Abortion at Gondar College Hospital, Ethiopia.

OBJECTIVE: To review the pattern and magnitude of abortion in order to establish baseline facts and data for future studies. DESIGN: A descriptive cross-sectional study. SETTING: Gondar College of Medical Sciences Hospital, Gondar, Ethiopia. RESULTS: Most of the subjects originated from the Gondar city and were married housewives, parous and relatively young. The abortion rate and ratio per 100 pregnancies and deliveries were 11.5 and 16.4, respectively. Only 13.4% of the patients admitted history of interference with the pregnancy. Previous history of abortion was obtained in 10.6% of the patients. The mean gestational ages for septic and non-septic cases were 14.6 and 15.2 weeks, respectively even though pregnancies less than 12 weeks from the last normal menstrual period accounted for 50.5%. The commonly diagnosed clinical type was incomplete, followed by inevitable and threatened abortion. The vast majority of the clinical conditions were non-septic (85.1 %) and spontaneous(85.6 %). The most common complications registered were anaemia, genital tract infection, shock of various causes and soft tissue injury. Four mothers died of abortion-related complications. The mean hospital stays for non-septic and septic abortion were three and five days, respectively. CONCLUSION: The study has attempted to address the issue of abortion in its general clinical pattern in relation to the various parameters. Being comprehensive, it also provides awareness and sensitivity on the magnitude of abortion and is assumed quite helpful for policy and decision makers.

Group B streptococcal meningitis complicating elective abortion: report of 2 cases.

The incidence of invasive disease due to Streptococcus agalactiae (group B streptococcus [GBS]) in adults is on the rise; however, meningitis in adults due to GBS remains rare. We report 2 cases of GBS meningitis complicating elective abortion, 1 of which was a septic incomplete abortion. Only 1 case of bacterial meningitis complicating elective abortion has been reported previously.

Acute renal failure in Central Anatolia.

BACKGROUND: The aetiological spectrum of acute renal failure (ARF) has changed in developed countries. It was the purpose of the study to evaluate whether similar changes have occurred in this part of the world as well. METHODS: In a prospective study a total of 439 patients with ARF were evaluated. They had been admitted to one hospital during two successive periods, i.e. 1983-1990 and 1991-1997. RESULTS: Of 439 patients with ARF, 116 were admitted in 1983-1990 (first period) and 323 in 1991-1997 (second period). The age of presentation increased from 49.8+/-6.2 years in the first period to 58.8+/-16.4 years in the second. Medical causes were present in 259 cases (59%), surgical causes in 110 cases (25%), and obstetric causes in 70 cases (16%). The frequency of surgical cases decreased from 28.4% in the first period to 23.8% in the second period. The respective figures for obstetric cases were 18.9% and 14.8%. Mortality did not change with time (33.6% in the first and 31.0% in the second period); the overall mortality was 31.7%. The mortality was higher for surgical (45.5%) than for obstetric (27.8%) and medical ARF (24.3%). CONCLUSION: In the mid-1970s, the most common causes of ARF in Turkey were obstetric complications and septic abortion. The aetiological spectrum of ARF has changed and today medical causes predominate. ARF resulting from septic abortion has become rare, possibly because of liberalization of abortion in 1983 in Turkey.

Aborto séptico, Hospital "Dr. Adolfo Prince Lara" 1985-1996 / Septic abortion Hospital \"Dr. Adolfo Prince Lara\" 1985-1996

Conocer la incidencia del aborto séptico y características de la embarazada por la íntima dependencia entre los factores sépticos y morbimortalidad materna. Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo, Venezuela. Estudio retrospectivo, descriptivo de 10157 abortos de los cuales 427 fueron sépticos en el período 1985-1996. El aborto tuvo una incidencia global de 16,17 por ciento; el aborto séptico 4,2 por ciento con rangos de 12,37 por ciento (1988) y 1,85 por ciento (1994), hay tendencia a cifras menores en los últimos 5 años. Predominaron pacientes residentes en barrios (56,67 por ciento), concubinas (67,45 por ciento), menores de 30 años (68,86 por ciento), con gestaciones entre II-V (63,7 por ciento), edad gestacional menor de 13 semanas (57,61 por ciento), antecedentes de maniobra abortiva (1,87 por ciento). El diagnóstico fue principalmente por clínica y laboratorio (69,09 por ciento), grado séptico I (92,51 por ciento), tratadas con antibióticos y curetaje (75,37 por ciento), Hospitalizadas de dos a tres días (57,85 por ciento), la mayor morbilidad fue anemia (5,85 por ciento). Hubo dos muertes maternas (1989-1990). Uno de cuatro abortos fue séptico revelándose factores sociales. Todo obliga a programas de apoyo y orientación familiar, adecuada atención médica para evitar secuelas de morbimortalidad materna

[Surfactant administration and laterally independent positive pressure ventilation in acute lung failure and atelectasis after septic abortion. Case report]. / Surfactantgabe und seitengetrennte Uberdruckbeatmung bei akutem Lungenversage und Atelektase nach septischem Abort. Kasuistik.

We report the case of a 35 years old female patient suffering from Staphylococcus aureus induced abortion in the 7th/8th week of gestation. Sepsis with acute respiratory failure (ARDS) developed, which could be treated successfully. Pneumonia, caused by Pseudomonas aeruginosa, induced a recurrence of ARDS, complicated by a persistent incomplete atelectasis of the left lung. Independent ventilation of both lungs with increased pressure on the left side combined with bronchoscopy guided instillation of 1 g of bovine surfactant (Alveofact), caused improvement of arterial oxygenation and radiological signs, signalling airation of collapsed lung areas.

Histerectomía obstétrica (1984-1995) / Obstetrical hysterectomy (1984-1995)

Objetivo. Conocer la incidencia, factores relacionados y repercusiones de la histerectomía obstétrica. Método. Estudio retrospectivo, descriptivo de 60 histerectomías realizadas entre 1984 y 1995, en 52817 casos obstétricos. Ambiente. Hospital Dr."Adolfo Prince Lara", Puerto Cabello Edo. Carabobo. Resultados. La frecuencia fue de 0,10 por ciento o de 1x880. La edad materna varió entre menos de 19 años y más de 40; hubo 11 a 19 o menos años (18,33 por ciento); Doce eran primigestas y 11 grandes multiparas. La principal indicación fue la sepsis, con 26 casos (12 posaborto, 9 poscesárea y 5 posparto), seguida por la atonía uterina, 21 casos, y la rotura o dehiscencia de la cicatriz, 12. Como complicaciones figuraron: anemia (75 por ciento), infecciones de la herida (13,33 por ciento) y 6 muertes maternas(10 por ciento). Conclusión. Se necesita estrategia de ataque séptico y mejora de las condiciones de asepsia y antisepsia del acto obstétrico

Renal cortical necrosis in pregnancy-related acute renal failure.

Of 63 patients of obstetrical acute renal failure, 15 cases (23.8%) had biopsy proven bilateral renal cortical necrosis. Remaining 48 patients (76.2%) had acute tubular necrosis. Eight of 39 cases in early pregnancy had cortical necrosis (postabortum) and 7 of 24 patients in late pregnancy revealed cortical necrosis. Diffuse and patchy cortical necroses were seen in 12 and 3 patients respectively. The incidence of cortical necrosis was almost equal in both early as well as late pregnancies. The high incidence (20.5%) of cortical necrosis following septic abortion remains the interesting feature of the present study in contrast to very low incidence (1.5%) of cortical necrosis in postabortum group in developed countries. The death occurred in most patients (14 ie, 93.3%) of cortical necrosis because of uraemic complications and sepsis.

Fluconazole in Candida albicans sepsis during pregnancy: case report and review of the literature.

Candida sepsis during pregnancy is a rare but life-threatening complication of infection with Candida albicans. In contrast to the situation with other antimicrobial agents, there exists only limited experience with systemic antifungal therapy during pregnancy. A recent report focuses on amphotericin B treatment in systemic fungal infection during pregnancy. The present report discusses a pregnant patient with Candida albicans sepsis and endophthalmitis as well as candida infection of the oral and genital mucous membranes, after hyperalimentation and broad spectrum antibiotic therapy via a central venous catheter. The patient was treated with 10 mg/kg fluconazole from week 16 of gestation for a total duration of 50 days. Adverse effects did not occur and the rest of the pregnancy proceeded favourably for both the mother and the baby.

Acute renal failure in pregnancy in South Africa.

This study compares our experiences of the incidence and etiology of acute renal failure in pregnancy (ARF-P) in patients requiring hemodialysis, a decade after a previous publication from our institution. A retrospective analysis of the hospital records of 42 patients with a diagnosis of ARF-P during a 3-year period from 1990 to 1992 was undertaken [16% of the total number of acute renal failure (ARF) patients needing hemodialysis]. The incidence of ARF-P (expressed relative to all cases of acute renal failure requiring hemodialysis) decreased from 24.6% (1978) to 16% (1992: p = 0.03). Preeclampsia-eclampsia (PE:E) replaced septic abortion as the principal cause of ARF-P. In those patients with PE:E, thrombocytopenia (platelet count < 150 x 10(9)/L) occurred in all, while 33% developed the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Ingestion of herbal toxins was noted mostly in patients with septic abortion. Maternal mortality was 5% and was due to multiorgan failure complicating septic abortion. The perinatal mortality of 55% occurred in women with early gestation, thrombocytopenia, and high serum creatinine levels. Acute renal failure in pregnancy continues to present a challenge in South Africa, a developing country. There were significantly more obstetric than gynecological causes in 1992 (p = 0.0003). This could be attributed to the steady decline in septic abortion since 1978. The main contributor to obstetric-related causes was PE:E. Greater emphasis should therefore be placed on detecting hypertension at antenatal visits.(ABSTRACT TRUNCATED AT 250 WORDS)

Maternal mortality and morbidity associated with clandestine abortions.

PIP: During 1992, 53 women were admitted to Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital in New Delhi, India, for septic induced abortion and 1855 were admitted for medical termination of pregnancy (MTP). Most septic induced abortion cases lived in semi-urban/urban slums (64.15%), were Hindus (98.11%) and married (94.34%), and had a parity of less than 2 (56.6%). The leading reason for abortion was unwanted pregnancy among septic abortion cases (81%) and contraceptive failure among MTP cases (98.3%). No septic abortion case had used contraception. Among septic abortion cases, termination methods included instrumentation by untrained midwives (62%), foreign body insertion (7.5%), and dilatation and curettage or suction by unqualified personnel (7.5%). About 33% of septic abortion cases presented with generalized peritonitis, septicemia, septic shock, acute renal failure, or disseminated intravascular coagulation (DIC). All septic abortion cases had pelvic inflammatory disease compared to 3.55% among MTP cases. 94.35% had anemia. About 34% needed a blood transfusion compared to 0.16% among MTP cases. MTP cases were significantly less likely to suffer uterine perforation than septic abortion cases. None of the MTP cases had septicemia. The need for laparotomy was more common among septic abortion cases than MTP cases (26.4% vs. 0.43%). A hospital stay of more than one week was also more common (72% vs. 0.43%). On discharge, MTP cases were more likely to be in satisfactory condition than septic abortion cases (100% vs. 75.7%). No one in the MTP group died, while 13.2% died in the septic abortion group. The causes of death were septic shock (7 cases), hepato-renal failure (2 cases), and DIC (1 case). The abortion ratio was 312/1000 births. The abortion mortality ratio was 1.7/1000 abortions. Illegally induced abortions were responsible for 20% of all maternal deaths at this institution in 1992. These findings suggest that family planning education, contraceptive use, and safe pregnancy termination facilities would prevent abortion-related morbidity and mortality.^ieng

Mortalidad por aborto séptico en el Hospital Nacional Cayetano Heredia 1985-1992 / Mortality due to septic abortion at the Hospital Nacional Cayetano Heredia

Estudio retrospectivo, transversal, clínico, epidemiológico, tipo caso control de 24 muertes por aborto séptico, comparadas con 72 controles escogidas mediante un muestreo sistemático de la población que no falleció. La tasa de mortalidad por aborto séptico para el período 1985-1992 fué de 67.3 por 100,000 nv., la más alta se obtuvo para 1991 con 176.6. El 42 por ciento de ingresos a Ginecología fue por aborto, siendo el 8 por ciento séptico. Los factores de riesgo para mortalidad fueron 5 ó más gestaciones (OR=1.7), edad gestacional mayor de 16 semanas (OR=5.0), tiempo de maniobras abortivas mayor de 5 días (OR=1.7), shock séptico (OR=8.5), anemia (OR=3.4), insuficiencia renal aguda (OR=17.0), perforación uterina (OR=5.5), coagulación intrasvascular diseminada (OR=60.0), tromboflebitis pélvica (OR=10.2), falla multiorgánica (OR=6.5) y pulmón de shock (OR=6.5). Los síntomas y signos con diferencia significativa fueron secreción maloliente, ictericia, petequias, disnea y mialgia. Para tratamiento médico encontramos transfusión, plasma, cardiotónicos y anticoagulantes, siendo para el quirúrgico histerectomía abdomInal total más salpingooforectomía bilateral. Las principales causas de muerte fueron shock séptico, insuficiencia renal aguda, falla multiorgánica, coagulación intravascular diseminada y tromboembolia pulmonar

Postabortal sepsis.

A review of postabortal sepsis following a 2-year study undertaken at the Department of Obstetrics and Gynaecology, SSG Hospital, Baroda is presented here with a view to know the incidence of postabortal sepsis and septic induced abortions and to re-evaluate the effectiveness of the MTP services in reducing its impact on maternal morbidity and mortality, since the implementation of the MTP Act in 1972. It has been observed that postabortal sepsis is a major cause of maternal mortality even now and MCH service is to be improved to reduce the same.

Acute renal failure in Addis Abeba, Ethiopia: a prospective study of 136 patients.

The causes and clinical course of 136 cases of acute renal failure (ARF) consecutively treated in the Renal Unit of Tikur Anbessa Hospital, Addis Abeba, Ethiopia, between January 1989 and December 1992 are described. There were 106 women and 30 men with mean age of 26.9 +/- 7.2 and 40.7 +/- 14.9 years respectively. Septic abortion is still the leading cause of ARF (71 patients) followed by falciparum malaria (29 patients) and nephrotoxic agents (12 patients). One-hundred-seventeen patients (86%) required dialysis. The overall case fatality rate was 33.8%, with similar mortality rates in septic abortion (36.6%) and falciparum malaria infection (37.9%), but a much lower rate (16.7%) in acute renal failure secondary to nephrotoxic agents. Septicaemia and pneumonia were leading causes of death. Derangement of liver function was associated with higher mortality rates in patients with septic abortion and malaria, whereas leukocytosis was found to be a poor prognostic finding in the latter. Non-oliguric ARF was seen in 33.8% of cases and was found commonly in patients with malaria (75.9%) or in nephrotoxin-induced ARF (83.8%). Mean duration of oliguria was 18.9 +/- 11 days. Compared to the previous report from the same centre, this larger series identified important clinical settings other than septic abortion which predispose to ARF. As renal function tests are not performed routinely in many Ethiopian hospitals and as many patients have non-oliguric ARF, cases may be being missed. Measures to prevent septic abortion and malaria, and the judicious use of nephrotoxic agents, may decrease the incidence of ARF.

Aportes de la imagenología en el diagnóstico precoz del síndrome de Mondor / Diagnostic imaging of Mondr's syndrome

En el presente trabajo los autores muestran la experiencia con la imagenología, fundamentalmente con el ultrasonido, a propósito de dos casos de pacientes con síndrome de Mondor secundario a aborto séptico provocado. Se presentan los cuadros clínicos y la evolución de los pacientes que difieren notablemente en relación a la precocidad de la consulta y su diagnóstico, ante igual tratamiento clínico-quirúrgico. Los hallazgos en ecografía tanto a nivel uterino como renal, son inespecíficos, pero ante la sintomatología y el reconocimiento de la paciente del acto abortivo efectuado, el diagnóstico de certeza no presenta dificultades. Se examinaron a ambas pacientes con ultrasonido y una de ellas con tomografía axilar computada, describiéndose asimismo los hallazgos anátomo-patológicos macroscópicos en las mismas

Aportes de la imagenología en el diagnóstico precoz del síndrome de Mondor / Diagnostic imaging of Mondrs syndrome

En el presente trabajo los autores muestran la experiencia con la imagenología, fundamentalmente con el ultrasonido, a propósito de dos casos de pacientes con síndrome de Mondor secundario a aborto séptico provocado. Se presentan los cuadros clínicos y la evolución de los pacientes que difieren notablemente en relación a la precocidad de la consulta y su diagnóstico, ante igual tratamiento clínico-quirúrgico. Los hallazgos en ecografía tanto a nivel uterino como renal, son inespecíficos, pero ante la sintomatología y el reconocimiento de la paciente del acto abortivo efectuado, el diagnóstico de certeza no presenta dificultades. Se examinaron a ambas pacientes con ultrasonido y una de ellas con tomografía axilar computada, describiéndose asimismo los hallazgos anátomo-patológicos macroscópicos en las mismas(AU)

A study of 500 cases of acute renal failure (1978-1991).

A retrospective study of 500 consecutive cases of acute renal failure (ARF) in a period covering 1978 through 1991 is presented. A total of 316 females and 182 males with an average age of 46.4 years (14 to 84) had a global survival rate of 68%. Oligoanuric ARF was present in 77% of the patients and, except in 13 cases, all were dialyzed with varied techniques. The treatment plan consisted of early and repetitive dialysis, rational use of antibiotics, and parenteral and/or oral nutritional support. The patients have been divided into three main categories according to etiology: gyneco-obstetric, medical, and postsurgical cases, the latter having the poorest survival rate. With regard to ARF post-septic abortion, we strongly believe that a hysterectomy should not be carried out except in the presence of gangrene or proven uterine perforation, as surgery increases the morbomortality rate in these septic patients.