Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

Abstract

BackgroundReducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon.MethodsA retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained from medical records from February 1, 2011 to September 30, 2012. Three groups of variables were measured: (1) timeliness of care, (2) adherence to a standard of process indicators, and (3) associated extraneous variables. Variables were analysed using logistic regression to explore their effects on maternal mortality.ResultsThe mean of triage response time and obstetric resident response time were longer in maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses (1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02–0.77). Magnesium sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths although insignificant statistically (OR 0.19; 95% CI 0.03–1.47). Prophylactic antibiotic was also more frequently given in near misses than in maternal deaths though insignificant statistically (OR 0.3; 95% CI 0.06–1.56). Extraneous variables, such as caesarean sections were less performed in maternal deaths (OR 0.15; 95% CI 0.04–0.51), vaginal deliveries were more frequent in maternal deaths (OR 3.47; 95% CI 1.05–11.54), and more women in near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01–0.91).ConclusionsThe near misses had relatively received better quality of care compared to the maternal deaths. The near misses had received faster response time and better treatments. Timely referral systems enabled benefits to prevent maternal death.

Changes in obstetric case fatality and early newborn mortality rates in hospitals after the implementation of the Expanding Maternal and Neonatal Survival program in Indonesia: Results from a health information system

“…Only 29.4% of maternal deaths occurred at the home. Several studies have suggested that poor quality of maternal care at health facilities in Indonesia contributes to high maternal mortality . A study in Papua province suggests poor quality and delays in receiving appropriate care at facilities are the major causes of maternal mortality …”

Advanced Life Support in Obstetrics

“…Worldwide, as in Indonesia, the most common causes of maternal mortality are postpartum hemorrhage, hypertensive disorders, prolonged labor, complications from unsafe abortion and infection. The risks of maternal near miss and mortality are highest during labor, delivery and the immediate postpartum period 1 .…”

Tren dan Faktor Risiko Kematian Maternal di RSUP Dr.Sardjito Yogyakarta tahun 2012-2017

“…Sehingga diperlukan sistem rujukan yang tepat untuk mencegah kematian ibu. 4 maternal, disertai dengan risiko lain seperti tempat melahirkan di fasilitas sekunder, multiparitas dan adanya riwayat keguguran sebelumnya. 5 Penelitian yang dilakukan di RSUP dr. Sardjito Yogyakarta sebelumnya menunjukkan bahwa ibu yang meninggal atau nyaris meninggal di RSUP dr. Sardjito sebagian besar merupakan pasien rujukan dari fasilitas perawatan kesehatan lainnya (OR 0,09; 95% CI 0,01-0,91).…”

“…Hal ini disebabkan keadaan umum yang buruk saat pasien dirujuk dan keterlambatan dalam merujuk. 4 Pada penelitian ini kasus-kasus rujukan berpengaruh secara signifikan terhadap kejadian kematian maternal (OR=11,67; 95% CI 4,51-30,2). Hal ini disebabkan ibu yang dirujuk dari fasilitas kesehatan lain, dengan kondisi umum ibu yang mengalami komplikasi kelahiran yang berat, keterlambatan merujuk dan keterlambatan mengenali kasus maternal dengan kegawatan obstetrik pada rumah sakit di bawah level tersier.…”