Objective: To describe the trends in maternal mortality in tertiary care hospitals in the last five years and compare the mortalities in the previous ten years. Methods: All pregnant women from January 2016 to December 2020 were analyzed. The primary outcome of this research was maternal mortality ratios. Various causes of maternal mortality were also evaluated. The correlation between maternal characteristics and maternal mortality was inspected using logistic regression models. Pregnancy outcomes of mothers who died versus mothers who survived were also evaluated. Results: One hundred seventy-three maternal deaths were noted in 49283 pregnant women in 2016-2020. The average maternal mortality ratio in 5 years period was 409 per 100,000 live births. It showed a decreasing curve over the five years, from 539/100,000 live births in 2016 to 295 in 2020. Five year clusters also demonstrated a falling trend, from 856/100,000 live births to 409. Hemorrhage (34.68%), hypertensive disorders of pregnancy (21.38%), suspected cases of thromboembolism (20.80%) were the leading causes of maternal mortality. Pregnancy outcomes in mothers who survived and who expired were evaluated. Almost 33% of maternal deaths had stillbirths as compared to 4.69% in alive mothers (RR 6.87); similarly, unknown outcomes (RR7.56) and ectopic pregnancies (RR 3.01) were more frequent in cases of maternal demise. Conclusion: Trends in maternal mortality show a decreasing curve. Hemorrhage remains the leading cause. Attainment of SDGs requires interventions both at primary and tertiary health care. Keywords: Maternal mortality and Maternal Mortality Ratio (MMR), trends, causes of maternal mortality.
Objectives: To determine the prevalence of urinary incontinence and assess its impact on these women’s quality of life and treatment-seeking behaviour
Objective: Evaluation of the frequency of anticardiolipin antibodies and lupus anticoagulant levels in women with histories of three or more first trimester recurrent miscarriages. Methodology: It was a descriptive case series carried out at private clinical practice in Peshawar. About 86 patients were enrolled in the study. They had three or more first trimester recurrent abortions. Pregnant patients between ages 22 and 35 years were included. Any patient diagnosed with other etiologies of recurrent miscarriages was excluded. Percentages and frequencies were used to analyze the data. Results: Mean age of pregnant patients was 28.4(±3.25) years. Mean number of miscarriages was 3.5. High anticardiolipin antibodies were detected in 23.3% of pregnant patients. There was no pronounced difference regarding high levels of IgG and IgM. No case of raised lupus anticoagulant was found. Conclusion: Pregnant patients who experience recurrent miscarriages show higher prevalence of antibodies of anticardiolipin type. It is recommended that all such cases should be subjected to APS screening.
Objective: To assess maternal health care by proxy indicators in terms of frequency of near misses, Maternal Near Miss (MNM) ratio and Mortality Index in a tertiary care, Lady Reading, hospital. Methodology: It was a Cross-sectional descriptive case study conducted in Obstetrics A unit of Lady Reading Hospital from January, 2019 to December, 2019.The WHO near miss “severe maternal complication” based inclusion criteria was used for case identification. The study population consisted of all women who were admitted during pregnancy, labor, or within the first 42 days of postpartum to our unit. Outcome was measured using the three indicators i.e. the mortality indices, maternal mortality ratio, mortality to near miss ratio, near miss cases/1000 deliveries Results: Total cases included in this study were 10439. The total Maternal Near Miss cases were 1776 (1.84%). Maternal Near Miss Rate MNMR was calculated as 170 per 1000 live births. There were 44 total maternal deaths, and maternal mortality rate was calculated as 421 per 100,000 live births. The Maternal Near Miss to Mortality ratio was 41:1. Mortality Index was 2.5%. Conclusion: Our hospital has a higher maternal near miss to mortality ratio of 41:1 showing good maternal care management. The WHO near miss indicators can be used in tertiary care care settings to evaluate the standard of care especially so in developing countries like Pakistan. Keywords: maternal near-miss, near miss indicators mortality index, maternal mortality.
Aim: The aim of the study is to govern the incidence of urinary incontinence in pregnant women and its impact on the life quality as well as its relationship with the number of births and age. Study design: A Cross-sectional study. Place and Duration: In the Obstetrics and Gynecology department of Habib Medical Complex, Private Health Care Facility Peshawar for six-months duration from July 2021 to December 2021. Methods: In the third trimester, i.e., after 28 weeks, according to LMP (last menstruation) or ultrasound in the first trimester, 320 healthy pregnant women were interviewed and the information on proforma was recorded. Women who had been diagnosed with urinary incontinence, renal dysfunction, diabetes or gestational diabetes prior to pregnancy were omitted from the analysis. The main outcomes measured were incidence of urinary incontinence among pregnant females as recorded from interviews. The data was analyzed with SPSS 21.0 version. Results: Out of 320 women, 147 reported urinary incontinence and its incidence was 45.9%, 116 (78.9%) had stress incontinence (SI), and urge incontinence in 31 (21.1%). The general SI prevalence is 36.2 % and the UI prevalence is 9.7%. 130 primigravida participated in the study, 51 of which reported urinary incontinence. The incidence of UI in the third trimester of pregnancy was 45.9%. Conclusion: The result of this analysis shows urinary incontinence is a common occurrence during pregnancy. The results could help develop more intensive training programs to avoid UI during pregnancy by growing urinary incontinence awareness among healthcare professionals caring for pregnant females. The UI frequency in the pregnant population was 45.9%. Keywords: Stress urinary incontinence, urinary incontinence, religious activities and urge incontinence.
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