Emergency obstetric admissions: late referrals, misdiagnoses and consequences.
Emergency obstetric admissions: late referrals, misdiagnoses and consequences.
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DOI：
10.1080/01443610120085492
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发表时间：
2001-11-01
期刊：
影响因子：
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通讯作者：
Ezechi, O C
中科院分区：
文献类型：
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作者：
Onwudiegwu, U;Ezechi, O C
这是一项前瞻性研究，探讨了尼日利亚一所大学医院产科急诊入院的性质，以及延迟转诊和误诊等因素及其对孕产妇和围产期发病率/死亡率的影响。该研究包括在6.5个月内连续144例产科急诊入院。急诊入院率为13.6%。尽管医院离产妇很近，但大多数产妇在社区内的不合格设施中分娩。只是在长时间拖延和出现并发症后才转介到大学医院。产科出血（24.6%）是转诊的最常见原因，其次是分娩障碍（19%）和高血压疾病（8.4%）。产妇死亡13例，产妇死亡率为6.2%，围产期死亡率为每1 000例活产461例。12名产妇死亡是居住在医院5公里范围内的妇女。剖腹产率为50.9%，诊断性剖腹手术率为4.8%，紧急子宫切除率为9%，紧急输血率为44%。转诊中心对68%的病例的临床状况作出了误诊，这是造成产妇发病率和死亡率高的原因之一。病人的态度是不使用教学医院设施的主要原因（32%的病例害怕手术，27.4%的病例来自朋友的劝阻意见，7%的病例工作人员态度消极）。需要和类型的方案，将促进更多的利用现代孕产妇保健服务在社区进行了讨论。
This is a prospective study that examined the nature of emergency obstetric admissions in a Nigerian university hospital in association with such factors as late referrals and misdiagnoses and their contribution to maternal and perinatal morbidity/mortality. The study comprised 144 consecutive emergency obstetric admissions to the hospital over a 6.5-month period. An incidence of 13.6% emergency admissions was recorded. Despite the proximity of the hospital to the parturients, most of them laboured in substandard facilities within the community. Referrals to the university hospital were made only after prolonged delay and onset of complications. Obstetric haemorrhage (24.6%) was the most common cause for referral followed by labour disorders (19%) and hypertensive disorders (8.4%). Thirteen maternal deaths occurred, giving a maternal mortality ratio of 6.2%, while perinatal mortality rate was 461 per 1000 births. Twelve of the maternal deaths were in women living within 5 km of the hospital. There was a caesarean section rate of 50.9%, a 4.8% incidence of diagnostic laparotomy, a 9% incidence of emergency hysterectomy and 44% of emergency blood transfusions. Misdiagnoses of clinical conditions were made by the referring centres in 68% of cases, which contributed to the high maternal morbidity and mortality. Patient attitude was the main cause of non-use of teaching hospital facilities (fear of operation in 32% of cases, dissuasive advice from friends in 27.4% and negative staff attitude in 7%). A need for and type of programme that will promote increased utilisation of modern maternal health services in the community are discussed.