Maternal Mortality from Obstructed Labor: A MANDATE Analysis of the Ability of Technology to Save Lives in Sub-Saharan Africa

Abstract

Objective The aim of the study is to evaluate clinical interventions to significantly reduce maternal mortality from prolonged labor, obstructed labor, and prolonged obstructed labor (PL/OL/POL) in sub-Saharan Africa (SSA). Methods A mathematical model-Maternal and Neonatal Directed Assessment of Technology ("MANDATE")-was created for SSA with estimated prevalence for PL/OL/POL and case fatality rates from hemorrhage, infection, and uterine rupture. Based on a literature review and expert opinion, the model was populated with estimated likelihoods of the current healthcare system ability to diagnose, transfer, and treat women with these conditions. Impact on maternal mortality of improved diagnosis, transfer, and delivery to relieve PL/OL/POL was assessed. Results Without current technologies, the model estimated 8,464 maternal deaths annually in SSA from these conditions. Imputing current diagnosis, transfer, and treatment of PL/OL/POL, an estimated 7,033 maternal deaths occur annually from these complications. With improved PL/OL/POL diagnosis and improved transfer, 1,700 and 740 lives could be saved, respectively. Improved diagnosis, transfer, and treatment for PL/OL/POL reduce the mortality rate to 864 maternal deaths annually, saving 6,169 lives. If improved transfusion and antibiotic use were added, only 507 women per year would die from PL/OL/POL in SSA. Conclusion In SSA, increasing diagnostics, transfer to higher care, and operative delivery could substantially reduce maternal mortality from PL/OL/POL. Synopsis A computerized model of obstructed labor in SSA was created to explore the interventions necessary to reduce maternal mortality from this condition.

Partograph utilization as a decision-making tool and associated factors among obstetric care providers in Ethiopia: a systematic review and meta-analysis

“…Partograph is an effective tool to monitor the progress of labor. When used effectively, it prevents obstructed labor, which is a leading cause of maternal and neonatal mortality, especially in developing countries [ 7 – 9 ]. Globally, it is estimated that obstructed labor occurs in 5% of pregnancies and accounts for an estimated 8% of maternal deaths [ 10 – 12 ], whereas the prevalence of obstructed labor is 47% in Ethiopia and accounts for 9% of the total maternal death [ 3 ].…”

Documentation of the partograph in assessing the progress of labour by health care providers in Malawi’s South-West zone

“…Although the maternal mortality ratio (MMR) has dropped by approximately 45% in the last two decades, around 300,000 women continue to die each year globally due to avoidable pregnancy related complications [ 1 ]. Obstructed labour is a leading cause of maternal and neonatal mortality, especially in developing countries [ 2 – 4 ]. Globally, it is estimated that obstructed labour occurs in 5% of pregnancies and accounts for an estimated 8% of maternal deaths [ 5 – 7 ].…”

Are there decision support tools that might strengthen the health system for perinatal care in South African district hospitals? A review of the literature

“…b) Evaluates the impact of different types of interventions (preventative, diagnostic and treatment) [24, 28, 36, 44, 54]…”

“…c) Assesses the impact of transferring mothers and neonates between different levels of care [24, 28, 36, 44]…”

“…Furthermore, the MANDATE model is preloaded with baseline estimates of accessibility, utilization and effectiveness of interventions in specific regions [24, 36]. All preloaded data were derived from published literature as well as reputable research websites and databases [24, 29, 44]. MANDATE users need to specify the geographic region where intervention will be applied, timeframe of assessment and the intended level of utilization, penetration and efficacy of interventions in order to generate output to guide prioritization of interventions [40].…”