Priorities in emergency obstetric care in Bolivia--maternal mortality and near-miss morbidity in metropolitan La Paz

2009 ◽  
Vol 116 (9) ◽  
pp. 1210-1217 ◽  
Author(s):  
M Rööst ◽  
VC Altamirano ◽  
J Liljestrand ◽  
B Essén
Keyword(s):  
Maternal Mortality ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Near Miss ◽  
La Paz

scholarly journals MATERNAL MORTALITY

2009 ◽  
Vol 16 (01) ◽  
pp. 135-138
Author(s):  
TASNIM TAHIRA REHMAN ◽  
MAHNAZ ROOHI
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Maternal Mortality Ratio ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Level ◽  
Maternal Deaths ◽  
Mortality Ratio ◽  
Study Setting ◽  
Very High

Objective: To find out maternal mortality ratio (MMR) and to determine major causes of maternal death. S t u d y d e s i g n:A descriptive study. Setting: Department of Obstetric and Gynaecology, Allied Hospital, Faisalabad. S t u d y period: From 01.01.2008 to31.12.2008. Materials a n d m e t h o d s : All cases of maternal death during this study periods were included except accidental deaths. Results:There were 58 maternal deaths during this period. Total No. of live births were 5975. MMR was 58/5975 x 100,000 = 970/100,000 live births.The most common cause of maternal death was hemorrhage (34.5%) followed by hypertensive disorders/eclampsia (31%). Most of thepatients (75.86%) were referred from primary & secondary care level. C o n c l u s i o n : Maternal mortality is still very high in underdevelopedcountries including Pakistan. We must enhance emergency obstetric care (EOC) to achieve the goal of reduction in MMR.

scholarly journals The effectiveness of training in emergency obstetric care: a systematic literature review

2019 ◽  
Vol 34 (4) ◽  
pp. 257-270 ◽  
Author(s):  
Charles A Ameh ◽  
Mselenge Mdegela ◽  
Sarah White ◽  
Nynke van den Broek
Keyword(s):  
Clinical Practice ◽  
Maternal Mortality ◽  
Health Outcomes ◽  
Emergency Obstetric Care ◽  
Case Fatality ◽  
Obstetric Care ◽  
Team Work ◽  
Knowledge And Skills ◽  
Effectiveness Of Training ◽  
Four Levels

Abstract Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before–after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.

scholarly journals Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

2015 ◽  
Vol 8 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Papa Dasari
Keyword(s):  
Maternal Mortality ◽  
Cause Of Death ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Emergency Admissions ◽  
Mortality Ratio

Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care.

scholarly journals Post-Partum Hemorrhage is Still Killing Mothers in Bangladesh: An Observation from the 2016 Bangladesh Maternal Mortality Survey (BMMS)

2020 ◽  
Author(s):  
Aminur Rahman ◽  
Anne Austin ◽  
Tahmina Begum ◽  
Iqbal Anwar
Keyword(s):  
Maternal Mortality ◽  
Universal Access ◽  
Post Partum ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Active Management ◽  
Director General ◽  
Public And Private ◽  
Third Stage ◽  
Mortality Survey

Abstract The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC). Both of these interventions mandate the administration of oxytocin. In Bangladesh there are nonfunctioning institutionalized guidelines from the Director General of Health Services on the storage of oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to evaluate the potency of current stores of oxytocin used in both in public and private facilities, develop and enforce protocols to ensure the potency of oxytocin, and promote universal access to quality AMSTL and CEmOC services.

scholarly journals Perceptions of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone

2020 ◽  
Author(s):  
R. Proos ◽  
H. Mathéron ◽  
J. Vas Nunes ◽  
A. Falama ◽  
P. Serry-Kamal ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Maternal Mortality ◽  
Sierra Leone ◽  
Health Care Workers ◽  
Health Workers ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Obstetric Complications ◽  
Care Workers

Abstract BackgroundSierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes the perspectives of health workers in rural facilities in Sierra Leone concerning the referral of women with obstetric complications.MethodsWe conducted semi-structured group interviews with health care workers in nine peripheral health units in rural Sierra Leone regarding the referral of women with obstetric complications. Themes discussed were based on an interview guide. The data was analysed by systematic text condensation.ResultsPerspectives were grouped according to the following themes identified: 1) communication between health care workers; 2) underlying influences on decision-making; 3) women’s compliance to referral; 4) logistic constraints.ConclusionSeveral factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among health care workers for having maternal deaths or severe obstetric complications at their own facilities. Furthermore, the decision-making of health care workers concerning referral is negatively influenced by an atmosphere of hierarchy between health care workers. Such factors must be considered in efforts to reduce maternal mortality.

scholarly journals Incidence of maternal near-miss in Kenya in 2018: findings from a nationally representative cross-sectional study in 54 referral hospitals

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Onikepe Owolabi ◽  
Taylor Riley ◽  
Kenneth Juma ◽  
Michael Mutua ◽  
Zoe H. Pleasure ◽  
...  
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Obstetric Care ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Live Births ◽  
Management Of Complications ◽  
Referral Hospitals ◽  
Nationally Representative

Abstract Although the Kenyan government has made efforts to invest in maternal health over the past 15 years, there is no evidence of decline in maternal mortality. To provide necessary evidence to inform maternal health care provision, we conducted a nationally representative study to describe the incidence and causes of maternal near-miss (MNM), and the quality of obstetric care in referral hospitals in Kenya. We collected data from 54 referral hospitals in 27 counties. Individuals admitted with potentially life-threatening conditions (using World Health Organization criteria) in pregnancy, childbirth or puerperium over a three month study period were eligible for inclusion in our study. All cases of severe maternal outcome (SMO, MNM cases and deaths) were prospectively identified, and after consent, included in the study. The national annual incidence of MNM was 7.2 per 1,000 live births and the intra-hospital maternal mortality ratio was 36.2 per 100,000 live births. The major causes of SMOs were postpartum haemorrhage and severe pre-eclampsia/eclampsia. However, only 77% of women with severe preeclampsia/eclampsia received magnesium sulphate and 67% with antepartum haemorrhage who needed blood received it. To reduce the burden of SMOs in Kenya, there is need for timely management of complications and improved access to essential emergency obstetric care interventions.

Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia

2010 ◽  
Vol 89 (3) ◽  
pp. 335-342 ◽  
Author(s):  
Mattias Rööst ◽  
Víctor Conde Altamirano ◽  
Jerker Liljestrand ◽  
Birgitta Essén
Keyword(s):  
Antenatal Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Near Miss

scholarly journals Maternal Mortality in a District Hospital of Bangladesh An In-Depth Search of the Underlying Causes

1970 ◽  
Vol 20 (2) ◽  
pp. 99-106
Author(s):  
Fatema Ashraf ◽  
SM Mustanzid ◽  
Marina Khanom
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Care Delivery ◽  
Emergency Obstetric Care ◽  
Case Fatality ◽  
Care Facility ◽  
Obstetric Care ◽  
Health Priorities

Maternal death is a tragedy - a social injustice to individual women, to a family and to their community. To reduce maternal mortality is at the top of the national health priorities. Emergency obstetric care service is thought to be the basis of reducing maternal mortality and morbidity. This study was carried out to determine the case fatality rate and risk factors of maternal mortality in Kushtia General Hospital, a secondary health care facility, where comprehensive Emergency Obstetric Care (EmOC) service is established. A total of 3,709 cases were admitted with pregnancy or related complications during pregnancy or within 42 days of confinement, from August 1999 to July 2000. Among them 3,186 were obstetric patients and 523 were gynaecological cases. Within this 12-months period 37 mothers died. Clinical causes of deaths were: 32 (86.48%) due to eclampsia, 3 (8.1%) due to ruptured uterus with shock, 1 (2.7%) due to induced incomplete abortion with shock and 1 (2.7%) due to PPH with shock. Almost 100% of the deaths could be prevented if they had come to the hospital at an earlier part of the disease. Responsible factors for these deaths could be at personal, familial, socio-cultural or health care center level. So this study was carried out to identify the risk factors of maternal death and also the status of health care delivery system at the peripheral level of the country i.e. the EmOC delay model in this perspective has been tried to identify. doi: 10.3329/taj.v20i2.3068 TAJ 2007; 20(2): 99-106

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