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Query: UMLS:C0036690 (sepsis)
 59,461 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

The DIC syndrome is the most common cause of an abnormal hemorrhage tendency during pregnancy and the puerperium and reflects systemic activation of the coagulation cascade by circulating thromboplastic material, with secondary activation of the fibrinolytic system. Its presence in a pregnant patient almost invariably is evidence of an underlying obstetric disorder such as abruptio placentae, eclampsia, retention of a dead fetus, amniotic fluid embolism, placental retention or bacterial sepsis. Diagnosis of the DIC syndrome rests on the demonstration of reduced levels of fibrinogen and platelets, prolongation of the thrombin, prothrombin and partial thromboplastin times, and the presence of fibrin/fibrinogen degradation products (FDP) in the serum. Therapy consists of prompt removal of the source of procoagulant material, replacement of depleted clotting factors and, in some cases, anti-coagulation with heparin.
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PMID:Disseminated intravascular coagulation in pregnancy. 91 82

In September 1989 in Thyolo district in southern Malawi, 5 field teams used the Sisterhood Method to interview 4124 people older than 15 in 7 traditional authorities to estimate the lifetime risk (LTR) of maternal death and the maternal mortality ratio (MMR) in this area. The teams also administered an in-depth questionnaire to respondents who knew about 140 of the 150 maternal deaths to determine the causes of maternal death. The LTR of maternal death stood at 1 in 36 (1/.0282). The MMR was 409/100,000 live births. 22% of all maternal deaths occurred within the last 5 years. The field team was able to accurately determine the cause of death in 98 (65%) cases. The leading causes of death were excess hemorrhaging (25%), obstructed labor (20%), abortion (18%), sepsis (13%), cesarean section (7%), and eclampsia (4%). 56% of all reported maternal deaths and 45% of maternal deaths within the last 5 years occurred outside a health facility. 99% of maternal death cases did not receive medical attention while their health deteriorated because the health facility was far away and therefore not accessible or there was no way to transport the women to the health facility. 87% of abortion-related deaths took place outside a health facility as did 67% of eclampsia cases, 56% of hemorrhage cases, 50% of obstructed labor cases, and 47% of sepsis cases. These findings should prove useful to community and health leaders in designing intervention strategies to reduce maternal mortality in the area. Further, key locations should have adequate transportation, e.g., bicycle ambulances of stretchers, to transport pregnant women to a primary or referral center.
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PMID:Maternal mortality in the Thyolo District of southern Malawi. 129 32

Twenty-nine maternal deaths were identified among 8656 pregnant women residing in Assiut city and three surrounding villages (Upper Egypt). This gives a maternal mortality ratio of 368 per 100,000 live births. Of these maternal deaths 83% were due to direct obstetric causes (hemorrhage, eclampsia, ruptured uterus and sepsis). Logistic regression analysis showed that residence (in villages versus Assiut city), parity (nullipara and grandmultipara) and illiteracy were significantly associated with increased risk of maternal death.
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PMID:Maternal mortality in Assiut. 136 Sep 14

This study was conducted in a subdivisional hospital of eastern Himalayan region among 5,273 pregnant women over a period of 8 years. There were 29 deaths, the maternal mortality rate was 55 per 10,000. Septic abortion was encountered in 4 among them. Direct obstetric cause was responsible in 72.41% of cases and indirect cause in 27.59% cases. Sepsis, both puerperal and postabortal resulted in 24.14% followed by postpartum haemorrhage in 20.69%. Two of these cases were associated with inversion of the uterus. Preeclampsia caused 10.34% and eclampsia 6.9% of the deaths. Among the indirect causes severe anaemia and pulmonary tuberculosis accounted for 10.34% and 6.9% respectively. Infective hepatitis was the cause in 6.9% cases. Only 17% of the cases were booked and the rest were unbooked. Majority of the cases (62.07%) belonged to the age group of 20-30 years. Primigravida constituted 41.38% of the cases.
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PMID:Maternal mortality in a subdivisional hospital of eastern Himalayan region. 151 13

Obstetrician-gynecologists analyzed maternal mortality data from at least 1 rural area of Indonesia, the Philippines, and Thailand to determine nonmedical factors contributing to maternal deaths. They also gathered data from Brunei and Singapore but the data were insufficient (only 3 deaths in Brunei and 0 in Singapore). Overall the leading causes of death were in order eclampsia/intracranial hemorrhage, postpartum hemorrhage, and sepsis. 33% of decreased mothers were 20 or 35 years old. Most mothers had lived in rural areas where there were few health care facilities, inadequate transportation, and much delay between emergence of a problem and medical attention. Lack of education was a risk factor, e.g., 40% of Thai mothers had no education. Most women in the Philippines and Indonesia worked long hours and hauled heavy loads. There was a considerable link between primiparae and grand multiparae and maternal mortality. 90%, 68%, and 59% of maternal deaths in Thailand, the Philippines, and Indonesia, respectively, were of these parities. Almost 66% of the women had not used contraceptives. Overall 33% of the women lived near medical facilities. In Indonesia, this figure was as high as 62%. 40%, 13%, and 9% in Thailand, Indonesia, and the Philippines, respectively, had no access to transportation to take them to a facility. 21%, 46%, and 30% in Indonesia, the Philippines, and Thailand did not receive any prenatal care and 50% of mothers in Indonesia did not feel they needed prenatal care. Inappropriate delivery techniques also contributed to maternal deaths. 90% of deaths occurred after delivery. Considerable bleeding was a contributing factor in 62%, 55%, and 40% of maternal deaths in Indonesia, the Philippines, and Thailand, respectively. A blood transfusion would have saved many of them.
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PMID:Safe childbirth needs more than medical services. 163 77

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

An adult conducted of the 51,058 deliveries recorded in 1985-87 in Zimbabwe's Midlands Province identified 70 maternal deaths, for a maternal mortality rate of 137.1/100,000 births. The 4 leading causes of death were uterine rupture (18 deaths), hemorrhage (16 deaths ), eclampsia (13 deaths), and sepsis (12 deaths). 7 women died undelivered; the routes of delivery for the remaining cases included cesarean section (22 cases), instrumental delivery (12 cases), normal vaginal delivery (15 cases), and laparotomy (10 cases). Most significantly, the audit revealed that only 9 (13%) of the maternal deaths in this series were unavoidable. The avoidable deaths involved the health service in 57% of cases and the patient in only 33%. An estimated 35 (50%) maternal deaths could have been averted if the physician had taken more appropriate action (e.g., proper diagnosis of uterine rupture, undue delay before medical action, and avoidance of nonmandatory cesarean sections). The audit concluded that at least 11 of the 22 cesarean section deliveries )largely those performed due to fetal distress and breech presentation) were necessary. In the 23 cases where patient behavior was a contributory factor, considerable delay before seeking medical help during abnormal labor (despite easy access to a clinic) was most often involved. In only 3 maternal deaths (all from hemorrhage) was access to a medical facility a problem. Overall, these findings suggest that 3 measures--careful assessment of whether the patient is able to tolerate anesthesia and cesarean section, investigation of the possibility of uterine rupture, and aggressive management and early delivery of all women with eclampsia--could substantially reduce maternal mortality.
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PMID:Maternal mortality audit in a Zimbabwean province. 236 51

2 studies have been done in China: 1) a longitudinal study on maternal mortality in Beijing from 1949 to 1983; and 2) a cross-sectional study on maternal mortality in the year 1984 in 21 of 29 provinces, municipalities, and autonomous regions. A maternal and child health network for care and referral of abnormal cases was set up with ambulances and transfusion facilities in place and training for traditional birth attendants. Aseptic delivery reduced the number of deaths due to sepsis from 213/100,000 live births to 4.2 in 5 years and to 0 in 9 years. Deaths from hemorrhage (including ruptured uterus) dropped by 86% in 5 years. With legalized abortion came a dramatic fall in maternal mortality from 685,100/000 live births to 15, a decrease of 98%. In 1949, 27% of women who died in childbirth had received hospital care; another 27% had no cure. In 1958, however, 80% of the fetal cases had obtained hospital care; the remaining 20% had been seen by a traditional practitioner or health worker. From 1959-68, the total maternal mortality was 1.3-28.1/1 00,000. From 69-78, the turmoil of the cultural revolution had "ill effects" on maternal and child health but by 1979, order was brought back again. The cross-sectional study covered a population of about 177 million. About 2.5 million live births occurred. 1211 maternal deaths were registered for a maternal mortality rate of 48.4/100,000. Maternal mortality varied a good deal in different parts of the country--from 17.7 in Shanghai to 108.2 in the region of the Hai people in Ningxia in northwest China. Maternal mortality rates correspond roughly to the level of economic development. The 5 main causes of death were hemorrhage, heart failure, pregnancy- induced hypertension (including eclampsia), postpartum infection and liver failure.
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PMID:Maternal mortality in China. 263 3

Incidence, risk factors and morphological features of the intravascular coagulation (IC) in 160 women who had died during pregnancy, after abortion and delivery were studied. IC was established in 118 (73.8%) of them. The main risk factors leading to IC were shock (59.3%), sepsis (28.8%), toxemia of pregnancy (incl. eclampsia) (25.4%), Caesarean section (19.5%), fetal death in utero (12.7%), amniotic fluid embolism (9.3%), and abruptio placentae (7.6%). Disseminated intravascular coagulation (DIC) was established in 66% of the cases, and local intravascular coagulation (univisceral localisation of microthrombi) in 28%. In the resting 6% of the cases there was consumptive coagulopathy without microthrombi. Lungs, pituitary gland, uterus, kidneys and adrenals were the most frequently affected organs. Necrosis in the parenchymal organs, hyaline membrane formation in the lungs and consumptive coagulopathy were particularly frequent in the cases with DIC. The leading causes of death were acute renal failure and ARDS. It was established that prolonged intensive care including artificial ventilation, massive blood transfusion, as well as surgical treatment, aggravate the course and morphological features of IC.
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PMID:Intravascular coagulation in relation to pregnancy and delivery. 281 60


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