dc.contributor.author |
Litorp, H |
|
dc.contributor.author |
Kidanto, H.L |
|
dc.contributor.author |
Rööst, M |
|
dc.contributor.author |
Abeid, M |
|
dc.contributor.author |
Nyström, L |
|
dc.contributor.author |
Essén, B |
|
dc.date.accessioned |
2014-11-18T08:28:13Z |
|
dc.date.available |
2014-11-18T08:28:13Z |
|
dc.date.issued |
2014 |
|
dc.identifier.citation |
Mantel, G. D., Buchmann, E., Rees, H., & Pattinson, R. C. (1998). Severe acute maternal morbidity: a pilot study of a definition for a near‐miss. BJOG: An International Journal of Obstetrics & Gynaecology, 105(9), 985-990. |
en_GB |
dc.identifier.issn |
/1471-2393/14/244 |
|
dc.identifier.uri |
http://hdl.handle.net/123456789/1491 |
|
dc.description.abstract |
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. |
en_GB |
dc.language.iso |
en |
en_GB |
dc.publisher |
BMC Pregnancy and Childbirth |
en_GB |
dc.relation.ispartofseries |
BMC Pregnancy and Childbirth 2014, 14:244; |
|
dc.subject |
Maternal near-miss |
en_GB |
dc.subject |
Maternal death |
en_GB |
dc.subject |
Caesarean section |
en_GB |
dc.subject |
Low-income country |
en_GB |
dc.title |
Maternal near-miss and death and their |
en_GB |
dc.type |
Article |
en_GB |