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This article reports the results of a review of all maternal deaths occurring in Jamaica in 1981-83. A total of 192 maternal deaths were identified, yielding a maternal mortality rate of 10.8/10,000 live births, which was considerably higher than the official rate of 4.8. 15% of these deaths were associated with abortion or ectopic pregnancy. The most common causes of death were hypertensive diseases of pregnancy (26%), hemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. Lowest rates were noted among women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. Avoidable factors were judged to be present in 68% of the deaths. The largest categories of avoidable factors were: nonuse of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of high-risk women; and delays in taking action when signs of complications developed before, during, and after delivery. In response to these findings, the Ministry of Health's Maternal Mortality Committee has called for the following actions: measures to encourage women to seek antenatal care early in pregnancy; improvements in antenatal monitoring; the referral of high-risk women for hospital delivery; the definition of standard procedures for dealing with specific complications of pregnancy, e.g., eclampsia and hemorrhage; regionalization of obstetric services and criteria for referring patients to hospital; and review of provision of blood and plasma for emergency transfusions.
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PMID:Maternal mortality in Jamaica. 286 18

In a 13-year review of maternal deaths at the University of Benin Teaching Hospital, Benin City, abortion was one of the 3 major causes of death, accounting for 37 (22.4%) out of the 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage, inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis (including tetanus), hemorrhage and trauma to vital organs, complications directly attributable to faulty techniques by unskilled abortion providers, a by-product of the present restrictive abortion laws. Total overhaul of maternal child health services and the family health education system, are suggested. Contraceptive practice should be made available to all categories of women at risk, and the cost subsidized by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and a review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notably in the African continent, is overdue.
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PMID:Abortion-related morbidity and mortality in Benin City, Nigeria: 1973-1985. 290 Jan 75

The maternal mortality rate in 10 hospitals scattered all over Anambra State, Nigeria, in a 5-year period were studied. The hospitals covered urban, semi-urban and rural areas. The maternal mortality rate varied from 1.8 to 13/1000 with a mean of 4.97/1000. This mean is 45 times the rate in England in 1978 and also compared less favorably with some other figures from third world sources. Attributable causes included obstetric hemorrhage (23%), ruptured uterus (27.6%), obstructed labor (13%), sepsis (12.1%), eclampsia (7.9%), anemia (2.9%), septic abortion (2.1%) and other causes. 16.7% of deaths were among 16-20 year olds; 14.6% among 21-25 year olds, 27.2% among 26-30 year olds; 18.8% among 31-35 year olds; and 22.6% among women older than 35. 87.5% of the women were unbooked. Of the 239 cases, 51 delivered vaginally, 162 by cesarean section, 12 by breech, 5 by TOP and 5 by destruction. Parity and age were important influences; at highest risk were primigravida and the grandmultipara, especially between para 4 and para 5. All the major causes of death are avoidable--either by obtaining prenatal and intrapartal care or by anticipating fetopelvic disproportion or abnormal lie. Lack of access to health facilities, especially in the rural areas, poor transportation, great distances to nearest health facility, are all implicated in obstructed labor deaths. Most cases of hemorrhage are avoidable through early diagnosis and recognition of high risk cases, prophylactic measures and availablity of blood transfusion and surgical delivery. Lack of antibiotics and non-adherence to normal aseptic precautions were also problems, especially in the 5 deaths from illegal abortions. Changes in the mortality rate can be made by accurate data collection, improved health facilities, improved socioeconomic status and basic education.
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PMID:Maternal mortality in Anambra State of Nigeria. 290 99

Grazing of ponderosa pine needles by pregnant cows may cause abortion. The abortions are frequently accompanied by retained placenta. Death is not uncommon in cows that abort. Ten cows were placed on a ponderosa pine needle experiment. Six of these cows were fed pine needles and four served as controls. All six cows receiving pine needles aborted, and three of them died shortly after the abortion. Death was due to a severe septicemia. Although the cows were necropsied shortly after death, all tissues were necrotic. Other lesions are described. Three of the six calves died shortly after the abortion. The other three were small and weak but survived due to intensive care.
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PMID:Pine needle abortion in cattle: pathological observations. 291 74

In a regional population of 32,120 liveborn newborn infants 65 (0.2%) had a birthweight less than or equal to 900 g (extremely small low birthweight = ESLBW) with mean gestational age 26.4 (range 22-31) completed weeks of gestation. The total 0-1 year survival rate was 48%. For the 42 infants treated in the Level III regional neonatal intensive care unit (NICU) the 0-1 year survival rate was 55% versus 34% for 23 infants not transferred to the Level III unit. In the ESLBW infants treated in the regional NICU the major complications were respiratory disorders requiring artificial ventilation (73%), bronchopulmonary dysplasia (26%), intracranial haemorrhages (40%), symptomatic persistent ductus arteriosus (36%) and sepsis (14%), persistent retinopathy of prematurity (8%). Duration of NICU treatment was 51 days (range 10-95) for survivors. Mode of delivery and rate of perinatal complications did not differ between survivors and non-survivors. Previous legal abortion occurred in 24%, fertility problems in 29% and 21% of the mothers were immigrants. Otherwise no significant abnormalities were found in maternal or socioeconomic conditions. Factors deciding neonatal outcome in the tiniest babies seem to be a combination of prenatal circumstances and neonatal minute fine care procedures.
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PMID:Neonatal outcome of extremely small low birthweight liveborn infants below 901 g in a Swedish population. 292 41

Depending on the extent of infection, abortions are usually classified as uncomplicated infected (feverish) abortions, in which only the fertilized egg and uterus are infected; complicated infected abortions, in which infection has spread beyond the uterus but remains localized in the pelvis minor; and septic abortions, in which infection has spread beyond the pelvis minor and become generalized. Disagreements are possible when defining uncomplicated and complicated abortions, since the term "infection within the uterus" can signify several inflammatory disorders varying in degree of severity and extent. The term "septic abortion" has also taken on a certain ambiguity and is even used to denote any abortion complicated by infection. The terms "septic abortion" and "septic condition" are often used synonymously. Infected abortions with clinical manifestations of septicemia are sometimes classified as "high-fever abortions" or "feverish abortions" with "septic abortion" syndrome. Recommendations for therapy are given: 1.) In uncomplicated infected abortions, the method of treatment is curettage of the uterus in the 1st hours after admission into the hospital. Medicinal preparation conducted for 2-6 hours before curettage reduces by nearly 1/3 the danger of inflammation spreading from the uterine cavity to the myometrium. 2.) When treating patients with complicated infected abortions, expectant-active treatment yields the best results. Curettage of the uterus is safe only after normalizing temperature, alleviating symptoms of toxic poisoning, and reducing local manifestations of infections. 3.) For patients with pronounced toxic poisoning related to resorptive-toxic fever or septicemia, clinical and laboratory observation and treatment must be conducted according to general procedures for acute sepsis therapy. Considering the special diathesis of these patients to septic shock, special measures to prevent shock should include increasing the dosage of antihistamines, medium doses of corticosteroids, and individually selected doses of heparin. This increases resistance to active intervention and the related entry of toxic substrate from the uterus into the blood stream. 4.) Treatment for an abortion complicated by generalized infection (septic abortion) should include radical surgical intervention on the primary septic source. The time and extent of surgical intervention are determined in each specific case individually, depending on the nature of the complication (sepsis, peritonitis, anaerobic infection) and condition of the patient. 5.) If indications develop for removal of the uterus, preference should be given to extirpation over amputation, since the harshest changes are usually localized in the isthmus of the uterus.
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PMID:[Debatable questions in the classification and therapy of the infectious complications of abortion]. 294 72

An uncontrolled clinical trail was carried out to assess the efficacy of cefoxitin as the sole antimicrobial agent in the treatment of 22 cases of septic abortion in Lagos, Nigeria. The mean age of patients studied was 21 years; 90% were from social classes IV and V. All study subjects satisfied the following diagnostic criteria: pyrexia of equal to or greater than 38 C, tachycardia equal to or greater than 90/min, foul smelling vaginal discharge, uterine tenderness, adnexal tenderness, peritonitis, or features of septicemia. All patients received initial doses of 2 gm of cefoxitin sodium by slow intravenous bolus and then 2 gm every 6 hours for the next 5 days. 17 (77%) of the patients improved on cefoxitin therapy. There was no mortality and no serious side effects. The mean duration of hospital stay was 9 days for the patients who responded to cefoxitin and 21 days for patients whose conditions was not improved by this treatment. Anaerobes, especially Bacteriodes bivius, were isolated from all 22 patients. 4 of the 5 patients who did not respond to 72 hours of treatment with cefoxitin harbored organisms such as Pseudomonas aeruginosa that are resistant to this drug. None of the patients treated with cefoxitin progressed to abscess formation. These findings suggest that cefoxitin can be used as a single antimicrobial agent in the treatment of septic abortion and may offer advantages over the use of a combination of antimicrobials.
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PMID:Cefoxitin: single agent treatment of septic abortion. 302 Sep 51

Listeriosis, caused by Listeria monocytogenes, appears to be increasing in incidence worldwide. The disease is of great concern to the food industry. A recent outbreak in California was linked to the consumption of Mexican-style soft cheese and involved more than 300 cases, 30% of which were fatal. L. monocytogenes can be found in a variety of dairy products, leafy vegetables, fish and meat products. It can grow in refrigerated foods and is more heat resistant than most vegetative microbes. The epidemiologic features of listeriosis are poorly understood, and the minimum infectious dose is unknown. Those predisposed to listeriosis include immunocompromised people and pregnant women and their fetuses. Meningitis, spontaneous abortion and septicemia are the primary manifestations of the disease. Early recognition is critical for successful treatment, and ampicillin is the preferred drug. Listeriosis should be considered in any febrile patient with neurologic symptoms of unknown origin, as well as in women with unexplained recurrent miscarriages, premature labour or fetal death. A food source should be the prime suspect if any isolated case or outbreak occurs.
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PMID:Listeria monocytogenes: a foodborne pathogen. 312 48

A prospective, randomized study was conducted in 113 women to evaluate the effect of antibiotic prophylaxis with cefotetan versus no prophylaxis in the prevention of post-partum and post-abortion sepsis. The administration of a single 2 g dose of cefotetan at the time of surgery significantly reduced the number of infectious complications, removal of the placenta or an internal inspection were carried out.
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PMID:[Prevention using cefotetan of post-partum and post-abortion infectious complications in intra-uterine procedures]. 314 25

In this study we describe biochemical, toxigenic and surface characteristics of 33 motile Aeromonas isolated from diseased mammals, 3 from moribund marine mammals, 24 from healthy fish and 4 from moribund fish. Aeromonas hydrophila, A. caviae and A. sobria were isolated from both mammals and fish but at a different incidence. Aeromonas hydrophila was the predominant species isolated from clinical specimens; it was isolated from pneumonia, wound infections, septicemia and abortion in horses, cattle and pigs. Aeromonas sobria was isolated from one mammal and 11 healthy fish. Aeromonas caviae was isolated in 2 cases from healthy fish and in 9 cases from diseased mammals. Variations in some biochemical tests including sorbitol, amylase and citrate, were observed between isolates from different sources. However, these differences did not allow the differentiation of isolates from diseased mammals and healthy fish. The majority of A. hydrophila isolates produced different extracellular products; A. sobria isolates produced less exotoxin. With A. caviae isolates no hemolysin, protease, enterotoxin or elastase were detected. There was no quantitative difference in hemolysin, protease, enterotoxin or elastase production between isolates from mammals and fish. It is suggested that A. hydrophila could be a potential pathogen for domestic animals, and fish may represent a potential reservoir of infection.
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PMID:Biochemical and toxigenic characteristics of Aeromonas spp. isolated from diseased mammals, moribund and healthy fish. 318 76


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