ABSTRACT
Background: Disseminated intravascular coagulation (DIC) is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy, DIC is a common contributor to maternal morbidity and mortality and is associated with up to 25% of maternal deaths.Aim of the study: To determine the risk factors associated with the development of disseminated intravascular coagulation (DIC) in obstetrical cases.Material & Methods:This descriptive type of study was carried out in the Department of Obstetrics and Gynecology of Janaki Medical College Teaching Hospital, RamdaiyaBhawadi, Janakpurdham, Nepal from January 2016 to December 2021. A total of 500 pregnant women complicated with DIC admitted for termination of pregnancy were included in this study. History and clinical examination were completed. The adverse obstetrical event that causes DIC is identified from clinical diagnosis and relevant investigations. Statistical analysis of the results was obtained by using windows computer software with Statistical Packages for Social Sciences (SPSS-version 26).Results:More than half (58.0%) of the patients did not receive any antenatal checkup. Regarding the risk factors for the development of DIC; abruptio placenta was associated with 185(37.0%) cases followed by PPH 147(29.4%) and preeclampsia and eclampsia 119(23.8%). Patients with risk factors of DIC were hypertension 360(72.0%), Antepartum heamorrhage 227(45.4%) and PPH 193(38.6%) these are the most common presenting features. More than two-thirds of the patients (68.0%) had spontaneous vaginal delivery. Almost two-thirds (64.0%) of patients stayed in the hospital for 8-14 days. Maternal death was found in 60(12.0%) cases and perinatal death in 121(24.2%) cases.Conclusion:Maternal and perinatal mortality in patients with DIC were 12.0% and 24.0% respectively. The major determinant of survival is prompt identification of the underlying trigger, elimination of the cause and appropriate management.
ABSTRACT
Introduction: Provision of contraceptive methods is an integralpart of standard postabortion care. Contraception is aneffective method for averting maternal mortality and morbidityby reducing the number of high risk pregnancies. Unwantedpregnancies leading to unsafe abortions can be prevented byeffective use of various methods of contraception. Postabortionperiod is an important time to counsel a woman and herpartner to accept a method of contraception. Various factorsinfluence the decision of a woman to choose or accept anycontraceptive. Identification of these factors can help indevising better counselling techniques.Materials and Methods: A cross- sectional observationalstudy analysis was conducted in Janaki Medical CollegeTeaching Hospital and Mithila Hospital Private Limited,Janakpur, Nepal from January, 2018 to January, 2019.Permission was granted by the hospital board to conduct thestudy. Data of 300 women who availed comprehensiveabortion care services were included in the study. Writtenconsent was obtained from all the participants. A pre designedquestionnaire was used to collect the data.Results: Literacy, spouse’s job location, Knowledge about thesafety and effectiveness of a particular method, previous use ofcontraception, presence of a living male child, desire to havea child sooner and rural background were found to impact thedecision of a woman counseled for postabortion contraception.Conclusion: Many factors influence postabortioncontraception choice. These factors are related to theeducation, need felt for a child; especially a male child,previous exposure to the contraception and place of livingalong with other factors. Identification of the factors thatinfluence the choice of contraception among woman of aparticular region or a particular group can help in devisingbetter counselling techniques.