THE EFFECT OF DELAY IN THE MANAGEMENT OF POSTPARTUM BLEEDING ON THE RATE OF NEAR-MISS AND
H Risanto Siswosudarmo
Department of Obstetrics and Gynecology
Faculty of Medicine Universitas Gadjah Mada/ Sardjito Hospital
Jogjakarta
Background: One of the reason of the cause of high maternal mortality rate is delayed of referring patients to hospital in postpartum hemmorhage cases.
Objective: to determined the relationship between delayed referral by midwife in postpartum hemmorhage cases and near-miss morbidity at Soeradji Tirtonegoro Klaten hospital from January 2009 until December 2010.
Methods: A cohort retrospective study was conducted in 191 women with postpartum hemmorhage. The population of this study are all of the postpartum hemorrhage cases referred by midwife to Soeradji Tirtonegoro Klaten hospital. Subjects in this study are those who met inclusion and exclusion criteria, consisting of a group of mothers with postpartum hemorrhage cases that were referred by midwife. Criteria for inclusion in this study were all cases of postpartum hemorrhage that was referred to Dr Soeradji Tirtonegoro Klaten hospital.
Results: There were significant relationship between status of midwife and midwife’s workplace with delayed of referring patient to hospital (p: 0,003 and p: 0,001; p< 0.05). The length of working period of midwife and the education of midwife have significantly influenced the occurrence of near miss (RR = 1.328 and 95%CI 1.027-1.717; RR=1.288 and 95%CI 1.047-1.585 ; RR =1.434 and 95%CI 1.155-1.782). We found that delayed of referring patients to hospital, status of midwife, the length working period of midwife and the education of midwife are the risk factors of near-miss morbidity in postpartum hemorrhage cases (OR > 1).
Conclusion: The incidence of morbidity nearmiss in cases of postpartum hemorrhage in the late group were referred by midwives is higher than the group that was not too late referenced
Keyword: referred by midwife, postpartum hemorrhage, near-miss morbidity
Background: In preparation for emergency cesarean section will involve many decisions and move the various personnel from various disciplines with specific time limits in order to save mothers and neonate. Lack of harmony among team members will result in the need for longer time intervals, so that morbidity and increased maternal and neonate mortality.
Objective: Todetermine the effect of “responsetime” of emergency cesarean section to the out come of pregnancy in the Sarjito hospital.
Methods: The study designis aretrospective cohort.
Results: There were 150 cases of emergency Caesarean sectionin dr. Sardjito hospital during January 1, 2011 through December 31, 2011. The data retrievalis doneby taking aretrospectivecohortdata frommedical records of patients who entere dthestudy subjects. There were 150 cases of emergency Caesarean sectionin 681 cases of Caesarean section during 2011. Fromtable 4it can be seenthat the distribution of execution Caesarean section based on worked hours, 64 cases(42.7%) founded at work and 86 cases(57.3%) in the off hours. Basedon gestational age≥37 weeks there were 116 cases (77.3%) and<37 weeks there were 34 cases(22.7%). As for the difference intime <60 minutes there were 22 cases (14.7%) andat ≥ 60 minutes the re were 128 cases(85.3%). Type ofanesthesiaused was 123 cases(82.6%) regional anesthesia (spinal/ epidural) and 27 cases (17.4%) GA. From all cases of emergency Caesarean section,90.5% operator is are sidentand the restby a specialist. There were nosignificant differences in bivariate and multivariate analyzesto morbidity and mortality to maternal and neonatal.
Conclusion: No significant difference was found morbidity and mortality out comes for maternal and neonatal carein the “responsetime” <60 minutes and≥60 minutes at SarjitoHospital.
Key words: emergency cesarean section, decision – delivery time interval, response time, delivery time
Background: Administration of GnRH agonist on endometriosis can increased apoptosis and inhibit proliferation of endometrial cells ectopic. How the effectiveness of GnRH agonist for 3-6months prior to FIV in endometriosis needs to be studied further. Objective: To determine the effectiveness of GnRH agonists for 3-6 months before FIV output number of mature oocytes, total dose and duration of gonadotropin stimulation with a long protocol stimulation.