Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

BMC Pregnancy and Childbirth

Research Article

Mohammad Hakimi¹  Adi Utarini²  Yuli Mawarti³ 

[1] Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Gadjah Mada, 55281, Sekip, Yogyakarta, Indonesia;Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, 55281, Sekip, Yogyakarta, Indonesia;Public Health Graduate Program, Faculty of Medicine, Universitas Gadjah Mada, 55281, Sekip, Yogyakarta, Indonesia;

关键词: Quality of maternal care;    Process indicators;    Response time;    Timeliness;    Maternal near miss;    Maternal mortality;    Academic hospital;   

DOI  :  10.1186/s12884-017-1326-4

 received in 2015-12-09, accepted in 2017-05-08,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017