Abstract

Background: Cesarean section is on the rise all over the world; it has become a safe surgery due to better anesthesia, asepsis, blood transfusion and antibiotics. Traditionally, the patients are kept nil orally till they pass flatus. This study was performed to find out acceptance and tolerability of early feeding, its side effects and complications if any.

Methods: This comparative study was conducted in a service hospital. There were two groups of 70 cases each where one was administered early feeding and the second group was put on standard delayed feeding as is traditionally done in most of the hospitals. Gastrointestinal outcomes and other parameters were noted in both the groups and analyzed.

Results: During the study period, every alternate willing case without any exclusion criteria was allotted to each group. Early feeding was started 6 h after surgery in the study group, whereas it was withheld till passage of flatus in the control group. Appearance of bowel sounds and passage of flatus were earlier in study group (21.6 and 34.5 h, respectively) as compared with control group (31.7 and 49.2 h, respectively). There were no complications or side effects of early feeding.

Conclusion: There is no justification to withholding oral feeds as is traditionally done. Early feeding should be initiated without fear of any side effects. Patients have an early postoperative recovery; it is cost-effective and results in higher patient satisfaction.

Abstract

Objective: The aim of our case–control study was to determine expression of VEGFA mRNA in placentae of preeclamsia (PE) versus uncomplicated pregnancy to further clarify its differential expression in pregnancy hypertensive disorders.

Study Design: The PE group was subdivided into severe and non-severe; those with or without HELLP syndrome and placental VEGFA characteristics were compared for these cohorts. Additionally, the neonatal and maternal outcomes were recorded. The quantification of placental VEGFA was done using quantitative real-time PCR and results were expressed as fold change.

Results: Out of 42 PE cases, 23 (55%) were non-severe and 19 cases (45%) were severe PE. Out of 19 severe PE patients, 8 (42%) were HELLP syndrome (complete HELLP) and remaining 11 (58%) were non-HELLP severe PE. Compared to controls, the true fold change in PE, HELLP, non-HELLP, severe PE, non-severe PE was - 2.186, - 13.333, - 6.698, - 8.950 and 1.466, respectively.

Conclusions: Our results showed a lowered VEGFA expression in PE placentae compared to uncomplicated controls. The finding of initial increase of VEGFA in nonsevere PE and subsequent marked lowering in HELLP strengthens the existing hypothesis of decompensated VEGF being a major role player in PE.

Abstract

Aim and Objectives: To construct a hybrid model classification for cesarean section (CS) deliveries based on the woman-characteristics (Robson’s classification with additional layers of indications for CS, keeping in view lowresource settings available in India).

Methods: This is a cross-sectional study conducted at Nalanda Medical College, Patna. All the women delivered from January 2016 to May 2016 in the labor ward were included. Results obtained were compared with the values obtained for India, from secondary analysis of WHO multicountry survey (2010–2011) by Joshua Vogel and colleagues’ study published in ‘‘The Lancet Global Health.’’ The three classifications (indication-based, Robson’s and hybrid model) applied for categorization of the cesarean deliveries from the same sample of data and a semiqualitative evaluations done, considering the main characteristics, strengths and weaknesses of each classification system.

Results: The total number of women delivered during study period was 1462, out of which CS deliveries were 471. Overall, CS rate calculated for NMCH, hospital in this specified period, was 32.21% (p = 0.001). Hybrid model scored 23/23, and scores of Robson classification and indication-based classification were 21/23 and 10/23, respectively.

Limitations of the Study: Single-study centre and referral bias are the limitations of the study.

Conclusion: Given the flexibility of the classifications, we constructed a hybrid model based on the woman-characteristics system with additional layers of other classification. Indication-based classification answers why, Robson classification answers on whom, while through our hybrid model we get to know why and on whom cesarean deliveries are being performed.

Abstract

Background: Mothers are the nurturing pillar of the family. When a woman dies or becomes ill, either during or after giving birth, the consequences have the potential to affect not only the woman herself, but her family, society and the nation as well.

Objectives: The study was designed to evaluate the maternal mortality ratio in a tertiary care hospital, assess the demographic profile, causes of maternal mortality, type of delay, and to suggest remedial measures for improvement.

Methods: A retrospective study was done from Jan 2013 to Dec 2016 at a tertiary care hospital in New Delhi. The medical records of all maternal deaths over a period of 4 years were reviewed and analyzed.

Results: The Maternal mortality ratio in the study period was 361.71/100,000 live births. The number of maternal death was 364. Unbooked cases accounted for the majority, i.e., 322, booked being 29 and registered 13. Two hundred and eleven cases were referred from other centers. Maximum deaths occurred between 21 and 30 years (73.07%).

Anemia was widely prevalent. Most maternal deaths were due to direct causes like hypertensive disorders (28.02%), pregnancy-related infections (20.87%), and hemorrhage (12.36%). Among indirect causes, anemia, hepatitis, heart disease and respiratory illness accounted for 15.93, 11.53, 3.29 and 5.49%, respectively. Type I delay was most common (64.28%).

Conclusion: Strengthening of the peripheral centers, hiring competent staffs and adequate blood bank facilities together with reference linkages must be done. Auditing the causes for maternal mortality is extremely helpful to identify the preventable causes and delays.

Abstract

Background: Over 98% of the world’s total stillbirths are believed to occur in developing countries and still have received very little research, programmatic or policy attention.

Aims and Objective: To collect data on epidemiological profile of cases experiencing stillbirths, to assess the associated antenatal high risk factors present and to find out the probable cause of stillbirth.

Materials and Methods: This was a cross-sectional, observational study, which was done as part of WHO SEARO project after ethical clearance. The study included all stillbirths which occurred in the hospital during the study period August 2015–February 2017. Antenatal records were reviewed; maternal investigations were done. Baby was examined after delivery. Pre-structured pro forma was filled for every case. Finally, the relevant condition found was classified under CODAC system of stillbirth classification. Result Out of 20,580 deliveries, 600 (2.9%) were stillborn. Maternal cause was noted in 145/600 (24.2%) cases, fetal cause was noted in 181/600 (30.2%), and placental and cord origins were suspected in 128/600 (21.3%) and 12/600 (2%) cases, respectively. In 72/600 (12.0%) cases the reason for stillbirth was unknown and unclassifiable. Among the maternal causes the most common was hypertension (89/600, 14.8%) followed by infection including fever (5.7%); the most common infection was hepatitis. Among the fetal causes birth defect was the most common (106/600, 17.7%) followed by extreme prematurity in 42/600 (7.0%).

Conclusion: Birth defects were the most important fetal cause of stillbirth; hypertension in pregnancy and fetal growth restriction were important associated factors.

Abstract

Purpose: Vitamin D deficiency has been proposed to be a risk factor in the pathogenesis of uterine fibroid in few recently published studies conducted in Europe and Africa. Nevertheless, no study has ever addressed similar query in Indian women where hypovitaminosis is very common.

Methods: A total of 144 women of age group 20–50 years belonging to Jamshedpur, Jharkhand, India, were included in the study. Out of which, 72 women had uterine fibroids and rest healthy women without fibroids served as controls. All women were subjected to ultrasound examination of uterus followed by measurement of serum FSH level (on 3rd day of menstruation) and serum vitamin D3.

Results: The mean serum concentration of vitamin D3 was significantly lower in women with uterine fibroids compared to controls (10.81 ± 6.18 vs. 22.91 ± 16.18, p\0.0001). On further analysis, 62.5% of cases were found to be severely deficient (vitamin D3\10 ng/mL) as compared to 26.39% of controls (p\0.0001). Besides that, only 2.77% of cases had sufficient vitamin D level as compared to 23.61% of controls (p = 0.0002). The odds ratio (OR) of occurrence of fibroid with serum vitamin D3 level of\10 ng/dl compared to that of level[10 ng/dl was 4.64 (95% confidence interval [CI] 2.28–9.44) (p = 0.0001).

Conclusion: Serum vitamin D3 level inversely correlated with burden of uterine fibroid and possibly its deficiency is a risk factor for uterine fibroid occurrence in eastern part of India.

Abstract

Objective: To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step versus two steps as a screening procedure.

Methodology: A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two-step approach (ACOG recommendation), and group B comprised of women screened by one-step method (IADPSG criteria). Women diagnosed with ‘gestational diabetes’ were followed in an antenatal clinic, and incidence of GDM and maternal and fetal outcome between two groups were analyzed using SPSS.

Results: The incidence of GDM was almost double using one-step versus two-step approach which was 19.2 and 11.8%, respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI 1.01–5.79). Further, fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A versus 7.4% in group B. In the group B, 15 patients (15.8%) with GDM (based on FBS >= 92 mg/dl at first ANC visit) showed clinical symptoms and blood sugars in hypoglycemic range on MNT requiring resumption of normal diet.

Conclusion: The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS C 92 mg/dl at first ANC visit as per IADPSG) and suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.

Abstract

Introduction: Adenoid cystic carcinoma of vulva (ACCvulva) is an extremely rare entity with < 100 cases reported in the literature so far.

Objective: To study the clinical profile and outcome of ACC-vulva treated at a tertiary cancer care centre in South India.

Methods: This is a retrospective, record-based study of histopathologically confirmed cases of ACC-vulva treated at our centre from January 2005 to March 2016.

Results: Only four patients were diagnosed with ACCvulva during the 11-year period under study. The longest duration of follow-up was 129 months. The age at diagnosis ranged from 32 to 43 years, with a median of 40 years. All patients were married, parous and premenopausal and presented with a painless unilateral vulval swelling. All patients had involvement of the Bartholin’s gland site with normal overlying skin. In all patients, wide excision was performed. Unilateral inguinal node dissection was done in one case. Perineural infiltration was documented in two cases, while positive excision margins were present in three cases. None of the patients had any lymph node involvement at diagnosis or during follow-up. Two patients had recurrence of disease. The disease-free interval was 23 months for one patient and 118 months for the other. In both, local (vulval) and distant (multiple lung) metastases were detected simultaneously.

Conclusion: Adenoid cystic carcinoma of vulva is an extremely rare, slowly progressing neoplasm mostly involving the Bartholin’s gland. The usual treatment includes wide excision and adjuvant radiotherapy (if required). There may be late local and distant recurrence.

Abstract

Introduction: Using an intrauterine device (IUD) is many times safer than pregnancy and more effective in preventing pregnancy than oral contraceptives, condoms, spermicidal, any barrier method, or natural family planning. Benefits of healthy timing and spacing of pregnancy are many. Postpartum contraception is becoming popular after introduction of PPIUCD services.

Objective: To study the incidence, management, clinical outcome of missing strings cases in post-placental and intra-cesarean IUCD.

Materials and Methods: This study was a retrospective observational study, carried out in the district of Balangir, Odisha, India. Status of women who had post-placental and intra-cesarean IUCD insertion in various institutions between January 2010 and December 2012 having followup as per the protocol was taken for the study. All the complications were recorded and studied. Incidence, clinical outcome, and management of missing strings were analyzed.

Results: Records of 1343 clients were studied. Six hundred and seventeen cases had failed to report for follow-up as per the study design. Seven hundred and twenty-six cases had follow-up as per the protocol. Of them, 36 had expulsion, and rest 690 cases were taken for the study. There were 209 missing strings at 3 months. At the end of the study, there was spontaneous descend in 138 cases. More than 50 % cases were asymptomatic. Ultrasonography was the method of diagnosis, and simple sounding of the uterus alone could also establish IUD in uterine cavity. Removal rate was higher in missing strings group, Continuation rate is higher in String visible group.

Conclusion: Post-placental intra-cesarean Copper T 380A insertion is a safe and effective method of reversible contraception; missing string is emerging as a potential distracter of its use. It is important that every user must be followed up and the providers must be competent in managing complication. Better after care in form of effective follow-up and complication management is needed to maintain popularity. Introduction of compensation scheme will also help improving the acceptance.

Abstract

Objective: This study was conducted at Swapna Health Care (a tertiary centre for endoscopy), to analyse the outcome of hysteroscopic resection of submucous fibroids in 125 symptomatic women.

Materials and Methods: A total of 125 women were diagnosed with submucous fibroids between 1994 and 2017, 83 presented with AUB, 31 with infertility and four with RPL. Seven postmenopausal women had thickened endometrium on routine transvaginal ultrasonography, and hysteroscopy showed submucous fibroids.

Results: Out of 83 with AUB, 68 were premenopausal and 15 were postmenopausal. All these patients underwent submucous fibroid resection by hysteroscopy. Out of 83, 75 (90.4%) had total relief from AUB and did not need any further management. Only eight patients needed hysterectomy after submucous fibroid resection. Thirty-one patients came for infertility. Twenty-five patients followed infertility treatment with us after SMFR. 32% of our infertile patients conceived (8/25).

Conclusions: Submucous fibroid resection is a safe procedure, giving good results in symptomatic women with AUB and infertility. Hence, all gynaecologists should be trained in diagnostic and operative hysteroscopy and should be able to offer this option to their patients in the spectrum of choices available.

Abstract

Objectives: To assess the effect of intravenous versus topical tranexamic acid in reducing intraoperative and postoperative blood loss in women with abdominal hysterectomy.

Materials and Methods: The study was a randomized double-blind placebo-controlled trial, carried out in a tertiary university hospital in Egypt, from November 2015 to October 2017. A total of 129 women undergoing abdominal hysterectomy for benign etiology were randomly assigned to three groups: Group I [43 patients received 110 ml normal saline IV just before skin in scion], Group II [43 patients received 1 g tranexamic acid in 100 ml saline IV just before skin in scion], and Group III [43 patients received 2 g topical tranexamic acid applied intra-abdominal after hysterectomy]. The primary outcome was intraoperative, postoperative, and all blood loss estimation.

Results: Both Group II (IV tranexamic acid) and Group III (topical tranexamic acid application) showed great reduction in intraoperative and postoperative blood loss (blood in the intra-abdominal drain) compared with Group I (placebo group), (P = 0.0001, 0.0001, 0.0001, 0.0001), so the overall estimated blood loss in groups II and III showed highly reduction compared with Group I (P = 0.0001, 0.0001).

Conclusion: Intravenous and topical tranexamic acid application is a safe and reliable method to help decrease blood loss during and after abdominal hysterectomy.

Abstract

Purpose: The objective was to observe the characteristicsamong pregnant patients with a diagnosedhemoglobinopathy and to study the obstetric and medicalmorbidity patterns during the antenatal and the perinatalperiods in this group of patients.

Methods: A prospective observational study was conductedin a tertiary care center.

Results: Sixty patients were studied in 11 months. Primi-gravidae (43.3%) formed the highest percentage ofpatients.bThalassemia trait was the most commonhemoglobinopathy, seen in 81.66% of study subjects. Thehemoglobin value ranged from 5.7 to 13.0, with an averageof 9.2 g/dl. Thyroid problems were the most commonassociated medical disorder. Though IUGR and placentaprevia were common, there were no major obstetric prob-lems. There were 57 live births and 1 fresh stillbirth. Twopatients had spontaneous abortion for which uterine curettage was done. LSCS was the most common obstetricoutcome. Patients with sickle-cell disease required moreblood transfusion than those with beta-thalassemia trait.There were 2 maternal mortalities, and both the patientswere the diagnosed cases of sickle-cell disease.

Conclusions: While the perinatal outcomes among womenwith sickle-cell disease are poor, the outcomes in pregnantpatients with beta-thalassemia trait were not a cause ofmajor concern.

Abstract

Introduction: Despite their relative frequency, paraovarian cyst received only scant attention. Clinician should be aware of the complications of paraovarian cyst.

Objective: To analyse the clinical profile, complications and management of paraovarian cyst.

Materials and Methods: Retrospective analysis of 51 patients with operative diagnosis of paraovarian cyst was carried out at our institution over a 5-year period.

Results: Majority (60.78%) of paraovarian cysts were found in the third and fourth decades, and the mean age of the patients was 31.8 years. 62.74% patients with paraovarian cyst presented with abdominal pain, and the rest were an incidental finding. Ultrasound made a correct diagnosis in 47.05% of patients. Mean size of paraovarian cyst was 7.51 cm. Complications of paraovarian cyst noted in our study are cyst enlargement (79.62%), adnexal torsion (18.51%), haemorrhage (7.4%), rupture (1.85%) and benign tumour (12.96%). 84.31% paraovarian cysts were managed by laparoscopy. Fertility-sparing surgery was done in 57.39% of paraovarian cysts.

Conclusion: Paraovarian cyst should be considered in the differential diagnosis of adnexal mass. The importance of differentiating it from ovarian cyst cannot be overemphasized. Laparoscopic approach and preferably a fertility-sparing surgery should be considered in the management of complications of paraovarian cyst.

Abstract

Background: Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. Aim To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. Methods This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24 h recall, food frequency and their log diaries) were collected.

Results: The mean age of the group was 29.9 ? 4.5 years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3 ? 1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronutrient intakes of the population were below the recommended daily allowances for Indians (60–70% of RDA). There was a deficit in the intake of calories, fibre, proteins, iron, calcium, carotene, folic acid, thiamine, riboflavin and niacin. Between the two groups, the pre-GDM women had a significantly better nutrient intake and this could be attributed to a greater exposure to nutrition counselling that they have received during the earlier part of their diabetes care.

Conclusion: The gestational period should be viewed as a window of opportunity to modify dietary patterns and introduce healthy lifestyle practices for the woman and her family

Abstract

Background: To compare between the sequential and concurrent use of vaginal misoprostol plus Foley catheter for labor induction.

Methods: This single-center, non-blinded randomized study was conducted at the department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University. A total of 160 women with full term singleton pregnancy, cephalic presentation and bishop score B 6 were randomized for labor induction with either concurrent or sequential use of vaginal misoprostol plus Foley catheter (80 cases in each group). The primary outcome measured was inductionto-delivery interval and secondary outcomes mesaured were vaginal delivery within 24 h, number of doses needed to induce labor, need of oxytocin for augmentation of labor, cesarean section rate, maternal or neonatal complications.

Results: The mean induction-to-delivery interval was 22.33 ± 13.28 h versus 18.45 ± 14.34 h (p = 0.041) in sequential and concurrent group, respectively. The percentage of women who completed vaginal delivery within 24 h was 51% versus 61% (p = 0.046) in sequential and concurrent group, respectively. Other maternal and neonatal outcomes were similar in both groups.

Conclusion: Concurrent use of vaginal misoprostol plus Foley catheter for labor induction was associated with shorter induction-to delivery interval compared to sequential use, and it increases the rate of vaginal delivery in the first 24 h.

Abstract

Objective: To study the prevalence, clinical and laparo-scopic characteristics of endometriosis in infertile women.Study DesignThis is a hospital-based prospective study.PatientsFive hundred and two (502) patients underwentdiagnostic laparoscopy for evaluation of cause for infer-tility. Staging of endometriosis was done according to therAFS scoring system.

Results: Out of 502 women, 276 (54.98 %) showed thepresence of endometriosis, while 226 (45.01 %) did nothave endometriosis. One hundred and eighty-three(66.3 %) women had stage I endometriosis, 49 (17.77 %)had stage II, 23 (8.33 %) had stage III and 21 (7.6 %) hadstage IV endometriosis.

Conclusion: More than 50 % of patients in our study wereasymptomatic; however, the presence of menorrhagia,dysmenorrhoea, dyspareunia and chronic pelvic pain arealso clinically statistically significant. So, we would like torecommend the evaluation and treatment of a patientreporting in gynaecological OPD with the above-men-tioned complaints with high suspicion of endometriosis.

Abstract

Objective: The study is to promote the least invasive approach that combines cholecystectomy and hysterectomy at the same operative sitting so as to provide maximum benefits to women.

Method: A series of 45 women between 40 and 75 years age from year 2001 to 2014 from the private practice of author and colleague surgeons in Mumbai were in need of hysterectomy as well as cholecystectomy for gynecological indication and symptomatic gallstones, respectively. Cholecystectomy was performed laparoscopically by general surgeon and was combined with hysterectomy with or without bilateral salpingo-oophorectomy (BSO) via vaginal route by gynecologist.

Result: The average surgical time was 40 min for laparoscopic cholecystectomy and 32 min for hysterectomy and 40 min for hysterectomy with bilateral salpingooophorectomy to 64 min when uteri needed heavy debulking. Total blood loss was approximately less than 50–100 ml for hysterectomy and up to 250 ml for hysterectomy needing fair amount of debulking. Blood loss for laparoscopic cholecystectomy was 10 ml to maximum of 80 ml.

Conclusion: Lesson for both, gynecologists and the surgeons, is to combine these two when required and possible. This provides maximum advantages through minimizing risk of anesthesia and time duration, hospital stay, costeffectiveness.

Abstract

Aim: The prevalence of scar endometriosis is increasing with the increasing caesarean deliveries and laparoscopic procedures done for pelvic endometriosis. To analyse the symptomatology and surgical perspective of scar endometriosis.

Materials and methods: Retrospective review of 16 women who underwent surgery for scar endometriosis in the period of 4 years in Amrita institute of medical sciences.

Results: Mean age of the patients is 35.19 years. Mean interval from the index surgery to the presentation is 4.56 years. Mean size of the swelling is 2.84 cm. In 68.8% of the patients, caesarean section was the inciting surgery. 18.7% had port site endometriosis. Cyclical pain and swelling at the scar site was present in 93.8% of the women. 18.9% had concurrent pelvic endometriosis. All women had involvement of the subcutaneous tissue followed by 11 women with the involvement of rectus sheath. There was no recurrence of the lesion in the operated patients in the mean follow-up period of 11.91 months.

Conclusion: In all women presenting with cyclical scar site pain and swelling, scar endometriosis should be considered. It commonly follows caesarean section and laparoscopic surgeries done for endometriosis. Wide local excision with or without reconstruction is the method of choice for this condition. Role of tumescent solution during surgery and postoperative medical management to reduce recurrence needs further prospective studies.

Abstract

Background: Some women experience unforeseen complications during pregnancy and childbirth, which may be life threatening; their survival depends on intensive support and timely interventions. The aim of this study was to assess the long-term prevalence of adverse health conditions and their impact on quality of life in women who had severe acute maternal morbidity (SAMM).

Methods: This is a prospective cohort study comprising 43 women with SAMM during 2015 (exposure group) and 43 women who had an uneventful pregnancy and delivery (non-exposure group) during the same study period. Those who consented were given an additional follow-up date for free medical health check at 1 year.

Results: The incidence of SAMM during study period was 8.6/1000 births. There were five deaths in the exposure group. Adverse health events were seen in 30 (78.94%) out of 38 survivors. Abnormal lipid profile, thrombocytopenia, cardiac diastolic dysfunction, amenorrhoea, Sheehan and Asherman syndrome were major findings in the exposed group. Four (10.52%) women required re-admission, and eight (20.05%) required additional procedures to confirm screening abnormalities. The exposure group had higher mean scores on the EPDS scale, incidence of suicidal thoughts and poorer performance in the WHOQOL BREF psychological domain.

Conclusion: Health programmes need to focus on maternal health, provide medical treatment and psychological support for a longer duration than the traditional 6 weeks postpartum in women who experience SAMM.

Abstract

Background: Some women experience unforeseen complications during pregnancy and childbirth, which may be life threatening; their survival depends on intensive support and timely interventions. The aim of this study was to assess the long-term prevalence of adverse health conditions and their impact on quality of life in women who had severe acute maternal morbidity (SAMM).

Methods: This is a prospective cohort study comprising 43 women with SAMM during 2015 (exposure group) and 43 women who had an uneventful pregnancy and delivery (non-exposure group) during the same study period. Those who consented were given an additional follow-up date for free medical health check at 1 year.

Results: The incidence of SAMM during study period was 8.6/1000 births. There were five deaths in the exposure group. Adverse health events were seen in 30 (78.94%) out of 38 survivors. Abnormal lipid profile, thrombocytopenia, cardiac diastolic dysfunction, amenorrhoea, Sheehan and Asherman syndrome were major findings in the exposed group. Four (10.52%) women required re-admission, and eight (20.05%) required additional procedures to confirm screening abnormalities. The exposure group had higher mean scores on the EPDS scale, incidence of suicidal thoughts and poorer performance in the WHOQOL BREF psychological domain.

Conclusion: Health programmes need to focus on maternal health, provide medical treatment and psychological support for a longer duration than the traditional 6 weeks postpartum in women who experience SAMM.