Knowledge, Attitude and Practices on Maternal Hypertensive Disorder Among Mothers in Kuantan, Pahang, Malaysia

Maternal hypertensive disorder (MHD) complicates 10% of pregnancy worldwide. In Malaysia, the percentage of maternal deaths due to MHD increased from 2012 to 2017 and did not show any decline yet. Hence, this study was aimed to develop and validate the questionnaires, to measure the level of knowledge, attitude and practices (KAP) on MHD, to evaluate the associated factors and any correlation between KAP on MHD. A cross-sectional study was conducted in Kuantan, Pahang between January 2020 and March 2020. A convenience sampling was used, and self-administered questionnaires were distributed to 100 respondents that fulfil the criteria. The questionnaire was developed through literature review and validated by five medical experts. Then, the pilot study validation was resulted in 0.894 of Cronbach’s Alpha test, which achieved the reliability between the questions. Most of the respondents had a moderate knowledge (n=63; 63.0%), moderate attitude (n=66; 66.0%) and high practices (n=61; 61.0%) on MHD. There was no significant association between socio-demographic factors and KAP of the respondents. A significant correlation is identified between knowledge and attitude (r=0.613, p<0.001) and knowledge and practice (r =0.326, p=0.001) but no significant association between attitude and practice (r=0.183, p=0.068). In conclusion, this study has revealed that majority of the respondents possess moderate knowledge and attitude, and excellent practice on MHD. Hence, future studies that related to KAP on maternal mortality and morbidity across setting should be done so that the early prevention steps can be taken to accommodate the possible problems that may arise in the future.

IMPACT OF GOVERNMENT SCHEMES ON MATERNAL HEALTH: AN OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

BACKGROUND: Maternal health is an important aspect for the development of any country in terms of increasing equity and reducing poverty. For reduction of maternal mortality and morbidity Government of India launched National health mission (NHM). Some of the major initiatives under NHM are– ASHA (Accredited Social Health Activist), JSY/JSSK (Janani Suraksha Yojana / Janani Shishu Suraksha Karyakaram), National mobile medical units, National ambulance services. METHODS: A retrospective observational study was performed in department of Obstetrics and Gynaecology, G.S.V.M Medical College, Kanpur, Uttar Pradesh which is a low performing state, during the period of 2018 to 2019. A total of 5134 obstetric patients including 1032 low general condition patients were included over duration of 20 months since January 2018 to august 2019. This observational study collected information regarding number of deliveries in different years in this tertiary care hospital, effect on availability of health facilities and antenatal care to the antenatal women after introduction of JSY, ASHA and ambulance services. CONCLUSIONS: After JSY there is major difference in OPD admission and institutional delivery rate. Ambulance services had major contributory role in reducing maternal mortality and morbidity. There is need to improve performance of ASHA by proper supervision and monitoring.

Study of pregnancy with disseminated intravascular coagulation

Background: At present time, obstetric bleeding remains to be the world’s main cause of maternal mortality, early identification of factors leading to haemorrhage and early management of underlying pathological process is the key stone of the treatment. The most important pregnancy related condition leading to bleeding with high maternal mortality and morbidity rate is disseminated intravascular coagulation (DIC).Methods: A prospective study of 50 cases of pregnancy with DIC was performed from May 2018 to November 2020 in our institute to detect the various aetiology and complications associated with DIC leading to maternal mortality and morbidity and study perinatal outcome in pregnant women with DIC.Results: The prevalence of DIC in our institute is 0.22%. Common causes of DIC were abruption (36%), haemorrhage (34%), preeclampsia (18%), sepsis (6%) and acute hepatic failure (6%). The composite severe maternal morbidity outcome in haemorrhage (100%), abruption (63%), preeclampsia (58%), and AVH (33%).Out of the three most common causes (abruption, haemorrhage and preeclampsia), the composite maternal morbidity outcome was significantly more in women with haemorrhage than with abruption and preeclampsia.Conclusions: DIC, as a marker of severe obstetrical complications, is associated with high levels of mortality and morbidity. Recognition of the antecedent causes and early investigation for and active management of DIC may help lower this morbidity.

A CLINICAL STUDY OF RISK FACTORS AND MATERNAL OUTCOME IN INTRA-UTERINE FETAL DEATH

Background: The objective of the present study was to examine the etiological factors, both maternal and fetal, that caused IUFD. Methods: It was a hospital based prospective observational study conducted in the Department of Obstetrics and Gynaecology at Jhalawar Medical College from January 2020 to December 2020. 120 cases of IUFD of ?24 weeks of gestation or foetuses weighing ?500 gramswere included in the study. Results: The incidence of IUFD was 37.8/1000 total birth. IUFD occurredmainly in 25-35yrs age group (55%), unbooked cases (70%),multigravida (59.2%), preterm (<37 weeks of gestation). The risk factors were PIH (49.2%), infections (9.2%), hypothyroidism (5%), Rh negative with hydrops fetalis (5%),GDM (4.2%), chronic hypertension (2.5%), previous H/O LBW (2.5%), H/O prior stillbirth (5%), hyperthyroidism (1.7%), oligohydramnios (46.7%), APH (20.8%) and congenital fetal anomalies (19.2%). Conclusion: IUFD rate still remains high. Therefore, regular ANC check up and early identification of risk factors like PIH, anaemia, infections, genetic counselling and timely referral to well equipped centre may help prevent IUFD and maternal mortality and morbidity. Keywords: IUFD, ANC, Preterm

BLOOD TRANSFUSION PRACTICES IN OBSTETRICS AND GYNAECOLOGY AT TERTIARY CARE CENTRE: A RETROSPECTIVE STUDY.

Background: This study was undertaken to ascertain the total patients receiving a transfusion, indications for transfusion, various blood components used, the timing of transfusion, and the presence of any risk factors in the patients transfused. Methods: Transfusion request forms of 2998 patients admitted to the Department of Gynaecology and Obstetrics in the zanana Hospital, SMS Medical College and attached group of hospitals Jaipur from May 2020 to July 2020were retrospectively reviewed for the types and volume of blood component transfused. Indication for each blood component transfusion was noted. Patients who had MOH were further analyzed to estimate the ratio of components transfused. Results: We have experienced 898 obstetric patients who underwent blood component transfusion during the study period. Out of these, 440 (49%) and 458 (51%) were primigravida and multigravida respectively. The mean age of patients who received transfusion was 27 years. The maximum number of patients was in the age group of 21–32 years Conclusion: Anemia during pregnancy is a significant cause of maternal mortality and morbidity. The decision for transfusion was done in this study when the Hb<7 gm%, and there were <4 weeks for delivery or in labor Keywords: Hb, Anemia, Pregnancy.

Rising trend in cesarean sections: a retrospective study at tertiary care hospital in Jammu

Background: The uncontrolled wave of cesarean rates has increased globally which has resulted in a significant amount of maternal mortality and morbidity. The present study aims to evaluate the trend in cesarean section rates in Jammu, India. Methods: The present retrospective study was carried out at the department of Obstetrics and Gynecology, SMGS Hospital, Jammu, India. We collected data based on total number of deliveries and cesarean sections performed at the hospital during (March2015-Feb2020) along with indications for CS.Results: The percentage of cesarean sections has increased drastically from 39.4% during (2015-16) to 49.9% in (2019-20). The study shows that the most common indication for CS is post CS followed by NPOL, Fetal distress, breech, APH, CPD, PIH and others.Conclusions: There is a growing concern among public and health care providers regarding the escalating and uncontrolled trend of cesarean sections which needs to be curtailed within optimal limits recommended by WHO.

Conceptual Framework for Implementing the Saudi Childbirth Initiative (SCI)

There are many efforts internationally to achieve safe and respectful MotherBaby–Family maternity care. This article is the first to provide a conceptual framework for implementing the Saudi Childbirth Initiative (SCI) in all health institutions in Saudi Arabia. It introduces the 10 Steps of the SCI to strategically achieve a safe and respectful MotherBaby–Family maternity care in order to improve maternal and infant outcome and implement evidence-based maternity care in Saudi Arabia. The SCI is developed upon previous initiatives and integrates and supports much of the current work being carried out by many organizations. The aim of the SCI's 10 Steps is to improve care throughout the childbearing continuum, to save lives, prevent illness and harm from the overuse of obstetric technologies, and promote health for mothers and babies and to provide clear guidelines for providing optimal maternity care. Safe and respectful MotherBaby–Family Maternity Care is measurable and for each of the 10 Steps, there is an associated assessment tool to ensure these guidelines are being established by health institutions. SCI envisions that successful implementation of the 10 Steps can be measured and monitored using the a combination of statistical information and key performance indicators (KPIs) to measure maternal mortality and morbidity outcomes (currently in development) using local assessors.

A STUDY OF NEAR MISS OBSTETRICAL EVENTS AT A TERTIARY CARE CENTRE AT MADHYA PRADESH

Background: Maternal mortality is the major indicator used to monitor maternal health. For every women, who dies, however, many suffer serious life threatening complications of pregnancy. Yet relatively little attention has been given to identifying a general category of morbidities that could be called near misses. Characterising near miss morbidity is valuable for monitoring the quality of hospital based case and for assessing incidence of life-threatening complications. Besides mortality data, the identication and accurate documentation of "near-miss" morbidity (a more sensitive index) is extremely important to assess the quality of health care systems. It can suitably guide to adopt appropriate measures to reduce maternal mortality and morbidity. Methods: A cross sectional observational study was conducted in department of obstetrics and gynecology, MGM medical college Indore (M.P.) over apeiod of 2 years. Out of all obstetric inpatients cases of near miss were taken, identied by WHO 2009 criteria. In all cases the demographic characteristics, frequency of near miss in each criteria, direct and indirect obstetric causes of maternal morbidity & mortality were noted .This study was approved by institutional ethical committee. The data was recorded in predesign coded case report form and statistical analysis was performed using the STATA12.1. Result: in the present study incidence of Near miss was 65.6, Maternal mortality ratio=558(2017) 590(2018) per 1 lakh live birth and Near miss to maternal death ratio was 11.4 Severe maternal outcome ratio=71.3 per 1000 live birth Conclusion: Maternal near miss reviews provide evidence of where the main problem in overcoming maternal mortality and morbidity may lie, and analysis can be done in practical terms and highlight the key areas requiring recommendations for health sector and community action as well as guidelines for improving clinical outcomes.