, physicians face many challenges when caring for these complicated patients. METHODS: A case series of 20 patients with pulmonary hypertension who were treated at Mekelle University Hospital, Ethiopia. RESULTS: 20 cases of severe PH from September 2015 to September 2017 were reviewed. Average systolic pulmonary arterial pressure measured by echocardiography was 104.1 mmHg (SD 11.4, range 83-134 mmHg). Etiology was attributed to chronic rheumatic valvular heart disease in 17 patients and congenital heart defects in 3 patients. Eight patients had disease classified NYHA functional class III or IV heart failure (40%). There were 5 confirmed deaths (25%). Eleven patients underwent cesarean deliveries, 4 underwent vaginal deliveries with assisted second stage. Three patients underwent termination of pregnancy and 2 died prior to delivery. Death was caused by pulmonary edema in 3 cases and pulmonary venous thromboembolism in 2 cases. Sixty-five percent of pregnancies resulted in live birth. CONCLUSION: Pulmonary hypertension complicating pregnancy continues to be a highly morbid disease worldwide. Increased mortality in this study may reflect differences in etiology as well as delays in diagnosis and reduced access to healthcare. Multidisciplinary teams including cardiology, anesthesia, and obstetrics, are important to improving maternal and fetal outcomes.
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