scholarly journals Assessment of maternal deaths using three delay model at a tertiary care centre in rural Maharashtra, India: retrospective six years study

2018 ◽  
Vol 7 (8) ◽  
pp. 3043 ◽  
Author(s):  
Jitendra P. Ghumare ◽  
Namrata Vasant Padvi
Keyword(s):  
Maternal Health ◽  
Tertiary Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Hospital ◽  
Delay Model ◽  
Maternal Deaths ◽  
Level Ii ◽  
Level I ◽  
Facility Level

Background: Maternal deaths are the social indicators of the human development and hence their place in MDGs and now in SDGs. Even though India has made a great stride in reducing maternal deaths, the differentials in the states are huge ranging from 46 to 237 maternal deaths per 100000 live births. The three delay model assesses the issues in the emergency obstetric care and upon which the interventions can be based to improve maternal health indicators.Methods: Retrospective record based observational study was carried out at an obstetrics and gynecology department of a tertiary care hospital located at Northern Maharashtra region. The records of deliveries, maternal deaths, age of the mothers, their time of presentation with obstetric complication, level of delay and the reason for delay were extracted for the period of 2011 to 2016. Three delays being, level I - delay in decision to seek care, level II - delay in identifying and reaching medical facility, level III - delay in receipt of adequate and appropriate treatment at facility.Results: Out of 54335 deliveries, there were 128 maternal deaths. 80% women died due to complication in their ANC, 55% being in the third trimester of ANC. Major causes of death were preventable, including Eclampsia (21%), Anaemia (17%), PIH (15%), Sepsis, Other infections and haemorrhage. 27% women had delay of level I, 21% had level III and 15% had a mix of two or three level of delays. The reasons for level I delay being Lack of ANC visits, no ANC registration, level II delay being lack of timely transport facility, level III delay being lack of adequate manpower, training, and lack of efficient intensive care facilities.Conclusions: A good quality emergency obstetric care equals good maternal health. It can be achieved by strengthening the health infrastructure, tackling manpower shortages, having better referral linkages.

scholarly journals Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

2015 ◽  
Vol 8 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Papa Dasari
Keyword(s):  
Maternal Mortality ◽  
Cause Of Death ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Emergency Admissions ◽  
Mortality Ratio

Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care.

scholarly journals Pattern of Impacted Mandibular Third Molar in Patients Presenting to Tertiary Care Hospital in Chitwan, Nepal

2019 ◽  
Vol 9 (2) ◽  
pp. 38-42
Author(s):  
Ashutosh Kumar Singh ◽  
Safal Dhungel
Keyword(s):  
Tertiary Care ◽  
Third Molar ◽  
Surgical Removal ◽  
Care Hospital ◽  
Third Molars ◽  
Depth Level ◽  
Level Ii ◽  
Mandibular Third Molar ◽  
Level I ◽  
Patient Side

Introduction: Impacted third molars are a major cause of visit to the oral surgeon and are associated with various complications like pain, inflammation of associated soft tissue and trismus leading to a need for their surgical removal. They are widely classified on the basis of angulation, depth and position as evident from orthopantomogram however they present in a diverse panorama of patterns each presenting different level of difficulty and different techniques for their removal. Our study describes different pattern of impacted lower third molars and perform brief literature review of dental and skeletal implications of impacted third molars. Materials & Method: A retrospective study was designed in which 401 orthopantomogram were examined and the sex of patient, side of impaction and winters angulation based classification, depth and position classification as given by Pell and Gregory were recorded. Descriptive data analysis was performed with SPSS version 24 software. Result: Out of total number of impactions 191(47.6%) were in females and 210(52.4%) were in males. Right sided impaction was seen in 199(49.6%) cases and 202(50.4%) were seen on left side. Mesioangular impaction was most common 203(50.6%) followed by distoangular 97(24.2%), horizontal 51(12.7%) and vertical 17(4.2%). Most common depth level of impaction was level I with 203(50.6%) followed by level II 178(44.4%) and level III 20(5%). Most common position was position B 355(88.5%) followed by position A 43(10.7%) and position C 3(0.7%). The most common pattern was IB (n=170) and IIB (n=166). Conclusion: The most common impaction is mesioangular followed by distoangular and horizontal. Most of the impacted third molars are in moderately difficult position.

scholarly journals Study of maternal mortality in a tertiary care hospital in a tribal KBK area of Odisha, India

2020 ◽  
Vol 9 (4) ◽  
pp. 1528
Author(s):  
Sasmita Behuria ◽  
Jyoti Narayan Puhan ◽  
Subhra Ghosh ◽  
Bhabani Sankar Nayak
Keyword(s):  
Maternal Mortality ◽  
Tertiary Care Hospital ◽  
Physiological State ◽  
Tertiary Care ◽  
Obstetric Care ◽  
Safe Motherhood ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Live Births ◽  
Hypertensive Disorders In Pregnancy

Background: Pregnancy, although being considered a physiological state, carries risk of serious maternal morbidity and at times death. This is due to various complications that may occur during pregnancy, labor, or thereafter. The major causes of maternal mortality are mostly preventable through regular antenatal check-up, proper diagnosis, and management of labor complications. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The aim is to study the incidence of MMR, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths.Methods: A retrospective hospital-based study was conducted in obstetrics and gynecology department, SLN MCH, a tertiary care referral hospital in a tribal area of southern Odisha over a period of 2 years from April 2017 to March 2019.Results: A total of 108 deaths were analyzed over 2 years period and MMR was calculated to be 1124/1 lakh live births. Most of the maternal deaths occurred in the age group of 20-24 years (35.1%), majority of maternal deaths were observed in multipara (46.3%), 70.3% deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (37%) were the leading direct cause followed by hemorrhage (14.8%) and sepsis (11.1%). Among the indirect causes jaundice (7.4%) and anaemia (3.7%) were the leading cause.Conclusions: MMR in our study was very high as compared to national average of 167/1,00,000 live births, being a tertiary care hospital as most of the patients were referred from peripheral centers. Most maternal deaths are preventable by intensive health education, basic obstetric care for all, strengthening referral and communication system and emphasizing on overall safe motherhood.

scholarly journals Audit on maternal mortality in a tertiary care centre in India of 6 years, a retrospective analysis

2020 ◽  
Vol 9 (2) ◽  
pp. 499
Author(s):  
Neha Agrawal ◽  
Hemangi K. Chaudhari
Keyword(s):  
Maternal Mortality ◽  
Retrospective Analysis ◽  
Tertiary Care ◽  
Obstetric Care ◽  
Hepatitis E ◽  
Hypertensive Disorder ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Maternal Deaths ◽  
Obstetrics And Gynaecology

Background: This study is carried out on 382 cases of maternal deaths from July 2010 to June 2016 at the department of obstetrics and gynaecology of tertiary centre to evaluate causes and risk factor associated with maternal deaths.Methods: Retrospective analysis of all maternal deaths occurred in department of obstetrics and gynaecology of tertiary care hospital from July 2010 to June 2016.Results: The MMR in the study period was 915/100000 live births. Maximum no. of maternal death 42.7% were in age group of 21-25 years, majority of them residing in urban area. 117 patients referred from sub-district/district hospital. 76.4% patients were registered. 60% maternal deaths were seen in postnatal period. In present study majority of maternal deaths 60% were due to indirect cause while 40% patients died due to direct cause. Major causes of maternal deaths were hypertensive disorder 12%, obstetric haemorrhage 11% tuberculosis 11%, hepatitis E 8% and pregnancy related infections 5.6%.Conclusions: High maternal mortality can be due to the fact that the study was conducted in tertiary care referral centre. Referral of moribund cases from rural, sub-district, district and peripheral hospital to our institute have inflated this mortality ratio. All of these being preventable causes of death can be avoided by improving standard of obstetric care, increasing number of health professionals, upgradation of healthcare facilities at first referral units and by making better health policies.

scholarly journals Study of causes and facility based lags in a tertiary care hospital contributing to maternal mortality

2017 ◽  
Vol 6 (5) ◽  
pp. 2044
Author(s):  
Ajit Kumar Nayak ◽  
S. Dhivya ◽  
Tajma Afzal
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Kidney Diseases ◽  
Tertiary Care ◽  
Cost Effective ◽  
Time Frame ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Live Births ◽  
Level I

Background: Maternal death is a tragic situation as these deaths occur during or after a natural process like pregnancy. By addressing the three levels of delays i.e., delay in seeking care, delay in reaching care and delay in receiving care; it can be prevented to a fair extent.Methods: All maternal deaths occurred in SCB Medical College and Hospital, Cuttack between September 2015 to September 2016 included in the study, Antepartum and postpartum events were documented as per the proforma. Opinions of respective faculties regarding diagnosis, treatment, possible preventable factors and any delays and lapses at our set up were obtained.Results: There were 10060 live births and 121 maternal deaths, giving the hospital based incidence of maternal mortality as 12.02 per 1000 live births. 42.98%, 6.61% and 50.41% of death were due to Level I, Level II and level III delays respectively. The delays due to unavailability of appropriate facilities in our institution are highlighted. Lack of ICU facility accounted 37.19% deaths. Unavailability of blood, a delay in surgery, delayed multispecialty referral and required investigation follow it. 91.7%. deaths were preventable.Conclusions: Hypertension, Obstetric hemorrhage, liver and kidney diseases were mainly responsible for maternal mortality. Facility based maternal death review system help in finding out the constraints in the existing system. It brings a sense of responsibility in all stake holders involved in delivery of MCH care. It is feasible and cost effective strategy to reach Millennium Development target 5 in extended time frame.

scholarly journals Maternal mortality in a tertiary care hospital: a 3-year retrospective study

2021 ◽  
Author(s):  
Harish K. M. ◽  
Shwetha N. ◽  
Nalini N.
Keyword(s):  
Retrospective Study ◽  
Maternal Mortality ◽  
Low Socioeconomic Status ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Epidemiological Data ◽  
Care Hospital ◽  
Contributing Factors

Background: Systematic review to determine the epidemiological aspects and causes of maternal mortality there by exploring possibility of intervention and implementing Evidence-based health policies and programmes to prevent future maternal death. Aims and objectives of the study were to calculate the maternal mortality rate in our hospital, to assess the epidemiological aspects of maternal mortality, to assess the type of delay and causes of maternal mortality and to suggest ways to reduce the MMR.Methods: This is a 3-year retrospective study from Jan 2017 to Dec 2019 that will be conducted in the department of obstetrics and gynaecology, The Apollo medical college and District hospital, Chittoor a tertiary care teaching hospital situated in the southernmost part of Andhra Pradesh state in India. It gets a large number of referrals from PHCs, CHCs, and maternity homes as well as from hospitals across Chittoor district. Epidemiological data will be collected from the hospital register. Maternal mortality ratio, epidemiological factors and causes affecting maternal mortality are assessed.Results: MMR in present study was 66 per 1,00,000 live births. Women in the age group of 20 to 30 years (85.72%), illiteracy (57.16%) and low socioeconomic status (100%) were risk factors for maternal mortality. Obstetric haemorrhage (57.16%) is most common cause whereas type 1 and type 2 delays are most common contributing factors for maternal mortality.Conclusions: Early identification and management of pregnancy complication, strengthening of existing Emergency obstetric care (EmOC) facilities, easy transport and appropriate referral linkages are keys to reduce maternal mortality to further extent.

scholarly journals A five-year retrospective study of maternal mortality in a tertiary referral centre

2021 ◽  
Vol 10 (5) ◽  
pp. 1935
Author(s):  
Meenal S. Sarmalkar ◽  
Arun H. Nayak ◽  
Shameel Faisal ◽  
Abhakumari .
Keyword(s):  
Retrospective Study ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Postnatal Period ◽  
Tertiary Referral Centre ◽  
Maternal Deaths ◽  
Mortality Ratio

Background: The objectives of this study were to calculate the maternal mortality ratio (MMR) and the causes of maternal deaths in an urban tertiary care institution.Methods: A retrospective study of 305 maternal deaths over the period from January 2014 to December 2018 was carried out. Data was analysed using frequency and percentage with the help of Microsoft Excel 2019.Results: The MMR during the study period was 666.75per 100,000 live births. Majority of maternal deaths (130, 42.62%) occurred in age group 21-25 years. Maximum number of women (288, 94.1%) came from urban area. Majority of maternal deaths occurred in referred cases (238, 78.03%) to our institution. Majority were registered cases (235, 77.0%).  Maximum women (201, 62%) died in the postnatal period. Majority of maternal deaths (222, 72.79%) occurred within 7 days of admission. Direct and indirect causes contributed to 40% and 59.67% of maternal deaths. Among the direct causes of maternal deaths, haemorrhage (45, 14.75%)) was the leading causes for death followed by hypertensive disorders (42, 13.77%) and sepsis (11, 9.02%). Tuberculosis (34, 18.68%) was the most common indirect cause of maternal mortality in our study followed by hepatitis (30, 16.48%) and respiratory conditions (25, 9.02%).Conclusions: Adequate surveillance of tuberculosis in the antenatal period, health education of pregnant women, proper antenatal, intranatal and emergency obstetric care in the first referral unit with proper blood banking facilities and timely referral to the tertiary care institute will help to lower the high death rate.

scholarly journals Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

2020 ◽  
Vol 41 (S1) ◽  
pp. s397-s398
Author(s):  
Ayush Lohiya ◽  
Samarth Mittal ◽  
Vivek Trikha ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
...  
Keyword(s):  
Surveillance System ◽  
Trauma Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Care Hospital ◽  
Middle Income ◽  
Predominant Pathogen ◽  
Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

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