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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The maternal deaths occurring in the Kilimanjaro Christian Medical Center (KCMC), which serves as a supraregional reference hospital for the 5 regions of Northern and Central Tanzania, are reviewed for the 1971-1977 period and avoidable factors are discussed. All deaths occurring within the hospital during pregnancy or the first 6 weeks of the puerperium were included in this survey. Postmortem examination was performed in 35% of the cases. In the remaining cases the diagnosis was made on clinical grounds. During the period under review, there were 10 deaths among 83 cases, a mortality of 12%. The major cause of rupture was obstructed labor associated with a contracted pelvis or abnormal lie. 25% of the patients had had a previous cesarean section scar give way. 2 other deaths were attributed to anesthetic accidents and 1 was probably due to pulmonary embolism. The primary cause of death in the 7 remaining cases was hemorrhage (4) and sepsis (3). If deaths from ruptured uterus are to be avoided, early diagnosis is essential. 1044 cases of moderate and severe EPH gestosis (preeclampsia) were treated in KCMC during the period under review together with 54 cases of eclampsia. There were 5 deaths among the patients with eclampsia, a mortality of 9%. In addition to the 11 sepsis deaths there were 3 others included among the cases of ruptured uterus. There were 4 cases of septic abortion and 3 of those admitted to criminal interference. Preexisting anemia was a complicating factor in 5 cases, all of whom died within 15 minutes of arrival. There were 4 deaths among 251 cases of ruptured ectopic pregnancy. There were 10 deaths associated with cesarean section among 1271 sections peformed during the period under review. Deaths from associated diseases included the following: enterocolitis (12 deaths); renal and hypertensive disease (4 deaths); cardiac disease (2 deaths); anemia (2 deaths); malaria (2 deaths); tuberculous meningitis (2 deaths); and miscellaneous associated conditions (11 deaths).
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PMID:Maternal deaths in the Kilimanjaro region of Tanzania. 47 24

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

A report on maternal deaths in England and Wales during the 3-year period, 1970-1972, is discussed. Maternal mortality is defined as death resulting during pregnancy, labor, or as a consequence of pregnancy or abortion. 606 deaths were reported for the period, 355 of which were directly attributable to pregnancy or childbirth. From 1952-1972, the maternal mortality rate dropped from .67 to .16. Most of the deaths were due to familiar causes: abortion (81), pulmonary embolism (61), toxemia (47), ectopic pregnancy (34), hemorrhage (27), amniotic fluid embolism (22), and ruptured uterus (12). It was thought there were avoidable factors in 34% of the cases. Social patterns and the availablility of obstetrics services may explain the regional variations in maternal mortality rates.
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PMID:Editorial: Maternal mortality. 124 37

Maternal mortality is examined from June 1980 to December 1986 at Mulago, Nsambyo, Old Kampala, Rubaga, and Mengo Hospitals in Kampala, Uganda. Clinical or immediate causes, direct and indirect, were recorded from case summary forms based on ICD9 definitions of obstetric complications. The nonabortion maternal mortality rate (NAMMR) was 2.65/1000 deliveries (580 deaths); the abortion-related maternal mortality rate (ARMMR) was 3.58/1000 abortions. The hospital maternal mortality rate was 2.0/1000 deliveries. 75% of maternal deaths of women of 28 weeks' gestation or more had delivered outside the hospital. NAMMR doubled between 1980-86, a statistically significant increase. ARMMR increases were almost significant. 75% were direct obstetric and 21% were indirect obstetric causes. 38% had clinical anemia, 29% had some sepsis, 18% had substantial bleeding, and 14% had obstructed labor. Other contributing conditions were pneumonia, ruptured uterus, laparotomy, evacuations and curettage, malaria, preeclampsia, sickle cell anemia, pulmonary embolism, malnutrition, tetanus, meningitis, prolonged labor, and hepatitis. At admission, 48% were in poor condition, 30% in good condition, and 22% in fair condition. 27% had sickle cell anemia, high blood pressure, multiple pregnancy, or malaria at admission. 64% were admitted within 24 hours after delivery, 67% 1-7 days after delivery, and 92% 7-42 days after delivery. Those in good condition were all admitted 7 days postdelivery. 41% of deaths were due to lack of drugs, 7% lack of fluids, 20% with theater problems, 14% with doctor-related factors, and 3% with midwife-related factors. Better information is needed on mortality before delivery, mortality in hospitals vs. outside, and mortality from abortion, and ectopic and hydatidiform molar pregnancies. An explanation given for the increase in maternal mortality is the decline in economic conditions. Abortion complications may be due to the concealment practiced. Causes are consistent with trends from the 1950s, 1960s, and 1970s in Uganda and developing countries in general. Availability and accessibility of gynecological and obstetric services needs great improvement. Training traditional birth attendants and obtaining rural ambulance services are also needed. Health workers lack creativity and imagination for developing country conditions; scarce resources are not the only problem.
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PMID:Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986. 176 15

A 30-year-old woman in the 36th week of her second pregnancy, suddenly developed jaundice with remarkable liver necrosis, accompanied by generalized bleeding due to disseminated intravascular coagulation (DIC). She underwent a caesarean and a dead foetus was extracted from the uterus. Heparin and frozen plasma infusion resulted in a prompt recovery from the haemostatic disorder. The course of the disease involved the successive appearance of haemorrhagic shock, intestinal ileus and pulmonary embolism all of which she recovered from. The liver biopsy showed severe cholestasis without derangement of the lobular structure. Hypotheses of acute veno-occlusive disease caused by the DIC, and acute fatty liver of pregnancy are discussed.
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PMID:[Disseminated intravascular coagulation and acute hepatic necrosis at the end of pregnancy. A case report]. 262 77

Metastatic gestational trophoblastic disease poses problems in diagnosis and management and has a poorer prognosis than the non-metastatic variant. The lung is the most common site of metastases. This paper reviews 97 patients with pulmonary metastasis developing after gestational trophoblastic disease who were seen at one centre over 26 years. Most patients had an antecedent molar pregnancy but an associated choriocarcinomatous lesion in the uterus was absent in the majority. In many patients the pulmonary lesion was asymptomatic. Whilst chemotherapy was the treatment of choice, selective thoracotomy in cases with solitary lung nodules reduced the treatment time and need for aggressive multi-drug combination regimens. The overall survival rate at 2 years after diagnosis was 65%. A higher mortality was found when the antecedent pregnancy ended at term, when the time interval between the preceding pregnancy and diagnosis of pulmonary metastases was greater than 1 year, when multiple pulmonary secondaries were present or when cerebral metastases occurred. The main causes of death were cerebral haemorrhage, respiratory failure and pulmonary embolism.
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PMID:Pulmonary metastases in gestational trophoblastic disease: a review of 97 cases. 282 61

There are 2 striking differences in the practice of medicine in the US and in the UK: 1) in the former, there is a great emphasis on private medicine, and 2) in the US there is a much higher incidence of litigation, whereas in the UK, family planning services are free, and litigation in this area is almost unknown. British medical opinion agrees with the US on the following oral contraceptive contraindications: 1) cancer of the breast, ovary, uterus, vagina, or cervix; 2) coronary thrombosis, pulmonary embolism, deep vein thrombosis, angina pectoris, or stroke; and 3) unusual or unexplained vaginal bleeding. Both countries agree that it is inadvisable to give the combined pill over the age of 45, and over the age of 35 in smokers. The UK agrees with 75% of the routines adopted by US doctors on a patient's 1st visit for oral contraceptives. However, a patient who becomes amenorrheic while taking the pill is not regarded as lightly in the UK as she would be in the US; she is closely monitored. If 1 of 4 risk factors (age 35 or over, hypertension, obesity, or smoking) is evident, a patient in the UK is closely supervised while taking the pill. If more than 2 risk factors are present, a UK doctor may advise against the pill. Since the 1960s the media have both praisd and condemned the pill. There is no doubt that, in the field of contraceptive advice, the US and the UK lead the way, and a closer liaison between the 2 medical professions is essential to reassure patients.
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PMID:Contraceptive advice: how the English differ from the Americans. 309 Feb 54

The causes of the high maternal mortality rate (21.6/1000) at the Goroka Base Hospital in Papua New Guinea are reviewed for the 1964-1973 period. This study covers deaths directly due to pregnancy and childbirth and deaths due to other causes occurring in association with pregnancy and childbirth (referred to as associated deaths). The definition of parity in this study is the number of previous pregnancies that have lasted 28 weeks or more. During the 10-year period, 6031 public patients were admitted for confinement and 542 public patients were admitted following delivery elsewhere. For the purpose of deriving the maternal mortality rate (MMR), only direct maternal deaths are considered. The MMR was much higher (97.8) for patients admitted after delivery than for those admitted before delivery. The parity of 74 of the patients who died from direct obstetric causes was recorded: para 0, 52.7%; para 1-4, 40.5%; and para 5 or more, 6.8%. Autopsy confirmed the cause of death in 33 (23.2%) of the 142 maternal deaths. In most patients, sufficient clinical data was available to establish the diagnosis. Sepsis was the predominant cause of death, accounting directly for 44 (38.3%) of the deaths. Obstructed labor accounted for 29 deaths (25.2%) with the uterus intact. Of patients whose parity was recorded, 15 (60%) were primigravida, 8 (32%) were multigravida, and 2 (8%) were multigravida. Of 45 patients admitted to Goroka Base Hospital with the diagnosis of ruptured uterus, the mortality was 28.9%. The incidence of ruptured uterus declined from 1.4% to 0.4% over the 10-year review period. Abortion was the cause of 14 deaths. Criminal interference was admitted in 9 patients and may have occurred in the others. The cause of death of 4 women was toxemia of pregnancy; 2 of these patients were referred from other hospitals, each after treatment for pre-eclampsia. Pulmonary embolism was responsible for 1 death as was extrauterine pregnancy. There were 29 deaths in patients delivered by caesarean section. Additionally, 3 women died after referral following caesarean section at other hospitals. The average duration of hospitalization for patients with peritonitis at or developing after caesarean section was 17.7 days. 27 deaths were associated with pregnancy, and the conditions responsible are listed in a table. Continuing education is necessary to reduce maternal morbidity and mortality. Simple proposals for health education purposes are identified.
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PMID:Maternal mortality at Goroka Base Hospital. 453 53

A case is reported of a 180 degrees levorotation of the gravid uterus with successful outcome for mother and child. Delivery was by cesarean section.Only 108 cases of rotation of the gravid uterus have been reported in the world's literature. A uterine tumour was associated in almost one third of cases. The condition usually presents as an acute abdomen. Complications include uterine rupture and pulmonary embolism. Treatment is by laparotomy and de-torsion, with cesarean section if at term or near term.
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PMID:Torsion of the gravid uterus. 475 58

A case is reported of a 39-year-old woman who had postoperative pulmonary embolism after taking combined oral contraceptives from 1967 to 1970. Her related history included birth of 2 large infants, phlebitis, and varicosities. Her operation for retroverted uterus and tubal sterilization was followed the next day by a severe pulmonary embolism treated with heparin. This treatment resulted in a pelvic hematoma, abundant metrorrhagia, and anemia requiring 4 transfusions. 4 months later she developed jaundice due to hepatitis virus B, which potentiated the effect of the antiprothrombin treatment and precipitated 2 new pelvic masses, fever, and metrorrhagia. She was given hysterectomy, which revealed bilateral hematosalpinx, probably related to endometriosis. 1 year later she was in good health, but her serum lipids were found high in the alpha- and pre-beta-lipoprotein bands. A delay of 2 months between stopping oral contraceptives and surgery is recommended.
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PMID:[Postoperative thromboembolic accident observed during estro-progestative treatment. Apropos of a case]. 516 37


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