Dilek Uygur

Maternal mortality due to hypertensive disorders in pregnancy, childbirth, and the puerperium between 2012 and 2015 in Turkey: A nation-based study

Objective: To analyze maternal deaths in Turkey due to hypertensive disorders. Material and Methods: In this retrospective study 812 maternal deaths were analyzed. Maternal demographic features, presence of antenatal care, medical and obstetric history, mode of delivery, and use emergency antihypertensive therapy were recorded. The delay model for each case was investigated. Results: Hypertensive disorders accounted for 15.5% (n=126) out of all maternal mortality. They were the third most frequent cause among all causes and the 2nd among direct causes of maternal deaths. Sixty-one (48.4%) cases were in severe preeclampsia or pre-existing hypertensive disorder with increased/superimposed proteinuria, 30.1% were in eclampsia, 9.5% cases were diagnosed as hemolysis, elevated liver enzymes, low platelet count syndrome, and 11.1% in pre-existing hypertension complicating pregnancy, childbirth, and puerperium without increased or superimposed proteinuria. The median age was 32 years, 37.3% women were ≥35 years. All deaths except for 2 cases occurred during the postpartum period. Twenty-three percent of deaths occurred in the first 48 hours postpartum, and 51.6% between 8-42 days. Intracranial hemorrhage was the major final cause of death with a rate of 41.3%. With the exception of fifteen patients with intracranial hemorrhage, emergency antihypertensive agents were not implemented in optimal dose and/or duration. A first and/or third delay was identified in 36.5% of cases. Conclusion: Approximately one third of maternal death due to hypertensive disorders could be prevented. The importance of acute antihypertensive treatment should be emphasized because of most frequent cause of death was intracranial hemorrhage.

Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey

Abstract The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (nu2009=u200911) than the antepartum period (nu2009=u20095). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.

Pulmonary Embolism Associated with Hyperemesis Gravidarum Two Case Reports

Pulmonary embolism is a major cause of death during pregnancy or the puerperium. The hemostatic changes in pregnancy creates a prothrombotic milieu. Hyperemesis gravidarum xa0is one of the recognised risk factors for venous tromboembolism.Two cases of maternal mortality were attributed to xa0PE associated with severe hyperemesis gravidarum in 2014 in Turkey. These two cases have been reported and discussed in the literature review. We aimed to alert clinicians that thromboprophylaxis should be considered when a pregnant woman suffers vomiting leading to clinical evidence of dehydration.