Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania.

IF 1.6 Q3 OBSTETRICS & GYNECOLOGY
Obstetrics and Gynecology International Pub Date : 2020-11-12 eCollection Date: 2020-01-01 DOI:10.1155/2020/8854498
Mzee M Nassoro, Enid Chiwanga, Athanase Lilungulu, Deogratius Bintabara
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引用次数: 10

Abstract

Background: Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths.

Methods: A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made.

Results: A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)).

Conclusion: Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.

坦桑尼亚多马地区转诊医院产科出血造成的产妇死亡。
背景:尽管多马地区转诊医院提供全面的产科急诊,但产科出血造成的死亡率仍然很高。进行这项研究是为了分析造成这些死亡的情况。方法:回顾性分析2018年1月至2019年12月产科出血死亡妇女的所有档案。结果:共有18296名妇女在DRRH分娩;其中,61人死于与怀孕有关的并发症,23人(38%)死于出血,其中许多人(44%)年龄在30至34岁之间。许多是大产妇女8人(35%),其中近一半(11人(48%))在DRRH停留时间少于24小时。半数以上(12例(52%))因子宫破裂行剖宫产后开腹分娩(8例(35%))。导致这些妇女死亡的主要因素是转诊晚(6例(26%))、因子宫张力导致的产后出血处理延迟(4例(17%))、可能发生PPH的患者准备不足(4例(17%))以及剖腹产手术延迟(3例(13%))。结论:Dodoma地区转诊医院因产科出血导致的孕产妇死亡率很高,2018年至2019年期间,超过三分之一的妇女死亡。几乎所有这些死亡都是可以避免的。造成这种情况的主要因素是:从其他卫生机构转诊的时间过晚、由于子宫张力过大导致的PPH管理技能不足、在DRRH进行剖腹产手术的时间过晚,以及胎盘早剥和宫内节育器不全患者的PPH管理准备不足,这些都是该疾病的危险因素。需要对转诊机构的保健工作者以及DRRH的保健工作者开展关于产科出血管理的支持性监督、指导和其他模式的教学方案。为了避免子宫破裂,还应强调使用产程监护和识别有危险的孕妇。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Obstetrics and Gynecology International
Obstetrics and Gynecology International OBSTETRICS & GYNECOLOGY-
CiteScore
3.60
自引率
0.00%
发文量
26
审稿时长
19 weeks
期刊介绍: Obstetrics and Gynecology International is a peer-reviewed, Open Access journal that aims to provide a forum for scientists and clinical professionals working in obstetrics and gynecology. The journal publishes original research articles, review articles, and clinical studies related to obstetrics, maternal-fetal medicine, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine and infertility, reproductive endocrinology, and sexual medicine.
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