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Many neurologic disorders, such as eclampsia, pseudotumor cerebri, stroke, obstetric nerve palsies, subarachnoid hemorrhage, pituitary tumors, and choriocarcinoma, can develop in the pregnant patient. Maternal mortality from eclampsia, which ranges from 0 to 14%, can be due to intracerebral hemorrhage, pulmonary edema, disseminated intravascular coagulation, abruptio placentae, or failure of the liver or kidneys. Associated fetal mortality ranges from 10 to 28% and is directly related to decreased placental perfusion. Pseudotumor cerebri can be associated with serious visual complications; thus, the therapeutic goal is to prevent loss of vision. The risk of stroke in the pregnant patient is 13 times the risk in the nonpregnant patient of the same age. The major causes of stroke in pregnant patients are arterial occlusion and cerebral venous thrombosis. Lumbar disk prolapse is common in pregnant patients, and lumbosacral plexus injuries can occur during labor or delivery. In addition, peripheral nerve compression or entrapment syndromes are thought to be caused by the retention of fluid during pregnancy. The incidence of subarachnoid hemorrhage during pregnancy is 1 in every 10,000 patients, a rate 5 times higher than in nonpregnant women. Because of a proliferation of prolactin-secreting cells, the pituitary gland can enlarge dramatically during pregnancy, a change that can disclose a previously unknown tumor or cause a known pituitary tumor to become symptomatic. The incidence of choriocarcinoma is 1 in 50,000 full-term pregnancies but 1 in 30 molar pregnancies. This malignant tumor has a high rate of cerebral metastatic lesions. In addition to these disorders that develop during pregnancy, the pregnant state can affect numerous preexisting neurologic conditions, including epilepsy, headaches, multiple sclerosis, myasthenia gravis, spinal cord injury, and brain tumors. We discuss advice for patients with such conditions who wish to become pregnant, recommendations for medical and surgical management, and surgical considerations for neurologic complications during pregnancy.
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PMID:Selected neurologic complications of pregnancy. 225 22

This article includes discussions about postpartum care of the dam and postpartum disorders in the bitch such as hemorrhage, uterine prolapse, metritis, mastitis, eclampsia, and subinvolution of the placental sites.
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PMID:Postpartum diseases. 348 55

This paper presents data on perinatal and maternal deaths occurring in the Black Lion Hospital, Addis Ababa, in 1980. The data were collected by a research midwife. A total of 3936 infants were delivered to 3868 women during this period. The stillbirth rate was 52.6/1000; the perinatal mortality rate was 8.6/1000; and the maternal mortality rate was 7.8/1000. Of the 207 stillbirths 92 (44.5%) were unexplained, 66 (31.9%) were due to mechanical causes (e.g., ruptured uterus, cord prolapse, obstructed labor), 34 (26.4%) resulted from pregnancy complications (e.g., hemorrhage,hypertensive disease, congenital abnormalities), and 15 (7.3%) were due to intrapartum death. There was no obvious pathology in 38 of the 84 neonatal deaths. The remaining cases were due to conditions such as intrapartum asphyxia, antepartum hemorrhage, septicemia, and congenital abnormalities. 10 of these death involved preventable factors. Of the 30 maternal deaths, 13 were due to sepsis, 9 to hemorrhage, 4 to surgical conditions, 3 to medical conditions, and 1 to eclampsia. Inadequate monitoring of shocked patients and the nonavailability of blood tranfusions contributed to some of these deaths. Although socioeconomic and cultural factors play a role in perinatal and maternal mortality, coordinated maternity services could produce short-term improvements. Such maternity services should embrace both primary care, with an emphasis on the training of traditional birth attendants and health assistants, and high-risk hospital care. Good prenatal care and monitoring can identify women at high risk and ensure that they receive adequate medical supervision.
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PMID:Maternal and perinatal deaths in an Addis Ababa Hospital, 1980. 674 50

94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of intrapartum mortality without maceration, 114 were caused by retroplacental hematomas, 61 by placenta previa, 74 by uterine rupture, 119 by prolapse of the cord, 51 by fetal malformation, 45 by dystochia, 53 by twin pregnancies, 104 by fetal distress, 44 by obstetrical trauma, 55 by prematurity, and 75 by undetermined causes. In 361 cases of early neonatal mortality, 88 were caused by renovascular syndromes, 24 by diabetes, 13 by Rh incompatibility, 34 by placenta previa, 94 by prematurity, 28 by fetal malformation, 35 by fetal infections, 31 by fetal distress, and 14 by obstetrical trauma. The rates of maternal and perinatal mortality are very high compared to those of European countries.
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PMID:[Maternal mortality and perinatal mortality]. 720 85

According to a 3-year collaborative study estimating maternal mortality rates from 41 hospitals affiliated with teaching centers in India, maternal mortality was 721 per 100,000 live births. Community studies in rural areas of Sirur, Pachod, and Ambula reported maternal mortality as 210-253 per 100,000. Cohort studies conducted by the Indian Council of Medical Research reported maternal mortality as 530 per 100,000 based on data from rural areas of Varanasi, 460 per 100,000 in urban Delhi, and 450 per 100,000 in urban Madras. The Ministry of Health gave the rate as 460 per 100,000 in 1984, while UNICEF gave a figure of 400 per 100,000 for 1980-91. India has 1 out of 4 of the world's maternal deaths, or 1 every 6 minutes. The risk of maternal death has been calculated to be one in 64. Risk is unevenly distributed geographically. Risk is low in Kerala compared to Uttar Pradesh or Madya Pradesh. In 1992 maternal mortality was calculated to be 1320 per 100,000 births based on 5 district hospitals. The cause of maternal deaths was anemia in 25% of cases. 75% of cases were accounted for by eclampsia, sepsis, hemorrhage, and abortion. Anemia (pre-existing the pregnancy) is acerbated by the demands of pregnancy and causes congestive heart failure and death. Blood losses of greater than 150 ml (due to hemorrhages of pregnancy and labor) can be fatal. During 1982-89 anemia was responsible for 17-24% of all maternal deaths in rural areas. Morbidity from pregnancy-related causes included obstetric fistulae, pelvic inflammatory disease, anemia, genital prolapse, and urinary incontinence. Quality of maternal care is an important factor in reducing maternal mortality and morbidity. Societal factors such as illiteracy and malnutrition, early marriage, poorly supervised pregnancies, and lack of transportation during emergencies are other determinants of mortality and morbidity. About 10% of maternal deaths are attributed to unsafe abortion. The government aim for the year 2000 of 100% prenatal care and care during delivery will require professional commitment and thousands more midwives in rural areas.
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PMID:How safe motherhood in India is. 765 33

During 1981-1990, there were 12,925 deliveries and 68,668 mothers received prenatal care at Wesley Guild Hospital in Ilesa, Nigeria. Physicians retrospectively analyzed data on these deliveries to determine trends in the perinatal mortality rate under harsh economic conditions. Rising economic hardship in Nigeria forced the hospital to introduce fees in late 1984, after which, the number of mothers receiving prenatal care and the resultant number of deliveries at the hospital declined significantly (p 0.001). In fact, the percentage of deliveries where the mothers did not receive prenatal care increased as the total number of deliveries decreased (p 0.001). The fees and the concurrent economic hardship decreased the purchasing power of the people, thus more and more mothers could not afford to pay for prenatal care and delivery in the hospital. During the study period, there were 747 perinatal deaths for a perinatal mortality rate of 57.8/1000 total births. The rate increased from 38.7 after introduction of fees and peaked at 110.5 in 1987. Leading obstetric complications were antepartum hemorrhage, prolonged obstetric labor, preeclampsia, cord prolapse, retained second twin, severe anemia, and maternal and fetal distress. The distribution of stillbirths, early neonatal deaths, and major obstetric complications was unequal during the study period. Stillbirths accounted for more than 75% of perinatal deaths. Factors related to stillbirth included prolonged obstructed labor, antepartum hemorrhage, multiple pregnancy, and eclampsia. The two leading causes of early neonatal death were preterm delivery (low birth weight 2500 g) (62.2%) and birth asphyxia (27.7%). More than 75% of these deaths occurred within the first 48 hours of life. More than 50% of the preterm infants weighed less than 1500 g at birth. These findings reflect the adverse effect of economic hardship and of the introduction of fees on perinatal health at Wesley Guild Hospital.
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PMID:Trends in utilization of obstetric care at Wesley Guild Hospital, Ilesa, Nigeria. Effects of a depressed economy. 859 70

This article discusses different techniques that can be used in the diagnosis and treatment of obstetrical emergencies. Female reproductive emergencies commonly encountered by small animal practitioners include pyometra, dystocia, cesarean section, mastitis, eclampsia, uterine torsion, and uterine prolapse. A thorough knowledge of normal and abnormal reproductive behavior will aid the emergency veterinarian in successfully managing such cases. Timely diagnosis and treatment of these emergencies will often give a good outcome.
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PMID:Obstetrical emergencies. 1099 21

Safe motherhood will require a multi-faceted strategy of improving girls' education and employment opportunities, providing primary and reproductive health care for women, taking a high risk approach with referral for all at-risk pregnant women, and including maternal mortality as part of the quality of life index. The World Health Organization in 1986 reported that 99% of maternal mortality occurred in developing countries: 640 per 100,000 live births in Africa, 420/100,000 in Asia, 270/100,000 in Latin America, 100/100,000 in Oceania, 450/100,000 in developing countries on average, and 30/100,000 in developed countries. The chances of maternal death ranges in the extremes from 1/9850 in northern Europe to 1/21 in Africa. In India, the chance of maternal mortality was estimated at 1/18; the surviving also might suffer from perineal tears, genital infections, uterovaginal prolapse, and vesico-vaginal fistula. Direct obstetric causes include those directly related to pregnancy, labor, and the postpartum period. Indirect causes include those resulting from previous existing diseases that were aggravated by the pregnancy. 75% of maternal mortality was caused by hemorrhage, obstructed labor, infection, eclampsia, and abortion. Proper handling could prevent maternal mortality in an estimated 63-80% of direct causes and 88-98% of all causes. Risk factors for postpartum hemorrhage include multiparity, age over 35 years with stretched uterus, and slight episodes of bleeding. Treatment must be immediate and sustained with oxytocic drugs and plasma expanders; the means of referral to an equipped facility must be available to women with hemorrhage. Risk factors for obstructed labor include very young age, height below 145 cms, previous prolonged labor or stillbirth, and previous cesarean, abnormal presentation, or labor progression. Delivery for these women must be in a facility offering trained doctors and well-equipped operating rooms. Prevention of infection is possible with pre-sterilized delivery kits, antibiotics in kits or within facilities, cleanliness of hands and delivery areas, and maternal tetanus immunization. Identification of edema in pregnancy would prevent eclampsia. Abortion complications could be prevented with safe and early practices and women's control over fertility.
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PMID:Maternal mortality and morbidity in the developing countries like India. 1228 6

Sharp rise in the caesarean section rate, over the past years has been causing lot of concerns. It is to be evaluated whether the decrease in perinatal mortality rate is due to the rising rate of caesarean section. Five hundred consecutive patients were selected on whom caesarean section had been performed. Both mother and baby were followed till they are discharged from the hospital. Foetal distress was the commonest indication in primigravidae who underwent caesarean section. The other indications of caesarean section in this study were breech, severe pre-eclampsia, eclampsia, cord prolapse, elderly primi, postdated, premature rupture of membrane, twin, compound presentation, meconium stained liquor. The occurrence of perinatal morbidity in caesarean section was 10% compared to 12% in vaginal delivery. Common causes of perinatal morbidity were asphyxia, prematurity, diarrhoea, septicaemia, jaundice, conjunctivitis and scalp injury. The occurrence of perinatal mortality in caesarean section was 3.8% compared to 3% in vaginal delivery. Causes of perinatal mortality were stillbirth, meconium aspiration syndrome, hypoxic ischaemic encephalopathy, prematurity and congenital malformation. In spite of safety of vaginal birth after caesarean section it continues to be underutilised. Good perinatal care proper screening and use of newer effective pharmacological agents improve the maternal progress as well as perinatal outcome without increasing the caesarean section rate.
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PMID:Impact of increased rate of caesarean section on perinatal outcome: sociolegal evaluation. 2218 63

Pregnancy is often associated with ocular changes which may be more commonly transient but occasionally, permanent. The ocular effects of pregnancy may be physiological or pathological or may be modifications of pre-existing conditions. Physiological changes include increased pigmentation around the cheeks, ptosis, changes in cornea and refractive status,decreased intraocular pressure. These usually resolve post partum. Pre-existing diseases such as Graves disease, Retinitis pigmentosa, optic neuritis, should be monitored due to their remission or relapses in pregnancy. There may be worsening of Diabetic retinopathy, and Central serous chorio-retinopathy with increased risk of Retinal detachment. Conditions like Glaucoma and Non infectious uveal inflammatory disorders may even improve transiently. Pre-eclampsia and eclampsia could result in hypertensive retinopathy, exudative retinal detachment and cortical blindness. Neuro-ophthalmological disorders such as venous sinus thrombosis, benign intracranial hypertension, pituitary adenoma, meningioma and optic neuritis should be kept in mind as differential diagnosis in pregnant women presenting with visual acuity loss, visual field loss, persistent headaches or oculomotor palsies. Use of ophthalmic drugs can affect fetal health during pregnancy.
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PMID:Ocular changes in pregnancy. 2234 13


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