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An observational study was performed at Purba Medinipur District Hospital, West Bengal, from April 1, 2018, to December 31, 2020, with an aim to find out the magnitude of maternal mortality and near miss cases and to assess the utilization of available maternal health care services by the deceased women and near miss cases. Result showed 4.5% women developed potentially life-threatening condition (PLTC) of which 21% women developed LTC. Maternal Near Miss (MNM) ratio was 9.46/1000 live birth and the MNM-to-Maternal Mortality ratio was 8.3:1 and the leading causes of MNM and maternal death were hemorrhage, pregnancy induced hypertension/eclampsia. The utilization of maternal health-care services revealed that there is a scope to increase the service delivery. Study finding indicates that health-care programs need to enhance the existing efforts to improve timely health seeking behavior of women.An observational study was performed at Purba Medinipur District Hospital, West Bengal, from April 1, 2018, to December 31, 2020, with an aim to find out the magnitude of maternal mortality and near miss cases and to assess the utilization of available maternal health care services by the deceased women and near miss cases. Result showed 4.5% women developed potentially life-threatening condition (PLTC) of which 21% women developed LTC. Maternal Near Miss (MNM) ratio was 9.46/1000 live birth and the MNM-to-Maternal Mortality ratio was 8.3:1 and the leading causes of MNM and maternal death were hemorrhage, pregnancy induced hypertension/eclampsia. The utilization of maternal health-care services revealed that there is a scope to increase the service delivery. Study finding indicates that health-care programs need to enhance the existing efforts to improve timely health seeking behavior of women.

ObjectivesTo study maternal heart disease in an Indian setting for: (1) different etiological factors, (2) different types of lesions, and (3) maternal and perinatal outcome.Methods281 women with heart disease who delivered ≥28 weeks of gestation at different teaching institutions (tertiary care centres) in India were studied.ResultsRheumatic heart disease (n = 195; 69.4 %) with isolated mitral stenosis (n = 75; 26.7 %) were the commonest. Septal defect (n = 27; 9.6 %) was the predominant lesion among the congenital heart disease (n = 60; 21.3 %) patients, whereas in the miscellaneous group (n = 26; 9.2 %), ischemic heart disease (n = 10; 3.6 %) was the leading cause. Multiple cardiac lesions were also diagnosed in 100 (35.58 %) women. In 87 (31 %) women, diagnosis was made first time in labor. Majority n = 131, (46.6 %) had spontaneous vaginal delivery and few (n = 9; 3.3 %) required induction of labor. Cardiac complications were noted in 72 women (25.6 %). There were three (1.06 %) maternal deaths and perinatal mortality was 4 % (n = 11).ConclusionIn this study, rheumatic heart disease in pregnancy is still predominant though acquired cardiac lesions are rising. In rheumatic heart disease, mitral valve involvement was the commonest and multiple valve lesions were a major observation. Most common obstetric complication was small for gestation baby. Maternal morbidities in the unbooked women are high and congestive cardiac failure was the major cardiac complication.

Background The aim of this study is to investigate whether planned caesarean delivery compared to planned induction of labour in women with severe pre-eclampsia at gestational age of more than 37 weeks of pregnancy will reduce maternal morbidity and/or perinatal morbidity. Method This randomized controlled study was conducted from April 2021 to March 2022 at Department of Obstetrics and Gynecology of Midnapore Medical College, West Bengal. Data were analysed with respect to socio demographic status, clinical presentation, complications and their management. Result One hundred and seventy-six women with severe pre-eclampsia were screened for eligibility, and 140 were included in the study. In 58.6% patients, the induction was successful. Type of delivery was successful in vaginal 37 (90.2%) and instrumental (ventouse and forceps) in four (19.8%) of the cases. In induction group, the most common reason for LSCS was MSL with foetal bradycardia. Foetal distress was seen in 22.90% of induction group, while absent in LSCS group. Conclusion In our study, we found that there was no differences in the primary maternal outcome and the secondary maternal outcome between the two groups. The primary neonatal outcome was significantly poor in induction group, whereas good in LSCS group. So LSCS is better option in patients with severe pre-eclampsia at term. Key words—Severe Pre-eclampsia, Induction of labour.

ObjectivesTo test the application of a clinical definition of life-threatening complications in pregnancy and determine the level of near miss maternal morbidity and mortality.Methods A prospective observational study was conducted in the obstetrics and gynaecology department, NRS Medical College, Kolkata, India, to identify life-threatening complications using a modification of the Mantel’s criteria. The main outcome measures were validity of identification criteria, main causes and incidence of life-threatening complications in pregnancy, maternal near miss: case fatality rates, morbidity–mortality index and use rate of effective interventions.ResultsIn total, 177 maternal near miss and 23 maternal deaths were identified in the screened 4400 women. The incidence of near miss was 4.02%. Main causes of maternal mortality were hypertensive disorders (43%) and renal failure (21%). Main causes of near miss were hypertensive disorders (55%), ectopic pregnancy (19%). Near miss mortality index was 7.7:1.ConclusionsA high proportion of women with life-threatening complications and all women who died were referred from peripheral hospitals. This signals that there may have been important failures in the referral system relating to maternal care and there is a need for further investigation.

The aim of the study was to estimate the prevalence of maternal near miss (MNM) and maternal death and to identify the factors associated with severe maternal outcome in women with eclampsia according to the World Health Organization (WHO) maternal near-miss criteria. A cross-sectional study was carried out over a period of 12 months incorporating pregnant women diagnosed as eclampsia during antepartum and postpartum period. The definition of maternal near miss was applied according to the WHO near-miss criteria. Data were collected in a case record form specially designed for the study and analyzed using statistical software. A total of 229 women with eclampsia included in the study over a period of 1 year. Among 229 women with eclampsia, 75 (32.75%) women diagnosed as maternal near miss (MNM), and 6 (2.62%) women had maternal death. Causes of near miss were neurological dysfunction (30.66%), respiratory dysfunction (24%), hematological dysfunction (18.67%), cardiological dysfunction (16%), hepatic dysfunction (10.67%) and uterine dysfunction (5.33%). Maternal near-miss ratio is 4.91 per 1000 live births, and severe maternal outcome ratio is 5.30 per 1000 live birth. Maternal near-miss mortality ratio (MNM:1MD) is 12.5:1, and mortality index is 7.40. The study shows that there is scope to improve antenatal care and utilization of health facilities. Early diagnosis, good perinatal supervision and appropriate treatment can ameliorate many cases.

Objective The aim of the study was to estimate the prevalence of maternal near miss (MNM) and maternal death and to identify the factors associated with severe maternal outcome in women with eclampsia according to the World Health Organization (WHO) maternal near-miss criteria. Method A cross-sectional study was carried out over a period of 12 months incorporating pregnant women diagnosed as eclampsia during antepartum and postpartum period. The definition of maternal near miss was applied according to the WHO near-miss criteria. Data were collected in a case record form specially designed for the study and analyzed using statistical software. Result A total of 229 women with eclampsia included in the study over a period of 1 year. Among 229 women with eclampsia, 75 (32.75%) women diagnosed as maternal near miss (MNM), and 6 (2.62%) women had maternal death. Causes of near miss were neurological dysfunction (30.66%), respiratory dysfunction (24%), hematological dysfunction (18.67%), cardiological dysfunction (16%), hepatic dysfunction (10.67%) and uterine dysfunction (5.33%). Maternal near-miss ratio is 4.91 per 1000 live births, and severe maternal outcome ratio is 5.30 per 1000 live birth. Maternal near-miss mortality ratio (MNM:1MD) is 12.5:1, and mortality index is 7.40. Conclusion The study shows that there is scope to improve antenatal care and utilization of health facilities. Early diagnosis, good perinatal supervision and appropriate treatment can ameliorate many cases.

The aim of this study is to investigate whether planned caesarean delivery compared to planned induction of labour in women with severe pre-eclampsia at gestational age of more than 37 weeks of pregnancy will reduce maternal morbidity and/or perinatal morbidity. This randomized controlled study was conducted from April 2021 to March 2022 at Department of Obstetrics and Gynecology of Midnapore Medical College, West Bengal. Data were analysed with respect to socio demographic status, clinical presentation, complications and their management. One hundred and seventy-six women with severe pre-eclampsia were screened for eligibility, and 140 were included in the study. In 58.6% patients, the induction was successful. Type of delivery was successful in vaginal 37 (90.2%) and instrumental (ventouse and forceps) in four (19.8%) of the cases. In induction group, the most common reason for LSCS was MSL with foetal bradycardia. Foetal distress was seen in 22.90% of induction group, while absent in LSCS group. In our study, we found that there was no differences in the primary maternal outcome and the secondary maternal outcome between the two groups. The primary neonatal outcome was significantly poor in induction group, whereas good in LSCS group. So LSCS is better option in patients with severe pre-eclampsia at term. Key words-Severe Pre-eclampsia, Induction of labour.

ObjectiveThe route of termination of pregnancy in eclampsia is not clearly established. This study aims to compare the fetomaternal outcome between planned vaginal delivery and planned cesarean section in women with eclampsia after 34 weeks of gestation.MethodsThis prospective observational study was conducted in the department of Obstetrics and Gynecology, Midnapore Medical College, West Bengal, India. 182 women with eclampsia carrying 34 weeks or more gestation were allocated to either cesarean(CD) or vaginal delivery (VD) group. The primary measure of outcome was severe maternal outcome. Secondary measures of outcome were perinatal mortality and morbidity.ResultsOf the 62 women allocated in vaginal delivery (VD) group, 60 women (32.97%) had vaginal delivery and 122 (67.03%) had undergone cesarean delivery (CD). Severe maternal outcome was more common in VD group in comparison with CD group (72.5% vs 27.5%, P < 0.00001 RR 2.64 OR 6.98). Perinatal outcome in relation to Apgar score at 5 min, still birth was better in CD group than VD group. Perinatal death was higher in VD group when compared with CD group (25.8%; vs. 8.33%; P = 0.002, RR 3.1 OR 3.83)ConclusionThere is increasing trend of delivering the eclampsia mother at > 34 weeks of gestation by cesarean section instead of inducing labor and delivering vaginally. Cesarean section when chosen as method of delivery does not increase morbidity or mortality.