Objective: To identify the frequency and type of cardiac diseases in pregnant women and their fetal and maternal outcome.
Objectives: To identify the fetomaternal complications in patients with Eclampsia and severe preeclampsia patients in association with induction to the delivery interval. Methods: This descriptive observational study was conducted From June to December 2019 in the department of obstetrics and Gynaecology at the Lady Reading Hospital, Peshawar, Pakistan. Antenatal patients with Eclampsia and pre-Eclampsia were included. IBM SPSS, Version 23.0 was used for data analysis, and tests were applied to find an association between induction to delivery interval and fetomaternal complications, chi-square test was applied and P -value < 0.05 was considered significant. Results: The final cohort comprised 60 women with a mean age of 28.72±6.02. Most Maternal complications were 25% (n= 15) seen in more than 18hr duration from induction to delivery, deranged renal function was the most common maternal complicated ion 13% ( n= 8), Pearson chi-square value of 0.01 shows a highly significant association between an increase in induction to delivery duration and maternal complications while stillbirth was most frequent fetal complication 13.3% ( n= 8A ). A P-value of 0.6 shows a non-significant association between induction to delivery duration and fetal complications Conclusion: Our study concludes that with an increase in induction to delivery time, maternal and fetal complication increases. Keywords Eclampsia, Pre-eclampsia induction to delivery interval
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.
Objective: To determine the frequency and management outcome of gestational trophoblastic disease (GTD) in Lady Reading Hospital.Methods: This was a retrospective observational study at Lady Reading Hospital, Peshawar, from January 2011 to December 2021. Hospital records of all patients with GTD were reviewed and all were included in this study except those with an incomplete record or unconfirmed histology. Treatment was analysed in terms of surgical, chemotherapy or no treatment, and outcomes were noted in terms of complete remission, disease persistence or death.Results: In 10 years 353 patients were admitted with GTD, and the frequency of the disease was 3.72 cases per 1000 pregnancies. The most frequent lesions were complete mole 65.2% (n=230) followed by invasive mole 20.4% (n=72). Mortality rate was 0.56% (n=2).Maternal blood group analysis revealed that B positive 28.3% (n=100) was more frequent. O positive blood group was found more in the malignant form of the disease at 3.96% (n=14). GTD was most prevalent in 21 to 30 years of age (41.4%, n=146). Regarding treatment, in 69.97% (n=247) of cases, suction and evacuation were performed, in 4.2% (n=15) of cases hysterectomy was performed as primary therapy, and 4.8% (17) needed hysterectomy for chemoresistance.In this study 42.49% (n=150) were given single-agent chemotherapy and 4.8% (n=17) were given multi-agent therapy. We had 21.33% (32) patients with a risk score of 7-9. In the group with a risk score of 7-9, 15.62% (n=5) patients were directly started on multi-agent therapy because of evidence of metastasis or choriocarcinoma; the remaining 84.37% (n=27) of patients who had no evidence of metastasis, no prior chemotherapy, no choriocarcinoma and International Federation of Obstetrics and Gynecology (FIGO) stage 1 were given single-agent methotrexate with folinic acid (eight days) after informed consent. In 18.75% of patients (n=6) hysterectomy was performed as the primary treatment either for haemorrhage or with age > 40, family completed, or reluctance to undergo chemotherapy. They all had a complete cure. In 3.1% (n=1) of cases, resistance to single-agent therapy was found and multi-agent treatment was started. Overall, in 96.29% of patients, complete remission was achieved with single-agent therapy in patients with risk scores of 7-9. Conclusion:The frequency of GTD was 3.4/1000 pregnancies. Complete mole was the most frequent lesion, and single-agent chemotherapy had a good outcome in low-and high-risk patients with a risk score of 7-9 (with no evidence of metastasis, prior chemotherapy, or choriocarcinoma and FIGO stage 1).
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