WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss)

AIM: To determine the prevalence of severe acute maternal morbidity (SAMM) worldwide (near miss). METHOD: Systematic review of all available data. The methodology followed a pre-defined protocol, an extensive search strategy of 10 electronic databases as well as other sources. Articles were evaluated according to specified inclusion criteria. Data were extracted using data extraction instrument which collects additional information on the quality of reporting including definitions and identification of cases. Data were entered into a specially constructed database and tabulated using SAS statistical management and analysis software. RESULTS: A total of 30 studies are included in the systematic review. Designs are mainly cross-sectional and 24 were conducted in hospital settings, mostly teaching hospitals. Fourteen studies report on a defined SAMM condition while the remainder use a response to an event such as admission to intensive care unit as a proxy for SAMM. Criteria for identification of cases vary widely across studies. Prevalences vary between 0.80% – 8.23% in studies that use disease-specific criteria while the range is 0.38% – 1.09% in the group that use organ-system based criteria and included unselected group of women. Rates are within the range of 0.01% and 2.99% in studies using management-based criteria. It is not possible to pool data together to provide summary estimates or comparisons between different settings due to variations in case-identification criteria. Nevertheless, there seems to be an inverse trend in prevalence with development status of a country. CONCLUSION: There is a clear need to set uniform criteria to classify patients as SAMM. This standardisation could be made for similar settings separately. An organ-system dysfunction/failure approach is the most epidemiologically sound as it is least open to bias, and thus could permit developing summary estimates

Fetal Blood-Sampling From the Intrahepatic Vein for Rapid Karyotyping in the 2nd and 3rd Trimesters

One hundred and twelve fetuses with structural anomalies (n = 84), intrauterine growth retardation (n = 21) or amniotic fluid volume disorders (n = 7) detected by ultrasound underwent blood sampling from the intrahepatic vein for rapid karyotyping. The procedure was successful in 95.5%. 12.5% of the fetuses had an abnormal karyotype. Fetal bradycardia was observed in two fetuses (1.8%) and intraperitoneal bleeding in three (2.7%). There were three procedure-related losses but these were not due to the intrahepatic vein sampling itself. Fetal blood sampling is the method of choice for rapid karyotyping in the second and third trimesters, and the intrahepatic vein is an alternate site when access is difficult or failure to sample occurs at the placental cord insertion. Additional advantages of fetal blood sampling at the intrahepatic vein include absence of cord complications, reduced risk of fetal blood loss and fetomaternal haemorrhage, and the lack of need to confirm the fetal origin of the sample

Bilateral simultaneous facial nerve palsy: A rare presentation of tubercular otitis media

Background: When the facial nerve on the other side becomes affected within 30 days of the first side, it is referred to as “bilateral simultaneous facial nerve palsy.” Case report: A 31-year-old Nepalese man with simultaneous bilateral facial nerve palsy and painful ear discharge presented to the emergency room. Ear examination revealed right bilateral myringitis and a perforation in the left ear. A pus culture was sent from the ears, and blood tests were done to exclude viral etiology. Using imaging techniques such computed tomography (CT) of the temporal bones and magnetic resonance imaging (MRI) of the brain, intracranial and intratemporal causes of the facial nerve involvement were ruled out. Suspecting tuberculous otitis media as an etiology, induced sputum and ear discharge were sent for AFB culture and TB PCR, which came back positive. Features indicative of pulmonary tuberculosis were seen on a chest CT scan. Antitubercular treatment started, and the patient followed up. Facial paralysis recovered to normal in 4 months. Conclusion: It is uncommon to have bilateral facial nerve paralysis. Ear discharge with early facial nerve involvement should raise suspicion of tubercular otitis media, and early diagnosis and treatment will prevent further complications and can reverse the paralysis