Obstetric haemorrhage continues to be a major cause of maternal mortality. Our analysis of records of over a period of 20 years from April 1982 to March 2002 reveals that it was a contributory cause of maternal mortality in 19.9% of cases. The majority of deaths, (65%) had occurred within 24 hours of admission and in 47.5% of cases there was severe anaemia on admission; 17.5% had died due to an atonic PPH, which was the largest category, followed by ruptured uterus (15%), abruptio placenta (15%) and retained placenta (12.5%). Deaths due to obstetric haemorrhage because of a ruptured uterus, retained placenta and abortion have decreased from 22.22% between 1982 and 1987 to zero in the last 5 years and an increase was seen in deaths due to haemorrhage because of gestational trophoblastic neoplasia and ectopic pregnancy, from 1.69% to 4.87%, unclassified haemorrhage 1.96% to 7.31% and placenta praevia from zero between 1982 and 1987 to 4.87% between 1997 and 2002.

A systematic study was conducted to evaluate the crosslinker and method of incorporation for bovine serum albumin (BSA) into chitosan hybrid scaffolds (CH-ALG) for better cartilage tissue engineering applications. Formaldehyde and sodium tripolyphosphate were used crosslinkers for fabrication of CH-ALG scaffolds using BSA as growth factor by direct incorporation and microencapsulation methods. An in vitro release study of BSA with maximum release (80%) for scaffolds of formaldehyde crosslinked was found. The present findings show that the CH-ALG hybrid scaffolds have been potential use in biomedical applications.

The present study was conducted to analyse the changing trends in maternal deaths and the factors affecting them in a rural institution in India. Analysis of case records of maternal deaths over a period of 20 years, between April 1982 and March 2002 was performed in relation to the age, parity and disorders leading to death. It was revealed that the maternal mortality ratio has declined significantly, from 890.7 between April 1982 and March 1987 to 259.4 between April 1997 and March 2002. Most of the deaths were in young women (20-29 years) and primigravidae. Hypertensive disorders (27.4%) and haemorrhage (12.9%) were the leading direct causes, while anaemia (13.9%) was the main indirect cause. It was shown that from 1982-1987 to 1997-2002 there was a fall in the percentage of deaths due to hypertensive disorders, from 27.5% to 14.6%, peripartum sepsis from 13.7% to 7.3% and ruptured uterus from 3.9% to nil, but there was a rise in deaths due to septic abortions from 9.8% to 14.0% and haemorrhage from 7.8% to 17.1%. Deaths within 24 hours of admission decreased from 60.8% between 1982 and 1987 to 46.3% between 1997 and 2002. It appears that even with resource constraints, maternal mortality can be reduced by improving peripheral services and individualised evidence- based appropriate interventions at referrals. However, the problems of anaemia and septic abortions need to be examined further.

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