Beyond maternal mortality: obstetric hemorrhage in a Malawian district
Beyond maternal mortality: obstetric hemorrhage in a Malawian district
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DOI：
10.1111/j.1600-0412.2011.01219.x
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发表时间：
2011-12-01
影响因子：
4.3
通讯作者：
Van Roosmalen, Jos
中科院分区：
文献类型：
--
作者：
Beltman, Jogchum;Van Den Akker, Thomas;Van Roosmalen, Jos
目标。确定马拉维农村地区医院一级产科出血管理中的不合格护理因素。设计。回顾性医院队列研究。设置。泰奥洛区医院。人口。2005年在这里分娩的妇女。方法。所有产科出血病例均按以下标准纳入：任何产前出血、分娩后24小时内出血量大于500ml的产后出血、子宫破裂、胎盘残留、围产期输血。主要结果测量。产前和产后出血的发生率，相关的孕产妇和围产期死亡率和分娩方式。结果。在3085例住院分娩中，共发生133例出血病例（每1000例分娩43.1例），其中6例导致产妇死亡（病死率4.5%）。95例产后出血中有20例（21%）为剖宫产周出血。16例剖宫产的胎儿没有生命，其中只有4例产妇有手术分娩的指征。对孕妇的监测经常不足，包括对在等待家中的妇女的监测，而且子宫强直剂的使用往往不一致。结论。发病率回顾揭示了重要的不合格护理因素，包括不必要的剖宫产。这些因素可以根据可负担的费用进行调整，这可能对产妇结局产生重要改善。
Objective. To identify substandard care factors in the management of obstetric hemorrhage at district hospital level in rural Malawi. Design. Retrospective hospital-based cohort study. Setting. Thyolo District Hospital. Population. Women who delivered at this facility in 2005. Methods. All cases of obstetric hemorrhage were included according to the following criteria: any antepartum hemorrhage, postpartum hemorrhage with more than 500ml of blood loss within 24hours after delivery, uterine rupture, retained placenta and peripartum blood transfusion. Main Outcome Measures. Incidence of antepartum and postpartum hemorrhage, related maternal and perinatal mortality and mode of delivery. Results. A total of 133 hemorrhage cases occurred among 3 085 hospital deliveries (43.1 per 1 000 deliveries), six of which resulted in maternal death (case fatality rate 4.5%). Twenty of 95 postpartum hemorrhage cases (21%) were peri-cesarean hemorrhages. Sixteen cesareans delivered lifeless fetuses, where a maternal indication for operative delivery was present in only four. Monitoring of pregnant women was regularly insufficient, including monitoring of women in waiting homes, and the use of uterotonics was often inconsistent. Conclusions. Morbidity review revealed important substandard care factors, including unnecessary cesarean sections. These factors may be modified against affordable cost, which could make an important improvement in maternal outcome.