Maternal near-miss, mortality and their correlates at a tertiary care hospital.

OBJECTIVE: To determine the frequency and causes of maternal near-miss and mortality among pregnant women. METHODS: The cross-sectional prospective study was conducted from January 2016 to December 2018 at the Services Hospital, Lahore, Pakistan, and comprised all near-miss cases admitted in the gynaecology department. The World Health Organisation criterion was used to identify the near-miss cases. Primary outcome measures were frequency and causes of near-miss and the ratio between maternal mortality and near-miss cases. Secondary outcome measures were delays, need for massive blood transfusion, intensive care unit admission, obstetric hysterectomy and hospital stay >7 days. Data was analysed using SPSS 23. RESULTS: Of the 10,739 live births, there were 344(3.2%) complications resulting in 305(2.8%) near-miss cases and 29(0.3%) maternal deaths. Frequency of near miss was 28.4 per 1000 live births and the ratio between maternal mortality and near-miss cases was 1:10.5. There were 215(62.5%) unbooked patients and 23(6.7%) of them died (p<0.001). Among the near-miss cases, haemorrhage accounted for 150(49.18%), hypertensive disorders 102(33.44%), cardiac disease 25(8.28%) and infection 12(3.97%). Maternal mortality was significantly low for haemorrhage, hypertension, sepsis and cardiac disease (p<0.001). Massive blood transfusion was given to 64(20.98%) patients, 48(15.74%) underwent hysterectomy, and 98(32.13%) required admission to intensive care unit. First and second delays were seen in 240(78.6%) near-miss and 25(86.2%) mortality cases (p<0.001). CONCLUSIONS: Haemorrhage and hypertension were found to be major reasons for near-miss cases, but timely intervention could prevent mortality.

Gynecological malignancies at tertiary care hospital, Pakistan: A five-year review.

BACKGROUND & OBJECTIVE: Gynecological malignancies are important cause of female morbidity and mortality. They pose significant burden on health resources in low middle-income countries. Data on presentation and risk factors can help in early identification and reduce this burden. Our objective was to evaluate frequency, stage of presentation and risk factors of gynecological malignancies in a tertiary care setting. METHODS: It was cross sectional study done in Gynecology Department, Services Institute of Medical Sciences, Services Hospital, Lahore from January 2015- December 2019. The records of the patients were retrospectively reviewed to include all cases of gynecologic malignancies. Demographic information, frequency, risk factors, symptoms, grade and stage of tumor was collected. RESULTS: There were 122 patients diagnosed with gynecological malignancy during the study period. Ovarian cancer was seen in 60 (49.18%) patients followed by cervical cancer in 29(23.7%), endometrial cancer 27(22.1%) and vulva 06(4.9%). Mean age for all cancers was 51±12.7 to 55±9.3 except cervical cancer which was seen in 43±8.9 years. Patients with ovarian cancer had significantly more hypertension and diabetes (p<0.05). Heavy menstrual bleeding and postmenopausal bleeding was significantly seen in patients of endometrial and cervical cancer (p<0.05). Abdominal symptoms of pain, mass and distension were seen in patients with ovarian cancer (p<0.05). Majority patients presented in advanced stage. Among ovarian cancer, 52/60(86.6%) were epithelial in origin while 25(86.2%) cervical cancer and all vulva cancers were squamous cell carcinoma. CONCLUSION: Ovarian cancer was commonest gynecological malignancy followed by cervical cancer. Late presentation with advanced stage was seen in majority of all cancers.