(Lancet. 2019;393:1973–1982)
The vast majority (99%) of maternal deaths occur in low-income and middle-income countries (LMICs). While cesarean section access is an important factor for improving maternal care, cesarean sections sometimes are performed too often. Lack of skilled medical workers and resources in LMICs make complications related to cesarean section even more severe than in high-income countries (HICs). There is a lack of large studies in LMICs on maternal and neonatal deaths after cesarean section. This systematic review and meta-analysis aimed to determine the risk of mortality in women from LMICs after undergoing cesarean section. In addition, risk factors for maternal and perinatal morbidity and mortality following cesarean section were investigated.
Although half of the women had successful pregnancy outcomes after rescue cerclage, pregnancy extended from previability to prematurity in most of them.
Introduction: The presentation of Ectopic Pregnancy (EP) can be highly variable and serum Beta hCG estimation plays an important role in early diagnosis.Aim: Aim of the study was to determine the trends of hCG levels in EP and to explore the role of hCG in decisions related to management and follow-up of EPs. materials and methods: A retrospective study of women who had EPs from January 2006 to December 2012 at an advanced tertiary care centre in southern India was carried out. These women had undergone treatment based on the hospital protocol.
Results:The study identified 337 women with EP. Thirty one surgically confirmed cases were diagnosed below the discriminatory zone of 1500 mIU/ml. Among women who had Beta hCG estimations 48 hours apart, plateauing was observed in 22.5% while decrease >15% was noted in 26.8%. Almost half (47.9%) of the cases had an increase >15% and a few (2.8%) demonstrated an initial fall followed by a rise in titres. In 23.9% of these women, there was a rise >53% similar to intrauterine pregnancy. The average pre-treatment Beta hCG was 429.8, 3866.2 and 12961.5 mIU/ml for those who received expectant, medical and direct surgical treatment respectively. 43 women with relative contraindications received medical management and 39 were lost to follow-up after medical and expectant management. Excluding them, the success rate of these two modalities was 76.6% and 85.0% respectively.
Conclusion:No single level of Beta hCG is diagnostic of EP and serial levels can demonstrate atypical trends in some cases. Hence, interpretation of these results should be done in conjunction with clinical and sonographic findings to arrive at a correct diagnosis.www.jcdr.net Kameswari Surampudi and Sirisha Rao Gundabattula, Beta hCG in Ectopic Pregnancy
Risk factors are similar to those in other population groups; however, primiparity appears to be associated with lesser risk and forceps delivery with greater risk of sphincter trauma than previously reported.
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