Maternal caesarean section infection (MACSI) in Sierra Leone: a case–control study

Gennaro, Francesco Di; Marotta, Claudia; Pisani, Luigi; Veronese, Nicola; Pisani, Vincenzo; Lippolis, V.; Pellizer, G; Pizzol, Damiano; Tognon, Francesca; Bavaro, Davide Fiore; Oliva, Fabrizio; Ponte, Sara Miranda; Bruce, Phoebe; Monno, Laura; Saracino, Annalisa; Koroma, Michael M.; Putoto, Giovanni

doi:10.1017/s0950268820000370

Cited by 39 publications

(35 citation statements)

References 38 publications

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“…Of note, uterine rupture as a reason for critical care referral signi cantly affected this cohort in Sierra Leone, with one in ten patients admitted with this potentially fatal condition. This nding con rms how this extreme complication still affects African women even in urban centres with wide access to primary care, as was also highlighted in a previous study on Caesarean Section infections in the same hospital (26).…”

Section: Discussionsupporting

confidence: 82%

Epidemiology, Outcomes and Risk Factors for Mortality in Critically–Ill Women Admitted to an Obstetric High Dependency Unit in a Resource–Limited Setting

Marotta¹,

Pisani²,

Fd³

et al. 2020

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Background: A better understanding of the context specific epidemiology, outcomes and risk factors for death of critically ill parturients in resource-poor hospitals is needed in order to tackle the still alarming in-hospital maternal mortality in African countries.Methods: One–year retrospective cohort in a referral maternity hospital in Freetown, Sierra Leone. Primary data source was the patient chart. The primary endpoint was the association between risk factors and HDU mortality. The study was registered on ClinicalTrials.gov (study identifier NCT04121234).Results: 523 patients (median age 25 years, IQR 21-30) were admitted to the HDU for a median of 2 (IQR 1-3) days. 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week. 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were: ward rather than post–operative referrals (odds ratio (OR), 3.21 [95%-confidence interval (CI) 1.48 to 7.01]; P = 0.003), admissions with a red vs. yellow/green OEWS (OR, 3.66 [95%-CI 1.15 to 16.96]; P = 0.04), responsiveness to pain or unresponsiveness on the AVPU scale (OR, 5.25 [95%-CI 2.64 to 10.94]; P =<0.0001), use of vasopressors (OR, 3.24 [95%-CI 1.32 to 7.66]; P =0.008). Higher SpO 2 was associated with improved survival (OR, 0.95 [95%-CI 0.91 to 0.98]; P =0.007).Conclusions: Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Mortality is high and mostly occurs during first day. Medical admission, a red OEWS code, a poor neurological and hemodynamic status were independently associated with mortality, while adequate oxygenation was associated with survival.Trial Registration: The study was registered on ClinicalTrials.gov (study identifier NCT04121234).Plain English summarySierra Leone is one of the countries with the highest maternal mortality rate of the world. Understanding of critical care issues and potential interventions is lagging behind approaches in the primary care and obstetric domain. This study, reporting data from 525 patients admitted to an obstetric HDU, to date represents the largest cohort of critically–ill parturients from a low–income country. At multivariable analysis, being referred from the ward rather than being post–operative (OR 3.21, 95% CI 1.48 to 7.01), red OEWS code (OR 3.66, 95% CI 1.15 to 16.96), being responsive to pain or unresponsive on AVPU scale (OR 5.25, 95% CI 2.64 to 16.96) at admission, use of vasopressors at admission (OR 3.24, 95% CI 1.32 to 7.66) were independent risk factors for mortality, while higher SpO2 (OR 0.95, 95% CI 0.91 to 0.99) was associated with increased survival.The findings of this study can be summarized as follows (1) in a low–resource referral maternity hospital one out of 14 deliveries needed critical care attention, with a crude mortality rate of 10.5%; (2) independent predictors of mortality were poor neurological status, a red OEWS code at admission to HDU and the use of vasopressors during the stay; (3) higher oxygenation was associated with survival. Clinicians and policy makers may use these findings to prioritize simple critical care interventions to address maternal mortality in a high burden scenario.

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Section: Discussionsupporting

confidence: 82%

Epidemiology, Outcomes and Risk Factors for Mortality in Critically–Ill Women Admitted to an Obstetric High Dependency Unit in a Resource–Limited Setting

Marotta¹,

Pisani²,

Fd³

et al. 2020

Preprint

Self Cite

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“…The major causes of maternal deaths in Africa are infections, postpartum hemorrhage, high blood pressure (preeclampsia and eclampsia), complications from delivery and unsafe abortion. [2][3][4][5] Substantial expenditure due to maternal complications could create a heavy economic burden to the households. Even when medical services are offered at reasonable prices or free of charge, indirect medical expenses associated with treatment may constitute a larger proportion of household income.…”

Section: Introductionmentioning

confidence: 99%

Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

Abadi

Mebratie

2021

RMHP

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“…Globally, more than 70 percent of maternal deaths are due to five major complications (which are direct obstetric complications), hemorrhage (25%), infection (15%), the complication of unsafe abortion (13%), hypertension (12%) and obstructed labor (8%) [ 4 ]. Infections are the underlying causes in 11% of maternal, and one-fourth of newborn deaths, but the true burden of maternal infections and related complications remains unknown [ 5 ]. Over the past two decades, Latin America and the Caribbean region have made significant progress in reducing maternal morbidity and mortality that as a result of encouraging skill delivery.…”

Section: Introductionmentioning

confidence: 99%

Institutional delivery services utilization and associated factors among mothers who gave birth in the last year in Mandura district, Northwest Ethiopia

Mitikie¹,

Wassie

Beyene

2020

PLoS ONE

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Background The risk of death from complications relating to pregnancy and childbirth for women’s lifetime is higher in developing countries. Improving maternal and child health through a well-organized institutional delivery service is central to achieving reduced maternal and child mortality. Despite the efforts that have been made to improve maternal health outcomes in Ethiopia, institutional delivery is still unacceptably low. Objective This study was conducted to assess institutional delivery service utilization and associated factors in the study area. Methods A Community-based cross-sectional study was conducted. A multi-stage sampling technique was used to employ a total of 546 women. Data were collected using an interviewer-administered questionnaire and entered into EpiData version 3.1 and then exported to SPSS version 23.0. for analysis. Logistic regression models were used to determine factors associated with the outcome variable. Adjusted Odds ratios with 95% CI were computed to measure the strength of association and statistical significance was declared at p-value <0.05. Results The Prevalence of institutional delivery in the study area was 38% (34%-42%). Factors significantly associated with institutional delivery were ANC visit 1.80 (1.12–2.91), knowledge of danger sign during pregnancy 3.60 (2.25–5.76), urban residency 2.09 (1.15–3.81), Parity 0.49 (0.25–0.95) accessibility of health facility 4.60 (2.01–10.89), husbands educational level: primary 2.50 (1.27–4.91), secondary and above 2.36 (1.24–4.48), mothers occupation: governmental employee 2.05 (1.00–4.18), and Private employee 2.42 (1.09–5.35). Conclusions The prevalence of institutional delivery in the District was low. Antenatal visits, residency, knowledge of pregnancy danger signs, parity, and accessibility of health facilities, maternal occupation, and husband education were factors significantly associated with institutional delivery.

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Maternal caesarean section infection (MACSI) in Sierra Leone: a case–control study

Cited by 39 publications

References 38 publications

Epidemiology, Outcomes and Risk Factors for Mortality in Critically–Ill Women Admitted to an Obstetric High Dependency Unit in a Resource–Limited Setting

Epidemiology, Outcomes and Risk Factors for Mortality in Critically–Ill Women Admitted to an Obstetric High Dependency Unit in a Resource–Limited Setting

Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

Institutional delivery services utilization and associated factors among mothers who gave birth in the last year in Mandura district, Northwest Ethiopia

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