Abstract
BackgroundWomen with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda.MethodsThis was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care.ResultsSevere pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1).ConclusionThe predictors of progression from severe maternal morbidity to mortalitywere: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community.
Highlights
Women with severe maternal morbidity are at high risk of dying
Of these 460 mothers survived while thirty nine died. This gave a ratio of severe maternal morbidity to maternal mortality of 12.8 to 1, incidence rate of 8% and maternal mortality ratio 7815/100,000
The deaths were due to obstetric haemorrhage (30.9%), eclampsia (12.8%), obstructed labour and ruptured uterus (10.3%), puerperal sepsis (12.8%), anaemia (15.4%), anaesthetic complications (2.6%), and medical diseases (15.2%)
Summary
Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. Factors that put a woman with severe maternal morbidity to the risk of mortality have been attributed to delay of patients to arrive in hospital and delay to receive treatment [14]. The quality of care factors in hospitals which predispose mothers with severe morbidity to progress to mortality include poor institutional deficiencies such as shortage of supplies, equipment, staffing and some are administrative. These have been reported to be responsible for most maternal deaths in Sri Lanka, contributing to 66% of maternal deaths [17], and similar findings have been reported in South Africa [18] and Tanzania [11]. It is important to study the predictors for progression of severe maternal morbidity to mortality so as to prevent maternal mortality in our community
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