الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
 |  | from | 129 |  |  |
| | | from | 129 | | |
Abstract
H.O defined maternal death as follows:
The death of any woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes .
Causes of maternal mortality:
Direct Obstetric Causes:
Include Hemorrhage, pregnancy induced hypertension, infection, Anesthesia and others (molar pregnancy and transfusion hemolysis)
Indirect Obstetric Causes:
Include cardiac diseases, vascular diseases as hypertensive vascular disease and vascular embolism, reproductive tract diseases (such as uterine and adnexal tumors), urinary tract diseases, hepatic diseases, Pulmonary diseases, metabolic diseases (such as Diabetes), others (such as appendicitis and peritonitis of non-puerperal origin).
Non-related Causes:
A death occurring during pregnancy or within 90 days of its termination from causes not related to the pregnancy or of its complications or management. Such as Communicable and infectious diseases, Blood Dyscrasias, Malignancy, Suicide and Murder.
The Three Delays Model
Delay type one: Deciding to seek care
Delay type two : is due to Distance to health centers and hospitals
Delay type three : In Receiving adequate health care
Material And Methods
This work was carried out to study maternal mortality in Minia Maternity Hospital, during the period from the first of January 2018 to the end of December 2018 and its comparison with same study in prev. 3 years.
Data was collected by reviewing the patients’ admission files of the Obstetric Department at minia university hospital and tracing questionaires of maternal mortality survey team at minia Directorate of health after getting the offical approval from the Minisrty of health .
Inclusion Criteria:
Pregnant females, or females who gave birth at time of presentation
to the Obstetric Department or within 42 days postpartum .
Exclusion Criteria:
Patients died after 42 days from termination of pregnancy.
Results
This is a prospective study of all maternal deaths that occurred among 12887 patients admitted to Minia maternity, children university hospital during the period from January 2017 to December of the same year in compare to12331 in 2016,while 10622 in 2015 and 12175in 2017.
The study revealed twinty eight (28) maternal death in 2017, twinty sixty (26) maternal deaths died in 2016due to different causes in compare to forty one (41) in 2015 while in 2018 no of cases died 31 .
In the present study, the causes of maternal mortality as :
According to possible cause of death in 2018:
A)Direct causes :
1) Major cause was Haemorrahge 12 cases (38,4%),6 PPHge and 6 APHge PPHge 6 cases (19,2%) : 1 of them was post hysterectomy collection, 2 cases delivered SVD outside the hospital, 2 post cs collection, 1 cases rupture uterus APHge 6 cases (19,2%): 2 of them Placenta accrete, 3 case pl. low lying 1 disturbed ectopic with intraperitoneal hge and irreversible shock 1 inevitible abortion with sever APHGE 1
2) the secondary major cause was Heart Failure & sepsis;
Heart failure 9 cases (29,8%) : which was there possible cause of death of them were HF,pulmonary embolism& cardiogenic shock Sepsis 2 cases (6,4%) : which were ended by multiorgan failure
3)Eclampsia 7 cases (22,4%) : 3 AP eclampsia and 2 postpartum eclamsia AP eclampsia and post partum eclampsia 1and one case was SPE .
6 case ended by intracranial haemorrhage ,4 case ended by DIC and 4 case ended by multiorgan damage
2) Indirect causes : 3 cases (9,6%) : which were as the following ;
Spinal complication ; represent 3 total spinal; case (9,6%)
In 2017:-
A)Direct causes :
1) Major cause; was Haemorrahge 11 cases (39.3%),8 PPHge and 3 APHge
2) the secondary major cause was Heart Failure & sepsis;
Heart failure 4 cases (14.3%)
Sepsis 4 cases (14.3%)
3)Eclampsia;
3 cases (10.7%) : 2 AP eclampsia and 1 postpartum eclamsia.
B) Indirect causes : 6 cases (21.4%); which were as the following ;
Spinal complication, Renal failure, Meningitis, GIT malignanc& Thromboembolism
In 2016 :-
A) direct causes 18 cases (69.2%) :
1) Majour cause;was eclampsia 7 cases (26.9%), 4 ante partum eclampsia and 3 postpartum eclampsia .
2) The second majour causes was haemmorrhge 6 cases;
3) Sepsis ; come the third one in causes: 3 cases
4) Preeclampsia ; the case was SPE and abruption IUFD then patien enter in acute pulmonary oedema.
5)HEG ; patient enter in massive intracranial haemmorrhge.
B) Indirect causes; 8 cases (30.8%)
Heart failure, Spinal complication, Acute renal failure, GIT malignancy, Meningitis, Thromboembolism
In 2015 : -
Direct causes were responsible for death of 31 women
(75.6%) :
Cardiopulmonary failure ( 14 cases representing 34.1 %) , DIC (7 cases representing 17.1 %) , intra cerebral Haemorrhage (6 cases representing 14.6 % and Septic shock (4 cases representing 9.8 %) .
Ten cases (24.4%) of deaths were due to indirect causes:
Total spinal shock ( 2 cases representing 4.9 % ), Pulmonary Embolism
(2 cases representing 4.9 %) , Peripartum cardiomyopathy ( 2 cases representing 4.9 %) , Toxicmyocarditis (1 case representing 2.4 %) , Amniotic fluid embolism (1 case representing 2.4 %) , Malignant hyperthermia (1 case representing 2.4 % )and Wernix encephalopathy (1 case representing 2.4 %).
In 2017:- Most of cases of maternal mortality died due to 3rd delay(13 cases representing 46.4%)followed by the 2nd delay 2 cases representing( 7.1%), while the least one was the 1ST delay No cases(0%) including:
Bad operative technique , Delayed decision of hysterectomy, Delayed referral to tertiary center, Anesthetic complication , bad anticipation of complications or Ignorance of patient’s history , improper evaluation and management of cases ,un diagnosis of preeclampsia before delivery .
In 2016 :- Most of cases of maternal mortality died due to 3rd delay (12 cases representing 46.2 % of total deaths)
While the 1st delay assume for 9 cases of total deaths representing 34.6%
But 2nd delay alone there in no cases .
1st and 2nd delay represent 3 cases (11.5%) while 2nd and 3rd delay represent one case (3.8%), 1st .2nd and 3rd delay represent one case (3.8%).
In 2015 :- Most of cases of maternal mortality died due to 3rd delay (19 cases representing 46.4 % of total deaths) , While the 1st delay assume for 13 cases of total deaths representing 31.7% , No Delay could be detected in 6 cases of total deaths representing 14.7 % .
2 cases had combined 2nd , 3rd delay representing 4.8% .
One case related to 2nd delay due to long distance , poor transportation representing 2.4 %.