scholarly journals Assessment of Risk Factors and Management Associated with Preterm Deliveries and their Outcomes in Tertiary Care Teaching Hospital

2021 ◽  
Vol 11 (1-s) ◽  
pp. 102-107
Author(s):  
T. Lakshmi Susheela ◽  
Meda. Venkata Subbiah ◽  
M. Ahamadi Tabasum ◽  
P. Amreen Khan ◽  
M.V. Swetha Kumari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antenatal Care ◽  
Tertiary Care ◽  
Bed Rest ◽  
Perinatal Morbidity ◽  
Exclusion Criteria ◽  
Neonatal Deaths ◽  
Observational Cohort ◽  
The Impact ◽  
Good Hygiene

Background: Preterm is a major obstetrical challenge of health care. It is the top most cause of perinatal morbidity and mortality of neonatal deaths. The births of these neonates are at a greater risk of developmental disabilities, health and growth problems than neonates of full term. Aim and objective: To assess the risk factors and management associated with preterm deliveries and their outcomes. Materials & Methods: “A prospective observational cohort study” was conducted over a period of 6 months on 80 Preterm subjects, who were enrolled based on inclusion and exclusion criteria. A detailed questionnaire was used to record socio-demographic, clinical profile and prescribing management. Statistical analysis was performed by percentage method using parameters like mean, standard deviation. Results: The impact of incidence range in the present study was 31.52%. Maximum preterm deliveries were observed in the age group of 18-23 years (44%). Multiparous woman was at more risk for preterm i.e., about 51%. The commonest risk factor for preterm was Anemia (45%) followed by Pre-eclampsia (24%). The treatment prescribed for preterm was Betamethasone, Tidilon, Magnesium sulphate, Progesterone. The commonest neonatal outcome was found to be low birth weight with KMC and supplements of vitamins, iron, calcium as a therapy for their better recovery. Conclusion: The study suggests an urgent need for strengthening effective guidelines and appropriate counselling for prevention of preterm. Maintenance of good hygiene, adequate   bed rest and proper antenatal care visits for the better outcomes.  Keywords: preterm, multiparous, risk factors, neonatal outcomes, antenatal care, cohort.

scholarly journals Study of cases of double mishap in a tertiary care teaching hospital

2019 ◽  
Vol 8 (4) ◽  
pp. 1650
Author(s):  
Fasiha Tasneem ◽  
Vijayalakshmi Shanbhag
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Active Management ◽  
World Health ◽  
Perinatal Morbidity ◽  
Neonatal Deaths ◽  
Third Stage ◽  
Mother And Child ◽  
Foetal Outcome

Background: “Make every mother and child count”- the slogan for World health day 2005 reflects the reality and need of the society even today. In India, many women die due to pregnancy-related complications and those who survive suffer from severe maternal morbidity. Authors have been impressed that the same obstetric conditions that kill mothers are also responsible for most of the stillbirths and many of the neonatal deaths as well. This is the study to identify the risk factors that has an effect on the health of both mother and baby, to evaluate the complications leading to maternal and perinatal morbidity or mortality so that timely interventions to prevent maternal and perinatal morbidity and mortality can be made.Methods: All the cases getting admitted in Dr SCGMC Nanded are analysed for maternal and foetal outcome over the study period of 18 months. The cases with both maternal and perinatal morbidity or mortality are included in the study. The associating factors and comorbidities if associated with the cases of double mishap are studied.Results: During the study period of 18mths, there were 21905 deliveries conducted in the study hospital and 742 reffered cases of outside hospital deliveries, it was found that there were 204 cases of double mishap. Out of 204 cases of double mishap, 71.56% had preeclampsia, 29.41% were anaemic, 6.86% had febrile illness, 4.41% were of placenta praevia, 33.33% had abruptio placenta.Conclusions: Authors can conclude by stating that through better antenatal care, early detection and proper management of risk factors like pre-eclampsia, anaemia and active management of third stage of labour with careful feto maternal monitoring the absolute goal of Obstetrics of having a healthy mother and healthy baby at the end of delivery can be achieved.

scholarly journals Geospatial analysis of determinants of neonatal mortality in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Duah Dwomoh
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Neonatal Death ◽  
Reproductive Age ◽  
Multiple Births ◽  
Demographic And Health Surveys ◽  
Neonatal Deaths ◽  
The Impact

Abstract Background Ghana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana. Methods The study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant. Results Population density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63–7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19–3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30–1.69, p < 0.05]. Conclusion Neonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women’s nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.

scholarly journals Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yan-Jun Zheng ◽  
Ting Xie ◽  
Lin Wu ◽  
Xiao-Ying Liu ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antifungal Therapy ◽  
Species Distribution ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Severe Neutropenia ◽  
Care Hospital ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

scholarly journals Maternal and perinatal mortality, morbidity and risk factor evaluation in ante partum hemorrhage associated with Placenta Praevia

2013 ◽  
Vol 1 (2) ◽  
pp. 65-70
Author(s):  
Farhana Kalam ◽  
Mohammad Omar Faruq ◽  
Saleha Begum Chowdhury
Keyword(s):  
Risk Factors ◽  
Prenatal Care ◽  
Hemorrhagic Shock ◽  
Post Partum ◽  
Tertiary Care ◽  
Placenta Praevia ◽  
Morbidity And Mortality ◽  
Teaching Hospitals ◽  
Perinatal Morbidity ◽  
Cross Sectional

Objective: To determine the maternal & perinatal morbidity and mortality associated with Placenta Praevia in Bangladesh. To assess the risk factors of antepartum hemorrhage associated with Placenta Praevia. Design: A cross sectional observational hospital based descriptive study. Setting: Obstetric inpatient units of two tertiary care teaching hospitals of Dhaka. Participants: One hundred pregnant mothers with diagnosis or Placenta Praevia proven by pelvic ultra sonography presenting with ante partum hemorrhage . Outcome: Incidence of maternal and fetal morbidity and mortality and risk factors of ante partum hemorrhage in Placenta Praevia. Results: 38% study mothers had no ante natal care. There was no maternal death. 96% of mothers were delivered by Caesarean Section. Incidence of primary post partum hemorrhage was 38%. There were 21% still birth and 16% neonatal death. 47% mothers had no complication after delivery. 22% mothers presented with hemorrhagic shock. 59% delivered babies had birth weight below 2.5 kg and 55% delivered babies had no complication. 57% mothers belonged to low socio economic group. Conclusion: The study reflects status of mothers presenting with Placenta Praevia with perinatal morbidity and mortality in a small urban population of Bangladesh treated at two tertiary care hospitals of Dhaka. It is recommended that mothers with Placenta Praevia need to have access to prenatal care and at the same time need to be educated about the benefit of prenatal care. Emergency management of ante partum hemorrhage with hemorrhagic shock should be widely available to improve the outcome of Placenta Praevia in our population. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17197 Bangladesh Crit Care J September 2013; 1 (2): 65-70

Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

2006 ◽  
Vol 27 (9) ◽  
pp. 893-900 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Mark G. Weiner ◽  
Irving Nachamkin ◽  
Warren B. Bilker ◽  
Angela Sheridan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Medical Center ◽  
Tertiary Care ◽  
Economic Outcomes ◽  
Control Group ◽  
Case Group ◽  
Tertiary Care Medical Center ◽  
Imipenem Resistance ◽  
The Impact

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

scholarly journals Perinatal outcomes in abruptio placenta

2019 ◽  
Vol 8 (3) ◽  
pp. 1070
Author(s):  
Zenab Tambawaala ◽  
Deepali Kale
Keyword(s):  
Perinatal Mortality ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Obstetric Care ◽  
Care Hospital ◽  
Perinatal Morbidity ◽  
Abruptio Placentae ◽  
Neonatal Deaths ◽  
Still Births ◽  
Abruptio Placenta

Background: Abruptio placentae is an obstetric emergency where placenta completely or partially separates before delivery of the baby. It occurs approximately in one in 120 deliveries. It is an important cause of perinatal morbidity and mortality.Methods: This was a prospective hospital-based study design conducted over a period of 2 years, in the Department of Obstetrics and Gynecology at a tertiary care hospital in Mumbai comprising of 60 cases.Results: The incidence of abruption placentae in Present study is 0.51%. Authors had perinatal mortality in 6.6% of the cases. Out of 60 cases, 2 deaths occurred in utero. Out of the remaining 58 cases, 24 babies needed NICU care, out of them, 22 went home alive and 2 had neonatal deaths. Perinatal morbidity in the form of hyperbilirubinemia, CNS depression, septicemia, neonatal anemia and neonatal DIC were noted.Conclusions: High incidence of perinatal mortality in abruptio placentae is because of increased number of still births. In our studies, the perinatal mortality is 6.6% as compared to all other studies. This decline in perinatal mortality is due to improved obstetric care and excellent NICU facilities which are required for a majority of the cases.

scholarly journals Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery

2019 ◽  
Vol 47 (2) ◽  
pp. E3 ◽  
Author(s):  
Samuel L. Rubeli ◽  
Donato D’Alonzo ◽  
Beate Mueller ◽  
Nicole Bartlomé ◽  
Hans Fankhauser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Postoperative Bleeding ◽  
Care Hospital ◽  
Infection Rates ◽  
Senior Faculty ◽  
Cutibacterium Acnes ◽  
The Impact

OBJECTIVEThe objective of this study was to quantify surgical site infection (SSI) rates after cranial neurosurgery in a tertiary care hospital, identify risk factors for SSI, and evaluate the impact of standardized surveillance and an infection prevention bundle (IPB).METHODSThe authors compared SSI rates during 7 months before and after the intervention. The IPB included standardized patient preparation, perioperative antibiotic/antiseptic use, barrier precautions, coaching of surgeons, and the implementation of a specialized technical operation assistant team.RESULTSThree hundred twenty-two unselected consecutive patients were evaluated before the IPB, and 296 were evaluated after implementation. Infection rates after 1 year decreased from 7.8% (25/322) to 3.7% (11/296, p = 0.03) with similar mortality rates (14.7% vs 13.8%, p = 0.8). The isolated bacteria included Staphylococcus aureus (42%), Cutibacterium acnes (22%), and coagulase-negative staphylococci (14%). Organ/space infections dominated with 67%, and mostly consisted of subdural empyema and meningitis/ventriculitis. Among the 36 SSIs, 13 (36%) occurred during hospitalization, and 29 (81%) within the first 3 months of follow-up. In multivariable analysis including established risk factors described in the literature, non-CNS neoplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.39–10.53), postoperative bleeding (OR 4.09, 1.44–11.62), operations performed by or under supervision of a senior faculty surgeon (OR 0.38, 0.17–0.84), and operations performed after the implementation of standardized surveillance and an IPB (OR 0.38, 0.17–0.85) significantly influenced the infection rate.CONCLUSIONSThe introduction of an IPB combined with routine surveillance and personal feedback was associated with a 53% reduced infection rate. The lower infection rates of senior faculty and the strong association between postoperative bleeding and infection underline the importance of both surgical experience as well as thorough supervision and coaching of younger surgeons.

scholarly journals P569 The role of multidrug-resistant infections in IBD patients undergoing surgery

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S480-S480
Author(s):  
F Colombo ◽  
G M B Lamperti ◽  
S Antinori ◽  
M Corbellino ◽  
G Maconi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Status ◽  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Tertiary Care Centre ◽  
Bowel Diseases ◽  
Resistant Infection ◽  
Few Data ◽  
The Impact

Abstract Background Inflammatory bowel diseases (IBD) patients are particularly vulnerable to an increased incidence of infections, due to both innate characteristics and prolonged pharmacological therapies as steroids, biologics and antibiotics. Very few data are available in the literature about multidrug-resistant (MDR) infections and previous studies have not taken into account the impact of the surgical treatment on infections. We focused on the identification of risk factors for the development of MDR infections in IBD patients undergoing surgical procedures, we investigated the involved microorganisms, and finally, we proceeded to a costs/complications analysis of the treatment. Methods 472 consecutive, unselected IBD patients (285 Crohn’s disease and 187 ulcerative colitis) undergoing surgery from 2016 to 2018 in our Tertiary Care Centre were divided into three groups: MDR infections, antibiotics sensitive infections (no-MDR) and no infections. Results In 37 CD patients nutritional status (p &lt; 0.0008), preoperative biologics (p &lt; 0.008) and antibiotic therapy (p &lt; 0.001), duration of surgical procedure (p &lt; 0.0001) and preoperative hospitalisation length (p &lt; 0.0001) were risks factors for MDR infection development. In 14 UC patients multidrug-resistant infection was related to age at surgery (p &lt; 0.003), disease duration (p &lt; 0.008), inflammatory/nutritional status (p &lt; 0.04), preoperative antibiotic therapy (p &lt; 0.04), and suture leakage (p &lt; 0,01). In the MDR CD group Gram + cocci (54%) were the most implicated pathogens, with a prevalence of 19% of Enterococcus faecium; while in MDR UC patients Gram – bacilli (59%) were the most involved pathogens, with prevalence of Escherichia coli ESBL+ (47%). The antibiotic therapy cost for the CD group was higher in MDR (3249 €) and no-MDR (924 €) groups vs. non-infected patients (41€). In UC we found higher cost only in the MDR group (1408€ vs. 33€). Conclusion Preoperative risk factors involved in the development of MDR infections in IBD patients undergoing surgery were identified. Some factors, such as nutritional status or preoperative antibiotic therapy, were found to be common between CD and UC patients, while some others were found to be specific for UC or CD. Some of these elements appear to be non-modifiable, while some others are part of the multidisciplinary approach, for which further studies are needed to improve the preoperative ‘patient optimisation’ in order to reduce surgical complications.

Maternal and Perinatal Outcome in Severe Pre-eclampsia and Eclampsia

2009 ◽  
Vol 1 (3) ◽  
pp. 25-28 ◽  
Author(s):  
Anshu LNU ◽  
Deepika LNU
Keyword(s):  
Pulmonary Embolism ◽  
Antenatal Care ◽  
Pulmonary Edema ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Perinatal Complications ◽  
Function Tests

ABSTRACT Background Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Present study was planned to find the maternal and perinatal outcome in patients of severe pre-eclampsia and eclampsia. Methodology It is a prospective study, carried out on 100 pregnant women admitted with severe pre-eclampsia and eclampsia at a tertiary care referral unit. Detailed history and examination was carried out. Investigations like complete hemogram, liver function tests, renal function tests, coagulation profile, fundus and 24 hours urine for protein were done. Obstetric management was done as per existing protocol in the department, magnesium sulphate was the drug of choice for controlling convulsions, and blood pressure was controlled either by oral nefidipene or methyl dopa. Maternal and perinatal complications were noted down. Results The majority of the patients was unbooked (82%), belonged to lower socioeconomic status (84%) and had rural background (84%). Headache was the most common antecedent symptom (44%) followed by epigastric pain (20%), oliguria (9%), blurring of vision (8%) and ascitis (5%). There was high incidence of maternal complications like PPH (31%), abruption placentae (11%), renal dysfunction (8%), pulmonary edema (8%), pulmonary embolism (4%), HELLP syndrome (2%) and DIC (2%). Maternal mortality was 8% and the causes were pulmonary embolism in four women, DIC in two, HELLP and pulmonary edema in one each. Perinatal complications were also high 71.43% were low birth weight, 66% had preterm delivery, 52.4% babies had birth asphyxia and 28.57% were still born. Maternal and perinatal outcome was much poorer in eclampsia as compared to severe pre-eclampsia. Conclusion There is a very high maternal and perinatal morbidity and mortality and 82% patients had no antenatal care. Good antenatal care could have been prevented severe pre-eclampsia and eclampsia to some extent. Thus it is suggested that developing countries have to go a long way to create awareness about importance of antenatal check ups and take measures for implementation.

scholarly journals A study on eclampsia and its maternal and perinatal outcome

2019 ◽  
Vol 8 (12) ◽  
pp. 4990
Author(s):  
Devika J. Kamat ◽  
Guruprasad Pednecar
Keyword(s):  
Antenatal Care ◽  
Perinatal Outcome ◽  
Health Centre ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Tertiary Care Centre ◽  
Neonatal Deaths ◽  
Nicu Admission ◽  
A Prospective Study

Background: Eclampsia is one of the major causes of maternal and perinatal mortality in India. Here authors present a prospective study which was conducted in a tertiary health centre to study the cases of eclampsia, the mode of presentation and the maternal and perinatal outcomes.Methods: A total 95 women were diagnosed as eclampsia during the period of 2 years. Various parameters and their effects on maternal and perinatal morbidity and mortality were studied. Maternal outcomes were assessed based on parameters like antenatal care received, mode of delivery, complications associated with eclampsia. Perinatal outcomes were noted depending upon the period of gestation, NICU admission, stillbirths and neonatal deaths.Results: Authors found the incidence of eclampsia to be 0.9%. 52.7% women had irregular antenatal follow up at any nearby health centre. A total 76.8% women had antepartum eclampsia. 56.8% delivered by caesarean section while 7.4% required operative vaginal delivery. 61.1% women delivered within 10 hours of onset of convulsion. Authors had 02 deaths in the study group, one due to ARDS with DIC and the other attributed to pulmonary oedema. There were 51.6% preterm deliveries. 21 neonates required NICU admission with 5 neonatal deaths and 11 stillbirths.Conclusions: Due to inadequate antenatal care, most of the cases of pre-eclampsia go unnoticed increasing the referrals to tertiary care centre for intensive care. Thus, it is necessary to emphasise on timely interventions and availability of blood bank, ICU and NICU facilities at the closest referral centre for better maternal and perinatal outcome.

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