Implementation of WHO Near-Miss Approach for Maternal Health at a Tertiary Care Hospital: An Audit.

OBJECTIVE: The objective of this study was to evaluate severe maternal outcomes (including maternal deaths and maternal near-miss cases). MATERIALS & METHODS: A prospective study of severe maternal outcomes (including maternal deaths and maternal near-miss cases) from May 2012 to April 2013 was performed. For each woman, data were collected on the occurrence of selected severe pregnancy-related complications, the use of critical interventions, and admissions to intensive care unit. RESULTS: The total number of deliveries were 2340. The number of maternal deaths was three. The natures of the near-miss cases during the study period were recorded. Prevalence of SAMM (severe acute maternal morbidity) was 2.025 %. CONCLUSION: In areas where the maternal mortality is low, there is a need to shift focus to maternal near-miss cases or SAMM, which is a useful adjunct to maternal death enquiries.

Chorioangioma of placenta: a rare placental cause for adverse fetal outcome.

Chorioangioma is a benign angioma of placenta arising from chorionic tissue. Large chorioangioma has unfavourable effects on both mother and fetus. We describe a case with large chorioangioma that had a poor outcome on the fetus. We also reviewed the literature on prognostic factors affecting fetal outcome.

Anthropometric measurements as predictors of cephalopelvic disproportion: Can the diagnostic accuracy be improved?

OBJECTIVE: We assessed the efficacy of maternal anthropometric measurements and clinical estimates of fetal weight in isolation and in combination as predictors of cephalopelvic disproportion (CPD). DESIGN: Prospective cohort study. SETTING: Tertiary care teaching hospital, two affiliated hospitals with facilities for conducting cesarean delivery and seven affiliated primary care facilities with no operation theaters. SAMPLE: Primigravidae over 37 weeks' gestation attending these facilities during a 20-month period with a singleton pregnancy in vertex presentation. METHODS: Several anthropometric measurements were taken in 249 primigravidae. Fetal weight was estimated. Differences in these measurements between the vaginal delivery and CPD groups were analyzed. The validity of these measurements in predicting CPD was analyzed by plotting receiver operating characteristic curves and by logistic regression analysis. MAIN OUTCOME MEASURE: Mode of delivery. RESULTS: Maternal height, foot size, inter-trochanteric diameter and bis-acromial diameter showed the highest positive predictive values for CPD. Combining some maternal measurements with estimates of fetal weight increased predictive values modestly, which are likely to be greater if the estimates of fetal weight are close to the actual birth weight. Based on multivariate analysis the risk factors for CPD in our population were foot length ≤23cm, inter-trochanteric diameter ≤30cm and estimated fetal weight ≥3 000g. CONCLUSIONS: Maternal anthropometric measurements can predict CPD to some extent. Combining maternal measurements with clinical estimates of fetal weight only enhances the predictive value to a relatively modest degree (positive predictive value 24%).