An audit of the initial resuscitation of severely ill patients presenting with septic incomplete miscarriages at a tertiary hospital in South Africa

BMC Pregnancy and Childbirth

Patricia Sebola¹  Jennifer Makin²  Sumaiya Adam³  Hennie Lombaard³ 

[1] Department of Obstetrics and Gynecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa;Medical Research Council Maternal and Infant Health Strategies Research Unit, University Pretoria, Pretoria, South Africa;Maternal and Fetal Medicine Unit, Department Obstetrics and Gynecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa

关键词: SAMM;    Shock index;    Maternal death;    Maternal near miss;    Septic incomplete miscarriage;   

Others  :  1161093
DOI  :  10.1186/s12884-015-0510-7

 received in 2014-10-31, accepted in 2015-03-19,  发布年份 2015

【 摘 要 】

Background

Septic incomplete miscarriages remain a cause of maternal deaths in South Africa. There was an initial decline in mortality when a strict protocol based approach and the Choice of Termination of Pregnancy Act in South Africa were implemented in this country. However, a recent unpublished audit at the Pretoria Academic Complex (Kalafong and Steve Biko Academic Hospitals) suggested that maternal mortality due to this condition is increasing. The objective of this investigation is to do a retrospective audit with the purpose of identifying the reasons for the deteriorating mortality index attributed to septic incomplete miscarriage at Steve Biko Academic Hospital.

Methods

A retrospective audit was performed on all patients who presented to Steve Biko Academic Hospital with a septic incomplete miscarriage from 1^st January 2008 to 31^st December 2010. Data regarding patient demographics, initial presentation, resuscitation and disease severity was collected from the “maternal near-miss”/SAMM database and the patient’s medical record. The shock index was calculated for each patient retrospectively.

Results

There were 38 SAMM and 9 maternal deaths during the study period. In the SAMM group 86.8% and in the maternal death group 77.8% had 2 intravenous lines for resuscitation. There was no significant improvement in the mean blood pressure following resuscitation in the SAMM group (p 0.67), nor in the maternal death group (p 0.883). The shock index before resuscitation was similar in the two groups but improved significantly following resuscitation in the SAMM group (p 0.002). Only 31.6% in the SAMM group and 11.1% in the maternal death group had a complete clinical examination, including a speculum examination of the cervix on admission. No antibiotics were administered to 21.1% in the SAMM group and to 33.3% in the maternal death group.

Conclusion

The strict protocol management for patients with septic incomplete miscarriage was not adhered to. Physicians should be trained to recognise and react to the seriously ill patient. The use of the shock index in the identification and management of the critically ill pregnant patient needs to be investigated.

【 授权许可】

   
2015 Lombaard et al.; licensee BioMed Central.

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