Postpartum Severe Acute Maternal Morbidity According to Gestational Age at Delivery in Twin Pregnancies: A Prospective Cohort Study

Objective: To assess the association between gestational age at delivery and postpartum severe acute maternal morbidity (SAMM) in twin pregnancies. Design: Population-based, national, prospective, cohort study Setting: From 02/2014 to 03/2015 in France Population: Women with twin pregnancies who gave birth after 32 weeks of gestation. We excluded women with fetal death or medical termination of either twin, with antepartum SAMM, with antepartum conditions responsible for postpartum SAMM. Methods: Gestational age at delivery was studied as the number of completed weeks of gestation. We assessed the association between gestational age at delivery and postpartum SAMM by using multivariable multilevel modified Poisson regression modelling. Main Outcome Measures: Composite criteria of postpartum severe acute maternal morbidity Results: Among the 7,713 women included, 410 (5.3%) developed postpartum SAMM, mainly (88.5%) postpartum haemorrhage. Compared with the reference category of 37 weeks, the risk of postpartum SAMM was significantly lower for all categories of earlier gestational age at delivery (from aRR=0.34, 95% CI 0.17-0.68 at 32 weeks to aRR=0.71, 95% CI 0.54-0.94 at 36 weeks), and did not differ for later categories. Conclusion: In twin pregnancies, compared with delivery at 37 weeks, delivery at earlier gestational ages is associated with a lower risk of postpartum SAMM. Continuing pregnancy beyond 37 weeks is not associated with an increased risk of postpartum SAMM. Funding: Supported by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique, AOM2012) and a grant from Université Toulouse III. Keywords: severe acute maternal morbidity, twin pregnancy, timing of delivery

“A STUDY OF INCIDENCE AND ASSOCIATED RISK FACTOR OF SEVERE ACUTE MATERNAL MORBIDITY (SAMM) IN A PRIVATE HOSPITAL”

INTRODUCTION- Maternal mortality is still a signicant public health problem now severe acute maternal morbidity (SAMM) has emerged as an important indicator in maternal health care to review the . cause of maternal deaths Severe morbidity data is very important for policy planner to evaluate the quality of health care system, to know the requirement of emergency obstetrics care (EMOC) and to improve the health care system. MATERIAL AND METHOD- This is a retrospective study done in a private maternity hospital in Gwalior (M.P.). The study was done during a period from 01/01/2017 to 01/01/2021. In our study 4808 live birth were there during this period 59 cases were diagnosed as severe maternal morbid cases. RESULTS- In present study the incidence of SAMM was 12.27 per one thousand live birth. In this study – most (54.23%) of women were in the age group of 21-25, were unbooked (57.62%) , primipara (38.98%), full term (47.45) and of low-income group (64.40%) In this study we found the most common morbidity was (30.50%) hypertensive disorder of pregnancy, the second one was (23.72%) of severe hemorrhage. In our study, severe anemia was the most frequent medical disorder present in morbid Patients. During the study period four patients died. The most common cause of maternal death was pregnancy-induced hypertension and its associated disorders. CONCLUSION- This study summarized that lack of awareness, lack of education, rst delay in reaching to the health care system, lack of antenatal visits, preexisting chronic medical disease, inadequate use of magnesium sulphate before transferring patient of severe PIH/eclampsia, and improper use of antibiotics and delay in diagnosis and referral to higher center are the main factor contributing to severe maternal morbid cases. Identication of SAMM cases is very useful in monitoring the quality and effectiveness of obstetrics care, it helps in improving the health care system.

Magnitude of Severe Acute Maternal Morbidity and Associated Factors Related to Abortion: A Cross-Sectional Study in Hawassa University Comprehensive Specialized Hospital, Ethiopia, 2019

Background. Abortion-related mortality is decreasing, but the complication is still causing a significant morbidity to mothers especially in developing countries. Recently, suitable criteria to assess maternal near miss for sub-Saharan countries were adapted in harmony with the previous World Health Organization near-miss criteria. The aim of this study was to assess the magnitude of severe acute maternal morbidity and associated factors related to abortion in Hawassa University Comprehensive Specialized Hospital, Ethiopia. Method. An institution-based cross-sectional study was conducted among 337 women who sought abortion services at Hawassa University Comprehensive Specialized Hospital from January 1 to October 30, 2019. The participants were selected conveniently. Data was collected by using prospective morbidity methodology with pretested anonymous structured English questionnaire. The collected data were then entered into SPSS version 20 for analysis. Variables with p value ≤ 0.2 in the bivariate analysis, not collinear, were entered to multivariable regression. The strength of association is presented by odds ratio and 95% confidence interval. p value less than 0.05 was used as a cut-off point to determine statistically significant association. Results. The magnitude of severe acute maternal morbidity and maternal near miss is found to be 35.6 and 17.7%, respectively. Factors significantly associated with severe acute maternal morbidity were as follows: women uneducated (AOR: 3.02; 95% CI 1.24-7.33), second-trimester pregnancy (1.89-9.14), and delayed presentation (AOR: 4.32, 95% CI 1.76-10.59). Conclusion. Severe acute maternal morbidity and maternal near miss related to abortion are high despite the availability of safe termination. Near-miss cases could be better traced by using reasonably adapted World Health Organization near-miss criteria for sub-Saharan countries. Lack of education, increased gestational age, and delayed presentation had increased severe acute maternal morbidity associated with abortion which may need further education on health care seeking culture of the community.