formed the study group. The women who escaped death due to medical or surgical interventions were categorized as Near Miss. These cases were defined based on WHO Criteria 2009.Results: There were 2424 births during this year and 33 were near miss cases. The bulk of these were directly admitted to our hospital (23 cases). The most common condition leading to this dreadful condition was hemorrhage, acute severe hypertensive disorder (preeclampsia/eclampsia) and sepsis. Disseminated Intravascular Coagulation was found to be the most common organ dysfunction. Emergency hysterectomy was the most frequent surgical intervention used to prevent mortality. Conclusion:Maternal Near Miss review is a viable review as it has potential to highlight the deficiency as well as positive elements of obstetric services in any health system. Hemorrhage followed by hypertensive disorders are the leading causes of near miss events.
Background: Anaemia in pregnancy is a global health challenge. It is the commonest medical disorder of pregnancy and a major cause of morbidity and mortality in developing countries. Main cause of anaemia in obstetrics is iron deficiency. There are specific risks for the mother and the fetus such as intrauterine growth retardation, prematurity, and blood transfusion. Hence, the importance of giving iron in the antenatal period and to be continued postnatally. Objectives: The study was conducted to determine the overall prevalence of anaemia among pregnant women presenting in third trimester and its effect on pregnancy outcome. Methods: This is a cross sectional descriptive study done at National Medical College & Teaching Hospital from September 2015 to August 2016. During the study period 2048 pregnant women attended antenatal clinic in third trimester. Among 2048, 1200 were booked cases and out of these women with haemoglobin less than 11gm/dl were labeled as anaemia. The prevalence was calculated along with the maternal and fetal outcome. Result: Among 2048, 1200 were booked cases, 368 (30.66%) were anemic, 66.30% were multigravida, 67.93% in age group of 21-30 years, 284 patients came for delivery. In 14.08% patients there was preterm labour, apgar score less than 7 in 66.19% babies. Majority of neonate weighed between 2.0 - 2.5kg (49.29%). Perinatal deaths were 2.81%. Conclusion: Anaemia in pregnancy need awareness about early and regular antenatal care with oral iron supplementation. Correction of anaemia will reduce the maternal and fetal complications.
Postpartum haemorrhage (PPH) Remains a significant complication of child birth worldwide. The most common cause of PPH is uterine atony. Recently, uterine tamponade using intrauterine condom appearsto be an effective tools in the management of uncontrolled primary PPH. Objectives of our studywas to see the effectiveness of large volume fluid filled condom catheter in the management of primary PPH. Methods: a condom was inserted in the uterus by means of a size 16 rubber catheter and inflated with 250 to 300ml normal saline until the bleeding was controlled. The condom was kept in situ for 24 to 48 hours. Results: Out of 53 cases, PPH was controlled in 52 cases. One patient died as the patient was eclamptic & develped disseminated intravascular coagulation (DIC). No patient required surgical intervention. Conclusion: fluid filled intrauterine condom is an effective method in the management of primary PPH when usual measures & drugs fail to control PPH.TAJ 2016; 29(1): 52-54
Recurrent miscarriage is three or more consecutive pregnancy loss before 20 weeks of gestation. Despite detailed investigation of couples experiencing RSA in 40 to 50% of cases, the aetiology cannot be ascertained and are termed Idiopathic Recurrent Spontaneous Abortions (iRSA). DISCUSSIONIn the clinical investigation of male partner of iRSA, semen analysis detailing the sperm parameters do not always reveal significant information that could assist the clinician in patient's treatment. Due to limited predictive potential of semen analysis, new markers with better diagnostic and prognostic characteristic and ability to efficiently predict adverse reproductive events are being investigated. The findings of these studies have reported oxidative stress associated with sperm DNA damage as a leading cause for lower conception rate after assisted conception techniques. These findings have also provided a new direction to the studies investigating molecular markers as free radicals, antioxidants and sperm DNA fragmentation. It has been suggested that these markers are more reliable than semen analysis in male infertility cases including male partners of couples experiencing iRSA. Further, these recent studies also suggest that oxidative stress and sperm DNA integrity may offer better potential to predict sperm reproductive capacity. CONCLUSIONThis review provides an in-depth understanding of iRSA, its causative factors, the clinical findings and the most preferred therapeutics that could assist to improve the pregnancy outcome in such cases.
Context: Over 31 million Americans live with Type 2 diabetes mellitus (T2DM), including socially vulnerable, low-income and minority populations, many of whom experience additional chronic illnesses. Social determinants of health (SDOH) and medical comorbidities impact the disease-specific work of self-management and contribute to disparities in diabetes-related outcomes. Exploration of the relationship between patients' experiences of treatment burden, challenges posed by SDOH, and comorbid chronic conditions may identify novel strategies for improving patient-centered care and reducing T2DM-related disparities. Objective: To understand experiences of treatment burden in diabetes self-management and related SDOH challenges faced by patients with comorbid T2DM. Study Design: Qualitative study using semi-structured interviews. Setting: Six urban safety-net primary care clinics. Population studied: 20 patients with T2DM and 1 or more additional chronic conditions who received care at a study clinic at least once in the past 18 months. Outcome Measures: We asked respondents about their experiences with T2DM self-management, treatment burden, and life context when experiencing good and poor control of their diabetes. We used a thematic approach, utilizing deductive and inductive codes, to analyze data. Results: Respondents described SDOH-related burden specifically concerning treatment costs and built environment impacts (e.g. access to fresh foods). We identified an emblematic theme of the phased phenomenon of diabetes management -burden is high at the time of diagnosis and early in illness and decreases over time through individual learning, adaptation, and routinization into daily life. However, ongoing challenges due to SDOH and lack of social and practical supports continued to impact T2DM control, intensifying during times of high stress and external situational demands. Comorbidities affecting physical functioning and mental health were particularly impacted by SDOH resulting in increased burden. Respondents described clinic-based mitigating resources such as outreach, transportation, and support for glucose monitoring technology. Conclusions: Understanding the complex forces influencing treatment burden can guide interventions to optimize diabetes care. Individualized strategies focused on easing burden that are adaptable over the course of chronic illness management may improve outcomes for medically complex and socially vulnerable patients.
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