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 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Causes of maternal deaths at the Lagos University Hospital were reviewed in order to highlight the problems associated with the practice of obstetrics in the hospital. Focus was on maternal deaths that occurred during the January 1, 1970-December 1970 period. There were a total of 11,041 births and 38 maternal deaths during this 1 year. The case notes of maternal deaths were studied; causes of death were extracted from them. The maternal mortality rate was 3.4/1000 total births, excluding abortions. Most of the hospitals booked cases are drawn from the mainland of Lagos and staff of both the Teaching Hospital and the Lagos University. Other high risk cases are referred from general practitioners. The unbooked cases are either referred from the neighboring private maternity homes or brought by relatives from native doctors and midwives because of impending fetal or maternal risk. 65.2% of the maternal deaths occurred in the unbooked cases in the 15-25 year age group. 17 deaths were due to eclampsia; 1 was a booked patient and 16 were unbooked patients. 10 booked patients died as a result of hemorrhage. Obstructed labor was the cause of death in 4 booked and 2 unbooked cases. 2 booked and 1 unbooked patient died following anesthesia, and 1 unbooked patient died because of infective hepatitis. Death occurred in 1 unbooked case suspected of having a ruptured uterus on admission. In the majority of cases the deaths were avoidable. Maternal death can be avoided if the general public is educated regarding good antenatal care and delivery in hospitals.
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PMID:Maternal mortality in the Lagos University Teaching Hospital. A 5-year survey--1970-1974. 72 69

This study attempts to collect reliable data on maternal deaths, estimate maternal mortality rate for the western state of Nigeria, and identify major causes of maternal deaths in the state. Standardized questionnaires were sent to randomly selected medical institutions (5 specialist hospitals and 25 general/district hospitals) in the state; only 23 institutions (4 specialist and 19 district/general hospitals) completed the questionnaires. The results show that maternal mortality ranged from 0/1000-13.3/1000 total births in 1972 and 0/1000-11.0/1000 total births in 1973; overall maternal mortality rate was 3.8/1000 in 1972 and 4.7/1000 in 1973. Mortality was higher among unbooked patients, accounting for 71.2% and 66.4% of total deaths in 1972 and 1973. Hemorrhage (antepartum and postpartum), obstructed labor (uterus unruptured and ruptured), eclampsia and anemia of pregnancy accounted for over 80% of total deaths. Nonobstetric causes of maternal deaths including poisoning, infective hepatitis, meningitis, encephalitis, bronchial asthma, hypertension, and pulmonary embolism. The major causes of death in this series were preventable. Maternal mortality is associated with age, parity, and past reproductive and medical history. The high maternal death rate in this study is compounded by nonutilization of available medical services by pregnant women most especially for antenatal care, the lack of basic essential life-saving facilities (e.g., for blood transfusion), lack of adequate transportation system, failure of medical/nursing personnel to refer patients early to specialist hospitals, and relative lack of obstetric services both in quality and quantity all over the country. Better coordination and integration of health services are needed, as are nationwide data collection of maternal death statistics, publication of periodical reports, and establishment of standards for overall maternity care.
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PMID:Maternal mortality in Western Nigeria. 108 Dec 90

This study considers the effects of a maternity care program within a community based maternal and child health and family planning program (MCH--FP) in rural Bangladesh (Matlab subdistrict). The area is rural and poor, with literacy rates of 30% for men and 17% for women; total fertility rates range from 5.5 to 4.3/woman and infant mortality from 110/1000 live births to 75/1000 in 1989. A demographic surveillance system was begun in 1966, and in 1977, MCH-FP was set up as a special treatment area separate from a comparable area with only Government health services. There are 80 community health workers (CHWs) who visit and collect data on each household of every village every 2 weeks. Maternal mortality is established by protocol. Maternal mortality in this study is defined as deaths occurring during pregnancy, delivery, or 6 weeks postpartum and attributable to obstetric complications but not conditions aggravated by the pregnancy or postpartum status (diarrhea, hepatitis, respiratory tract infections). Maternity care and referral is provided by the CHWs. Up to 1986, contraceptive use prevalence rates increased but maternal mortality remained at 5.5/1000 live births. Interventions based on a retrospective study of causes and conditions of maternal mortality were instituted in 1987. These consisted of posting professional midwives equipped to treat immediately obstetric complications in villages and a backup referral system. The intervention program was set up in 50% of the MCH--FP area and consisted of 48,000 people living in 39 villages. There were 1600 pregnancies a year in the program area, or an average of 33 a month/midwife (4 midwives in 2 outposts). Backup included a new maternity clinic without surgical, radiological or modern laboratory facilities, but staff available to stabilize patients for transfer to a regional hospital. Data was collected by the midwives, including the ratio of deaths/1000 live births as the best measure of the risk of dying during pregnancy. The results of the comparison between the intervention area, which also had a higher infant and adult female mortality rate, and the control area for 1987-89 showed that the odds ratio of obstetric death in the pre and post period was .31 (95% CI .11-.81, p=.007); there was no significant change in the control area. The principal causes of death reduced by the program and ranked in decreasing order were abortion complications, postpartum hemorrhage, postpartum sepsis, obstructed labor and eclampsia. It is likely that the intervention was the significant factor in the mortality reduction since the areas were similar sociodemographically. Another method for reducing maternal mortality has been implemented and being evaluated: the use of female paramedical field workers to detect high risk pregnancies.
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PMID:Effect on mortality of community-based maternity-care programme in rural Bangladesh. 168 49

Liver disease in pregnancy is uncommon, acute viral hepatitis being the most frequent. The latter has a normal prognosis in pregnancy, with the possible exception of NANB hepatitis in India and North Africa. Immunization of neonates born of mothers suffering from acute or chronic HBV is essential and effective. Acute fatty liver of pregnancy has a better prognosis than previously thought, perhaps due to diagnosis of milder cases or improved intensive care. Its etiology is still unknown, but metabolic stress may be important. The confusion and overlap of AFLP, the HELLP syndrome, and liver disease of eclampsia suggest common etiological factors. Urgent delivery of the fetus is recommended in AFLP. The related condition of acute liver rupture may be diagnosed by ultrasound. Successful conservative management has been reported. Estrogens are involved in the pathophysiology of ICP, but this does not explain the profound racial differences in incidence. The nature of the sensitivity to estrogens is not understood, although reduced membrane fluidity, which may be counteracted by S-adenosyl-L-methionine, is one possible explanation. The increased fetal loss associated with ICP suggests that treatment should be more energetic than hitherto. In the worst affected individuals, fetal malnutrition secondary to maternal steatorrhea may be an important factor. In general, patients with chronic liver disease have increased maternal and particularly fetal mortality.
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PMID:Diagnosis and management of liver disease in pregnancy. 240 96

Aztreoman (SQ 26,776, AZT), a synthetic monobactam antibiotic, was applied clinically in the field of obstetrics and gynecology. AZT was administered by intravenous drip infusion for 6 to 8 days at a daily dose of 2 g divided in 2 times to 5 cases. Klebsiella in 1 case with puerperal endometritis, Enterococcus, Propionibacterium and Bacteroides in each 1 case with pyometra was isolated. The clinical effect of Klebsiella was excellent. Bacteroides in 1 not-examined case was good. Enterococcus and Bacteroides with pyometra was not effective. Side effects were observed in 2 cases. One case with eclampsia arised LDH and A1-P in serum and 1 case with hepatitis arised GOT and GPT in serum.
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PMID:[Clinical experience with aztreonam in the field of obstetrics and gynecology]. 383 57

Many hepatic lesions, ranging from subcellular alterations to malignant tumors, have been attributed to the use of anabolic steroids (AS) and contraceptive steroids (CS). These lesions that have been attributed to AS and CS are discussed with focus on the following: biochemical changes; subcellular alterations; intrahepatic cholestasis; vascular complications (sinusoidal dilatation, peliosis hepatitis, Budd-Chiari syndrome); hyperplasia and neoplasia (diffuse hyperplasia, nodular transformation, focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, and miscellaneous malignant tumors); and miscellaneous effects (effects of preexisting liver disease, cholelithiasis, and pancreatitis). OCs have a number of physiologic effects on the liver. These include decreased bile flow, diminished secretion of organic anions, and decreased synthesis and secretion of bile acids. Retention of bromosulfophthalein has been noted with AS during late pregnancy and in the puerperium. It is well established that the CS can lead to elevations of serum ceruloplasmin and copper levels. Subcellular alterations have been reported in both humans and rats on AS or women on CS and involve multiple organelles of the several systems of the liver. Both AS and CS have been implicated in intrahepatic cholestasis. Jaundice usually develops after 2-5 months of therapy with AS or after 3 months of OC use. The lesions attributed to CS and AS can involve any of the systems of the liver. At times more than 1 system is affected simultaneously. Most of the steroid related lesions resemble similar ones caused by other etiologies. Some, such as peliosis hepatitis, are rarely related to other etiologies, but others can be termed steroid specific. A number of diseases associated with the CS or AS also occur in pregnancy. Acute fatty metamorphosis of pregnancy and the periportal hemorrhagic necrosis characteristic of eclampsia have not been reported in patients on CS. Spontaneous rupture of the liver during pregnancy has not been attributed to the CS.
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PMID:Hepatic lesions caused by anabolic and contraceptive steroids. 628 45

Maternal mortality was examined in a semi-urban Nigerian community over a 10-year period. Maternal mortality was defined as death occurring as the direct result of childbearing and measured per 1000 births. Abortions at below 20 weeks gestation were excluded. From 1966 to 1975, there were 90 maternal deaths out of 13,182, a rate of 6.8/1000. The hospital records of the Baptist Medical Center, located in the western part of Nigeria, were carefully reviewed and cross-checked with obstetric statistical records. Only 13 of the deaths occurred in hospitalized patients. 78 (80%) were due to direct obstetric causes; 12% were from nonobstetric causes. Anemia due to blood loss was the leading casue of death, accounting for 30, or 33%, of the deaths. Anemia, with or without congestive heart failure accounted for 7 deaths. Infection was responsible for 5 deaths. Ruptured uterus, preeclampsia, and eclampsia occurred in equal percentages, 10-11%. Indirect obstetric deaths, such as sudden death, accounted for 10 deaths. 50% of these were anesthetic deaths; the remainder were due to pulmonary embolism. Sickle cell intrapartum crisis was the cause of 1 death. Associated causes included featured pneumonia, nephritis, hepatitis, meningitis, enteritis, and cerebrovascular accident. Parity ranged from 0-11. 25 babies were salvaged in this series. Prevention continues to be the cornerstone in improving maternal mortality figures in developing countries. The Baptist Medical Center's model for providing maternal care is described briefly and is identified as responsible for the encouraging decline in the maternal mortality rate.
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PMID:Maternal mortality in a semi-urban Nigerian community. 720 76

This study shows that certain direct causes of hospital-based maternal mortality can be validly determined by verbal autopsies. Data were obtained during 1993-95 from a rural district hospital in Kilombero District, Tanzania; a rural teaching hospital in Oromiya Region, Ethiopia; and a rural district hospital in Bawku District, Ghana. Hospital deliveries averaged 1200-1500/year. Maternal deaths averaged 20-30/year. The study population included all adults aged over 15 years dying at ages 15-49 years in the specified hospitals and who lived within 60 km. Data also included hospital records and death certificates. Findings among physicians indicate that direct maternal causes (DMCs), including abortion, had a sensitivity of 82% and a specificity of 93%. For indirect maternal causes (IMCs), the specificity was 97% and the sensitivity was 38%. The positive predictive value (PPV) was 70% for DMCs and 67% for IMCs. Sensitivity was the lowest measure of reliability for all causes. Sensitivity was higher than 60% for all DMCs, with the exception of eclampsia (40%), and lower than 50% for common IMCs. IMCs had a specificity over 98%. The PPV was under 60% for most IMCs and DMCs, except obstructed labor (80%), abortion (64%), and hepatitis (100%). Findings using the algorithm showed lower specificities (93% for DMCs and IMCs). Sensitivity was 60% for DMCs and 68% for IMCs. There was reasonable agreement between physician diagnoses and algorithms. Individual misclassifications of causes were higher in algorithm-based verbal autopsies. False nonmaternal causes were greater among algorithm-based verbal autopsy diagnoses.
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PMID:The validity of verbal autopsies for assessing the causes of institutional maternal death. 991 34

The paper presents the maternal mortality rates in St. Mary's Hospital Urua Akpan from the period of 1979-1985 excluding (1981 Author on leave). 70% of maternal deaths were among unbooked local Annang women who lived within a radius of 15-20 miles from the hospital. They had been attended to by traditional birth attendant (TBAs) and referred too late. The maternal rate decreased from 10/1000 in 1979 to 4/1000 in 1985. The main causes of maternal death during this period include ruptured uterus, septicemia, hepatitis, hemorrhage, eclampsia, and hypertension/nephritis. A community survey (190 interviewed women) revealed that up to 50% of women still prefer to deliver at home and are attended to by TBAs. A training program for TBAs in the Local Government Area (LGA) was started in June 1983. Each course lasted 3 months in which basic instruction in hygiene, simple antenatal care, labor and its complications, and care of mother and child was given. Since starting the program, the TBAs have referred 320 patients with medical pregnancies, vacuum, and symphysiotomy. From 1983-1986, there were 38 perinatal deaths and 2 maternal deaths among the TBAs referrals. Since 1983, the maternal death rate and morbidity have fallen especially among women from the LGA; maternal mortality declined 50% among these women which account for only 30% of the total hospital births/year. Furthermore, 16,000 children have been vaccinated. The beneficial aspects of TBA training include observing the principles of hygiene, early referral of patients to hospital, encouraging village children to come for vaccinations and generally using their influence in the cultural, ritual and religious life of traditional society to become good health educators.
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PMID:Training traditional birth attendants reduces maternal mortality and morbidity. 1217 76

The objectives of this study are to determine the trend of maternal mortality at the University of Ilorin Teaching Hospital, to identify the causes of death, and to identify ways of minimizing the frequency of preventable deaths. Analysis of 75 cases of maternal deaths seen over 3 1/2 years (January 1983-June 1986) was conducted. During this period, there were 26,905 births, giving a maternal mortality rate of 279/100,000. 84% of the deaths were due to direct causes while the remaining 16% were classified under the indirect and pregnancy related categories. The main direct causes of death include hemorrhage (35.6%), septicemia (24.7%), and anemia (13.7%). Other direct obstetric causes include eclampsia, anesthetic death, hemoglobinopathy, and ruptured uterus. The most important indirect causes were native drug intoxication (6.8%), fulminant hepatitis (5.5%), and pulmonary embolism (2.7%). The maternal mortality was highest in the age ranges 25-29 years (31.5%). Median age and parity were 27 years and 4.5 respectively. While the maternal mortality rate of 2.8/1000 is an improvement over the previous years' (1972-1982) record of 4.3/1000, it is still unacceptable. The majority of these deaths could have been prevented if delivery had occurred in a well equipped hospital where blood transfusion and surgical facilities are available, if sterile manipulations for pregnant women had been employed, if appropriate antenatal care was available, and if specialist anesthetist services were accessible. Recommendations to reduce the maternal mortality rate include improved education and training of traditional birth attendants, improved immunization of women against tetanus, and increased community involvement through education. Furthermore, policy makers must set new priorities such as encouraging greater investment in improving clinics and hospital facilities, improving access to contraception, increasing awareness of the magnitude of the problem and encouraging community leadership and action.
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PMID:Maternal mortality at Ilorin, Nigeria. 1217 82


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