Abstract
BackgroundReducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon.MethodsA retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained from medical records from February 1, 2011 to September 30, 2012. Three groups of variables were measured: (1) timeliness of care, (2) adherence to a standard of process indicators, and (3) associated extraneous variables. Variables were analysed using logistic regression to explore their effects on maternal mortality.ResultsThe mean of triage response time and obstetric resident response time were longer in maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses (1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02–0.77). Magnesium sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths although insignificant statistically (OR 0.19; 95% CI 0.03–1.47). Prophylactic antibiotic was also more frequently given in near misses than in maternal deaths though insignificant statistically (OR 0.3; 95% CI 0.06–1.56). Extraneous variables, such as caesarean sections were less performed in maternal deaths (OR 0.15; 95% CI 0.04–0.51), vaginal deliveries were more frequent in maternal deaths (OR 3.47; 95% CI 1.05–11.54), and more women in near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01–0.91).ConclusionsThe near misses had relatively received better quality of care compared to the maternal deaths. The near misses had received faster response time and better treatments. Timely referral systems enabled benefits to prevent maternal death.
Highlights
Reducing maternal mortality remains a major challenge for health care systems worldwide
History of Preeclampsia/ eclampsia in previous pregnancy was higher in maternal death (16.7%) than the near miss (5.95%)
Obstetric resident response time, surgery waiting time and intensive care unit (ICU)
Summary
Reducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. 34 out of 75 priority countries, where 95% of global maternal and children deaths occurred, had achieved MDG 4 and 5 [1]. Most countries claimed high coverage of antenatal care (ANC) and deliveries by health workers [2, 3]. Maternal death clusters around labour, delivery and the immediate postpartum period and reflects the strength of the health care system [5, 6]. A cross-sectional study in Banten, Indonesia, demonstrated that the prevalence of near misses was much greater in public hospitals than private hospitals [13]
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