OBJECTIVE:  To determine the frequency and causes of maternal near miss and mortality among pregnant women. METHODS: This cross-sectional study was conducted Jan 2016 - Dec 2018. All near miss cases, admitted in Gynecology department of Services Hospital Lahore during the study period, were prospectively recruited. WHO criteria was used to identify maternal near miss cases. Primary outcome measures were frequency and causes of near miss and maternal mortality to near miss ratio. Secondary outcome measures were delays, need for massive blood transfusion, ICU admission, obstetric hysterectomy and hospital stay> 7 days. RESULTS: During the study period, there were 10,739 live births, 305 near miss cases and 29 maternal deaths. Frequency of near miss was 28.4/ 1000 live births and maternal mortality to near miss ratio was 1:10.5. There were 215(70.4%) unbooked patients and 23(79.3%) of them died (p<0.001). Hemorrhage accounted for 150 (49.18%), hypertensive disorders 102 (33.44%),cardiac disease 25 (8.28%) and infection for 12 (3.97%) near miss cases respectively. Maternal mortality was significantly low for hemorrhage, hypertension, sepsis and cardiac disease; 6 vs 150, 8 vs102, 3vs 12 and 10 vs 25 respectively (p<0.001). Massive blood transfusion was given to 20.98%patients, 15.74% underwent hysterectomy, 32.13% required ICU admission. First and second delay was seen in 78.6% of patients with 86.2% deaths (p<0.001) CONCLUSION: Hemorrhage and hypertension are major reasons for near miss but timely intervention can prevent mortality. Strengthening care at primary and secondary level can reduce the burden of maternal morbidity.  Continuous....

Objective: To evaluate hepatitis E infection outcomes among pregnant women admitted in a tertiary care hospital. Materials and Methods: Study Design: Cross-sectional study Study Setting: Department of Gynecology and Obstetrics Unit I, Services Institute of Medical Sciences, Lahore Study Duration: May 2019 to Feb 2020, After approval from Institutional Review Board. Data Collection Procedure: 30 Pregnant women with Hepatitis E confirmed on ELISA IgM, fulfilling the inclusion criteria age, 25 – 40 years of age in any trimester of pregnancy will be included in the study through Non-probability / convenience sampling. Data was entered and analyzed in SPSS ver: 25.0 Qualitative variables like Socio-demographic details and Clinical variables like the feto-maternal outcome were presented as frequency and percentages. The outcome was cross-tabulated with the demographic and clinical profiles. Chi-square test was applied with p < 0.05 was taken as a statistically significant Results: 30 patients were recruited for the study. 96.7% were between the ages of 18- 40 years. 43.3% were primigravida. 76.7% were delivered through spontaneous vaginal delivery. 66.7% had coagulation defects, Fetal outcomes showed 63.3% were alive, 20.0% were still-birth and 16.7% had ENND. The maternal outcome was 96.7% recovered from Hepatitis E. 14.3% of pregnant women who were delivered with LSCS died which was statistically significant. (p=.045). Conclusions: The present findings suggest a high Hepatitis E infectivity in pregnancy results in considerable high maternal and fetal morbidity and mortality. This high disease burden can be minimized by the provision of clean drinking water and access to better sanitary conditions for pregnant women.