- Email: [email protected]
P3.11.24 Puerperal psychosis: Sociodemographic characteristics, obstetric events and disease pattern
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target is 50,000), because 65.3% of deliveries in the rural area were helped by Traditional Birth Attendants (TBAs). Training TBAs by village midwives and coordinating with administering department came to be one of the six basic elements of safe motherhood in Indonesia. The present economic crisis is predictable as holding back efforts towards safe motherhood and the programs to cut the MMR. An increase in family planning program drop out (example in DKI Jakarta province is almost 30% and in Kutai regency in east of Kalimantan province is 8.92% in 1998) will cause a “baby boom” and greater MMR in the future, particularly, deaths due to direct obstetrical causes and abortion. The economic crisis also causes use of untrained TBAs, rising risks and causing a predictable increase in MMR.
P3.11.24 PUERPERAL PSYCHOSIS: SOCIODEMOGRAPHIC CHARACTERISTICS, OBSTETRIC EVENTS AND DISEASE PATTERN M. Mtawali, Dept. OBIGYN, Muhimbili University College of Health Science, Tanzania Objectives: To determine sociodemographic characteristics, obstetric events and disease pattern among women with puerperal psychosis. Study Methods: Sixty-seven women with puerperal psychosis were included in this Descriptive Hospital Based Study conducted between March and December 1998. Information was obtained using a structured questionnaire, physical and mental status evaluation with selected Laboratory Investigations such as Hemoglobin, Blood Slide for malaria parasite, endocervical swab for microbiological studies and ELISA test for HIV Antibodies. Data was entered and analyzed using EPI Info computer program number 6.4 May 1996 version. Results: Majority 95.8% of the women were primipara, married 44.8% with age less than 2 years (76%). Most of them were housewives and had attained primary level of education. Among those who were married, 59% received support from the partners but only 27% of them got satisfied. Majority had labored between 12 and 24 hours with spontaneous vertex delivery and a near birth weight of 3.4kgs. Most of the babies born were healthy. The commonest organic symptoms were headache, body weakness and abnormal vaginal discharge while the psychotic symptoms were affective in nature, 19% of the women had severe anemia and 42% moderate anemia. 24.3% had Falciparum malaria infection, 16.1% had a positive endocervical swab for Escherichia Coli infection and 16% had a positive HIV test. Conclusions: There is a need to conduct a case control study to determine it’s risk factors.
P3.11.25 SEVERE PREECLAMPSIA AND HYPERTHYROIDISM ASSOCIATED WITH A PARTIAL HYDATIFORM MOLE AT 20 WEEKS GESTATION M.L. Cafiete, A.Sanchez-Dehesa, M.V. Bravo, J.C. Moreno, P. Rincon, Dept. OBIGYN, Hospital Virgen de la Salud, Toledo, Spain. Objectives: Partial hydatiform mole is a histopathologic entity characterized by focal trophoblastic proliferation and hidropic degeneration together with a coexisting fetus. We report a case in which clinical findings are unusual since preeclampsia and hyperthyroidism associated with large thecal luteal cysts and high B-HCG titers occur less frequently in patients with partial moles. Case report: A 27.year-old white female, gravida 1, para 0, at 20 weeks gestation, presented with gestational hypertension, legs oedema, proteinuria and elevated liver enzymes. An ultrasonographic examination revealed an abnormal hydropic placente and a growth retarded, microcephalic fetus with cerebral ventricular dilation, both ovaries were enlarged with thecal luteal cysts. Fetal karyotyping by funiculocentesis revealed a triploid fetus (69 XXX), B-HCG titers were greater than 500,000 IUIL. Further tests detected asymptomatic hyperthyroidism. A cesarean section was performed delivering a 190 g male fetus. After two months of follow-up, B-HCG titers were plateaud, requiring treatment with methotrexate. Conclusion: Partial hydatiform mole is usually diagnosed as missed or incomplete abortion. The complete clinical syndrome including preeclampsia before the 20th week of gestation, hyperthyroidism, large thecal luteal cysts and high B-HCG titers is highly unusual in partial
WEDNESDAY,
SEPTEMBER
6
moles. Nevertheless, B-HCG must be determined until negative since metastatic disease is always a possibility.
P3.11.26 SOCIAL PROBLEMS AND MATERNAL MORTALITY PAKISTAN’S PERSPECTIVE S. Saleem (l), S. Syed (2) (1) Hamdard University Hospital, Pakistan. (2) Sobhraj Maternity Hospital, Pakistan.
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Though there are many reasons for increase in mortality among childbearing women in Pakistan, yet, the social reasons are perpetuating the gloomy state of affairs. A series of interviews were conducted on women attending the antenatal and postnatal clinics in large maternity hospitals over a period of one year. It was recorded that lack of involvement of community, male members of family, poverty, illiteracy, gender bias and ignorance were the major contributing factors leading to maternal ill-health, pregnancy related complications and maternal death. These issues need urgent attention. This can be achieved through improvement in socioeconomic conditions, awareness, improvement in services and health education. This paper also discusses the plight of selected women who were the victims of “unfortunate circumstances”. Key words: Maternal mortality, gender bias, maternal health
P3.11.27 TENDENCIES IN MATERNAL MORTALITY IN THE REPUBLIC OF UZBEKISTAN Sh.S. Mukhamedova. Dept. of Surgical and Conservative Gyn., Research Inst. of OB/ GYN, Tashkent, Uzbekistan Objectives: The aim of the investigation was to study the structure and clinical aspects of maternal mortality in the Republic of Uzbekistan within 1989 and 1998. Study Methods: A retrospective analysis of medical documentation of lethal outcomes was undertaken with the subsequent computer-assisted processing. Results: The study was undertaken to analyze 2,694 cases of maternal lethal outcomes within the mentioned period. The analysis demonstrated that 88.2% pregnant women in labor died at the gestation term of 28 weeks and more, 11.0% at the term of up to 28 weeks including mortality from abortion, 0.87% from ectopic pregnancy. The reasons for the death of pregnant females, those in labor puerperas died at the gestation term of 18 weeks were the following ones: bleeding in 29.1% of cases, septic postnatal diseases in 16.1%, gestosis in 15.4%, hysterorrhexis in 5,6%, embolism due to amniotic fluid in 3.1%. 14.7% females died due to extragenital diseases, in 13.0% cases the death was caused with reasons not related with their pregnancies (thromboembolitic complications in 32.3%, acute renal insufficiency in 30.4%, complications due to anesthesia and resuscitation mistakes in 18.3%, anaphylactic and hemotransfusion shock in 11.5% and 7.1% of cases respectively). In 3.0% of females lethal outcomes were due to uncertain reasons as autopsy was absent. The analysis demonstrated that 6.5% of females died pregnant, the other women died in the postnatal period, 28.5% of women died within the first 24 hrs and 55.0% during the first week after labor. According to an expert evaluation lethal outcomes were inevitable in 72.3% of the women died. Conclusions: The results of the study urge the necessity in development of effective ways in pregnancy, natal and postnatal follow-up to decrease maternal mortality.
P3.11.28 THE MANAGEMENT OF OBSTRUCTIVE UROPATHY IN PREGNANCY E. Alexououlos, P. Sakellariou, S. Karpathios, G. Siampalioti, N. Kyritsis, M. Stathi, C. Papanicopoulos, K. Kakoullis, G. Pavlides, Alexandra Maternity Hospital, Athens, Greece Objectives: The aim of the study was to investigate the clinical efficacy of the insertion of a double .I ureteral catheter in the management of patients with upper urinary tract dilatation secondary to obstruction.
target is 50,000), because 65.3% of deliveries in the rural area were helped by Traditional Birth Attendants (TBAs). Training TBAs by village midwives and coordinating with administering department came to be one of the six basic elements of safe motherhood in Indonesia. The present economic crisis is predictable as holding back efforts towards safe motherhood and the programs to cut the MMR. An increase in family planning program drop out (example in DKI Jakarta province is almost 30% and in Kutai regency in east of Kalimantan province is 8.92% in 1998) will cause a “baby boom” and greater MMR in the future, particularly, deaths due to direct obstetrical causes and abortion. The economic crisis also causes use of untrained TBAs, rising risks and causing a predictable increase in MMR.
P3.11.24 PUERPERAL PSYCHOSIS: SOCIODEMOGRAPHIC CHARACTERISTICS, OBSTETRIC EVENTS AND DISEASE PATTERN M. Mtawali, Dept. OBIGYN, Muhimbili University College of Health Science, Tanzania Objectives: To determine sociodemographic characteristics, obstetric events and disease pattern among women with puerperal psychosis. Study Methods: Sixty-seven women with puerperal psychosis were included in this Descriptive Hospital Based Study conducted between March and December 1998. Information was obtained using a structured questionnaire, physical and mental status evaluation with selected Laboratory Investigations such as Hemoglobin, Blood Slide for malaria parasite, endocervical swab for microbiological studies and ELISA test for HIV Antibodies. Data was entered and analyzed using EPI Info computer program number 6.4 May 1996 version. Results: Majority 95.8% of the women were primipara, married 44.8% with age less than 2 years (76%). Most of them were housewives and had attained primary level of education. Among those who were married, 59% received support from the partners but only 27% of them got satisfied. Majority had labored between 12 and 24 hours with spontaneous vertex delivery and a near birth weight of 3.4kgs. Most of the babies born were healthy. The commonest organic symptoms were headache, body weakness and abnormal vaginal discharge while the psychotic symptoms were affective in nature, 19% of the women had severe anemia and 42% moderate anemia. 24.3% had Falciparum malaria infection, 16.1% had a positive endocervical swab for Escherichia Coli infection and 16% had a positive HIV test. Conclusions: There is a need to conduct a case control study to determine it’s risk factors.
P3.11.25 SEVERE PREECLAMPSIA AND HYPERTHYROIDISM ASSOCIATED WITH A PARTIAL HYDATIFORM MOLE AT 20 WEEKS GESTATION M.L. Cafiete, A.Sanchez-Dehesa, M.V. Bravo, J.C. Moreno, P. Rincon, Dept. OBIGYN, Hospital Virgen de la Salud, Toledo, Spain. Objectives: Partial hydatiform mole is a histopathologic entity characterized by focal trophoblastic proliferation and hidropic degeneration together with a coexisting fetus. We report a case in which clinical findings are unusual since preeclampsia and hyperthyroidism associated with large thecal luteal cysts and high B-HCG titers occur less frequently in patients with partial moles. Case report: A 27.year-old white female, gravida 1, para 0, at 20 weeks gestation, presented with gestational hypertension, legs oedema, proteinuria and elevated liver enzymes. An ultrasonographic examination revealed an abnormal hydropic placente and a growth retarded, microcephalic fetus with cerebral ventricular dilation, both ovaries were enlarged with thecal luteal cysts. Fetal karyotyping by funiculocentesis revealed a triploid fetus (69 XXX), B-HCG titers were greater than 500,000 IUIL. Further tests detected asymptomatic hyperthyroidism. A cesarean section was performed delivering a 190 g male fetus. After two months of follow-up, B-HCG titers were plateaud, requiring treatment with methotrexate. Conclusion: Partial hydatiform mole is usually diagnosed as missed or incomplete abortion. The complete clinical syndrome including preeclampsia before the 20th week of gestation, hyperthyroidism, large thecal luteal cysts and high B-HCG titers is highly unusual in partial
WEDNESDAY,
SEPTEMBER
6
moles. Nevertheless, B-HCG must be determined until negative since metastatic disease is always a possibility.
P3.11.26 SOCIAL PROBLEMS AND MATERNAL MORTALITY PAKISTAN’S PERSPECTIVE S. Saleem (l), S. Syed (2) (1) Hamdard University Hospital, Pakistan. (2) Sobhraj Maternity Hospital, Pakistan.
-
Though there are many reasons for increase in mortality among childbearing women in Pakistan, yet, the social reasons are perpetuating the gloomy state of affairs. A series of interviews were conducted on women attending the antenatal and postnatal clinics in large maternity hospitals over a period of one year. It was recorded that lack of involvement of community, male members of family, poverty, illiteracy, gender bias and ignorance were the major contributing factors leading to maternal ill-health, pregnancy related complications and maternal death. These issues need urgent attention. This can be achieved through improvement in socioeconomic conditions, awareness, improvement in services and health education. This paper also discusses the plight of selected women who were the victims of “unfortunate circumstances”. Key words: Maternal mortality, gender bias, maternal health
P3.11.27 TENDENCIES IN MATERNAL MORTALITY IN THE REPUBLIC OF UZBEKISTAN Sh.S. Mukhamedova. Dept. of Surgical and Conservative Gyn., Research Inst. of OB/ GYN, Tashkent, Uzbekistan Objectives: The aim of the investigation was to study the structure and clinical aspects of maternal mortality in the Republic of Uzbekistan within 1989 and 1998. Study Methods: A retrospective analysis of medical documentation of lethal outcomes was undertaken with the subsequent computer-assisted processing. Results: The study was undertaken to analyze 2,694 cases of maternal lethal outcomes within the mentioned period. The analysis demonstrated that 88.2% pregnant women in labor died at the gestation term of 28 weeks and more, 11.0% at the term of up to 28 weeks including mortality from abortion, 0.87% from ectopic pregnancy. The reasons for the death of pregnant females, those in labor puerperas died at the gestation term of 18 weeks were the following ones: bleeding in 29.1% of cases, septic postnatal diseases in 16.1%, gestosis in 15.4%, hysterorrhexis in 5,6%, embolism due to amniotic fluid in 3.1%. 14.7% females died due to extragenital diseases, in 13.0% cases the death was caused with reasons not related with their pregnancies (thromboembolitic complications in 32.3%, acute renal insufficiency in 30.4%, complications due to anesthesia and resuscitation mistakes in 18.3%, anaphylactic and hemotransfusion shock in 11.5% and 7.1% of cases respectively). In 3.0% of females lethal outcomes were due to uncertain reasons as autopsy was absent. The analysis demonstrated that 6.5% of females died pregnant, the other women died in the postnatal period, 28.5% of women died within the first 24 hrs and 55.0% during the first week after labor. According to an expert evaluation lethal outcomes were inevitable in 72.3% of the women died. Conclusions: The results of the study urge the necessity in development of effective ways in pregnancy, natal and postnatal follow-up to decrease maternal mortality.
P3.11.28 THE MANAGEMENT OF OBSTRUCTIVE UROPATHY IN PREGNANCY E. Alexououlos, P. Sakellariou, S. Karpathios, G. Siampalioti, N. Kyritsis, M. Stathi, C. Papanicopoulos, K. Kakoullis, G. Pavlides, Alexandra Maternity Hospital, Athens, Greece Objectives: The aim of the study was to investigate the clinical efficacy of the insertion of a double .I ureteral catheter in the management of patients with upper urinary tract dilatation secondary to obstruction.