Obstetric cerebral venous thrombosis

Pregnancy and puerperium are most prevalent prothrombotic states leading to cerebral venous thrombosis. Likelihood of stroke to be of venous origin is greater in stroke associated with pregnancy compared to stroke unrelated to pregnancy. Pregnancy induces several changes in coagulation system, which persists at least during early puerperium, rendering it a prothrombotic state. Hypercoaguability worsens further after delivery as a result of volume depletion and trauma. During puerperium additional risk factors include infection and instrumental delivery or Caesarean section. The management follows general rules as for the venous thrombosis unrelated to pregnancy, however the prognosis is different

Implementation of warning tool to improve maternal newborn health outcomes in a developing country

Objective: To improve health outcomes through the implementation of national early warning sign tool for babies delivered through emergency caesarean section in off-work hours. Methods: This comparative clinical study was conducted at the Aga Khan Hospital for Women and Children, Karachi, from April to August 2014, and comprised women who had an emergency caesarean section. Maternal and perinatal outcomes were compared of patients in Group A and Group B which represented individuals before and after the implementation of the national early warning score respectively. Results: Of the 200 participants, there were 100(50%) in each group. The overall mean age was 26.79±5.10 years. The mean age was 26.3±5 years in Group A, and 27.2±5 years in Group B (p=0.25). The two groups were also comparable in terms of parity (p=0.77) and co-morbidities (p =0.51). There was no stillbirth or maternal death, but decline in complications due to post-partum haemorrhage (p=0.00) was observed due to early recognition and timely management. None of the women required referral to higher facility. Conclusion: National early warning score was found to be a practical early warning tool for obstetric population

Referral pattern of emergencies in obstetrics: implications for defining scope of services and policy

Objective: To analyse referral pattern of high-risk obstetric cases from secondary to tertiary care hospitals and to assess their maternal and neonatal outcomes. Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised all referred obstetric cases from secondary-level hospitals to tertiary-level care within and outside the Hospital between January 2011 and December 2014. Day and time of referral, reason for referral as well as maternal and neonatal outcomes were collected. SPSS 19 was used for data analysis. Results: Of the 634 obstetric referrals, 279(44%) patients were referred to the study site, while 355(56%) sought care in other hospitals. Of those patients who were referred to the AKUH, medical records of 195(69.9%) were available for review. The mean age of the participants was 28±4.7 years. Obstetric complications led to 122(61%) referrals. The top three reasons among these were pregnancy-induced hypertension, preterm labour and foetal causes. Medical causes such as viral infections were the cause of 50(27%) referrals. Moreover, 177(91%) patients were pregnant at the time of referral and the remaining 18(9%) were referred after delivery. Of the pregnant women, 133(75%) delivered at the study site. Caesarean section was the mode in 92(69%) deliveries. There was 1(0.75%) maternal death due to puerperal sepsis while 9(7%) neonatal deaths were recorded. Conclusion: The most common reason for referrals was obstetric indications. Moreover, a quarter of referrals were initiated due to medical conditions, most of which were due to infections

Midwives\u27 perception about their practice in a midwifery-led care model in Karachi, Pakistan

Objective: To explore the experiences and perceptions of midwives practising the midwifery-led care model at two private facilities of women and children hospital in Karachi, Pakistan. Methods: The descriptive qualitative data was collected through semi-structured questionnaires with 10 midwives. Results: The findings of the study revealed one theme and four related categories. The theme of the study emerged as ‘struggling to be a professional midwife’ and the related four categories were: (i) asking to perform within the full scope of practice, (ii) obstetricians’ reliance and trust in midwives\u27 expertise, (iii) raising concerns about expensive midwifery services, and (iv) encountering barriers to practise midwifery as independent practitioners. Conclusion: Midwives face some challenges practising the midwifery-led care model such as lack of visibility in society, low salaries and increased workload due to the shortage of staff. Lack of higher education was also highlighted by the midwives as they have no opportunities for career growth. This study will increase midwives\u27 autonomous role and decision-making in the clinical setting

P23. Prediction of preeclampsia during early pregnancy in primiparas with soluble fms-like tyrosine kinase-1 and placental growth factor

Objective: To test the hypothesis that preeclampsia (PE) can be predicted in primiparas early by measuring serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). Methods: All normotensive primiparas attending antenatal clinics of Aga Khan University Hospital and Aga Khan Hospital for Women, Karachi, Pakistan without any known risk factor for PE were invited to participate in the study. They were divided into two groups based on the development of PE. Blood samples of the participants were collected at 8–15; 16–22; 23–28; 29–34 weeks of pregnancy and a postnatal sample and were analyzed for sFlt-1 and PlGF. Results: 611 (46.7%) out of 1307 recruited primiparas completed the study according to the protocol. Out of these, 39 (6.4%) women developed PE. Difference in the serum sFlt-1 was evident as early as up to 15 weeks of gestation. Higher levels of sFlt-1 were present in women who later developed PE. Relatively higher levels of PlGF were observed in non-PE women compared to PE women up to 22 weeks of gestation. However, after 23 weeks of pregnancy, PlGF levels increased in both Groups but less so in PE Group. ROC curve analysis showed that even in early pregnancy (\u3c15 weeks of gestation); sFlt-1 alone has the potential to predict PE with AUC, sensitivity and specificity of 0.81, 75.9 and 72.4, respectively. Conclusions: PE can be predicted in primiparas in early part of second trimester with serum sFlt-1 and in later part of second trimester with serum PlGF