scholarly journals Near-miss Obstetric Events in a Tertiary Care Teaching Hospital in Nepal: An Audit

2015 ◽  
Vol 10 (1) ◽  
pp. 30-32 ◽  
Author(s):  
BS Gurung ◽  
RB Koju ◽  
Y Dongol
Keyword(s):  
Blood Transfusion ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Near Miss ◽  
Coagulation Disorder ◽  
Hypertensive Disorder ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Obstetric Haemorrhage ◽  
Almost All

Aims: This study aims to determine the frequency of near-miss obstetric events and analyze its nature such as reasons for near-miss, organ dysfunction associated and critical management required among pregnant women managed over a 3-year period in a Tertiary Care Teaching Hospital in Nepal. Methods: This hospital based prospective, descriptive study was done from August 2011 to February 2015. Case eligibility was defined by WHO Near-Miss Guidelines. Medical records of the patients and the interview with the patient, accompanying family members and health workers from referral centres were used to generate the data which were filled in the pre-designed questionnaire. The data generated and analyzed included age and gestation weeks, parity, mode of intervention, associated organ dysfunctions, reasons for near-miss and critical intervention accompanied to manage the near-miss cases. Results were presented in mean ± SD and percentages, wherever applicable. Results: There were 4617 deliveries with 28 near-miss cases. The major factors contributing near-miss events were obstetric haemorrhage followed by hypertensive disorder. Three fourth (n=21) of cases required blood transfusion and almost all cases (n=26) required ICU management. Coagulation disorder was observed in majority of cases (n=23) followed by cardiovascular, respiratory and uterine atony. Conclusions: In this study, maternal near-miss event was mainly attributable to obstetric haemorrhage followed by hypertension and sepsis. Major organ-system disorders observed were coagulation disorder, cardiovascular, respiratory and uterine disorders. Almost all the cases were managed in ICU and majority of them required blood transfusion. 

scholarly journals Evaluation of causes of still birth in a tertiary care teaching hospital

2018 ◽  
Vol 7 (3) ◽  
pp. 911
Author(s):  
Shivani Kothiyal ◽  
Anjoo Agarwal ◽  
Vinita Das ◽  
Amita Pandey ◽  
Smriti Agarwal
Keyword(s):  
Teaching Hospital ◽  
Health Centre ◽  
Tertiary Care ◽  
Morphological Characteristics ◽  
Hypertensive Disorder ◽  
Care Hospital ◽  
Still Birth ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Obstructed Labour

Background: Whenever pregnancy occurs there is an expectation that every pregnancy will end with the birth of a healthy baby, yet in a developing country like India 22 in every 1000 births are stillborn. The objective of this study was to evaluate the rate and causes of still birth in a tertiary care teaching hospital, Queen Mary, King George Medical college and university, Lucknow, Uttar Pradesh, India.Methods: Present study was an observational study in a tertiary care hospital. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. After informed consent, details of history about epidemiological factors, obstetric history and medical history were obtained. Antenatal investigations including imaging, delivery details and stillborn morphological characteristics were analyzed to identify the cause of stillbirthResults: Out of 7024 deliveries, stillbirth rate was 78.30/1000 total births. Cause of intrapartum stillbirth showed statistically significant correlation with patient’s place of residence (rural>urban), distance of health centre from her house, time taken to reach first point of contact and her parity. The major obstetrical causes of stillbirth identified were APH 22.36%, hypertensive disorders of pregnancy 19.27%, IUGR 15.27%, unexplained causes 11.09%, mal-presentations 9.64%, rupture uterus 9.09% and obstructed labour 6.36%. Severe anemia was found in 24.91% as an associated obstetrical cause of stillbirth.Conclusions: The rate of stillbirth is higher as compared to the Indian data (22/1000 total births). Antepartum obstetric complications (APH, hypertensive disorder of pregnancy, IUGR) were the most common. 15.45% cases showed intrapartum causes of stillbirth (obstructed labour and rupture uterus) which was significantly higher than developed countries where such cases are negligible. The higher number of intrapartum deaths indicate that better healthcare services can drastically reduce stillbirth rates in developing countries.

scholarly journals Antepartum hemorrhage at a tertiary care teaching hospital in Nepal

2017 ◽  
Vol 4 (2) ◽  
pp. 44-48
Author(s):  
Sarada Duwal Shrestha ◽  
Reena Shrestha ◽  
Alka Singh ◽  
Praban Sharma ◽  
Anagha Malla Pradhan ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Blood Transfusion ◽  
Teaching Hospital ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Hypovolemic Shock ◽  
Perinatal Morbidity ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching

Introductions: Antepartum hemorrhage (APH) is a serious obstetrical emergency and is a leading cause of maternal and perinatal morbidity and mortality. Incidence varies from 2-5% of all deliveries. The maternal and perinatal complications of APH are anemia, postpartum hemorrhage, shock, low birth weight, intrauterine fetal death and birth asphyxia. Methods: This descriptive study was conducted at Department of Obstetrics and Gynaecology of Patan Hospital, a tertiary care teaching hospital of Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. All patients who were admitted after 22 weeks of gestation with diagnosis of antepartum hemorrhage from April 2012 to April 2016 were included. Results: The incidence of APH was 0.23% in the present study. Out of 84 patients, 39.3% were in age group of 25-29 years, 63% were multigravidae, 63% had placenta previa, 92.3% lower segment caesarean section done in new onset APH and 53.1% done in previous admitted cases of APH, 23.8% developed hypovolemic shock, 14.3% needed blood transfusion, 9.5% had postpartum hemorrhage, 1.2% had caesarean hysterectomy, 54.8% had preterm delivery, 9.5% were admitted in neonatal intensive care unit and perinatal mortality was 10.7%. Conclusions: APH is a major cause of maternal and perinatal morbidity and mortality. In our study, the most common cause of APH was placenta previa. The commonest mode of delivery was caesarean section. The major maternal complication was hypovolemic shock with consequent high blood transfusion rate and fetal complication in prematurity.  

scholarly journals Comparison of near miss obstetric events and maternal deaths in a tertiary care teaching hospital from Eastern India

2018 ◽  
Vol 7 (9) ◽  
pp. 3619
Author(s):  
Sushree Samiksha Naik ◽  
Subhra Ghosh
Keyword(s):  
Teaching Hospital ◽  
Tertiary Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Eastern India ◽  
Maternal Deaths ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Hypertensive Disorders ◽  
Mortality Index

Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. Timely audit of the obstetrics near miss data would help in reducing maternal mortality.Methods: A retrospective chart review of the maternal near miss (MNM) and death based on WHO 2009 criteria was carried out in a tertiary care teaching hospital from Eastern India over 12 months. Main outcome measures were severe acute maternal morbidity (MNM) and maternal deaths.Results: During the study period, there were 9204 deliveries, 116 near miss cases, and 69 maternal deaths. The MNM incidence ratio was 13.75/1000 live births, MNM to mortality ratio was 1.68:1, and mortality index was 37.3%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hypertensive disorders accounted for the highest number of near miss cases (40.5%), followed by sepsis (31%), haemorrhage (18%), and dystocia (10%). The mortality index was 36.58%, 33.33%, 19.23%, and 07.6% for hypertensive disorders, sepsis, haemorrhage, and dystocia, respectively.  Most common causes of maternal deaths were hypertensive disorders, followed by systemic infections, HELLP syndrome, embolism, haemorrhage, malaria, and ruptured uterus. On bivariate analysis, there was an increased risk of maternal death in those illiterate, incomplete antenatal check-up (<3), multipara, preterm pregnancy, and home delivery.Conclusions: Hemorrhage and hypertensive disorders are the leading causes of MNM events and mortality. Early identification, remedial measures, and timely treatment would help to decrease the burden of maternal near miss and mortality.

scholarly journals A survey of hand-washing facilities in the outpatient department of a tertiary care teaching hospital in India

2010 ◽  
Vol 5 (02) ◽  
pp. 114-118 ◽  
Author(s):  
Mahesh Devnani ◽  
Rajiv Kumar ◽  
Rakesh Kumar Sharma ◽  
Anil Kumar Gupta
Keyword(s):  
Teaching Hospital ◽  
Tertiary Care ◽  
Hand Washing ◽  
Outpatient Department ◽  
Direct Patient Care ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Antiseptic Agent ◽  
Correct Technique ◽  
Almost All

Introduction: Inadequate hand-washing facilities have been reported as a barrier to hand washing. This study aimed to evaluate the availability and accessibility of hand-washing facilities and supplies of hand-washing agents in the outpatient department (OPD) complex of a tertiary care teaching hospital. Methodology: A checklist containing 13 variables was prepared and all rooms of direct patient care in the OPD were assessed on one occasion.  Results: Out of 211 rooms surveyed, a hand-washing facility was available in 209 (99.05%) rooms. Among these, 206 (98.56%) sinks were easily accessible and were placed close to users. Almost all sinks (99.5%) had hand-operated taps. Thirty-five (16.75%) sinks had no soap stand, and at 21 (10.5%) sinks, soap stands were found to be broken. At 14 (6.70%) sinks, soap bars were not available, while an antiseptic agent was available at 6 (2.87%) sinks. Four (1.91%) sinks had no towel stand, and at 8 (3.83%) sinks the towel stands were broken. At 43 (20.57%) sinks no towel was available, and at 23 (11%) sinks the towels provided were dirty. No sink drain was found to be blocked. No sink had hand-washing instructions displayed demonstrating the correct technique of hand washing. Conclusion: Physical facilities required for hand washing were adequate though not perfect. There is a need to shift from hand-operated taps to non-manual taps and from cloth towels to paper towels. Hospital managers in developing countries should continuously strive to provide the best possible hand-washing facilities within their financial resources.

Congenital Anomalies Among Singleton Live Births in a Tertiary Care Teaching Hospital

2011 ◽  
Vol 3 (11) ◽  
pp. 358-360
Author(s):  
Manikanta Reddy. V Manikanta Reddy. V ◽  
◽  
Senthil Kumar. S Senthil Kumar. S ◽  
Sanjeeva Reddy. N Sanjeeva Reddy. N
Keyword(s):  
Teaching Hospital ◽  
Congenital Anomalies ◽  
Tertiary Care ◽  
Tertiary Care Teaching Hospital ◽  
Live Births ◽  
Care Teaching
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