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Article
Hospital Registration of Maternal Mortality in Iraq 2001-2007
تسجيل وفيات الامهات في المستشفيات في العراق للفترة 2001 - 2007

Author: Batool Ali Ghalib Yassin د.بتول علي غالب ياسين
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2009 Volume: 22 Issue: 1 Pages: 65-70
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Pregnancy and childbirth are the leading causes of death among women in many developing countries. In most developing countries, monitoring the level of maternal mortality rates and ratios seems to be very difficult. Ministry of Health, in its effort to improve the registration system through the cooperation between Maternal and Child Health Section (Directorate of Public Health and Primary Health Care), Department of Health and Vital Statistics (Directorate of Planning and Resource Development) and the World Health Organization (WHO), implemented a special maternal mortality inquiry form for hospital registrations of maternal deaths started on the year 2000. Aim of the study: To evaluate the trend in maternal mortality registration during the period 2001-2007.Materials & Methods: A review of records was performed during the first half of 2008, to study the trend of registering maternal mortality over the last seven years. All the reports received by the Ministry of health for the last seven years were reviewed to evaluate the progress in hospital registration of maternal deaths.Results: The study revealed more than one and a half fold increase in the number of registered maternal deaths over the seven years period after implementing the special inquiry form, with marked variation in registration between different governorates and within the same governorate . Conclusions and Recommendations :Implementing a special maternal mortality inquiry form, by the Ministry of Health, lead to noticeable improvement in registering maternal mortality in health facilities, yet further studies are recommended to review each case of death.Key wards: Maternal death, maternal mortality ratio

المقدمة:تعتبرمضاعفات الحمل والولادة من الاسباب الرئيسية للوفاة في الدول النامية ، وبالنظر لافتقار معظم الدول النامية الى نظام تسجيل حيوي شامل، فقد انعكس هذا على مؤشرات صحة الام وبالاخص معدل ونسبة وفيات الامهات واصبحت معظم المعلومات المتوفرة عن هذه المؤشرات تحتسب من المسوحات وتقديراتها والتي لا تخلو من صعوبات.اعتمدت ، وزارة الصحة العراقية ( شعبة رعاية الام والطفل وقسم الاحصاء الصحي والحياتي) وبالتنسيق مع منظمة الصحة العالمية، وفي محاولة لتطوير نظام المعلومات الصحي وخاصة فيما يتعلق بمؤشرات صحة الام، استمارة خاصة لتسجيل وفيات الامهات في المستشفيات في عموم القطر. ابتدأ العمل بهذه الاستمارة منذ عام 2001 ولحد الان. هدف الدراسة:تقييم تسجيل وفيات الامهات في مستشفيات العراق للفترة من 2001 – 2007طريقة البحث: نفذت دراسة مقطعية خلال النصف الاول من عام 2008 لدراسة سياق تسجيل وفيات الامهات خلال السنوات السبع المنصرمة. تمت مراجعة كافة تقارير الوفيات الخاصة بالامهات والواردة الى شعبة صحة الام والطفل في وزارة الصحة للفترة من 2001 وحتى 2007.النتائج :اظهرت الدراسة زيادة ملحوظة في تسجيل وفيات الامهات في عموم مستشفيات القطر بمقداريقترب من مرة ونصف خلال السنوات السبعة المنصرمة بعد استخدام الاستمارة الخاصة لتسجيل وفيات الامهات في المستشفيات، مع وجود تفاوت واضح في تسجيل الوفيات بين محافظات القطر وتفاوت التسجيل ضمن المحافظة الواحدة خلال فترة الدراسة.الاستنتاجات و التوصيات: اعتماد الاستمارة الخاصة لتسجيل وفيات الامهات في المستشفيات من قبل وزارة الصحة ساهم في تحسين تسجيل وفيات الامهات في عموم القطر، وتوصي الدراسة بضرورة اجراء دراسات مستقبلية تشمل مراجعة تفصيلية لكل حالة وفاة.


Article
MATERNAL MORTALITY IN BASRAH HOSPITALS; AN OVERVIEW OF THE LAST TWO DECADES

Authors: Salman K Ajlaan --- Edward Zaia --- Faiz A Alwaeely --- Fouad H Al-Dahhan
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2006 Volume: 12 Issue: 1 Pages: 3-3
Publisher: Basrah University جامعة البصرة

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Abstract

This study aimed to determine the MMR in Basra hospitals for 20 years (1983-2002), to determine the main causes of maternal deaths with regards to direct, indirect & fortuitous causes & to verify the impact of major events including wars & sanction on the trend of maternal deaths. This is a retrospective study included all maternal deaths occurred in hospitals as well as deaths recorded in emergency departments, forensic medicine department & statistical units throughout the study period. Detailed information was taken to verify the cause of death in each woman. A total of 206 deaths occurred during the study period, MMR did not run a steady fashion, they showed gradual decline during 1980s. Following the second gulf war, there was considerable increase in MMR with the peak one observed in 1996. There after the ratio decline gradually to pre 2nd war levels. Direct obstetric causes remain the major causes of maternal death throughout the 20 years with, in a decreasing frequency, hemorrhage, sepsis & AFE were the major direct causes. However, indirect causes showed some, but noticeable increment during the sanction years. We concluded that the major political events, including wars that Iraq & Iraqi peoples exposed to had substantial adverse influence on the trends of maternal deaths. Although a direct maternal death outweigh indirect death, however, sanction years caused obvious increment in direct deaths.

Keywords

MATERNAL --- MORTALITY --- BASRAH


Article
Maternal mortality in Southern Iraq Marshes

Author: A.Q. Jebraa and O.S. Habib
Journal: Marsh Bulletin مجلة الاهوار ISSN: 18169848 Year: 2009 Volume: 4 Issue: 1 Pages: 36-50
Publisher: Basrah University جامعة البصرة

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Abstract

Background: Maternal mortality is suffering a longstanding ignorance in most of the developing countries including Iraq which lies with countries that have poor registration systems. In addition, maternal mortality is especially important since the WHO have put the reduction of MMR as one of the six health related MDGs adopted by United Nations and declared in 2000.Methods: The principal method was the sisterhood method which is especially recommended for the situation of Iraq. It involved household visits and made successful interviews with 3683 females in the reproductive age. The questionnaire used was a bit modified from the original survey questions invented for this approach. Results: The estimated maternal mortality ratio of 92/100 000 live births which looks reasonable if compared to the national estimates made by the Iraqi Ministry of Health, Ministry of Planning and other organizations in the relevant time period.Conclusion: The current estimate of maternal mortality in marshes of 92 per 100000 live births is reasonable within national context. The present study revealed a tendency for maternal mortality to have declined overyears. Most of the causes of female mortality and maternal mortality are preventable

Keywords

Maternal --- mortality --- Marshes --- longstanding


Article
Maternal satisfaction of pediatric care providers for children with chronic diseases.

Authors: Russul F. Mussa رسل فيحان موسى --- Adeebah A. Alyasiri أديبة الياسري --- Jasim M. Al-Marzok جاسم المرزوك
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2015 Volume: 11 Issue: 19 Pages: 41-46
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background: Children with chronic illnesses need continuous correlation with pediatrician. Assessment of patient satisfaction allows health care providers to explore the extent to which their service meets the needs of their patients. Interview techniques are important for explanation of the problem to the family. The pediatrician deals with respect to the parent's ideas to improve their self-esteem and competency Objective: To assess maternal satisfaction of pediatric providers of children with selected chronic illness.Patients and Method: A cross sectional study, conducted in Babylon Gynecology and Pediatrics Teaching Hospital (wards and outpatient clinic), Al-Hilla, Iraq. From October 2011 to November 2012. Information was collected by interview with mothers of 110 children with one of four chronic illnesses (asthma, diabetes mellitus, cerebral palsy and congenital heart disease) to determine their response about pediatric providers whom they consulted in the last year, seen most frequently, and who were seen over the longest period of time. Rates of dissatisfaction with those providers are also reported. Result: The probability of reporting a high level of satisfaction (extreme satisfaction) was for subspecialist pediatric care providers than with specialist pediatrician, P- value <0.04, but mothers mentioned that specialist pediatrician providing better general health care, P-value <0.001,realy listening to their opinions, P-value <0.002,and ability to answer questions about condition, P-value <0.02.Conclusions: Achievement of Mothers-pediatrician communication ensures best maternal satisfaction

خلفية الدراسة: يعرف المرض المزمن بأنه حاله مرضية مستمرة. يعتمد الأطفال المصابون بأمراض مزمنة اعتمادا كبيرا على علاقة مستقرة, مستمرة مع الأطباء السريريين و نظام الرعاية الصحية. إن استمرارية الرعاية بمثابة أساس لبناء الثقة، كما يعد الاتصال الفعال بين العائلات المتضررة و الأطباء شرط أساسي للجودة العالية. إن تقييم اقتناع المرضى يسمح باستكشاف مستوى خدمة الأطباء و الممارسين العاميين في تلبية احتياجات المرضى. يسهل نظام المقابلة في الإفصاح عن المشكلة للعائلة. يبدي الأطباء الاحترام عندما يضمنون أفكار الآباء مما يزيد ثقتهم بالنفس والشعور بالكفاءة الهدف: تهدف الدراسة الحالية إلى تقييم اقتناع الأمهات بموفري العناية من أطباء الأطفال للأطفال المصابين بأمراض مزمنة مختارة.الطريقة : دراسة مقطعية شاملة ، أجريت في مشفى بابل التعليمي للنسائية و الأطفال (الردهات و العيادات الخارجية في المشفى) في مدينة الحلة العراق للفترة من أكتوبر 2011 إلى نوفمبر 2012. وقد جمعت المعلومات من خلال مقابلة مع الأمهات ل 110 طفلا مصابا بواحد من أربعة من الأمراض المزمنة ( الربو, مرض البول السكري ، الشلل الدماغي ،والأمراض القلبية الولادية) لتحديد أجوبتهم عن موفري العناية من أطباء الأطفال الذين استشاروهم في العام الماضي، عاينوهم في أغلب الأحيان، والذين كانوا يعاينوهم أطول فترة من الوقت. معدلات سجل عدم الاقتناع بموفري العناية من أطباء الأطفال أيضا. النتائج: إن احتمالية تسجيل مستوى عالي من الاقتناع (اقتناع بالغ) لمقدمي الرعاية من أطباء الأطفال ذوي الأختصاص الدقيق أكثر من أطباء الأطفال المختصين بقيمة تنبؤية < 0.04 ، ولكن الأمهات ذكرن أن الأطباء الأختصاص ( يوفرون الرعاية الصحية العامة بشكل أفضل بقيمة تنبؤية <0.001 ,يستمعون إلى آرائهم بقيمة تنبؤية <0.002 و القدرة على الإجابة على الأسئلة حول حالة المرضى بقيمة تنبؤية <0.02). الاستنتاجات: الأمهات أكثر اقتناعاً عندما تتحقق معظم أو كل الاتصالات المتوقعة بين الآباء والأطباء.


Article
Causes of maternal death in Mizan Aman and Gebretsadik shawo general hospitals from 2011 – 2015: A case - control study using propensity score matching analysis
مسببات وفيات الامهات للمدة من 2011 - 2015 : دراسة الشاهد والحالة بتوظيف تحليل درجة مطابقة الميل في مستشفيين الميزان امان و جيبريتسادك العامي

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Abstract

Objective: To identify causes of maternal death in MizanAman and Gebretsadikshawogeneral hospitalsMethodology: A case control study on 595 charts, 119 cases and 476 controls was conducted in MizanAman&Gebretsadikshawogeneral hospitals. Data was analyzed by STATA 13.1. Propensity score matching analysis was used to see causes of maternal death. Results:Hemorrhage were the main direct causes of maternal death which accounts 47.9% (β =0.58 (95% CI (0.28,0.87)) in hospital but when projected to population based the sample (β =0.26 (95% CI (0.22,0.31)). Followed by infection 36 (25.21%) (β = 0.50 (95% CI (0.08, 0.92)). when projected to population based the sample PIH 7.6%) is significant cause (β = 0.16 (95% CI (0.13, 0.19). Most death (74.8%) occurred during post-partum period.Recommendation:The health professionals must work on awareness creation on early arrival at health institution for delivery before development of different complications

Objective: To identify causes of maternal death in MizanAman and Gebretsadikshawogeneral hospitalsMethodology: A case control study on 595 charts, 119 cases and 476 controls was conducted in MizanAman&Gebretsadikshawogeneral hospitals. Data was analyzed by STATA 13.1. Propensity score matching analysis was used to see causes of maternal death. Results:Hemorrhage were the main direct causes of maternal death which accounts 47.9% (β =0.58 (95% CI (0.28,0.87)) in hospital but when projected to population based the sample (β =0.26 (95% CI (0.22,0.31)). Followed by infection 36 (25.21%) (β = 0.50 (95% CI (0.08, 0.92)). when projected to population based the sample PIH 7.6%) is significant cause (β = 0.16 (95% CI (0.13, 0.19). Most death (74.8%) occurred during post-partum period.Recommendation:The health professionals must work on awareness creation on early arrival at health institution for delivery before development of different complications


Article
Silent Herpes Simplex virus infection in women with preterm premature rupture of membranes

Author: Shatha F.Abdullah
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 4 Pages: 409-411
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: genital herpes simplex virus infection in pregnancy poses a major risk to the fetus and it has been associated with bad obstetric out come causing preterm labor, intrauterine growth retardation and spontaneous abortion. This study was conducted to determine if premature rupture of membranes before 37 weeks of gestational age are observed with subclinical shedding of herpes simplex virus (HSV).Patients and methods: Cervical swabs were taken from 75 women with a history of preterm premature rupture of membranes before 37 weeks of gestation, and 20 women with normal obstetrical history for the presence of HSV antigen using Enzyme linked Immuno Sorbent Assay (ELISA) method.
Results: HSV antigen was detected in 37 swabs(49.3%) which revealed a significant association with preterm premature rupture membranes(PPROM) compared to control group(P<0.05).The majority of HSV infected women were asymptomatic 34(91.9%), and 23(56.1%) of the cases was associated with history of recurrent PPROM, compared to those women with history of single PPROM.Conclusion: The risk of maternal transmission of HSV to the fetus or newborn is a major health concern and the high rates of undiagnosed or asymptomatic HSV infections complicate the issue of prevention. With advent of serologic test that can reliably detect the virus in asymptomatic patient. Maternal HSV screening now is mandatory.

Keywords

HSV --- preterm PROM --- maternal herpes.


Article
Impact of maternal risk factors on the outcome of pregnancy in Baghdad city
تأثير عوامل الخطورة للام على ناتج الحمل

Author: Fatin A. Al-saffar فاتن عبد الأمير الصفار
Journal: Baghdad Science Journal مجلة بغداد للعلوم ISSN: 20788665 24117986 Year: 2010 Volume: 7 Issue: عدد خاص بمؤتمر العلمي النسوي 1 Pages: 813-820
Publisher: Baghdad University جامعة بغداد

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Abstract

To find out the impact of maternal risk factors on the outcome of pregnancy in Baghdad city. A descriptive purposive study was carried out on 100 postpartum women who had delivered for 1 hr. to 24 hrs. ago . the study sample was selected from three hospitals in Baghdad city ( Baghdad teaching hospital ,Fatima Al-Zahra'a maternity and pediatric teaching hospital and Al-Yarmook teaching hospital),during the period from 25 Jan. to 25 Feb. 2006. The data were collected through the use of questionnaire format reviewing pregnants' records and personal interview and were analyzed by using descriptive and inferential statistical approaches. The finding revealed that maternal pregnancy complications had weak effects on pregnancy outcome , while maternal employment & spouse's consanguinity were predictors for poor pregnancy outcome . The study recommended the necessity of establishing health education programs for pregnant to be self monitoring & early detection of complications that associate the pregnancy . In addition promote the system of follow up care during antenatal ,perinatal,& postnatal.

ايجاد تأثير عوامل الخطورة عند الأم الحامل على ناتج الحمل في مدينة بغداد. دراسة وصفية غرضية أجريت على 100 امرأة قد وضعن حملهن ما قبل 1ساعة الى24ساعة مضت. تم اختيار عينة الدراسة من ثلاث مستشفيات في مدينة بغداد ) مستشفى بغداد التعليمي ,مستشفى فاطمة الزهراء للولادة والأطفال التعليمي ,ومستشفى اليرموك التعليمي( خلال الفترة من 25 كانون الثاني الى 25 شباط 2006. تم جمع البيانات باستخدام الاستمارة الاستبيانية والمقابلة الشخصية وتحليل البيانات باستخدام الاحصاء الوصفي والاستنتاجي. أظهرت النتائج أن مضاعفات الحمل لها تأثير ضعيف على ناتج الحمل بينما يتنبأ عمل الأم ودرجة القرابة مع الزوج بناتج حمل ضعيف. أوصت الدراسة بضرورة بناء برامج صحية تثقيفية للحوامل وتوعيتهن بالكشف المبكر لعوامل الخطورة والمضاعفات التي ترافق الحمل .اضافة الى تطوير نظام المتابعة والرعاية الصحية لهن خلال الحمل ,الولادة ,وما بعد الولادة.


Article
Effect of Maternal Age on the Course and Outcome of

Author: Enas Talib Abdul -Karim
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 1 Pages: 19-25
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Delayed childbirth has become a common phenomenon in the developed world as a result of social,educational, and economic factors .OBJECTIVE:To demonstrate the effect of age on the pregnancy course and outcome among young and oldmothers.Subjects &methods:A cross sectional study was conducted at Al-Kadhimia Teaching Hospital. Data was collected by atrained medical students during the period from first of February to April 2010 .Total of 230women were included in the study using a convenient random sample technique, the sample wasdivided into two groups,128 women < 30 years old (group A) and 102 women ≥ 35 years old(group B), and were taken from obstetric department in Al-kadhimiya teaching hospital .Information were directly obtained from the mother herself and filled in a well designedquestionnaire form.RESULTS:The results showed that there was no significant difference between the two groups regarding somesociodemographic characteristics like address, education, occupation, antenatal care. There was asignificant increase in the presence of medical &obstetric complication, parity, history of abortionand No of abortion in the older age group mothers. As to the outcome of pregnancy, twin deliveryand low birth weight babies were significantly higher in older age group mothers. Interestingly,there was no significant difference regarding presence of congenital anomalies in babies of mothersin both groups.CONCLUSION:Mothers ≥35 years old showed higher rate of obstetric complication than young age group ofmothers, while congenital anomalies were higher but not significant among young age group ofmothers (≤30 years old).


Article
14- DIABETES MELLITUS IN PREGNANCY; MATERNAL & PRENATAL OUTCOME

Authors: Methal A AL-Rubaee --- Rabia A Alkaban
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 1 Pages: 95
Publisher: Basrah University جامعة البصرة

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Rabia A Alkaban* & Methal A AL-Rubaee@*MB,ChB. @MB,ChB, DGO, CABOG, Department of Obstetric & Gynecology, Medical College,University of BasrahAbstractThis is a case-control comparative study carried out over the period (July 2007-July2008) to identify the frequent type of D.M., analyze demographic features of diabeticcases as well as to identify maternal, fetal & neonatal complications of D.M. duringpregnancy.This study included 160 diabetic pregnant women as (cases) compared to 180 nondiabeticpregnant women as (control) who were admitted to three known hospitals withobstetrical & Gynecology department during same period of study. Such controls hadapproximated age & parity to that of cases.Type 2 DM was the commonest type among cases who tend to be more advanced intheir age with higher BMI compared to controls. Three major risk factors that predisposeto develop GDM were family history of type 2 or GDM, advanced maternal age & obesity.Diabetic pregnancy was more likely complicated by abortions, hypertensive disorders,polyhydramnious and preterm delivery with high C/S rate as well as P.P.H. & birth tractinjury in comparison to controls. Cephalo-pelvic disproportion consequent tomacrosomia was main indication for C/S in diabetic cases in whom not only macrosomicnewborns were more but also stillbirth rate was higher with lower Apgar score & moreadmission to NICU.Diabetic newborns were more likely to be affected by RDS, hypoglycemia & congenitalmalformation.In conclusion, D.M. is a major medical disorder that exhibit burden on health of bothmother & fetus with high maternal morbidity, prenatal & neonatal morbidity & mortality.


Article
Presentation and Management Outcome of Eclampsia at AlElwiya Teaching Hospital

Authors: Samar Sarsam, Thikra madlol --- Yousif Abdul Raheem, Inteasar Twaigery
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 277-281
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Eclampsia is a life-threatening complication of pregnancy for both the baby and the mother. Research isunderway to understand this complex condition and to improve the treatments that are currently used tocontrol it as it is a preventable complication of pre-eclampsia.OBJECTIVE: The study reviews the cases of eclampsia managed at Elwiya teaching Hospital with respect toincidence, management, maternal and perinatal outcome. METHODS: This prospective observational study was carried out in the department of Obstetrics and Gynaecologyat Elwiya Teaching Hospital – Baghdad-Iraq. Fifty two cases of eclamptic fits were dealt with from the1st of January till the 31st of December 2008. Pregnant patients with other convulsive disorders andmore than 7 days postpartum were excluded from the study. All the patients included were evaluated bydetailed history (taken from the attendants). Management was according to basic protocol foreclampsia; stabilization of patients, anticonvulsive therapy Magnesium sulfate, phenytoin and/ordiazepam and early delivery. A team of specialists and trained nurses were needed in the intensive careunit to deal with eclamptic mothers.RESULTS: During the year 2008, total number of deliveries from the 1INTRODUCTION: Eclampsia is one of the fatal complications of preeclampsiawhich is a multisystem disorder; itpresents a challenge to obstetricians and otherphysicians. Eclampsia is defined as seizure activityunrelated to other cerebral conditions in a pregnantwoman with pre-eclampsia. The condition wasknown to the ancient Greeks, who named it eclampsia. It has been prevalent since the time ofHippocrates; it remains an important cause ofmaternal mortality throughout the world,accounting for about 50000 deaths worldwide.Department of Obstetrics and Gynecology atElwiya Teaching Hospital – Baghdad . (1)st of January till the 31An eclamptic seizure occurs in 0.5% of mildly preeclampticpregnancies and 2% of severe preeclamptics.(2) st of December was12154, of these patients 52 presented with eclamptic fit with incidence rate of 4.28 per 1000 deliveries.The distribution of cases regarding the seasons was more in winter. 35 patients (67.31%) had poorantenatal care, 17 (32.69%) had good antenatal care. Four patients had history of eclampsia in theirprevious pregnancies. All the patients gave history of imminent eclampsia; two of them had blindnessalso; albumin in urine was negative in two cases only. Serious maternal complications occurred in28(53.84%) cases. Eight of the neonates died due to severe RDS.CONCLUSION: Eclampsia is still present and common in our locality; we need better antenatal care to predict pregnantladies liable to develop eclamptic fit in order to decrease the incidence of eclampsia complicatingpregnanc

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