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MATERNAL MORTALITY AND ASSOCIATED NEAR-MISS AMONG EMERGENCY INTRAPARTUM OBSTETRIC REFERRALS IN MULAGO HOSPITAL, KAMPALA, UGANDA
Abstract
ABSTRACT
Many maternal deaths (as well as related severe morbidity) are of women who don't attend
antenatal care in a given health unit but are referred there when they develop life threatening
obstetric complications.
Objective: The objective was to determine the reproductive characteristics of emergency
obstetric referrals, and determine the contribution of emergency obstetric referrals to severe
acute maternal morbidity (near-misses) and maternal mortality.
Study design. Descriptive cross-sectional study done in Mulago hospital
Subjects: 983 consecutive women admitted as emergency obstetric referrals in labour or
puerperium from 1st March to August 30th 2000, in Mulago, the national referral hospital.
Interventions: Subject,. were followed from time of admission to discharge (or death). They
were interviewed (or examined) to obtain data on socio-demographic characteristics,
reproductive history, obstetric outcome of the index pregnancy, obstetric complications and
cause of death. Their records were reviewed to determine evidence of severe acute morbidity
from acute organ/system dysfunction, using the definition by Mantel et al. This data was
analysed using the Epilnfo computer programme in term,; of means, frequencies, and
percentages.
Main outcome measures: Socio-demographic characteristics, obstetric complications, cause
of deaths, cause and type of near miss mortality, and case fatality rates.
Results: Of the 983 referrals, over 100 were near-misses and 17 died. Using Mantel et al.'s
definition of near-misses enabled identification of six times as many near-misses as maternal
deaths. The commonest causes of death were postpartum haemorrhage and eclampsia. Low
status was highly associated with both maternal deaths and near misses.
Many maternal deaths (as well as related severe morbidity) are of women who don't attend
antenatal care in a given health unit but are referred there when they develop life threatening
obstetric complications.
Objective: The objective was to determine the reproductive characteristics of emergency
obstetric referrals, and determine the contribution of emergency obstetric referrals to severe
acute maternal morbidity (near-misses) and maternal mortality.
Study design. Descriptive cross-sectional study done in Mulago hospital
Subjects: 983 consecutive women admitted as emergency obstetric referrals in labour or
puerperium from 1st March to August 30th 2000, in Mulago, the national referral hospital.
Interventions: Subject,. were followed from time of admission to discharge (or death). They
were interviewed (or examined) to obtain data on socio-demographic characteristics,
reproductive history, obstetric outcome of the index pregnancy, obstetric complications and
cause of death. Their records were reviewed to determine evidence of severe acute morbidity
from acute organ/system dysfunction, using the definition by Mantel et al. This data was
analysed using the Epilnfo computer programme in term,; of means, frequencies, and
percentages.
Main outcome measures: Socio-demographic characteristics, obstetric complications, cause
of deaths, cause and type of near miss mortality, and case fatality rates.
Results: Of the 983 referrals, over 100 were near-misses and 17 died. Using Mantel et al.'s
definition of near-misses enabled identification of six times as many near-misses as maternal
deaths. The commonest causes of death were postpartum haemorrhage and eclampsia. Low
status was highly associated with both maternal deaths and near misses.
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