Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study

BMC Pregnancy and Childbirth

Research Article

Ahmad Abo Al Chamat¹  Yara Almerie¹  Yasser Shahrour¹  Asmaa Abdulsalam¹  Muhammad Q Almerie²  Hosam E Matar³ 

[1] Department of Obstetrics & Gynaecology, Faculty of Medicine, Damascus University, Damascus, Syria;Diana, Princess of Wales Hospital, Scartho Road, Grimsby DN33 2BA, UK. Previously: Medical Student, Faculty of Medicine, Damascus University, Damascus, Syria;North Middlesex University Hospital, Sterling Way, London N18 1QX, UK. Previously: Medical Student, Faculty of Medicine, Damascus University, Damascus, Syria;

关键词: Maternal Mortality;    Maternal Death;    Obstetric Care;    Hypertensive Disorder;    Maternal Mortality Ratio;   

DOI  :  10.1186/1471-2393-10-65

 received in 2010-02-20, accepted in 2010-10-19,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundInvestigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities.MethodsRetrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions.ResultsThere were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU).ConclusionNear-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health care professionals to manage infrequent but fatal conditions like sepsis. An urgent review of the referral system and the emergency obstetric care in Syria is highly recommended.

【 授权许可】

CC BY   
© Almerie et al; licensee BioMed Central Ltd. 2010