scholarly journals Factors Influencing Maternal Mortality from Severe Preeclampsia and Eclampsia

Author(s):  
Denny Khusen

Objective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/μl, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsia

2019 ◽  
Vol 14 (3) ◽  
Author(s):  
Mekar Dwi Anggraeni ◽  
Rahmi Setiyani ◽  
Nina Setiawati

<p>Maternal mortality is an indicator of a country’s health status. Postpartum hemorrhage is the main cause of maternal mortality. Understanding the postpartum hemorrhage risk factors useful to develop strategy in order to reduce maternal mortality. The aim of this study was to find modifiable postpartum hemorrhage's risk factors. This study used 6 steps which include formulating the research questions and objectives, searching the extant literature, screening for inclusion, assessing the quality of primary studies, extracting data, and analyzing data. The article was searched from Google Scholar and NCBI databases using bilingual keywords: "faktor-faktor, perdarahan postpartum, risk factors, and postpartum hemorrhage". There were 1736 papers founded and only 14 articles met the inclusion criteria and included in the analysis. The review revealed that anemia, age, parity, birth passage laceration, obstetric history, multiple pregnancy, placental retention, prolonged labor, atonia uteri, pre-eclampsia, pregnancy induced hypertension, section caesarian, placental complication, history of post-partum hemorrhage, episiotomy, high neonatal birth weight. Anemia is the only modifiable risk factor which may be prevented by nurses. </p>


2018 ◽  
Vol 25 (1) ◽  
pp. 6 ◽  
Author(s):  
Amelia Rahmah Kartika ◽  
Muhammad Ilham Aldika Akbar ◽  
Pirlina Umiastuti

Objectives: to determine which of the risk factors above associated with the occurrence of severe preeclampsia at dr. Soetomo Hospital, Surabaya during 2015.Materials and Methods: The type and design of the study were analytic and retrospective. This study was held in the dr. Soetomo Hospital from April until November 2016. The instrument of the study was the medical records then being coded and analysed. The samples were 134 pregnant women, consisting of 67 pregnant women with severe preeclampsia as cases and 67 pregnant women as controls.Results: Maternal obesity (OR= 5,786; 95% CI: 2,300–14,555), history of hypertension (OR= 6,693; 95% CI: 1,848–24,237) and secondary elderly primi (OR= 6,384; 95% CI: 1,357–30,031) are associated with the development of severe preeclampsia.Conclusion: In conclusion, the significant risk factors of severe preeclampsia in dr. Soetomo Hospital Surabaya during 2015 are obesity, history of hypertension and secondary elderly primi variables.


Author(s):  
Sulis Diana ◽  
Chatarina Umbul Wahyuni ◽  
Budi Prasetyo

Background: Maternal mortality could be prevented through early detection, including the period preceding pregnancy. Women of childbearing age are faced with extreme uncertainties, hence the purpose of this study was to analyse maternal complications and the possible high-risk factors connected to maternal mortality.Design and methods: A case-control study was used to study the causes of maternal mortalities amongst pregnant, delivering, and postpartum mothers between 2017 and 2018. A total sample size of 48 samples was selected through simple random sampling. Results: The result of logistic regression analysis showed nutritional status, prominence of anemia, history of illness, age, antenatal care ANC examination, method of delivery, late referral, occupational status, as well as postpartum complications, as the most influencing risk factors. This very high significance for maternal mortality was based on the chi-square value of 109.431 (p equal to 0.000), and R square (0.897). Conclusions: In conclusion, the potential risk factors of maternal mortality include nutritional status, state of anemia, history of illness, age, ANC examination, delivery method, late referral, occupational status, and pregnancy complications, which is specifically the most dominant factor.


2016 ◽  
Vol 51 (4) ◽  
pp. 272
Author(s):  
Warih Angesti P ◽  
Ernawati Ernawati ◽  
Dwi Susanti

Hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLPs) is complication following severe preeclampsia which is one of the three leading causes of maternal mortality in Indonesia. The purpose of this study was to understand the prevalence, characteristics, and post-partum outcome of HELLPs patients who deliver in Dr. Soetomo Hospital in July 2012-June 2013. This study was observational-descriptive, cross sectional study. The population observed was the severe preeclampsia patients who deliver in Dr. Soetomo Hospital and have complete medical data in July 2012-June 2013. study subject taken by total sampling. HELLPs follow the 7% of severe preeclampsia patients. The maternal average age of HELLPs group was 30.2 (19-43), while in non-HELLPs was 30.8 (17-46). Most HELLPs patients were in the first and second pregnancy. The average of gestational age at labor in HELLPs was 33-34 weeks. Both in HELLPs and non-HELLPs most performed Cesarean Section delivery. No post-partum maternal mortality found in HELLPs, but 25% had stillbirth. The average of birth weight in HELLPs was 1994.4 g. First minute Apgar score >7 was 33.3% in HELLPs group. In conclusion, Most HELLPs patients were in the first and second pregnancy, while non-HELLPs were in first pregnancy. The average of gestational age at labor was lower in HELLPs group. Neonates mortality were higher in HELLPs group. The average of birth weight was lower in HELLPs group. First minute Apgar score > 7 was higher in non-HELLP group.


2017 ◽  
Vol 3 (1) ◽  
pp. 19-37
Author(s):  
Legawati Legawati ◽  
Nang Randu Utama

The maternal mortality rate (MMR) and infant mortality rate (IMR) is a barometer of a country's health services. In developed countries, the incidence of severe preeclampsia and eclampsia ranges from 6-7% 0.1 to 0.7%. While the maternal mortality rate due to pre-eclampsia and eclampsia in developing countries is still high (Betty & Yanti, 2011). To analyze the risk factors of weight in Pre eclampsia Referral Hospital Sultan Imanudin Pangkalan Bun and Dr. Doris Sylvanus Palangkaraya. This was an observational study conducted using a cross sectional study design. A cross-sectional study is when the influence of independent variables (exposure) and the dependent variable (effect) is observed and measured at the same time. Based on multivariable logistic regression analysis of factors affecting the risk factors PEB is the mother's age, education, gestational age, parity, ANC. Factors unrelated significantly is work, spacing, PE history, history of diabetes, Gemelli, economic and social decision-making. Factors that increase the risk of PEB is the mother's age, education, occupation, gestational age, parity, history of PE, the ANC and the social economy. Factors unrelated significantly is spasing, history of diabetes, Gemelli, and decision making. For pregnant women can do a pregnancy without looking at risk factors for PEB or no risk factors, to see some of the risk factors determinants. For health workers to carry out pregnancy tests with a focus on the pregnancy.


Author(s):  
Mamatha Poondru ◽  
R. Kala ◽  
A. Kumar

Background: The aim is to study the prevalence of prelabour rupture of the membranes (PROM), to identify risk factors, mode of delivery, and its maternal and fetal effects.Methods: This was a cross-sectional study conducted in the department of obstetrics and gynaecology at Government Head Quarters Hospital, Cuddalore, Tamil Nadu, with a duration of 6months (January 2020 – June 2020). The study was conducted on 800 pregnant women between 28-42 weeks of gestational age consecutively and those who met the inclusion and exclusion criteria were taken into study.Results: The prevalence of PROM was 27.9% (tPROM 24.6% and PPROM 3.2%). Most of the cases were primigravida (74%). Risk factors associated with PROM were low socioeconomic state (63.2%), urinary tract infection (UTI) (7.2%), vaginal infections (5.8%), and previous history of PROM (3.1%). Most of the patients were delivered by lower segment caesarean section (LSCS) (55.2%), normal vaginal delivery (39.9%) and forceps delivery (4.9%). The most common indication for LSCS was fetal distress (43.9%). Misoprostol induction was associated with more failed induction (2 times) than syntocinon. Maternal complications were post-partum haemorrhage (PPH) (8%), fever (6.7%), wound infection (6.2%), manual removal of placenta (4.4%), and puerperal sepsis (0.9%). Neonatal complications were neonatal intensive care unit (NICU) admissions (14%), respiratory distress syndrome (RDS) (11%), neonatal sepsis (2.6%). Maternal (54.5%) and neonatal (90%) morbidity were more in prolonged PROM >24 hours.Conclusions: Antenatal screening for genitourinary infections especially in cases of the previous history of abortions and PROM should be done. Oxytocin is the preferred method of induction over misoprostol in this study. Active management in term PROM cases can reduce the cesarean section rate.


2017 ◽  
Vol 2 (1) ◽  
pp. 32
Author(s):  
Latifiyan Nurnaningtiyas Aminoto ◽  
Setyawati Soeharto Karyono ◽  
Dina Dewi S. L. I.

Severe preeclampsia is a problem that causes emergency, thus increasing morbidity and maternal mortality. There are several risk factors that influence the occurrence of severe preeclampsia. This study aimed to explore the risk factors associated with severe preeclampsia. The study design is cross sectional. sample 64 respondents, divided into 32 severe preeclampsia and mild preeclampsia 32 hospitals in the delivery room. dr. Moh. Soewandhi Surabaya. Logistic regression analysis of the test, it was found that obesity and stress is a risk factor that significantly affects the occurrence of severe preeclampsia. 


2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Nurulia Muthi Karima ◽  
Rizanda Machmud ◽  
Yusrawati Yusrawati

AbstrakPre-eklampsia Berat (PEB) masih merupakan salah satu penyebab morbiditas dan mortalitas ibu apabila tidak ditangani secara adekuat. Ada banyak hal yang mempengaruhi terjadinya PEB, beberapa diantaranya adalah usia ibu, paritas, usia kehamilan, jumlah janin, jumlah kunjungan ANC, dan riwayat hipertensi. Tujuan penelitian ini adalah untuk mengetahui hubungan antara faktor risiko dengan pre-eklampsia berat di RSUP Dr. M. Djamil Padang.Penelitian ini menggunakan rancangan case-control study dengan metode analitik observasional. Pengumpulan data dilakukan pada Januari 2013 dengan menggunakan data sekunder, yakni data rekam medik ibu melahirkan dengan pre-eklampsia berat dan tanpa pre-eklampsia di bagian obstetrik dan ginekologi RSUP Dr. M. Djamil, periode 1 Januari 2010 – 31 Desember 2011. Dari 148 data sampel didapatkan angka distribusi pada variabel riwayat hipertensi yang hanya didapatkan pada ibu dengan PEB. Hasil analisis bivariat dengan menggunakan uji chi-square diperoleh hasil tidak terdapat hubungan signifikan antara faktor risiko (usia ibu, paritas, usia kehamilan, jumlah janin, jumlah kunjungan ANC) dengan masing-masing nilai p > 0,05. Analisis multivariat dengan menggunakan uji regresi logistik didapatkan bahwa usia ibu > 35 tahun merupakan faktor risiko terhadap kejadian PEB dengan nilai p = 0,034. Jadi, usia ibu > 35 tahun dan riwayat hipertensi memiliki hubungan terhadap kejadian pre-eklampsia berat.Kata kunci: pre-eklampsia berat, faktor risiko, hipertensi AbstractSevere Pre-eclampsia is one of the contributors of maternal morbidity and mortality if not getting an adequate treatment. There are many things that affect it, such as maternal age, parity, gestational age, number of fetuses, the number of ANC visits, and history of hypertension. The objective of this study was to determine relationship between the risk factors and the incidence of severe pre-eclampsia The design of this research is case-control study with observational analytic methods. The data was collected in January 2013 by using secondary data, maternal medical record data with severe pre-eclampsia and without pre-eclampsia of the obstetrics and gynecology department Dr. M. Djamil, period 1 January 2010-31 December 2011. From 148 samples obtained figures the variable history of hypertension which is only found in women with severe pre-eclampsia. The results of the bivariate analysis using chi square test results obtained there was no significant relationship between risk factors (maternal age, parity, gestational age, number of fetuses, the number of ANC visits) with each p value > 0.05. While the results of the multivariate analysis using logistic regression found that maternal age> 35 years was a risk factor for the incidence of severe pre-eclampsia with p = 0.034. Maternal age > 35 years and history of hypertension had a relationship to the incidence of severe pre-eclampsia. Keywords: severe pre-eclampsia, risk factor, hypertension


Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Arbia A Gorrab ◽  
Asma Abed Bouaziz ◽  
Linda Spigelblatt ◽  
Anne Fournier ◽  
Nagib Dahdah

Background: The real incidence of Kawasaki disease (KD) in the Maghreb countries (Morocco, Algeria, and Tunisia) is unknown. It is estimated low according to the literature. However, the number of Maghrebi children living in Quebec (Qc) affected by KD seems important. We sought to determine the incidence of KD among Maghrebi children in Qc, Canada, and to study its epidemiological and clinical features and to clarify possible risk factors related or superimposed to their immigration. Methods: A retrospective study of KD in Maghrebi children living in Qc (n=24) (1996-2013), compared to reports from Fes, Morocco (n=23) a doctoral thesis published in 2010 (2001-2009) and from Tunisia (n=31) collected in five university hospitals with four from the Great Tunis and one from Nabeul city (1996-2013). There are no reports available from Algeria. The “country of origin” specific population in the Province of Qc was obtained from Statistics Canada. Results: The annualized incidence rate (AIR) of KD among Maghrebi children in Qc was 9.58/100,000 children under 5 years(Standard-Denominator (SD)).This is 6 times higher in Qc (5.57/SD and 19.02/SD among Tunisian and Moroccan descents) vs Tunisia (Nabeul Governorate) and Morocco (Fes) (0.95/SD and 3.15/SD). Personal and family history of allergy were significantly higher in Qc 42% (10/24) and 75% (18/24), respectively, whereas these features were reported near 0% in both reports from Morocco and Tunisia. The prevalence of incomplete KD criteria was relatively high in the 3 series 46% (11/24) in Qc vs 43% (10/23) and 35% (11/31); (p=NS). Diagnosis was late (gt day 10 of fever) in 1/24(4%) in Qc vs 7/23 (30%) in Morocco and 11/31 (35%) in Tunisia; (p 0.01). IVIG were administered in the acute phase to all patients in Qc, 5/23 in Morocco and 28/31 in Tunisia. However coronary complications were more common in Qc 42% (10/24) vs 22% (5/23) vs 19% (6/31) (p=0.02). Aneurysms were significantly associated with the incomplete form in the 3 groups (p=0.01). Conclusions: The observed AIR of KD in the Maghreb community in Qc is higher than the countries of origin where underdiagnosis is possible. Atopy may still be a risk factor in Qc. The coronary artery disease seems linked not only to therapeutic delay but also to the underlying terrain.


Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rakhee Lalla ◽  
Ryan Dunlow ◽  
Karen L Yarbrough ◽  
Prachi Mehndiratta ◽  
Michael S Phipps ◽  
...  

Introduction: The AHA notes that more than 76% of strokes are the first occurrence. There are class 1 recommendations for the management of common risk factors such as atrial fibrillation (AF), hyperlipidemia (HLD), hypertension (HTN), diabetes (DM), and vascular disease. The purpose of this study is to investigate the percentage of large vessel strokes that are potentially preventable with adequate management of vascular risk factors. Methods: A retrospective chart review was conducted on all patients undergoing endovascular therapy (EVT) from 2012-2019. Data was collected on vascular risk factors present prior to admission including HTN, DM, HLD, AF, and smoking. Preventable stroke was defined as having at least one of the following: untreated AF, untreated HLD, poorly controlled HTN (presence of left ventricular hypertrophy on transthoracic echo), history of vascular disease not on an antiplatelet agent, poorly controlled DM (A1c>10), current smoking. Groups were compared based on age, sex and 90 day functional outcomes, with favorable outcome defined as mRS ≤ 2. Results: Our sample included 396 patients who underwent EVT (mean age 65, 50% female). 42% of patients with Afib were not on anticoagulation, 31% of patients with HLD were untreated, 39% of patients with HTN were poorly controlled, 27% of patients with a history of vascular disease were not on an antiplatelet, 14% of patients with DM were poorly controlled, and 46% of all patients were smokers. In total, 78% of patients had at least 1 poorly controlled risk factor and 37% had at least 2. There was no difference in rates of preventable stroke between males and females (48% vs 52%, p=0.30) and between age groups above and below 70 (40% vs 60%, p=0.68). 64% of patients with well controlled risk factors had a favorable outcome compared to 51% with at least one poorly controlled risk factor (p=0.03). Conclusions: Our data suggests that despite guidelines on management of vascular risk factors, a large number of these are poorly controlled prior to admission for large vessel stroke, leading to a potentially preventable procedure. Not only could improved primary prevention save the wide array of resources utilized in EVT, but it could also influence long term outcomes in this cohort of patients.


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