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Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania.
Litorp, Helena; Kidanto, Hussein L; Rööst, Mattias; Abeid, Muzdalifat; Nyström, Lennarth; Essén, Birgitta.
Afiliação
  • Litorp H; Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, 751 85 Uppsala, Sweden. helena.litorp@kbh.uu.se.
BMC Pregnancy Childbirth ; 14: 244, 2014 Jul 23.
Article em En | MEDLINE | ID: mdl-25056517
BACKGROUND: The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications. METHODS: We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated. RESULTS: We identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33-39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460-730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6-11) of the MNM events and 13% (95% CI 6.4-23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12-37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8-12) (risk ratio 3.2, 95% CI 1.5-6.6). CONCLUSIONS: The occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cesárea / Mortalidade Materna / Eclampsia / Hemorragia Pós-Parto / Hospitais de Distrito / Hospitais Universitários Tipo de estudo: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Middle aged / Pregnancy País como assunto: Africa Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cesárea / Mortalidade Materna / Eclampsia / Hemorragia Pós-Parto / Hospitais de Distrito / Hospitais Universitários Tipo de estudo: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Middle aged / Pregnancy País como assunto: Africa Idioma: En Ano de publicação: 2014 Tipo de documento: Article