OBJECTIVE: To identify substandard care factors in the management of obstetric hemorrhage at district hospital level in rural Malawi. DESIGN: Retrospective hospital-based cohort study. SETTING: Thyolo District Hospital. POPULATION: Women who delivered at this facility in 2005. METHODS: All cases of obstetric hemorrhage were included according to the following criteria: any antepartum hemorrhage, postpartum hemorrhage with more than 500 ml of blood loss within 24 hours after delivery, uterine rupture, retained placenta and peripartum blood transfusion. MAIN OUTCOME MEASURES: Incidence of antepartum and postpartum hemorrhage, related maternal and perinatal mortality and mode of delivery. RESULTS: A total of 133 hemorrhage cases occurred among 3 085 hospital deliveries (43.1 per 1 000 deliveries), six of which resulted in maternal death (case fatality rate 4.5%). Twenty of 95 postpartum hemorrhage cases (21%) were peri-cesarean hemorrhages. Sixteen cesareans delivered lifeless fetuses, where a maternal indication for operative delivery was present in only four. Monitoring of pregnant women was regularly insufficient, including monitoring of women in waiting homes, and the use of uterotonics was often inconsistent. CONCLUSIONS: Morbidity review revealed important substandard care factors, including unnecessary cesarean sections. These factors may be modified against affordable cost, which could make an important improvement in maternal outcome.
OBJECTIVE: To identify substandard care factors in the management of obstetric hemorrhage at district hospital level in rural Malawi. DESIGN: Retrospective hospital-based cohort study. SETTING: Thyolo District Hospital. POPULATION: Women who delivered at this facility in 2005. METHODS: All cases of obstetric hemorrhage were included according to the following criteria: any antepartum hemorrhage, postpartum hemorrhage with more than 500 ml of blood loss within 24 hours after delivery, uterine rupture, retained placenta and peripartum blood transfusion. MAIN OUTCOME MEASURES: Incidence of antepartum and postpartum hemorrhage, related maternal and perinatal mortality and mode of delivery. RESULTS: A total of 133 hemorrhage cases occurred among 3 085 hospital deliveries (43.1 per 1 000 deliveries), six of which resulted in maternal death (case fatality rate 4.5%). Twenty of 95 postpartum hemorrhage cases (21%) were peri-cesarean hemorrhages. Sixteen cesareans delivered lifeless fetuses, where a maternal indication for operative delivery was present in only four. Monitoring of pregnant women was regularly insufficient, including monitoring of women in waiting homes, and the use of uterotonics was often inconsistent. CONCLUSIONS: Morbidity review revealed important substandard care factors, including unnecessary cesarean sections. These factors may be modified against affordable cost, which could make an important improvement in maternal outcome.
Authors: Jogchum Jan Beltman; Thomas van den Akker; Dieudonné Bwirire; Anneke Korevaar; Richard Chidakwani; Luc van Lonkhuijzen; Jos van Roosmalen Journal: BMC Pregnancy Childbirth Date: 2013-02-15 Impact factor: 3.007
Authors: Tom Witteveen; Hans Bezstarosti; Ilona de Koning; Ellen Nelissen; Kitty W Bloemenkamp; Jos van Roosmalen; Thomas van den Akker Journal: BMC Pregnancy Childbirth Date: 2017-06-19 Impact factor: 3.007
Authors: Sarah Saleem; Elizabeth M McClure; Shivaprasad S Goudar; Archana Patel; Fabian Esamai; Ana Garces; Elwyn Chomba; Fernando Althabe; Janet Moore; Bhalachandra Kodkany; Omrana Pasha; Jose Belizan; Albert Mayansyan; Richard J Derman; Patricia L Hibberd; Edward A Liechty; Nancy F Krebs; K Michael Hambidge; Pierre Buekens; Waldemar A Carlo; Linda L Wright; Marion Koso-Thomas; Alan H Jobe; Robert L Goldenberg Journal: Bull World Health Organ Date: 2014-06-05 Impact factor: 9.408