Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania

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.

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A ten year analysis of maternal deaths in a tertiary hospital using the three delays model

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03262-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mo’men M. Mohammed ◽

Saad El Gelany ◽

Ahmed Rida Eladwy ◽

Essam Ibrahium Ali ◽

Mohamed T. Gadelrab ◽

...

Keyword(s):

Maternal Mortality ◽

Paradigm Shift ◽

Tertiary Hospital ◽

Health Facilities ◽

Phase Delay ◽

Second Phase ◽

Maternal Deaths ◽

Third Phase ◽

Three Delays ◽

Three Phases

Abstract Background Reducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services’ coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR. This study aims to examine the contribution of the three delays in relation to maternal deaths. Methods During a 10 year period (2008–2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model. Results From 2008 to 2017 MMR in this hospital was 186/100.000 live births. Most frequent causes of maternal mortality were postpartum hemorrhage, hypertensive disorders of pregnancy and sepsis. Third phase delay occurred in 184 deaths (88.9%), second phase delay was observed in 104 deaths (50%), always together with other phases of delay. First phase delay alone was observed in 13 deaths (6.3%) and in 82 deaths (40%) with other phases of delay. One fifth of the women had experienced all three phases of delay together. Major causes of third phase delay were delayed referral from district hospitals, non-availability of skilled staff, lack of blood transfusion facilities and shortage of drugs. Conclusions There is a paradigm shift from first and second phases of delay to the third phase of delay as a major contributor to maternal mortality. Reduction of maternal mortality can be achieved through improving logistics, infrastructure and health care providers’ training. Trial registration This study is a retrospective study registered locally and approved by the ethical committee of the Department of Obstetrics and Gynaecology, Minia University Hospital on 1/4/2016 (Registration number: MUEOB0002).

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Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182336 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2283

Author(s):

Darshna M. Patel ◽

Mahesh M. Patel ◽

Vandita K. Salat

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Rural Areas ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Care Hospital ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Live Births ◽

Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

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GAMBARAN ANGKA KEMATIAN IBU DI RSUP. Prof. Dr. R. D. KANDOU MANADO PERIODE JANUARI 2014 – SEPTEMBER 2015

e-CliniC ◽

10.35790/ecl.4.1.2016.11038 ◽

2016 ◽

Vol 4 (1) ◽

Author(s):

Ria Mariani Andini ◽

Joice Sondakh ◽

Bismarch J. Laihad

Keyword(s):

Maternal Mortality ◽

Hemorrhagic Stroke ◽

Maternal Mortality Ratio ◽

Sampling Technique ◽

Complex Problem ◽

Health Issues ◽

Maternal Deaths ◽

Live Births ◽

Mortality Ratio ◽

And Child Health

Abstract: Maternal mortality is a complex problem that is caused by a variety of causes that can be distinguished on the determinant of near, intermediate and far. Maternal mortality or maternal death is one indicator to see the progress of the health of a country, especially with regard to maternal and child health issues. The research objective was to determine the description of Maternal Mortality Rate (MMR) in RSUP Prof. Dr. dr. R. D. Kandou Manado period January 2014 - September 2015. Methods: This study is a retrospective descriptive study. The population is all deliveries in RSUP Prof. Dr. dr. R. D. Kandou Manado period January 2014 - September 2015. The samples is 20 persons, sampling with total sampling technique. Results: based on this research, the highest number of births was in 2014 that as many as 3,347 people (70.8%), while in 2015 as many as 1,380 people (29.2%). Maternal Mortality Ratio (MMR) was 298 per 100,000 live births in 2014 and 725 per 100,000 live births in 2015. The number of maternal deaths in the period from January 2014 through September 2015 respectively by 10 people (50%). The most diagnosis entry patients is eclampsia by 10 persons (50.0%) Based on the causes of maternal mortality, that most because of hemorrhagic stroke by 7 people (35.0%).. Conclusion: Maternal Mortality Ratio (MMR) was 298 per 100,000 live births in 2014 and 725 per 100,000 live births in 2015. By entering the patient's diagnosis, most of the patients with the diagnosis of eclampsia and cause most maternal deaths are patients who died because stroke hemorrhagic period January 2014 through September 2015.Keyword: Maternal Mortality RateAbstrak: Kematian ibu merupakan salah satu indikator untuk melihat kemajuan kesehatan suatu negara, khususnya yang berkaitan dengan masalah kesehatan ibu dan anak. Tujuan penelitian adalah mengetahui gambaran Angka Kematian Ibu (AKI) di RSUP. Prof. Dr. R. D. Kandou Manado Periode Januari 2014 – September 2015. Metode: penelitian ini merupakan jenis penelitian deskriptif retrospektif. Populasi yang diambil adalah semua persalinan di RSUP. Prof. Dr. R. D. Kandou Manado Periode Januari 2014 – September 2015. Jumlah sampel adalah 20 orang, penentuan sampel dengan teknik total sampling. Hasil: berdasarkan hasil penelitian, jumlah persalinan terbanyak adalah pada tahun 2014 yaitu sebanyak 3.347 orang (70,8%) sedangkan pada tahun 2015 sebanyak 1.380 orang (29,2%). Rasio Angka Kematian Ibu (AKI) 298 per 100.000 kelahiran hidup pada tahun 2014 dan 725 per 100.000 kelahiran hidup pada tahun 2015.Sedangkan jumlah Jumlah Kematian Ibu pada periode januari 2014 sampai september 2015 masing-masing sebanyak 10 orang (50%). Diagnosa masuk pasien terbanyak yaitu eklamsia sebesar 10 orang (50,0%) Berdasarkan penyebab kematian ibu, yang tebanyak karena stroke hemoragik sebesar 7 orang (35,0%). Kesimpulan: Rasio Angka Kematian Ibu (AKI) adalah 298 per 100.000 kelahiran hidup pada tahun 2014 dan 725 per 100.000 kelahiran hidup pada tahun 2015. Berdasarkan diagnosis masuk pasien, terbanyak adalah pasien dengan diagnosa eklampsia dan penyebab kematian ibu terbanyak adalah pasien yang meninggal karena stroke hemoragik periode januari 2014 sampai september 2015.Kata kunci: Angka Kematian Ibu

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A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1431 ◽

2016 ◽

Vol 8 (4) ◽

pp. 261-265

Author(s):

Smiti Nanda ◽

Shaveta Yadav

Keyword(s):

Observational Study ◽

Maternal Mortality ◽

Prospective Observational Study ◽

Maternal Mortality Ratio ◽

Near Miss ◽

Maternal Deaths ◽

Live Births ◽

Mortality Index ◽

Severe Maternal Outcome ◽

Mortality Ratio

ABSTRACT Purpose To study the incidence and causes of near-miss cases and maternal deaths (MDs) and also search the level of delay. Materials and methods The prospective observational study was carried out in the Department of Obstetrics and Gynecology for a period of one and a half year (September 2012 to February 2014). For identifying near-miss events, disease-specific criteria were used. Near-miss cases were identified among women with pregnancy-related complications whose diagnoses were meeting the criteria. Detailed information of maternal mortalities and near-miss cases for demographic features, underlying causes, treatment received, and level of delay were also obtained. Results There were 15,170 obstetric admission, 13,851 live births, 184 near-miss cases, and 60 MDs during the study period. The maternal near-miss (MNM) rate was 13.2/1,000 live births and maternal mortality ratio was 433.1/100,000 live births. The mortality index (MD/MNM+MD) was reported as 25%. The maternal mortality to near-miss ratio was 1:3.07. Severe maternal outcome rate (MNM/MNM+MD) was 17.6/1,000 live births. Hemorrhage (54.89%) was the leading cause of nearmiss events followed by hypertension (24.45%) and anemia (13.59%). Hypertension (26.66%) was responsible for most of the MDs followed by anemia (25%), hemorrhage (20%), and puerperal sepsis (10%). The most common level of delay was found on the part of women and/or family to seek help. Conclusion Hypertension, hemorrhage, and anemia are leading causes of maternal morbidity and mortality. Lessons need to be learnt from cases of near-miss, which can serve as a useful tool in making strategies and putting efforts to reduce maternal mortality. How to cite this article Yadav S, Nanda S. A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics. J South Asian Feder Obst Gynae 2016;8(4):261-265.

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Temporal Evolution of Maternal Mortality: 1980-2019

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1735300 ◽

2021 ◽

Vol 43 (09) ◽

pp. 662-668

Author(s):

Janete Vettorazzi ◽

Edimárlei Gonsales Valério ◽

Maria Alexandrina Zanatta ◽

Mariana Hollmann Scheffler ◽

Sergio Hofmeister de Almeida Martins Costa ◽

...

Keyword(s):

Maternal Mortality ◽

Medical Records ◽

Causes Of Death ◽

Maternal Mortality Ratio ◽

Liver Steatosis ◽

Reproductive Age ◽

Porto Alegre ◽

Maternal Deaths ◽

Live Births ◽

Mortality Ratio

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

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Maternal mortality and morbidity

10.1093/med/9780198713333.003.0031 ◽

2016 ◽

Author(s):

Suni Halder ◽

Steve Yentis

Keyword(s):

Maternal Mortality ◽

Women’S Health ◽

Women's Health ◽

Maternal Mortality Ratio ◽

Developed Countries ◽

Surveillance Systems ◽

Maternal Deaths ◽

Live Births ◽

The World ◽

Mortality Ratio

The risk to women’s health is increased during pregnancy, and maternal mortality is used as an indicator of general healthcare provision as well as a target for improving women’s health worldwide. Morbidity is more difficult to define than mortality but may also be used to monitor and improve women’s care during and after pregnancy. Despite international efforts to reduce maternal mortality, there remains a wide disparity between the rate of deaths in developed (maternal mortality ratio less than 10–20 per 100,000 live births) and developing (maternal mortality ratio as high as 1000 or more per 100,000 live births in some countries) areas of the world. Similarly, treatable conditions that cause considerable morbidity in developed countries but uncommonly result in maternal death (e.g. pre-eclampsia (pre-eclamptic toxaemia), haemorrhage, and sepsis) continue to be major causes of mortality in developing countries, where appropriate care is hampered by a lack of resources, skilled staff, education, and infrastructure. Surveillance systems that identify and analyse maternal deaths aim to monitor and improve maternal healthcare through education of staff and politicians; the longest-running and most comprehensive of these, the Confidential Enquiries into Maternal Deaths in the United Kingdom, was halted temporarily after the 2006–2008 report but is now active again. Surveillance of maternal morbidity is more difficult but systems also exist for this. The lessons learnt from such programmes are thought to be important drivers for improved maternal outcomes across the world.

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A study to assess proportion of the maternal near miss to maternal death in a tertiary care teaching hospital of North East India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202334 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2486

Author(s):

Pradip Sarkar ◽

Jahar Lal Baidya ◽

Ashis Kumar Rakshit

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Near Miss ◽

Maternal Near Miss ◽

Maternal Deaths ◽

Live Births ◽

Medical Disorders ◽

Mortality Ratio

Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.

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Estimating Maternal Mortality Level in Rural Northern Nigeria by the Sisterhood Method

International Journal of Population Research ◽

10.1155/2012/464657 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Henry V. Doctor ◽

Sally E. Findley ◽

Godwin Y. Afenyadu

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Maternal Mortality Ratio ◽

Lifetime Risk ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Northern Nigeria ◽

Maternal Deaths ◽

Live Births ◽

Sisterhood Method

Maternal mortality is one of the major challenges to health systems in sub Saharan Africa. This paper estimates the lifetime risk of maternal death and maternal mortality ratio (MMR) in four states of Northern Nigeria. Data from a household survey conducted in 2011 were utilized by applying the “sisterhood method” for estimating maternal mortality. Female respondents (15–49 years) were interviewed thereby creating a retrospective cohort of their sisters who reached the reproductive age of 15 years. A total of 3,080 respondents reported 7,731 maternal sisters of which 593 were reported dead and 298 of those dead were maternal-related deaths. This corresponded to a lifetime risk of maternal death of 9% (referring to a period about 10.5 years prior to the survey) and an MMR of 1,271 maternal deaths per 100,000 live births; 95% CI was 1,152–1,445 maternal deaths per 100,000 live births. The study calls for improvement of the health system focusing on strategies that will accelerate reduction in MMR such as availability of skilled birth attendants, access to emergency obstetrics care, promotion of facility delivery, availability of antenatal care, and family planning. An accelerated reduction in MMR in the region will contribute towards the attainment of the Millennium Development Goal of maternal mortality reduction in Nigeria.

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Maternal mortality and its causes in a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193637 ◽

2019 ◽

Vol 8 (9) ◽

pp. 3471

Author(s):

Goter Doke ◽

Jyoti Kamda

Keyword(s):

Maternal Mortality ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Medical Science ◽

Age Groups ◽

Care Hospital ◽

Pregnancy Induced Hypertension ◽

Maternal Deaths ◽

Live Births ◽

Induced Hypertension

Background: Maternal mortality is defined as the death of a woman while being pregnant or within 42 completed days of termination of pregnancy. The aim of this study was to study the maternal mortality and analyze the complications leading to maternal deaths.Methods: A retrospective study of hospital records and death summaries of all maternal deaths over the period of two year from April 2017 to March 2019 was conducted in the Department of Obstetrics and Gynecology, Tomo Riba Institute of Health and Medical Science, a tertiary level healthcare referral center in Naharlagun, Arunachal Pradesh, India.Results: There was a total of 6 maternal deaths out of 6311 live births giving maternal mortality ratio (MMR) of 95.07 per 1,00,000 live births. The majority of deaths were reported in the age groups 30-40 years (66.66%). More deaths were reported in multiparous women (83.33%) as compared to primiparous women (16.66%). Most of them were unbooked cases (66.66%). Haemorrhage (33.33) and pregnancy induced hypertension (33.33%) were the major direct cause of maternal deaths.Conclusions: Haemorrhage and pregnancy induced hypertension were found to be major cause of maternal deaths. In our study, there was no maternal death from anemia and other medical disorder.

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Prevalence and Risk Factors for Maternal Mortality at a Tertiary Care Centre in Eastern Nepal- Retrospective Cross Sectional Study

10.21203/rs.3.rs-226005/v1 ◽

2021 ◽

Author(s):

Sarita Sitaula ◽

Tulasa Basnet ◽

Ajay Agrawal ◽

Tara Manandhar ◽

Dipti Das ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Maternal Mortality ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Type I ◽

Maternal Deaths ◽

Live Births ◽

Contributory Factors ◽

Mortality Ratio

Abstract Background:Maternal mortality ratio is an important public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and to identify the various risk factors and causes of maternal mortality.Methods: This is a retrospective study conducted in a tertiary care center of Eastern Nepal from 16th July,2015 to 15th July 2020. Maternal mortality ratio per 100,000 live-births over 5 years of study period was calculated. The causes of death, delays of maternal mortality and different sociodemographic profiles were analyzed by descriptive statistics.Results:There were total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in year 2015 to 2020. The mean age and gestational age of women having maternal deaths were 24.69 ±5.99 years and 36.15± 4.38 weeks of gestation respectively. The common causes of maternal deaths were obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis. The leading contributory factors to the death were delay in seeking health care and delay in reaching health care facility (type I delay:40.84%).Conclusions:Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors were due to delay in seeking care and delayed referral from other health facilities. Contributory factors related to maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and puerperium.

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