Maternal near miss and mortality in a tertiary care hospital in Rwanda

Abstract

BackgroundTo determine the prevalence and factors associated with severe (‘near miss’) maternal morbidity and mortality in the University Teaching Hospital of Kigali – Rwanda.MethodsWe performed a cross sectional study of all women admitted to the tertiary care University Hospital in Kigali with severe “near miss” maternal morbidity and mortality during a one year period using the WHO criteria for ‘near miss’ maternal mortality. We assessed maternal demographic characteristics and disease processes associated with severe obstetric morbidity and mortality.ResultsThe prevalence of severe maternal outcomes was 11 per 1000 live births. The maternal near miss ratio was 8 per 1000 live births. The majority of severe obstetric morbidity and mortalities resulted from: sepsis/peritonitis (30.2 %)--primarily following caesarean deliveries, hypertensive disease (28.6 %), and hemorrhage (19.3 %). Majority of our patients were found to be of lower socioeconomic status, refered from district hospitals to the tertiary care center, and resided in the eastern part of the country.ConclusionThe main causes associated with MNH were peritonitis, hypertensive disorders and bleeding. The high prevalence of peritonitis may reflect suboptimal intraoperative and intrapartum management of high-risk patients at district hospitals. Direct causes of severe maternal outcome are still the most prevalent.The study identified opportunities for improvement in clinical care to reduce potentially these adverse outcomes.

Maternal near‐misses at a provincial hospital in Papua New Guinea: A prospective observational study

“…In developing countries, factors that contribute to maternal near‐misses and deaths are multiple. For instance, political instability and conflicts are significant causes of weak healthcare systems that contribute to poor maternal health in some countries . In developing countries such as Papua New Guinea (PNG), decentralisation of the healthcare system and lack of capacity and resources to enable universal maternal health coverage at the district level, compounded by remote geography, logistics difficulties, under‐staffing at health facilities and inadequately funded health services, are some contributors to poor maternal health .…”

Factors Associated With Severe Maternal Outcomes at a Regional Referral Hospital in South-Western Uganda: A Case-Control Study

“…This implies that a bigger proportion of mothers with severe maternal outcomes die at MRRH. The mortality index is lower than the one observed in Mozambique [21.8%] and Rwanda [26%] [20,21]. The difference in the findings is probably because both these studies were cross-sectional, and they used a different maternal near miss criteria (Clinical diagnostic criteria) instead of the recommended WHO maternal near miss criteria of 2009.…”

Maternal near-miss in labor and delivery in the light of technologies in health

“…Urinary tract infection is another pathology present in the periods of pregnancy and giving birth of innumerable women, and which can progress to chorioamnionitis, puerperal infection or even sepsis. Again, the importance of the professional having skills that correspond to the light and hard technologies in health is emphasized in order to manage the presented pictures properly (19) .…”