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Background and Objectives: Eclampsia poses a global threat in terms of feto-maternal morbidity and mortality and all medical practitioners fear the ailment. It is one of the major causes behind preventable maternal death. Etio-pathogenesis of the disease condition is ambiguous and is considered to be multi-factorial. This study was done to analyze cases of eclampsia in relation to maternal and fetal outcomes at a tertiary level care hospital. Materials and Methods: A descriptive cross-sectional observational study was carried out in patients developing eclampsia over a period of five years starting from July 2011 to June 2016 at National Medical College and Teaching Hospital, Birgunj. Relevant data were collected from the statistics section of hospital reviewing the case sheets. Results: There were 291 cases of eclampsia out of 16,445 deliveries and prevalence of eclampsia was calculated to be 1.77%. Fourty-five percent of eclamptic women had age less than 20 years and two-third was primigravida. Approximately 84% of women were unbooked. Antepartum eclampsia was observed in 78.8% followed by postpartum eclampsia (14.8%) and intrapartum eclampsia (6.5%).  At the time of admission systolic blood pressure more than 140 mmHg and diastolic blood pressure more than 90 mmHg were noted in 79% and 92.1% cases respectively. Caesarean section was the preferred mode of delivery and was performed in 62.9% cases. ICU admission was required in 35.7% and remaining cases were managed in general/eclampsia ward. Renal failure was the most common cause of maternal mortality seen in 29.4%. Still birth was noted in 13.4%. Conclusion: Institutional obstetric patients are gradually facing eclampsia as prime cause of maternal death and unfortunately most of the cases are primigravid at younger age. All health care professionals should be proficient to manage eclamptic women instantaneously. Key words: Eclampsia; Fetal Mortality; Maternal Mortality; Pre-Eclampsia

(Mayo Clin Proc. 2019;94(5):811–819) Heart disease is responsible for a quarter of all deaths in women in the United States and a leading cause of maternal morbidity and mortality. The risk of cardiovascular disease-related mortality is higher in women who have had pregnancies complicated by hypertensive diseases of pregnancy (HDP). HDPs affect up to 8.2% of US deliveries. Previous studies have shown a long-term increase in postpartum heart failure in women diagnosed with HDP. There is a lack of data from large epidemiological studies on the prevalence of readmission in the immediate postpartum period for new-onset heart failure or postpartum cardiomyopathy (PPCM). This study hypothesized that rates of readmission for newly diagnosed heart failure or PPCM in the immediate postpartum period would be higher in women with HDP.

Aims: To analyze the medical records of emergency peripartum hysterectomy in a teaching hospital Methods: A hospital based descriptive cross-sectional study was carried out on emergency peripartum hysterectomy at National Medical College and Teaching Hospital, Birgunj, Nepal from July 2011 to July 2016. Data were collected from the medical record. Results: There were 29 maternal survivors out of 33 cases of emergency peripartum hysterectomy, among which 21 cases were of subtotal and rest 11 had undergone total hysterectomy. The incidence of emergency peripartum hysterectomy was found out to be 0.2%. Most of the women who had undergone hysterectomy were of high parity (≥4) and advanced maternal age. Mean age of hysterectomy was 27 years. Major indications for hysterectomy were uterine rupture (n=13, 40%) followed by uterine atony (n=11, 33%), placental complications (n=8, 24%) and uterine inversion (n=1, 3%). Three-fourth of women who underwent hysterectomy for placental complications had history of previous caesarean section. Emergency peripartum hysterectomy following caesarean section was 19 (57.6%) and the rest 14 (42.4%) had delivered vaginally. Twenty-six women (79%) were referred-in cases. Conclusions: Majority (88%) of peripartum hysterectomies were maternal near-miss and resulted in mortality of 12%. Uterine rupture and atony constituted almost three-fourth of cases and emergency procedure was in rising trend each year over five years of record. Keywords: caesarean section, peripartum hysterectomy, postpartum haemorrhage

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