Maternal and perinatal mortality

A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved socioeconomic standards, better obstetric and pediatric services, education of the public to use such services, and treatment of diseases complicating pregnancy and research. The clinical and practical aspects of obstetric care are the most important areas in training undergraduates. For existing facilities to yield maximum benefits, hospital deliveries should be restricted to high risk patients. To accomplish this, closer integration of the hospital and domiciliary services is necessary.     

Maternal diabetes and perinatal outcomes in West Virginia Medicaid enrollees

Diabetes Mellitus (DM) is a serious problem in West Virginia. Diabetes during pregnancy has been associated with several negative outcomes. This study tested the hypotheses that women who had DM during pregnancy would have more negative perinatal outcomes than those who did not and women with pre-gestational DM would have more negative perinatal outcomes than women with gestational DM. The population included 14,583 mothers enrolled in WV Medicaid in 2001 and 2002. The population was divided according to the presence of DM in the mother, and then sub-divided into pregestational and gestational DM groups. Results showed significant associations between maternal diabetes and occurrence of macrosomia, pre-term delivery and less than optimal one-minute Apgar scores. The pre-gestational DM group had significantly more occurrences of macrosomia, pre-term birth, less than optimal Apgar scores, occurrence of complications of labor and/or delivery and occurrence of congenital anomalies than the gestational DM group.     

Maternal complications and perinatal outcomes in booked and unbooked Nigerian mothers

INTRODUCTION: The study aimed to compare the sociodemographical characteristics, obstetrical complications and foetal outcome in delivered booked mothers and delivered unbooked mothers and to determine the correlation of maternal and perinatal outcomes. METHODS: In a prospective study over a 22-month period, outcomes of pregnancies of women booked for antenatal care were compared with that of unbooked women, who delivered in our unit at the Wesley Guild Hospital, Nigeria. RESULTS: 29 percent of the 1,154 deliveries in the study period comprised unbooked mothers. Compared with booked mothers, unbooked mothers had a higher tendency to be younger (29.3 +/- 6.08 vs. 31.12 +/- 4.80; p-value is less than 0.001), unmarried (9.2 percent vs. 1.8 percent; p-value is less than 0.01), with lower educational status (25.8 percent with postsecondary education vs. 58.7 percent; p-value is less than 0.01), lower social class (25.0 percent in upper class vs. 52.3 percent; p-value is less than 0.001) and with higher proportion of multipara (12.5 percent vs. 5.5 percent; p-value is less than 0.02), higher incidence of antepartum haemorrhage (odds-ratio [OR] 5.96, 95 percent confidence interval [CI] 2.53-14.29, p-value is less than 0.001), anaemia (OR 2.75, 95 percent CI 1.09-4.47, p-value is less than 0.001) and preeclampsia/eclampsia. Unbooked mothers were half as likely as booked mothers to deliver by spontaneous vaginal delivery (OR 0.45, 95 percent CI 0.29-0.71, p-value is less than 0.001) but were twice as likely to deliver preterm babies (OR 2.03, 95 percent CI 1.14-3.59, p-value is less than 0.009) and three times more likely to have babies with birth asphyxia. Perinatal and maternal mortalities were higher in unbooked mothers. CONCLUSIONS: The study showed a positive correlation between unbooked mothers and an increased risk of maternal and foetal adverse outcomes.     

子痫围产儿结局与产前保健的关系分析

目的:探讨子痫围产儿结局与产前保健的关系。方法:回顾性分析4 4例子痫孕妇和5 0例正常孕妇的产前检查和围产儿情况。结果:子痫组的IUGR发生率、新生儿窒息发生率和围产儿病死率均高于正常妊娠组,差异均有统计学意义(均P<0 .0 5 ) ;子痫组产前检查次数低于正常组(P<0 .0 1 ) ;子痫组有4 7.7%未作产前检查,高于正常组的1 2 .0 %(P<0 .0 1 )。结论:加强围产期保健,可以预防子痫,改善子痫围产儿的预后。     

Maternal malnutrition,perinatal mortality and foetal pathology--a clinicopathological study

The close relationship between the maternal malnutrition and consequent birth of low birth weight babies and the perinatal mortality is now an accepted fact and has been studied extensively in developed countries, though the problem is more acute in developing countries. The present study was proposed to find out relationship between the maternal nutritional status and the perinatal mortality. Autopsy was performed on 100 babies dying perinatally and pathological examination of different foetal organs in both well and malnourished mothers was also undertaken. Maternal nutritional status was evaluated by estimating haemoglobin level and total serum protein level. A mother with haemoglobin level below 11 g/dl and/or serum protein level below 5 g/dl was considered as malnourished. Pathological findings in the dead babies included low birth weight (500-1,999g), haemorrhage in multiple organs, atelectasis of the lungs, fatty changes in the liver, cystic changes of the kidneys and ill developed parenchyma of the pituitary.     

Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment

CONTEXT: Persons with lower-extremity peripheral arterial disease (PAD) are often asymptomatic or have leg symptoms other than intermittent claudication (IC). OBJECTIVE: To identify clinical characteristics and functional limitations associated with a broad range of leg symptoms identified among patients with PAD. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 460 men and women with PAD and 130 without PAD, who were identified consecutively, conducted between October 1998 and January 2000 at 3 Chicago-area medical centers. MAIN OUTCOME MEASURES: Ankle-brachial index score of less than 0.90; scores from 6-minute walk, accelerometer-measured physical activity over 7 days, repeated chair raises, standing balance (full tandem stand), 4-m walking velocity, San Diego claudication questionnaire, Geriatric Depression Score Short-Form, and the Walking Impairment Questionnaire. RESULTS: All groups with PAD had poorer functioning than participants without PAD. The following values are for patients without IC vs those with IC. Participants in the group with leg pain on exertion and rest (n = 88) had a higher (poorer) score for neuropathy (5.6 vs 3.5; P<.001), prevalence of diabetes mellitus (48.9% vs 26.7%; P<.001), and spinal stenosis (20.8% vs 7.2%; P =.002). The atypical exertional leg pain/carry on group (exertional leg pain other than IC associated with walking through leg pain [n = 41]) and the atypical exertional leg pain/stop group (exertional leg pain other than IC that causes one to stop walking [n = 90]) had better functioning than the IC group. The group without exertional leg pain/inactive (no exertional leg pain in individual who walks 相似文献   

老年脑卒中患者相关性肺炎危险因素及临床特点分析

目的分析老年脑卒中相关性肺炎（SAP）的相关危险因素,并观察其临床特点。方法收集我科2009年1月-2012年1月收治的180例老年脑卒中患者的资料,其中50例发生SAP作为SAP组,130例未发生SAP作为非SAP组,对两组患者年龄、性别、糖尿病、房颤、卒中类型、意识障碍、气管插管/切开、呼吸机使用、吞咽困难等临床资料进行统计分析,观察其与SAP发生的关系,同时观察对SAP患者进行痰培养并进行药敏试验的结果。结果单因素及多因素Logistic分析结果显示,年龄、糖尿病、房颤、吞咽困难、气管插管/切开、呼吸机使用及意识障碍等均为SAP发病的危险因素,性别、高血压及卒中类型不是SAP病的危险因素。SAP患者中,30例痰培养阳性,以金黄色葡萄球菌（30.00%）、肺炎克雷伯杆菌（23.33%）最为多见,其次为大肠埃希菌（16.67%）、铜绿假单胞菌（16.67%）及肺炎链球菌（6.67%）,真菌感染较少见,药敏试验结果显示革兰阴性杆菌对亚胺培南保持较高的敏感染,耐药性低,革兰阳性菌对万古霉素最为敏感。结论 SAP的相关危险因素较多,临床上应引起重视并尽早采取合理的治疗和干预措施,对防治相关性肺炎的发生具有重要意义。     

Risk factors associated with ischaemic stroke in Guadeloupe

We carried out a case control study at the University Hospital of Pointe-à-Pitre, Guadeloupe, during eight months. Seventy patients with ischaemic stroke and seventy age- and sex-matched controls were involved. A standard questionnaire reported clinical characteristics and medical history. Seventy-six per cent of patients suffered from hypertension. Obesity and diabetes were more frequent in the case group than in the control group. Serum creatinine concentration (86 vs 74 mumol/l; p < 0.001), total cholesterol (5.9 vs. 5.2 mmol/l; p < 0.001), apolipoprotein B (1.2 vs 1.0 g/l; p < 0.001) and lipoprotein (a) (82 vs 48 mg/dl; p < 0.001) were significantly higher in patients than controls. Multiple logistic regression analysis revealed that in addition to serum creatinine, serum apolipoprotein B, hypertension, obesity, serum lipoprotein (a) and diabetes mellitus were associated independently and significantly with ischaemic stroke. These findings have implications for clinical practice and further research particularly with respect to serum creatinine concentration as a marker of renal damage from hypertension and as a risk factor itself for cerebrovascular disease.     

新生儿缺氧缺血性脑病围产期相关因素的探讨

目的 了解新生儿缺氧缺血性脑病(HIE)围产期的影响因素并探讨干预措施。方法 通过回顾分析早产、低体重、胎儿宫内窘迫、第二产程时间长、羊水Ⅲ°混浊、阿氏评分高低及治疗过程中并发低血糖对HIE的影响,且对中、重度HIE患儿与轻度HIE患儿进行U检验。结果 发生HIE的程度与早产、低体重、胎儿宫内窘迫、第二产程延长、羊水Ⅲ°混浊、阿氏评分较低及治疗过程中并发低血糖有显著性相关。结论 减少早产、低体重儿发生率,进行孕前期健康教育,优生咨询。孕期做好产检,筛查高危因素。分娩时产程延长,缺氧应予以吸氧、尽早结束分娩、实行新法复苏等处理及治疗过程中维持血糖在正常范围等是减轻HIE的主要措施。     

剖宫产术对母体和胎婴儿的风险及益处

目的 探讨剖宫产术对母体和胎婴儿的风险及益处.方法 对湖北省荆门市第一人民医院产科2008年7月至2009年7月住院分娩的900例产妇的临床资料进行回顾性分析. 结果剖宫产妇女发生严重产褥期疾病的风险明显高于阴道分娩者,其术后使用抗生素的风险是阴道分娩者的5倍,但可减少严重软产道裂伤并发症.排除多变量和孕周后,择期剖宫产可减少死胎的发生.头先露择期及产时剖宫产术均可增加新生儿重症监护(≥7 d)的风险.排除多变量及孕周后,其优势比及可信区间(CI)分别为 2.1(1.75～2.55)、1.93(1.63～2.79),同时可增加新生儿死亡率,其优势比及CI分别为1.66(1.26～2.2)、1.99(1.51～2.63).臀位先露剖宫产术并不增加这种风险.结论 剖宫产术益处为可减少母体严重软产道裂伤并发症及提供臀先露新生儿好的结局,头先露择期剖宫产术可减少死胎的发生,但剖宫产术同时增加了母体和新生儿患病和死亡的风险.     

81例住院早产儿相关围产因素临床分析

目的探讨早产儿的原因、临床问题、死因及防治措施。方法分析2002年1月1日．2003年12月31日收治的。81例早产儿原因、合并症，死因及治疗情况。结果导致早产最常见的原因是羊膜早破、多胎妊娠，其中多胎妊娠与近年开展的试管婴儿所至多胎妊娠有一定因果关系；早产儿的胎龄越小，体重越轻，严重合并症如RDS、窒息发生率、死亡率越高；同时新生儿黄疸也常见，原因与海南属沿海地区，是红细胞6-磷酸葡萄糖脱氢酶（G-6PD）缺陷症高发区有关。结论产儿科协同可预防低孕周、极低出生体重儿的出生，常见临床问题的预防治疗应针对早产儿的特点及地区疾病差别，尽早处理并发症及减轻其程度。