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.
In an attempt to evaluate the contributory factors to the high frequency of referred cases in obstructed labour at the State's referral hospital, a questionnaire-based survey of 396 maternity care-providers from 66 randomly selected peripheral delivery units in Ogun State, Nigeria was conducted over a 2-month period, to evaluate their knowledge and use of the partograph. The majority of the personnel were nurses/midwives (45.5%) and community health extension workers (CHEW) (42.7%). Of the 216 personnel (54.5%) who were aware of the partograph, 36 (16.7%), 119 (55.5%) and 61 (28.2%) demonstrated poor, fair and good levels of knowledge, respectively. No junior CHEW had a satisfactory knowledge of the partograph. Only 39 (9.8%) of all the personnel routinely employed the partograph for labour management and almost half of these individuals had a poor level of knowledge. Efforts to limit the frequency of referred cases of established obstructed labour to the State's referral hospital should include training of care-providers at the peripheral delivery units, especially junior personnel in the effective use of the partograph, in addition to employing quality assurance measures to check inappropriate use.
A cross-sectional study involving 564 parturients who delivered singleton babies and 214 matched non-pregnant controls was carried out to determine the prevalence and impact of asymptomatic maternal malaria parasitaemia at parturition on the perinatal outcome. One hundred and forty (24.8%) parturients and 50 (23.4%) non-pregnant women were found to have asymptomatic malaria parasitaemia, respectively, while the congenital malaria rate in the neonates of the parasitaemic parturients was 0.7%. The incidence of malaria parasitaemia was higher in the para 2 and over (29.33%) as compare to the para 1 (21.43%) and primigravid (18.42%). There was no significant difference between the mean birth weight of infants delivered by parasitaemic parturients (2.93+/-0.61 kg) and aparasitaemic parturients (3.07+/-0.32 kg) (P=0.501). There was also no significant difference when comparing the mean placental weight of the parasitaemic mothers (0.60+/-0.15 kg) with that of the aparasitaemic mothers (0.62+/-0.20 kg) (P=0.329). Only in the para 2 and over was the mean placental weight of the parasitaemic mothers significantly lower than that of the aparasitaemia mothers (0.46+/-0.16 kg; 0.66+/-0.23 kg P=0.035). The mean packed cell volume of the parasitaemics parturients (30.89+/-1.87) was significantly lower than the aparasitaemic parturients (31.98+/-2.25) (P<0.001). Significant difference was not achieved between the parasitaemics and aparasitaemics inrespect of apgar score at 1 minute, or at 5 minutes, premature births (16.43%; 15.33%; P>0.05), stillbirth rate (3.57%; 2.59, P>0.05), mean placental index (0.204, 0.202, P>0.50) and mode of delivery. The findings in this study show that even though malaria parasitaemia is prevalent in our locality, the effects on maternal and fetal wellbeing are comparable with the aparasitaemics.
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