scholarly journals Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mzee M. Nassoro ◽  
Enid Chiwanga ◽  
Athanase Lilungulu ◽  
Deogratius Bintabara
Keyword(s):  
Caesarean Section ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Uterine Atony ◽  
Referral Hospital ◽  
Contributing Factors ◽  
Regional Referral Hospital ◽  
Obstetric Haemorrhage ◽  
Almost All ◽  
Late Referral

Background. Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. Methods. A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. Results. A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). Conclusion. Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.

scholarly journals Rising Trend of Caesarean Section in a Tertiary Hospital Over a Decade

1970 ◽  
Vol 29 (3) ◽  
pp. 126-132 ◽  
Author(s):  
R Nazneen ◽  
RA Begum ◽  
K Sultana
Keyword(s):  
Caesarean Section ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Tertiary Hospital ◽  
Background Information ◽  
P Value ◽  
Demographic And Health Surveys ◽  
College Hospital ◽  
Medical College ◽  
Foetal Movement

Background information: Since the early 1990s, emergency obstetric care (EmOC) in Bangladesh has played important role to reduce the maternal mortality rate. Along with other indicators of improved maternal care, there is a trend of rising caesarean section rates over the last decade affecting the economy of the country. According to demographic and Health Surveys conducted between 1993 and 2004, rate of caesarean section has risen from 2% to 6% which is more pronounced in urban area. Objective: To assess the indications and the trends of caesarean sections done over a 10-year period from 1995- 2004. Study Design: A retrospective observational study of the cases of caesarean sections over a decade. Study setting: Holy Family Red Crescent Medical College Hospital. Results: 23748 women were admitted in department of Obstetrics and Gynacology. Total deliveries were 21149(89.05% of total admission). The caesarean birth rate increased from 45.85% to 70.55%. The indications varied a little in cases of malpresentation and eclampsia. APH and IUGR has risen a little (from 2.56 to 2.6 to 1.83 to 2.34%) respectively. But proportion of repeat caesarean section and that of presumed foetal distress (or less foetal movement) increased (from 25.99 to 31.45% and from 8 to 15%), recently the indication, as maternal choice is also coming up (from .43 to .8%). The proportion has fallen in prolonged labour for cervical dystocia (from 17 to 2.6%) and obstructed labour (from 4.6% to .36%). The data were compared and analyzed by Z Test and corresponding P value was calculated which was not significant. Conclusion: Though caesarean section is a very safe intervention in obstetrics at present, crucial evaluation of the indications is advocated to reduce the rates of caesarean secion. Keywords: Caesarean section rates; Indications DOI: http://dx.doi.org/10.3329/jbcps.v29i3.9432 JBCPS 2011; 29(3): 126-132

scholarly journals Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Isaac Waniala ◽  
Sandra Nakiseka ◽  
Winnie Nambi ◽  
Isaac Naminya ◽  
Margret Osuban Ajeni ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Qualitative Data ◽  
Health Workers ◽  
Maternal Mortality Ratio ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Male Involvement ◽  
Community Perceptions ◽  
Caesarean Section Delivery ◽  
Eastern Uganda

Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.

scholarly journals Barriers to Emergency Obstetric Care Services in Perinatal Deaths in Rural Gambia: A Qualitative In-Depth Interview Study

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Abdou Jammeh ◽  
Johanne Sundby ◽  
Siri Vangen
Keyword(s):  
Perinatal Outcomes ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Obstetric Complications ◽  
Transport Cost ◽  
Contributing Factors ◽  
Perinatal Deaths ◽  
Danger Signs ◽  
Care Services ◽  
Transport Services

Objective. The Gambia has one of the world's highest perinatal mortality rates. We explored barriers of timely access to emergency obstetric care services resulting in perinatal deaths and in survivors of severe obstetric complications in rural Gambia. Method. We applied the “three delays” model as a framework for assessing contributing factors to perinatal deaths and obstetric complications. Qualitative in-depth interviews were conducted with 20 survivors of severe obstetric complications at home settings within three to four weeks after hospital discharge. Family members and traditional birth attendants were also interviewed. The interviews were translated into English and transcribed verbatim. We used content analysis to identify barriers of care. Results. Transport/cost-related delays are the major contributors of perinatal deaths in this study. A delay in recognising danger signs of pregnancy/labour or decision to seek care outside the home was the second important contributor of perinatal deaths. Decision to seek care may be timely, but impaired access precluded utilization of EmOC services. Obtaining blood for transfusion was also identified as a deterrent to appropriate care. Conclusion. Delays in accessing EmOC are critical in perinatal deaths. Thus, timely availability of emergency transport services and prompt decision-making are warranted for improved perinatal outcomes in rural Gambia.

scholarly journals Rising Rates of Caesarean Section in Urban Nepal

2019 ◽  
Vol 16 (41) ◽  
pp. 479-480 ◽  
Author(s):  
Sulochana Dhakal Rai ◽  
Pramod Raj Regmi ◽  
Edwin van Teijlingen ◽  
Juliet Wood ◽  
Ganesh Dangal ◽  
...  
Keyword(s):  
At Risk ◽  
Caesarean Section ◽  
Rural Areas ◽  
Emergency Obstetric Care ◽  
Health Resources ◽  
Obstetric Care ◽  
The Other ◽  
Sharp Rise ◽  
Private Hospitals

The rising rate of caesarean section in urban Nepal is alarming as the lack of access for women in rural areas to emergency obstetric care, putting lives at risk. The latter is referred to as ‘Too little too late’. At the same time, the sharp rise in caesarean section rates in cities presents the other extreme: “Too much too soon”. The overuse of caesarean section causes harm, unnecessary costs, and misuse of health resources. Availability of private hospitals and increasing hospital childbirth may contribute to the rising rate of caesarean section. This article highlights the rising rate of caesarean section in urban Nepal.Keywords: Caesarean section; emergency obstetric care; Nepal.

scholarly journals A nationwide population-based cohort study of peripartum hysterectomy and arterial embolisation in Belgium: results from the Belgian Obstetric Surveillance System

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016208 ◽  
Author(s):  
Griet Vandenberghe ◽  
Marine Guisset ◽  
Iris Janssens ◽  
Virginie Van Leeuw ◽  
Kristien Roelens ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Population Based ◽  
Abnormal Placentation ◽  
Peripartum Hysterectomy ◽  
Obstetric Haemorrhage ◽  
Significant Difference ◽  
Depth Analysis ◽  
Invasive Placenta

ObjectivesTo assess the prevalence of major obstetric haemorrhage managed with peripartum hysterectomy and/or interventional radiology (IR) in Belgium. To describe women characteristics, the circumstances in which the interventions took place, the management of the obstetric haemorrhage, the outcome and additional morbidity of these women.DesignNationwide population-based prospective cohort study.SettingEmergency obstetric care. Participation of 97% of maternities covering 98.6% of deliveries in Belgium.ParticipantsAll women who underwent peripartum hysterectomy and/or IR procedures in Belgium between January 2012 and December 2013.ResultsWe obtained data on 166 women who underwent peripartum hysterectomy (n=84) and/or IR procedures (n=102), corresponding to 1 in 3030 women undergoing a peripartum hysterectomy and another 1 in 3030 women being managed by IR, thereby preserving the uterus. Seventeen women underwent hysterectomy following IR and three women needed further IR despite hysterectomy. Abnormal placentation and/or uterine atony were the reported causes of haemorrhage in 83.7%. Abnormally invasive placenta was not detected antenatally in 34% of cases. The interventions were planned in 15 women. Three women were transferred antenatally and 17 women postnatally to a hospital with emergency IR service. Urgent peripartum hysterectomy was averted in 72% of the women who were transferred, with no significant difference in need for transfusion. IR procedures were able to stop the bleeding in 87.8% of the attempts. Disseminated intravascular coagulation secondary to major haemorrhage was reported in 32 women (19%).ConclusionThe prevalence in Belgium of major obstetric haemorrhage requiring peripartum hysterectomy and/or IR is estimated at 6.6 (95% CI 5.7 to 7.7) per 10 000 deliveries. Increased clinician awareness of the risk factors of abnormal placentation could further improve the management and outcome of major obstetric haemorrhage. A case-by-case in-depth analysis is necessary to reveal whether the hysterectomies and arterial embolisations performed in this study were appropriate or preventable.

scholarly journals Rates and indications of caesarean section deliveries in Bhutan 2015–2019: a national review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thinley Dorji ◽  
Phurb Dorji ◽  
Sonam Gyamtsho ◽  
Saran Tenzin Tamang ◽  
Tshering Wangden ◽  
...  
Keyword(s):  
Caesarean Section ◽  
General Hospital ◽  
Referral Hospital ◽  
Hospital Records ◽  
Regional Referral Hospital ◽  
Emergency Caesarean ◽  
Institutional Deliveries ◽  
National Rate ◽  
National Referral Hospital ◽  
Eastern Regional

Abstract Background Bhutan has made much efforts to provide timely access to health services during pregnancy and increase institutional deliveries. However, as specialist obstetric services became available in seven hospitals in the country, there has been a steady increase in the rates of caesarean deliveries. This article describes the national rates and indications of caesarean section deliveries in Bhutan. Methods This is a review of hospital records and a qualitative analysis of peer-reviewed articles on caesarean deliveries in Bhutan. Data on the volume of all deliveries that happened in the country from 2015 to 2019 were retrieved from the Annual Health Bulletins published by the Ministry of Health. The volume of deliveries and caesarean deliveries were extracted from the Annual Report of the National Referral Hospital 2015–2019 and the data were collected from hospital records of six other obstetric centres. A national rate of caesarean section was calculated as a proportion out of the total institutional deliveries at all hospitals combined. At the hospital level, the proportion of caesarean deliveries are presented as a proportion out of total institutional deliveries conducted in that hospital. Results For the period 2015–2019, the average national rate of caesarean section was 20.1% with a statistically significant increase from 18.1 to 21.5%. The average rate at the six obstetric centres was 29.9% with Phuentsholing Hospital (37.2%), Eastern Regional Referral Hospital (34.2%) and Samtse General Hospital (32.0%) reporting rates higher than that of the National Referral Hospital (28.1%). Except for the Eastern Regional Referral and Trashigang Hospitals, the other three centres showed significant increase in the proportion of caesarean deliveries during the study period. The proportion of emergency caesarean section at National Referral Hospital, Central Regional Referral Hospital and the Phuentsholing General Hospital was 58.8%. The National Referral Hospital (71.6%) and Phuentsholing General Hospital reported higher proportions of emergency caesarean sections (64.4%) while the Central Regional Referral Hospital reported higher proportions of elective sections (59.5%). The common indications were ‘past caesarean section’ (27.5%), foetal distress and non-reassuring cardiotocograph (14.3%), failed progress of labour (13.2%), cephalo-pelvic disproportion or shoulder dystocia (12.0%), and malpresentation including breech (8.8%). Conclusion Bhutan’s caesarean section rates are high and on the rise despite a shortage of obstetricians. This trend may be counterproductive to Bhutan’s efforts towards 2030 Sustainable Development Goal agendas and calls for a review of obstetric standards and practices to reduce primary caesarean sections.

scholarly journals Factors Associated With Non-Adherence To Antidiabetic Medication Among Patients at Mbarara Regional Referral Hospital, Mbarara, Uganda

2021 ◽  
Author(s):  
Karekoona Faisal ◽  
TADELE MEKURIYA ◽  
Jonans Tusiimire
Keyword(s):  
Diabetes Mellitus ◽  
Data Entry ◽  
Cross Sectional Study ◽  
Referral Hospital ◽  
Antidiabetic Medication ◽  
Contributing Factors ◽  
Diabetes Clinic ◽  
Cross Sectional ◽  
Regional Referral Hospital ◽  
Adherence Scale

Abstract Background Non–adherence is a major concern in treatment of diabetes mellitus and undermines the goals of treatment. The objective of this study was to determine the magnitude of non-adherence and its contributing factors among diabetes mellitus patients attending the Diabetes mellitus clinic at Mbarara Regional Referral Hospital. Objective To assess the factors contributing to non-adherence to antidiabetic medication among diabetes mellitus patients in the Diabetic clinic at Mbarara Regional Referral Hospital Methods A descriptive cross-sectional study was done at the Diabetes clinic, Mbarara Regional Referral Hospital, between July and October 2020. Study participants were systemically sampled and data regarding their medication non-adherence was collected using a structured questionnaire, based on the Hill-Bone medication adherence scale. Data entry was done using Microsoft Excel Version 2010 and analysis was carried out using STATA version 13. Results A total of 257 participants were recruited with 100% response rate. More than one third (98, 38.1%) of the participants were non-adherent to their antidiabetic medication. Age above 60 years (AOR = 6.26, 95%CI = 1.009–39.241, P = 0.049), and duration of diabetes mellitus above 5years (AOR = 1.87, 95%CI = 1.034–3.392, P = 0.038) were independently associated with non-adherence to antidiabetic medication. Conclusion The prevalence of non-adherence to antidiabetic medication was higher than that revealed in previous studies in Uganda. Patients with age above 60 years were six times more likely to be non-adherent to their antidiabetic medications. Patient education is important to address the challenge of medication non-adherence.

scholarly journals Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Mzee M. Nassoro ◽  
Paul Chetto ◽  
Enid Chiwanga ◽  
Athanase Lilungulu ◽  
Deogratius Bintabara ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Phase Delay ◽  
Referral Hospital ◽  
Second Phase ◽  
Contributing Factors ◽  
Maternal Deaths ◽  
Regional Referral Hospital ◽  
Live Births ◽  
Third Phase

Background. Maternal mortality has remained a challenge in Tanzania. The Tanzania Demographic and Health Survey 2015-16 has shown that the problem has been increasing despite various strategies instituted to curb it. It has been shown that most of the maternal deaths occurring in health facilities, whether direct or indirect, have other contributing factors. The objective of this study was to analyse causes and associated factors for maternal deaths in Dodoma Regional Referral Hospital (DRRH). Methods. A retrospective review of all files of the women who died in 2018 and were classified as maternal deaths. Results. A total of 8722 women gave birth in DRRH, out of which 35 died and were confirmed as maternal deaths. The number of live births was 8404 making the maternal mortality ratio of 417 per 100,000 live births. The leading causes of maternal death were eclampsia (9), sepsis (6), ruptured uterus (5), and haemorrhage (5). The third-phase delay was the leading contributing factor to 19 maternal deaths. This includes delays in referral from another facility as well as delays in getting treatment at DRRH and inadequate skills of providers at both the referring facilities and DRRH. The first-phase and second-phase delays contributed to 7 and 6 deaths, respectively. Furthermore, poor antenatal care contributed to 2 deaths. Conclusion. Maternal mortality is still high in Dodoma Regional Referral Hospital. Eclampsia was the leading cause of maternal deaths in 2018 followed by sepsis and obstetric haemorrhage. Delays associated with health system factors (third-phase delay) contributed much more to maternal mortality than the first-phase delay. Mentorship programmes on management of obstetric complications need to be instituted in order to reduce maternal deaths in Dodoma Regional Referral Hospital.

Sign in / Sign up

Export Citation Format

Share Document