Systematic review on the incidence and prevalence of severe maternal morbidity.

OBJECTIVE: To summarize the prevalence and the incidence of serious morbidity from studies reporting data on severe maternal morbidity and to compare study designs and definitions. METHODS: A literature search was used to identify relevant studies, which report data on prevalence/incidence of severe complications during pregnancy, delivery and postpartum. For assessment of the quality of studies a structured data collection form from World Health Organization for systematic review of maternal mortality and morbidity was used. Incidence/prevalence and case-fatality ratios were extracted. RESULTS: In this review 24 studies were included, most of them--cross-sectional hospital based (16/24). In ten studies data about one severe maternal condition (admissions to intensive care unit, and hysterectomy) was presented, while fourteen studies dealt with multiple causes of severe maternal morbidity (rupture of uterus, hemorrhage, sepsis, and hypertensive disorders of pregnancy). In these studies very different inclusion criteria due to structure of diseases and severity were used. CONCLUSIONS: The prevalence of severe maternal morbidity ranged from 0.07-8.23% and the case-fatality ratio from 0.02-37%. Studies estimating the incidence of severe maternal morbidity have used different definitions and ways of identification. Severe hemorrhage, sepsis and hypertensive disorders of pregnancy are the commonly used "near-miss" conditions. Further work will be able to create clear definition and method of identification.

Prevalence of activated protein C resistance among women with recurrent miscarriage.

UNLABELLED: Since 1996 activated protein C resistance is closely associated with various obstetric pathologies. The most widely discussed is that of secondary infertility due to recurrent miscarriage. However, there is still widespread discussion about the role of activated protein C resistance in this and other obstetric pathologies. AIM: To investigate whether the activated protein C resistance is a cause of early recurrent miscarriage. MATERIAL AND METHODS: A study was designed as a case-control study. Two study groups were formed. Group I included women who have experienced 2 or more miscarriages (61 patients), and Group II included women who have experienced 3 or more miscarriages (33 patients). We investigated the prevalence and compared it in the control and both study groups. RESULTS: In Group I activated protein C resistance was found for 8 patients (14.7%), in Group II--for 5 patients (16.5%), in the control group--in 4 cases (5%). By comparing different groups the prevalence of activated protein C resistance in Group I was statistically significantly higher than in the control group (p<0.05). The prevalence of activated protein C resistance in Group II and the control group as well as between both study groups was statistically non-significant (p>0.05). CONCLUSION: Activated protein C resistance might be a factor behind spontaneous recurrent miscarriage. There was no statistically significant difference between women who had suffered from 2 or 3 spontaneous abortions.