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P313 Organophosphates and carbamates intoxication in pregnancy: A case-report
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Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
measured. If intrauterine pregnancy is seen, these patients can resume antepartum care. If IUP is not seen, the patients will follow up with an US in one week and/or BHCG in 2 days. Within a week, if no IUP is seen, we can assume that this is not a viable pregnancy, and may be an ectopic. If stable, patient will be treated with methotrexate. If unstable, they are taken for an exploratory minilaparotomy. Research is currently being done to evaluate the efficacy of this intervention. P312 Community-based interventions for the reduction of maternal mortality – the role of professional health associations, non-governmental organisations and community-based organisations in Delta State, Nigeria M. Oseji1 , R. Ogu2 , U. Onwumah3 . 1 Delta State Ministry of Health, Asaba, Nigeria, 2 University of Port Harcourt Teaching Hospital/University of Port Harcourt, Nigeria, 3 Public Health Impact Research Centre, Asaba, Nigeria Objectives: To examine the contributions of professional health associations, non-governmental organisations and community-based organisations in implementing community-based interventions for the reduction of maternal mortality in Delta State Nigeria. Materials and Methods: Various publications, reports, public presentations and policy documents on activities of professional health associations, non-governmental organisations and communitybased organisations in Delta State of Nigeria were collected by the authors. In analyzing the information, specific activities by organisations that have contributed to reduction of maternal mortality were identified and their relationship to desirable outcomes were linked. Results: The interventions identified include: – Advocacy workshop on safe motherhood; – Legislation for the notification of maternal deaths; – Community maternal death audit; – Tracking of maternal mortality ratios for locations; – Community-based post-natal services; – Community Health Insurance Scheme; – Provision of behaviour change communication materials on birth preparedness; – Sharing of data on maternal and child health with members of the community and use as advocacy tool in their own community to support efforts to reduce maternal mortality; – Participation at Strategic Planning Workshop for free maternal health care services in Delta State; – Participation in the Integrated Maternal, Newborn and Child Health Strategy in Delta State Formation of a coalition of family planning champions; – Advocacy for free blood transfusion; – Advocacy for emergency transportation; – Strengthening of the Two-Way Referral System; – Advocacy for the concept of maternity waiting homes; – Sensitisation of Local Governement Authorities on MDGs; – Advocacy for incentives to retain doctors and midwives in rural areas; – Advocacy to traditional leaders and Local Government Officials to support strategies to reduce maternal mortality; – Dissemination and utilisation of national policy documents to guide implementation of programmes; – Support for reproductive health commodities security; – Sensitisation and re-integration of internally displaced persons. Professional Health Associations include: – Nigerian Medical Association; – Society of Gynaecologists and Obstetricians of Nigeria; – Paediatric Association of Nigeria; – Association of Public Health Physicians of Nigeria; – Medical Women’s Association of Nigeria; – Pharmaceutical society of Nigeria;
– National Association of Nigerian Nurses and Midwives. Non-governmental organisations include: – I-Care Project of the Wife of the Governor of Delta State; – Public Health Impact Research Centre; – Early Child-Care Reproductive Health Education Team; – International Centre for Women Empowerment and Child Development; – Community-based organisations include: Oshimili South AIDS Awareness Programme; – Konyenum Imala Foundation. Outcomes: – Successful Implementation of Delta State Free Maternal Health Care Programme since November 2007; – Strengthening of the health system using data management and evidence-based interventions; – Scaling up of pilot safe motherhood projects to state-wide level; – Increase in contraceptive utilisation; – Better understanding of factors that could have directly or indirectly led to deaths of women who were pregnant. Conclusion: There are many players in the quest to reduce maternal mortality and morbidity. The challenge is in coordination of interventions and tracking indicators to measure desired impact. P313 Organophosphates and carbamates intoxication in pregnancy: A case-report F. Campanharo1 , A. Caetano1 , C. Lopes1 , R. Cavalcante1 , M. Lopes, R. Mattar1 , S. Sun1 . 1 S˜ ao Paulo Federal University, 2 Background: Organophosphates (OP) and Carbamates (CA) are pesticide coumpounds with potent cholinesterase inhibition profile. Little is known about intoxication in pregnancy. OP/CA can cross the placental barrier. Around 300,000,000 exposures occurs yearly with 300,000 fatalities. Aims: To report a case of OP/CA poisoning in pregnancy resulting in fetal death. Case report: A 22-year-old, primigravida, 27 weeks pregnancy, brought to Emergency Department, unconsciousness, with history of seizures, salivation and fasciculation in limbs and face. Admission: Blood pressure 140×94 mmHg, heart rate: 86 bpm, respiratory rate: 36 ipm and oximetry: 89%. Obstetric examination: Fundal Height of 24 cm, no uterine contractions, fetal heart tones and cervical dilatation. Eclampsia was considered and MgSo4 infusion was done without success. The pacient developed a respiratory failure and underwent endotracheal intubation. Brain CT and laboratory tests were normal. A hypothesis of OP/CA intoxication was made and Atropine administration iniciated with improvement of clinical status. Plasma cholinesterase activity assay confirmed the diagnosis. Labor was induced. There were no complications and patient was discharged from the hospital with psiquiatric follow up. Conclusion: Poisoning is rare in pregnancy and can be misdiagnosed. Fetal death may occurs due to fetal bradycardia or placenta insuffiency secondary to maternal bradycardia. Adequate diagnosis and treatment can save mother and fetus. P314 Maternal mortality in an academic hospital in S˜ao Paulo, Brazil: 10 years experience C. Lopes, D. Meleti, F. Campanharo, J. Mazzola, M. Lopes, A. Caetano, S. Sun, R. Mattar. S˜ ao Paulo Federal University Objectives: It is estimated that 600,000 women die globally as a result of pregnancy-related conditions, and most of these deaths are considered preventable. Little is known about maternal mortality rates and characteristics in developing countries. The aim of this study is to assess the prevalence of maternal mortality in an academic hospital in S˜ao Paulo-Brazil.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
measured. If intrauterine pregnancy is seen, these patients can resume antepartum care. If IUP is not seen, the patients will follow up with an US in one week and/or BHCG in 2 days. Within a week, if no IUP is seen, we can assume that this is not a viable pregnancy, and may be an ectopic. If stable, patient will be treated with methotrexate. If unstable, they are taken for an exploratory minilaparotomy. Research is currently being done to evaluate the efficacy of this intervention. P312 Community-based interventions for the reduction of maternal mortality – the role of professional health associations, non-governmental organisations and community-based organisations in Delta State, Nigeria M. Oseji1 , R. Ogu2 , U. Onwumah3 . 1 Delta State Ministry of Health, Asaba, Nigeria, 2 University of Port Harcourt Teaching Hospital/University of Port Harcourt, Nigeria, 3 Public Health Impact Research Centre, Asaba, Nigeria Objectives: To examine the contributions of professional health associations, non-governmental organisations and community-based organisations in implementing community-based interventions for the reduction of maternal mortality in Delta State Nigeria. Materials and Methods: Various publications, reports, public presentations and policy documents on activities of professional health associations, non-governmental organisations and communitybased organisations in Delta State of Nigeria were collected by the authors. In analyzing the information, specific activities by organisations that have contributed to reduction of maternal mortality were identified and their relationship to desirable outcomes were linked. Results: The interventions identified include: – Advocacy workshop on safe motherhood; – Legislation for the notification of maternal deaths; – Community maternal death audit; – Tracking of maternal mortality ratios for locations; – Community-based post-natal services; – Community Health Insurance Scheme; – Provision of behaviour change communication materials on birth preparedness; – Sharing of data on maternal and child health with members of the community and use as advocacy tool in their own community to support efforts to reduce maternal mortality; – Participation at Strategic Planning Workshop for free maternal health care services in Delta State; – Participation in the Integrated Maternal, Newborn and Child Health Strategy in Delta State Formation of a coalition of family planning champions; – Advocacy for free blood transfusion; – Advocacy for emergency transportation; – Strengthening of the Two-Way Referral System; – Advocacy for the concept of maternity waiting homes; – Sensitisation of Local Governement Authorities on MDGs; – Advocacy for incentives to retain doctors and midwives in rural areas; – Advocacy to traditional leaders and Local Government Officials to support strategies to reduce maternal mortality; – Dissemination and utilisation of national policy documents to guide implementation of programmes; – Support for reproductive health commodities security; – Sensitisation and re-integration of internally displaced persons. Professional Health Associations include: – Nigerian Medical Association; – Society of Gynaecologists and Obstetricians of Nigeria; – Paediatric Association of Nigeria; – Association of Public Health Physicians of Nigeria; – Medical Women’s Association of Nigeria; – Pharmaceutical society of Nigeria;
– National Association of Nigerian Nurses and Midwives. Non-governmental organisations include: – I-Care Project of the Wife of the Governor of Delta State; – Public Health Impact Research Centre; – Early Child-Care Reproductive Health Education Team; – International Centre for Women Empowerment and Child Development; – Community-based organisations include: Oshimili South AIDS Awareness Programme; – Konyenum Imala Foundation. Outcomes: – Successful Implementation of Delta State Free Maternal Health Care Programme since November 2007; – Strengthening of the health system using data management and evidence-based interventions; – Scaling up of pilot safe motherhood projects to state-wide level; – Increase in contraceptive utilisation; – Better understanding of factors that could have directly or indirectly led to deaths of women who were pregnant. Conclusion: There are many players in the quest to reduce maternal mortality and morbidity. The challenge is in coordination of interventions and tracking indicators to measure desired impact. P313 Organophosphates and carbamates intoxication in pregnancy: A case-report F. Campanharo1 , A. Caetano1 , C. Lopes1 , R. Cavalcante1 , M. Lopes, R. Mattar1 , S. Sun1 . 1 S˜ ao Paulo Federal University, 2 Background: Organophosphates (OP) and Carbamates (CA) are pesticide coumpounds with potent cholinesterase inhibition profile. Little is known about intoxication in pregnancy. OP/CA can cross the placental barrier. Around 300,000,000 exposures occurs yearly with 300,000 fatalities. Aims: To report a case of OP/CA poisoning in pregnancy resulting in fetal death. Case report: A 22-year-old, primigravida, 27 weeks pregnancy, brought to Emergency Department, unconsciousness, with history of seizures, salivation and fasciculation in limbs and face. Admission: Blood pressure 140×94 mmHg, heart rate: 86 bpm, respiratory rate: 36 ipm and oximetry: 89%. Obstetric examination: Fundal Height of 24 cm, no uterine contractions, fetal heart tones and cervical dilatation. Eclampsia was considered and MgSo4 infusion was done without success. The pacient developed a respiratory failure and underwent endotracheal intubation. Brain CT and laboratory tests were normal. A hypothesis of OP/CA intoxication was made and Atropine administration iniciated with improvement of clinical status. Plasma cholinesterase activity assay confirmed the diagnosis. Labor was induced. There were no complications and patient was discharged from the hospital with psiquiatric follow up. Conclusion: Poisoning is rare in pregnancy and can be misdiagnosed. Fetal death may occurs due to fetal bradycardia or placenta insuffiency secondary to maternal bradycardia. Adequate diagnosis and treatment can save mother and fetus. P314 Maternal mortality in an academic hospital in S˜ao Paulo, Brazil: 10 years experience C. Lopes, D. Meleti, F. Campanharo, J. Mazzola, M. Lopes, A. Caetano, S. Sun, R. Mattar. S˜ ao Paulo Federal University Objectives: It is estimated that 600,000 women die globally as a result of pregnancy-related conditions, and most of these deaths are considered preventable. Little is known about maternal mortality rates and characteristics in developing countries. The aim of this study is to assess the prevalence of maternal mortality in an academic hospital in S˜ao Paulo-Brazil.