"Near-miss" obstetric events and maternal deaths in Sagamu, Nigeria: A retrospective study

被引：65
作者：
Oladapo O.T. [1 ]
Sule-Odu A.O. [1 ]
Olatunji A.O. [1 ]
Daniel O.J. [2 ]
机构：
[1] Maternal and Fetal Health Research Unit, Department of Obstetrics and Gynaecology, Obafemi Awolowo College of Health Sciences/Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State
[2] Department of Community Medicine and Primary Care, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State
来源：
Reproductive Health | / 2卷 / 1期
关键词：
Intensive Care Unit Admission; Maternal Mortality; Maternal Death; Obstetric Care; Eclampsia;
D O I：
10.1186/1742-4755-2-9
中图分类号：
学科分类号：
摘要：
Aim: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre. Methods: Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss case definition was based on validated disease-specific criteria, comprising of five diagnostic categories: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. The near-miss morbidities were compared with maternal deaths with respect to demographic features and disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for life-threatening obstetric conditions. The maternal death to near-miss ratios for the three years were compared to assess the trend in the quality of obstetric care. Results: There were 1501 deliveries, 211 near-miss cases and 44 maternal deaths. The total near-miss events were 242 with a decreasing trend from 2002 to 2004. Demographic features of cases of near-miss and maternal death were comparable. Besides infectious morbidity, the categories of complications responsible for near-misses and maternal deaths followed the same order of decreasing frequency. Hypertensive disorders in pregnancy and haemorrhage were responsible for 61.1% of near-miss cases and 50.0% of maternal deaths. More women died after developing severe morbidity due to uterine rupture and infection, with mortality indices of 37.5% and 28.6%, respectively. Early pregnancy complications and antepartum haemorrhage had the lowest mortality indices. Majority of the cases of near-miss (82.5%) and maternal death (88.6%) were unbooked for antenatal care and delivery in this hospital. Maternal mortality ratio for the period was 2931.4 per 100,000 deliveries. The overall maternal death to near-miss ratio was 1: 4.8 and this remained relatively constant over the 3-year period. Conclusion: The quality of care received by critically ill obstetric patients in this centre is suboptimal with no evident changes between 2002 and 2004. Reduction of the present maternal mortality ratio may best be achieved by developing evidence-based protocols and improving the resources for managing severe morbidities due to hypertension and haemorrhage especially in critically ill unbooked patients. Tertiary care hospitals in Nigeria could also benefit from evaluation of their standard of obstetric care by including near-miss investigations in their maternal death enquiries. © 2005 Oladapo et al; licensee BioMed Central Ltd.
引用
收藏
相关论文
共 19 条
  • [1] Ronsmans C., Filippi V., Reviewing severe maternal morbidity: Learning from survivors from life-threatening complications, Beyond the Numbers: Reviewing Deaths and Complications to Make Pregnancy Safer, pp. 103-124, (2004)
  • [2] Pattinson R.C., Buchmann E., Mantel G., Schoon M., Rees H., Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries?, BJOG, 110, pp. 889-893, (2003)
  • [3] Cochet L., Pattinson R.C., MacDonald A.P., Severe acute maternal morbidity and maternal death audit- a rapid diagnostic tool for evaluating maternal care, S Afr Med J, 93, pp. 700-702, (2003)
  • [4] Vandecruys H.I.B., Pattinson R.C., Macdonald A.P., Mantel G.D., Severe acute maternal morbidity and mortality in the Pretoria Academic Complex: Changing patterns over 4 years, Eur J Obstet Gynecol Reprod Biol, 102, pp. 6-10, (2002)
  • [5] Sule-Odu A.O., Maternal deaths in Sagamu, Nigeria, Int J Gynecol Obstet, 69, pp. 47-49, (2000)
  • [6] Gandhi M.N., Welz T., Ronsmans C., Severe acute maternal morbidity in rural South Africa, Int J Gynecol Obstet, 87, pp. 180-187, (2004)
  • [7] Filippi V., Ronsmans C., Gohou V., Goufodji S., Lardi M., Sahel A., Saizonou J., De Brouwere V., Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals, Acta Obstet Gynecol Scand, 84, pp. 11-16, (2005)
  • [8] Robson S.C., Hypertension and renal disease in pregnancy, Dewhurst's Textbook of Obstetrics and Gynaecology for Postgraduates 6th Edition, pp. 166-185, (1999)
  • [9] ICD-10: International Statistical Classification of Diseases and Health-related Problems, 2, (1993)
  • [10] Epi Info 2002 - Database and Statistics Software for Public Health Professionals
12