Near-misses at the Port Moresby General Hospital: a descriptive study.

BACKGROUND: The World Health Organization (WHO) defines 'maternal near-miss' as 'a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of her pregnancy'. With declining rates of maternal mortality, near-miss analysis is being examined in both developed and developing country settings for the assessment of obstetric care. AIMS: Over a 15-month period, details of cases that could be classified as 'near-misses' were collected at Port Moresby General Hospital (PMGH), to assess the practicality of collecting such data routinely and determine near-miss rates for the hospital. MATERIALS AND METHODS: Information about all cases that fitted the WHO definition of 'near-miss' was collected prospectively. RESULTS: During the audit period, there were 13 338 live births at PMGH; 131 women presented with a life-threatening condition of whom 122 met WHO criteria for 'maternal near-miss'; there were nine maternal deaths. The maternal mortality ratio was 67.5/100 000 live births, the maternal near-miss index ratio 9.1/1000 live births and the combination of maternal deaths and near-misses gave a severe maternal outcome ratio of 9.8/1000 live births. Main causes of the 'near-misses' were obstetric haemorrhage, hypertensive disorders and infections. Grandmultiparity, nulliparity, no antenatal attendance and age beyond 30 years were associated with maternal near-misses. CONCLUSION: Assessment of near-misses equivalent to that provided in developed countries is possible in less well-resourced settings such as PMGH. Knowledge of causes of near-misses will assist health professionals to anticipate or prevent devastating maternal morbidities and thereby improve maternal and perinatal outcomes.

Antepartum prediction of respiratory distress syndrome: a comparison of the shake test, the tap test and the turbidity test.

The shake test, the tap test and the turbidity test were evaluated to determine their accuracy in predicting lung function maturity, ie their ability to predict respiratory distress syndrome (RDS). The turbidity test was the most efficient with a sensitivity of 60%, a specificity of 97%, a positive predictive value of 82% and a negative predictive value of 92%. The shake test had a sensitivity of 40%, a specificity of 95%, a positive predictive value of 63% and a negative predictive value of 88%. The tap test at 2 minutes had a sensitivity of 57%, a specificity of 78%, a positive predictive value of 35% and a negative predictive value of 89%. It was fortuitous that the simplest and cheapest test was found to be the most efficient test of the three. We recommend that the turbidity test or at least one of these tests should be used to determine the maturity of lung function when non-urgent elective deliveries are contemplated, to help reduce the incidence of RDS in this group of patients.

A case-control study of early neonatal deaths at the Port Moresby General Hospital to determine associated risk factors.

From June 1998 to December 1999, mothers of 150 babies who died in the early neonatal period and 150 controls whose babies did not die were studied. In multiple logistic regression analysis the following variables were positively associated with early neonatal deaths: lack of antenatal attendance, thick meconium staining of the liquor, male sex, very low birthweight and delivery at gestational age less than 34 weeks. Maternal betelnut chewing was negatively associated with neonatal deaths. When babies with birthweight below 1000 g were excluded, the following variables were associated with early neonatal deaths: unmarried status, thick meconium staining of the liquor and gestational age below 34 weeks. The negative association with betelnut chewing persisted. The main causes of early neonatal deaths were respiratory distress syndrome, septicaemia, birth asphyxia, meconium aspiration syndrome and congenital abnormalities. Avoidable factors in these deaths were associated with the patient (53%), the labour ward (28%), the antenatal clinic (9%), the postnatal ward (8%) and the special care nursery (2%).