Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study

Abstract

BackgroundThe vast majority of maternal deaths in low-and middle-income countries are preventable. Delay in obtaining access to appropriate health care is a fairly common problem which can be improved. The objective of this study was to explore the association between delay in providing obstetric health care and severe maternal morbidity/death.MethodsThis was a multicentre cross-sectional study, involving 27 referral obstetric facilities in all Brazilian regions between 2009 and 2010. All women admitted to the hospital with a pregnancy-related cause were screened, searching for potentially life-threatening conditions (PLTC), maternal death (MD) and maternal near-miss (MNM) cases, according to the WHO criteria. Data on delays were collected by medical chart review and interview with the medical staff. The prevalence of the three different types of delays was estimated according to the level of care and outcome of the complication. For factors associated with any delay, the PR and 95%CI controlled for cluster design were estimated.ResultsA total of 82,144 live births were screened, with 9,555 PLTC, MNM or MD cases prospectively identified. Overall, any type of delay was observed in 53.8% of cases; delay related to user factors was observed in 10.2%, 34.6% of delays were related to health service accessibility and 25.7% were related to quality of medical care. The occurrence of any delay was associated with increasing severity of maternal outcome: 52% in PLTC, 68.4% in MNM and 84.1% in MD.ConclusionsAlthough this was not a population-based study and the results could not be generalized, there was a very clear and significant association between frequency of delay and severity of outcome, suggesting that timely and proper management are related to survival.

Factors Associated with Maternal Deaths in District and Upazila Hospitals of Bangladesh

“…Although evidence based interventions are well known to manage obstetric complications 23,24 ; the patient records could not confirm that the dying women had received evidence-based interventions like fundal massage, oxytocic or blood transfusion in postpartum haemorrhage or injection magnesium sulphate in preeclampsia-eclampsia or else. Thus, poor availability of signal functions or standardized care resulted into high maternal mortality at facility: a phenomenon was also observed in other studies 25,26 .…”

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

“…In Uganda, just as in most low-income countries, financial services are largely inaccessible to rural populations [6–8] who are considered to have small transaction sizes and poor infrastructure that make it difficult for formal financial services to reach them [7,9]. Work by Finscope showed that 62% of people were excluded from financial services [8].…”

The first antenatal appointment: An exploratory study of the experiences of women with a diagnosis of mental illness

“…Women with severe and enduring mental illness are also more likely to experience obstetric complications, and their babies are at risk of low birth weight, premature birth, still birth and intrauterine growth restriction which further increases the risk of neurodevelopment, long-term cognitive problems and infant mortality (Howard et al, 2003;Jablensky et al, 2005;Holditch-Davis et al, 2007;Talge et al, 2007). Research on the causes of these risk factors has suggested genetic susceptibility, along with a delayed access to antenatal care, socioeconomic factors, and lifestyle factors including smoking and substance misuse (Howard, 2005;Pacagnella et al, 2014).…”