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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Maternal mortality ratio (MMR) is the most important index for monitoring the progress of safe motherhood programmes. A retrospective analysis of all maternal deaths at RG Kar Medical College and Hospital, Calcutta from 1st January, 1995 to 31st December, 1997 was carried out. There were 29,563 live births and 203 maternal deaths giving cumulative MMR of 686.67 per 100,000 live births. Among the victims 25.6% were < or = 20 years of age, majority (73.4%) were unbooked, mostly from rural (59.6%) or urban slum (20.2%) and from low socio-economic status (59.6%). Most (60.10%) were multiparous and 50.74% patients died within 24 hours of hospital admission. Direct causes were responsible for 83.25%, indirect causes for 14.78% and unrelated causes for 1.97% of maternal deaths. Toxaemia was the leading cause (53.20%) of maternal mortality. Other important causes were haemorrhage (16.75%), sepsis (12.31%), severe anaemia (6.4%), infective hepatitis (1.47%) and heart disease (3.44%). In comparison to previous years no significant changes in MMR had been found though there were temporary decline in some years. The contribution of toxaemia in maternal deaths is significantly high and is on the rise. The other national and global pictures were reviewed. India is among the countries of high MMR and far away from achieving safe motherhood. Majority of deaths are preventable. The medical causes of maternal deaths are in fact, the end point of a longer chain of many underlying factors like low socio-economic status, poverty, illiteracy, high parity and inadequate or no health care. An active community-based health care system accessible to every mother with strong referral system is the most effective approach to achieve safe motherhood.
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PMID:Safe motherhood--a long way to achieve. 1147 55

Toxic megacolon belongs to the severe acute complications of inflammatory bowel diseases. The frequency is 1.6-21.4% among patients with ulcerative colitis and 0.3-2% in those with Crohn's disease. The main characteristics of toxic megacolon are toxemia, sepsis and distension of the colon due to the diminished muscular tone, loss of motor activity and increased amount of colonic gas. Sepsis and/or perforation of the large bowel can complicate this situation. The most important diagnostic procedure is the abdominal X-ray. Should the diameter of colonic distension exceed 60 mm, the diagnosis of toxic megacolon has been confirmed. Conservative treatment of toxic megacolon consists of water and electrolyte replacement, total parenteral nutrition, administration of corticosteroids and broad-spectrum antibiotics and repeat patient's prone positioning. If medical therapy is not successful during the first 72 hours, surgical intervention is indicated. The most common procedure is subtotal colonic resection with creation of an ileostomy. Patients with toxic megacolon should be managed at specialised centers, where cooperation of experienced gastroenterologists, surgeons and intensive care experts is possible.
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PMID:[Toxic megacolon]. 1178 11

Anthrax is caused by Bacillus anthracis, a gram-positive spore-forming bacterium. Septicemia and toxemia rapidly lead to death in infected mammal hosts. Currently used acellular vaccines against anthrax consist of protective antigen (PA), one of the anthrax toxin components. However, in experimental animals such vaccines are less protective than live attenuated strains. Here we demonstrate that the addition of formaldehyde-inactivated spores (FIS) of B. anthracis to PA elicits total protection against challenge with virulent B. anthracis strains in mice and guinea pigs. The toxin-neutralizing activities of sera from mice immunized with PA alone or PA plus FIS were similar, suggesting that the protection conferred by PA plus FIS was not only a consequence of the humoral response to PA. A PA-deficient challenge strain was constructed, and its virulence was due solely to its multiplication. Immunization with FIS alone was sufficient to protect mice partially, and guinea pigs totally, against infection with this strain. This suggests that spore antigens contribute to protection. Guinea pigs and mice had very different susceptibilities to infection with the nontoxigenic strain, highlighting the importance of verifying the pertinence of animal models for evaluating anthrax vaccines.
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PMID:Anthrax spores make an essential contribution to vaccine efficacy. 1179 96

Women aged 15-19 represent a high proportion of the female population of the Dominican Republic, and their rate of consensual unions of 24.6% leads to high rates of adolescent pregnancy. A retrospective study was made of the records of 600 adolescent pregnancies followed between 1975- 80 at a maternity hospital in Santo Domingo. The adolescents were classified into 3 age groups. Group 1 included 27 adolescents aged 12- 14, group 2 included 305 aged 15-17, and group 3 included 268 aged 18- 19. 3 adolescents in group 1, 64 in group 2, and 108 in group 3 had already had a child, while 10 in group 2 and 38 in group 3 had 2 previous children. 7 in group 3 had 3 or more children. 1 mother in group 1, 7 in group 2, and 12 in group 3 had a history of cesarean section. 331 of the 600 had no form of prenatal care. 202 had 1-4 prenatal visits and 67 had 5 or more. Among the 331 adolescents with no prenatal care, there were 92 cases of threatened premature delivery, 30 of slight and 31 of moderate to severe toxemia, and 7 of eclampsia. Among the 269 patients with prenatal care, there were 19 cases of slight and 2 of moderate toxemia during pregnancy. On admission to the hospital, there were 58 cases of threatened premature deliver, 23 of slight and 14 of moderate to severe toxemia, and 14 of premature rupture of membranes. Among the total group of 600 adolescents, 25% had threatened premature delivery, 8.8% had slight and 7.5% had moderate to severe toxemia, 1.1% had eclampsia, 4.2% had premature rupture of membranes, 1.3% had abortions, and .5% had syphilis. 428 deliveries occurred at 38-40 weeks. There were 57 caesareans and 8 abortions. 214 newborns had Apgar scores of under 7 points. There were 15 fetal deaths in utero, 28 hemorrhages during delivery, and 3 cases of retention of the placenta. There were 3 maternal deaths due to sepsis. It is apparent that adolescent pregnancy entails a high degree of risk.
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PMID:[Adolescent fertility. 1. Pregnancy and childbirth]. 1217 96

The People's League of Health (England) appointed a special committee in July 1935 to study the influence of the nutrition of expectant and nursing mothers on maternal and infant mortality and morbidity. The primary investigation was conducted from March 1938 to t he end of 1929 and was planned to reveal whether additions of vitamins and minerals to the food would be beneficial to the course of pregnancy and labor and to the newborn infant. 5022 pregnant women participated in the investigation. These women were patients at the antenatal clinic s of participating hospitals from the initiation of the study, exclusive of those women whose pregnancy was beyond the 24th week and those suffering from any physical disease or abnormality. The women were divided into experimental and control groups with the experimental group receiving the vitamin supplements. Within each of these groups women we re classified into women pregnant for the 1st time and women with a history of 1 or more pregnancies as well as a division of women under 25, women between 25 and 30 years, and women who were older than 30. It was found that for all ages the percentage of toxemia in the treated primiparae is significantly lower than among the controls, 27.1% in contrast to 31.7%. For sepsis there is no satisfactory evidence that supports treatment with vitamin supplements. A smaller incidence of prematurity was revealed among the treated women, and this is particularly significant since about 50% of infant deaths under 1 month are due to prematurity. Although the percentage of children breast-fed increased with extended treatment, it is only when the mother had taken the supplementary diet for 24 weeks and over that their ability to breast-feed was slightly better than that of the controls. It might be expected that as the infants of the treated mothers had the more positiv e experience in regard to prematurity and birth weight they would show lower rates of stillbirth and neonatal mortality. This was found to be the case in regard to stillbirth but not in regard to neonatal mortality which is notably higher in infants born to treated primiparae and slightly higher in treated multiparae.
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PMID:The nutrition of expectant and nursing mothers in relation to maternal and infant mortality and morbidity. 1225 45

83 cases of maternal deaths in Eden Hospital, Calcutta, India, during 1976 are analyzed and high-risk cases were sorted out in relation to hospital admission. 60% of the 83 deaths occurred in patients aged 21-30 years, a period of high obstetric admissions. 23% were under age 20, 16% were aged 31-40 years, and 1.2% were over 40 years of age at time of death. The grand multiparas were the high-risk patients: 26% of deaths were in primiparas, 23% in 2nd gravida, 20% in 3rd, 6% in 4th, and 24% in 5th+ gravidas. Sepsis was responsible for 22.9% of deaths, toxemia for 21.4%, hemorrhages for 7.2%, and anemia for 7.2%; uterine rupture accounted for 3.6% of deaths. Abortions individually accounted for 18.4% of deaths (92% of these were illegal procedures). Overall, maternal mortality rate at Eden was 10.32 or 8.46/1000 total births including and excluding abortions. The high-ranking causes of death were sepsis (22.9%), which included cases of septic abortion, toxemia, jaundice, anemia, and hemorrhages, in descending order. However, when the percentages of deaths caused by individual conditions were viewed against their hospital admission, jaundice, anemia, and acute obstetrical emergencies were the highest risk cases in terms of likelihood of death.
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PMID:Trends of maternal mortality in Eden Hospital during 1976. 1227 9

National data on maternal health status in Malaysia is minimal. These data, from Maternity Hospital, Kuala Lumpur, are presented toward the goal of accumulation of basic information. From 1978-81, there were 74,105 deliveries and 9,899 abortion admissions in this hospital, which serves as a referral center for areas within a 100-mile radius. 39 maternal mortalities were recorded in this time. Maternal mortality excluding that associated with abortions was 29.27/100,000 births; when abortions are included, the figure increases to 70.54. 50% of the women who died were under 30 years of age. 28.2% of deaths occurred among primigravida, and 25.64% were associated with parity 5 or above. Malays had a mortality rate double that of Chinese or Indians. Major causes of death were toxemia, hemorrhage, embolism, medical disease, and sepsis. These causes accounted for 89% of deaths, while the remaining 11% were due to uterine inversion, obstetric trauma, and pulmonary edema. Avoidable factors were isolated in all the deaths except 3, 1 due to infective hepatitis, and 2 due to cardiac disease. Inefficient hospital care occurred in 17 patients, defective care before admission in 2, and 4 death were associated with patients' failure to seek or accept medical attention. The need for documenting all maternal mortalities is a priority in Malaysia.
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PMID:The pattern of maternal mortality at maternity hospital Kuala Lumpur. 1227 87

Family planning comprises a group of activities that permit couples to decide freely the spacing and number of their children. Its other goals are to identify high risk pregnancies and treat infertility. Family planning improves the health of mothers, children, and entire families. Women understanding the benefits of family planning can space pregnancies at least 2 years apart to allow time to care for the new baby and to recuperate after the birth. Women and children in Chad and throughout Africa are the most vulnerable population groups with the greatest need for high quality nutrition, but they usually are relegated the food left over after men and other family members have eaten. Too frequent and too numerous pregnancies are likely to lead to maternal death from hemorrhage, toxemia, or septicemia. Chronic malnutrition reduces the defenses of the woman's body. Couples who plan their births for the times when the mother is best prepared avoid high risk pregnancies. Young infants whose mothers become pregnant too soon are subjected to abrupt weaning and sometimes physically separated from their mothers. The baby is at risk of infection and malnutrition because of its lack of adjustment to its new diet, and high rates of mortality are 1 result. The 2nd baby often is low birth weight and receives less milk because his malnourished, anemic, and chronically fatigued mother is unable to produce more. The infant is prey to infections, which his undernourished body is less able to fight. Traditional African societies recognized the importance of spacing and achieved it by abstinence until the child would walk. Family planning programs provide contraception, treatment and advice on sexually transmitted diseases, and alternatives to illegal abortion. Adolescents in particular should be provided with information on the consequences of too early sexual activity.
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PMID:[Is family planning beneficial for our society?]. 1228 49

Nearly 99% of maternal deaths in the world each year occur in developing countries. New efforts have recently been undertaken to combat maternal mortality through research and action. The medical causes of such deaths are coming to be better understood, but the social mechanisms remain poorly grasped. Maternal mortality rates in developing countries are difficult to interpret because they tend to exclude all deaths not occurring in health care facilities. The countries of Europe and North America have an average maternal mortality rate of 30/100,000 live births, representing about 6000 deaths each year. The developing countries of Asia, Africa, and Latin America have rates of 270-640/100,000, representing some 492,000 deaths annually. For a true comparison of the risks of maternal mortality in different countries, the risk itself and the average number of children per woman must both be considered. A Nigerian woman has 375 times greater risk of maternal death than a Swedish woman, but since she has about 4 times more children, her lifetime risk of maternal death is over 1500 times greater than that of the Swedish woman. The principal medical causes of maternal death are known: hemorrhages due to placenta previa or retroplacental hematoma, mechanical dystocias responsible for uterine rupture, toxemia with eclampsia, septicemia, and malaria. The exact weight of abortion in maternal mortality is not known but is probably large. The possible measures for improving such rates are of 3 types: control of fertility to avoid early, late, or closely spaced pregnancies; effective medical surveillance of the pregnancy to reduce the risk of malaria, toxemia, and hemorrhage, and delivery in an obstetrical facility, especially for high-risk pregnancies. Differential access to high quality health care explains much of the difference between mortality rates in urban and rural, wealthy and impoverished areas of the same country. The social determinants of high maternal mortality rates include political, geographic, and economic mechanisms of exclusion which affect the vast majority of the population in developing countries. Political power is concentrated in the hands of relatively small groups whose decisions about such expenditures as health care are usually more favorable to the privileged. A consequence of the very unequal regional development in most Third World countries is that health, educational, and most other resources are concentrated in large cities and perhaps 1 or 2 strategic regions, leaving most of the population underserved. The low social position of women leaves them doubly vulnerable. The social factors adding to risks of maternal mortality should be considered in programs of prevention if the causes and not just the consequences are to be addressed.
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PMID:[Maternal death: unequal risks]. 1228 79

The Lady Dufferin Fund, founded in 1885 in India, had by 1940 established 400 hospitals to alleviate diseases and mortality related to childbirth. After independence 2328 community health centers and 21254 primary health centers were created in the country. During 1974-94 more than 131,000 subcenters were set up and about 620,000 auxiliary nurse midwives (ANMs) had been trained. The Ministry of Health introduced four health prevention schemes in 1969: 1) immunization of children against diphtheria, pertussis, and tetanus; 2) immunization of pregnant women against tetanus; 3) prophylaxis of mothers and children against nutritional anemia; and 4) prophylaxis of children against blindness caused by vitamin A deficiency. As a result, infant mortality declined from 146/1000 live births to 74/1000 in 1993; but maternal mortality still stayed around 4-5/1000. In 1993 an estimated 117,356 maternal deaths occurred out of a total of 26,057,000 births, equalling 4.5 deaths per 1000 live births. The main causes of maternal deaths are hemorrhage, anemia, abortion, toxemia, and puerperal sepsis. Only about 411 first referral units in community health centers are functioning properly. Prenatal care of mothers includes the administration of tetanus toxoid and iron-folic acid tablets. However, the prenatal coverage reached only about 50% of mothers; and the coverage was only 21.4% in Bihar, 23.8% in Nagaland, 29.3% in Rajasthan, and 29.6% in Uttar Pradesh. In these areas administrative inefficiency is widespread with nonavailability of essential drugs for malaria, infections, sepsis, dysentery, and colds. During 1992-93 the rate of hospital deliveries ranged from 6.1% in Nagaland to 88.4% in Kerala, with a national average of only 25.6%. 71% of deliveries in rural areas and 30% in urban areas were conducted by untrained assistants. Although there are 450 ANM training schools in the country, the level of training has deteriorated. The major causes of infant deaths are respiratory infections and diarrhea, responsible for 13.5% and 6.9% of mortality, respectively. Severe malnutrition and inadequate vaccination are other major causes of child deaths and morbidity.
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PMID:Maternal and child health in India: a critical review. 1229 Sep 61


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