The role of institutional factors in maternal mortality from obstructed labour

Abstract

We conducted a ten-year review of maternal mortality from obstructed labour in University of Calabar Teaching Hospital (UCTH), between January 1st 1990 and December 31st 1999. The aim was to examine the role of Institutional factors in maternal mortality arising from this condition. The review showed that a total of 702 patients were managed as a result of obstructed labour giving an incidence of 3.7%. Fifty-five patients died giving a case fatality rate (CFR) of 7.8%. Fifty-one (92.7%) of the patients who died were not booked, thirty-four (61%) were brought from spiritual churches, while 17(31%) were from the traditional birth attendants' (TBAs) homes. Four (7.2%) were booked cases who were earlier scheduled for elective caesarean section but defaulted and reported late in labour with ruptured uterus. All patients were in social classes IV and V. Although 48 (47.3%) of these patients were seen by doctors within one hour of admission, only 6(10.9%) had initial assessment by senior doctors. Five (9.1%) had surgery within two hours of admission, 21(38.2%) had surgery in four hours of admission whereas 29(52.7%) had surgery after four hours of admission. The probable causes of maternal deaths were haemorrhage 24(43.6%), septicemia 5(27.3%), post operative shock 8(14.5%) renal failure 5(9.1%) anaesthetic deaths 3(5.5%). The twenty-four patients who died from haemorrhage had no blood transfusion. Nine of the patients who died from septicemia had no antibiotics before surgery. Anaesthetic deaths were seen in those who were managed by junior residents in conjunction with the anaesthetic nursing staff. Suggestions are offered on how to improve the quality of services provided by our hospitals with the aim of reducing maternal mortality from it. Keywords: Maternal mortality, Obstructed Labour, Institutional factors (Global J Med Sci: 2003 2(1): 13-17)