Criteria based audit and outcomes on the management of eclampsia at Muhimbili national hospital; comparison of 2009 and 2017/2018 audits

Abstract

Background: Globally eclampsia accounts for 10% of all maternal deaths. At Muhimbili National Hospital (MNH) eclampsia is among the three leading causes of maternal mortality. It is paramount that an audit of eclampsia is done periodically to improve on obstetric care and reduce adverse outcomes. Objectives: To audit the adherence to the standard protocol in the management of eclampsia in women admitted at MNH and compare the adherence with the 2009 audit and obtain current outcomes. Methodology: A descriptive cross-sectional study was conducted in the department of Obstetrics and gynaecology, MNH. Data were collected from October to November 2019. Case files of patients managed for eclampsia from January 1 st 2017 to December 31st 2018 were selected to reach a total sample of 400 cases. The selected criteria were adopted from pre-existing MNH guidelines. There was a total of fourteen criteria from which the checklist was derived. Data collection was done using a structured checklist and analyzed by SPSS version 23. Calculation of proportion to the adherence to management criteria was done. The comparison between the frequency of pre-determined standards between this study and the 2009 audit by kidanto et al was carried out by using a student t-test. The proportion of eclamptic women who were managed as per the standard criteria was obtained by calculating the percentage of adherence for each criteria. Results: The adherence in the management offered to eclamptic women against the standard protocol ranged between 9.5%-100% with eight out of fourteen standards scoring 90% and above. There is a statistically significant reduction in adherence to six standards out of fourteen, from the 2017/2018 in comparison to the 2009 audit of eclampsia. The case fatality rate in the current audit was 1.8% compared to 0% in the 2009 audit. There was a statistically significant improvement from 2009 audit in blood pressure monitoring, caesarean section delivery within 2hrs of decision and corticosteroid use for pregnancies less than 34weeks from (39-99.8%), (61-100%) and (24-39.9%) respectively. Conclusion: There was a reduction in upholding of almost half of the total standard criteria over the duration of eight years from previous audit. There was a significant case fatality rate compared to no maternal deaths in the 2009 audit