Near-miss maternal morbidity from severe haemorrhage at caesarean section: A process and structure audit of system deficiencies in South Africa

Maswime, Salome; Buchmann, Eckhart

doi:10.7196/samj.2017.v107i11.12340

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…The Pretoria study also had a low MI for haemorrhage of 2%, [22] whereas in Pakistan it was much higher at 17.2%. [19] An audit in Johannesburg on morbidity and mortality from obstetric haemorrhage in caesarean deliveries showed an MI of 7% (93 near-misses and 7 maternal deaths), [23] and although our study did not focus on morbidity/mortality from caesarean deliveries, we found a caesarean section rate of 62.5% and 33.9% of near-misses due to obstetric haemorrhage, with an MI of 0%. The lower MI in SA studies could reflect better prevention and/or management of obstetric haemorrhage in SA.…”

Section: Discussionmentioning

confidence: 52%

Maternal near-miss audit in the Metro West maternity service, Cape Town, South Africa: A retrospective observational study

2018

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Background.A maternal near-miss is defined as a life-threatening pregnancy-related complication where the woman survives. The World Health Organization (WHO) has produced a tool for identifying near-misses according to criteria that include the occurrence of a severe maternal complication together with organ dysfunction and/or specified critical interventions. Maternal deaths have been audited in the public sector Metro West maternity service in Cape Town, South Africa, for many years, but there has been no monitoring of near-misses. Objectives. To measure the near-miss ratio (NMR), maternal mortality ratio (MMR) and mortality index (MI), and to investigate the nearmiss cases. Methods. A retrospective observational study conducted during 6 months in 2014 identified and analysed all near-miss cases and maternal deaths in Metro West, using the WHO criteria. Results. From a total of 19 222 live births, 112 near-misses and 13 maternal deaths were identified. The MMR was 67.6 per 100 000 live births and the NMR 5.83 per 1 000 live births. The maternal near-miss/maternal death ratio was 8.6:1 and the MI 10.4%. The major causes of near-miss were hypertension (n=50, 44.6%), haemorrhage (n=38, 33.9%) and puerperal sepsis (n=13, 11.6%). The first two conditions both had very low MIs (1.9% and 0%, respectively), whereas the figure for puerperal sepsis was 18.9%. Less common near-miss causes were medical/surgical conditions (n=7, 6.3%), non-pregnancy-related infections (n=2, 1.8%) and acute collapse (n=2, 1.8%), with higher MIs (33.3%, 66.7% and 33.3%, respectively). Critical interventions included massive blood transfusion (34.8%), ventilation (40.2%) and hysterectomy (30.4%). Considering health system factors, 63 near-misses (56.3%) initially occurred at a primary care facility, and the patients were all referred to the tertiary hospital; 38 (33.9%) occurred at a secondary hospital, and 11 (9.8%) at the tertiary hospital. Analysis of avoidable factors identified lack of antenatal clinic attendance (11.6%), inter-facility transport problems (6.3%) and health providerrelated factors (25.9% at the primary level of care, 38.2% at secondary level and 7.1% at tertiary level). Conclusions. The NMR and MMR for Metro West were lower than in other developing countries, but higher than in high-income countries. The MI was low for direct obstetric conditions (hypertension, haemorrhage and puerperal sepsis), reflecting good quality of care and referral mechanisms for these conditions. The MIs for non-pregnancy-related infections, medical/surgical conditions and acute collapse were higher, suggesting that medical problems need more focused attention.

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Section: Discussionmentioning

confidence: 52%

Maternal near-miss audit in the Metro West maternity service, Cape Town, South Africa: A retrospective observational study

2018

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“…[15][16][17] Active management of the third stage of labor is the most effective strategy for prevention of PPH. 18 Given the risk of under reporting among studies because of the focus on deaths or severe forms of morbidity from PPH, 19,20 studies focusing on the overall morbidity from PPH are essential to reveal the burden of the problem for designing appropriate preventive services and planning for resource allocation. However, there is limited data on burden of PPH, especially among women surviving complications.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: A Cross-Sectional Study

Mesfin

Dheresa

Fage

et al. 2021

IJWH

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Objective: Despite implementation of different strategies, postpartum hemorrhage (PPH) continued to account for a substantial proportion of maternal deaths in Ethiopia. The objective of this study was to assess the magnitude of PPH and its associated factors among women who gave birth in a university hospital in eastern Ethiopia from 1 to 31 March 2020. Methods: An institution-based cross-sectional study was conducted. A review of 653 randomly selected medical records of all deliveries from 1 March 2018 to 29 February 2020 in Hiwot Fana Specialized University Hospital (HFSUH), a university hospital in eastern Ethiopia, was conducted. Data were collected on sociodemographic characteristics, obstetric and reproductive health conditions, and presence of PPH. Data were coded, checked for completeness and entered using EpiData 3.1 and exported to SPSS 20 for analysis. Results were expressed using frequencies, tables and figures. Binary and multiple logistic regression were fitted to identify factors associated with PPH and associations were described using adjusted odds ratio (aOR) along with 95% confidence intervals (CI). Associations with p<0.05 in the multivariable logistic regression were declared as statistically significant. Results: From a total of 642 (98.3%) women included in this study, 83 (12.9%; 95% CI 10.4-15.6) had PPH. Maternal age >35 years (aOR = 3.08; 95% CI 1.56, 6.07), no antenatal care (aOR = 3.65; 95% CI 1.97, 6.76), history of PPH (aOR = 4.18; 95% CI 1.99, 8.82), and being grand multigravida (aOR = 3.33; 95% CI 1.14, 9.74) were significantly associated with having PPH. Conclusion:A high proportion of women who gave birth in HFSUH experienced PPH. Prevention and management of PPH should focus on improving antenatal care and prioritize grand multigravida, older women, and women with a previous history of PPH.

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“…In Botswana in 2012/2013 during the transition from Option B to universal ART for PPHIV, despite widespread uptake of ART, 24-month postpartum mortality was five times higher in PPHIV than those without HIV, not differing by cessation or continuation of ART postpartum [25]. Here, rates of stillbirth were similar between PPHIV receiving ARTor antiretroviral prophylaxis for vertical HIV transmission prevention versus pregnant people without HIV, but PPHIV not receiving any antiretrovirals also had a higher stillbirth rate [29].…”

Section: Discussionmentioning

confidence: 82%

Maternal and birth outcomes in pregnant people with and without HIV in the Western Cape, South Africa

Slogrove,

Bovu,

de Beer

et al. 2023

Aids

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Introduction: We evaluated associations of HIV and antiretroviral therapy (ART) with birth and maternal outcomes at a province-wide-level in the Western Cape, South Africa, in a recent cohort before dolutegravir-based first-line ART implementation. Methods: This retrospective cohort study included pregnant people delivering in 2018-2019 with data in the Western Cape Provincial Health Data Centre which integrates individual-level data on all public sector patients from multiple electronic platforms using unique identifiers. Adverse birth outcomes (stillbirth, low birth weight (LBW), very LBW (VLBW)) and maternal outcomes (early and late pregnancy-related deaths, early and late hospitalizations) were compared by HIV/ART status and adjusted prevalence ratios (aPRs) calculated using log-binomial regression. Results: Overall 171,960 pregnant people and their singleton newborns were included, 19% (N = 32,015) identified with HIV. Amongst pregnant people with HIV (PPHIV), 60% (N = 19,157) were on ART preconception, 29% (N = 9,276) initiated ART during pregnancy and 11% (N = 3,582) had no ART. Adjusted for maternal age, multiparity, hypertensive disorders and residential district, stillbirths were higher only for PPHIV not on ART (aPR 1.31 [95%CI 1.04–1.66]) compared to those without HIV. However, LBW and VLBW were higher among all PPHIV, with aPRs of 1.11–1.22 for LBW and 1.14–1.54 for VLBW. Pregnancy-initiated ART was associated with early pregnancy-related death (aPR 3.21; 95%CI 1.55–6.65), and HIV with or without ART was associated with late pregnancy-related death (aPRs 7.89–9.01). Conclusions: Even in the universal ART era, PPHIV experienced higher rates of LBW and VLBW newborns, and higher late pregnancy-related death regardless of ART status than pregnant people without HIV.

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Near-miss maternal morbidity from severe haemorrhage at caesarean section: A process and structure audit of system deficiencies in South Africa

Cited by 9 publications

References 13 publications

Maternal near-miss audit in the Metro West maternity service, Cape Town, South Africa: A retrospective observational study

Maternal near-miss audit in the Metro West maternity service, Cape Town, South Africa: A retrospective observational study

Assessment of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: A Cross-Sectional Study

Maternal and birth outcomes in pregnant people with and without HIV in the Western Cape, South Africa

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