title: Severe acute maternal morbidity (SAMM) in postpartum period requiring tertiary Hospital care.
abstract: BACKGROUND
  Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation.
  
  
  OBJECTIVE
  To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities.
  
  
  METHODS
  This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11.
  
  
  RESULTS
  The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions). The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH) (50%), preeclampsia and eclampsia (30%) and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34) and maternal mortality rate was 4.8%.
  
  
  CONCLUSIONS
  PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high.
authors.affiliation: Department of Obstetrics and Gynecology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
authors.forename: Seema
authors.initials: S
authors.lastname: Bibi
authors.affiliation: Countess of Lady Dufferen Fund (C.D.F), Maternity Hospital, Hyderabad, Pakistan.
authors.forename: Saima
authors.initials: S
authors.lastname: Ghaffar
authors.affiliation: Department of Pediatric Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
authors.forename: Shazia
authors.initials: S
authors.lastname: Memon
authors.affiliation: Department of Pediatric Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
authors.forename: Shaneela
authors.initials: S
authors.lastname: Memon
keywords: Postpartum period; Severe acute maternal morbidity (SAMM); Tertiary hospital admission