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Maternal near-miss and death and their association with caesarean section complications [Elektronisk resurs] : a cross-sectional study at a university hospital and a regional hospital in Tanzania

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Författare/Namn	Litorp, Helena,
Titel	Maternal near-miss and death and their association with caesarean section complications [Elektronisk resurs] : a cross-sectional study at a university hospital and a regional hospital in Tanzania
Anmärkning: Allmän	Published
Anmärkning: Innehållsbeskrivning, sammanfattning	BACKGROUND:The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications.METHODS:We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated.RESULTS:We identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33-39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460-730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6-11) of the MNM events and 13% (95% CI 6.4-23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12-37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8-12) (risk ratio 3.2, 95% CI 1.5-6.6).CONCLUSIONS:The occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS.
Ämne	Medical and Health Sciences Medicin och hälsovetenskap Medical and Health Sciences Medicin och hälsovetenskap Maternal near-miss; Maternal death; Caesarean section; Low-income country
Medarbetare	Kidanto, Hussein L, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell kvinno- & mödrahälsovård och migration/Essén Författare/medförfattare Rööst, Mattias, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell kvinno- & mödrahälsovård och migration/Essén Författare/medförfattare Abeid, Muzdalifat, 1973-, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell sexuell och reproduktiv hälsa/Larsson Författare/medförfattare Nyström, Lennarth, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden Författare/medförfattare Essén, Birgitta, 1961-, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell kvinno- och mödrahälsovård och migration/Essén Författare/medförfattare
Institutionsnamn	Uppsala universitet. Umeå universitet.
Värdpublikation	BMC Pregnancy and Childbirth ISSN 1471-2393 14:1, s. 244 14:1<244
Elektronisk adress och åtkomst (URI)	http://uu.diva-portal.org/smash/get/diva2:738503/FULLTEXT01.pdf FULLTEXT http://umu.diva-portal.org/smash/get/diva2:738617/FULLTEXT01.pdf FULLTEXT
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*0247 $a10.1186/1471-2393-14-244$2doi
*0247 $a25056517$2pmid
*0247 $a000340799000001$2isi
*0247 $aurn:nbn:se:uu:diva-229946$2urn
*0247 $aurn:nbn:se:umu:diva-91949$2urn
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*1001 $aLitorp, Helena,$d1980-,$uUppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell kvinno- & mödrahälsovård och migration/Essén$4aut$0(SwePub:uu)helli994
*24510$aMaternal near-miss and death and their association with caesarean section complications$h[Elektronisk resurs] :$ba cross-sectional study at a university hospital and a regional hospital in Tanzania
*500  $aPublished
*5203 $8eng$aBACKGROUND:The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications.METHODS:We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated.RESULTS:We identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33-39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460-730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6-11) of the MNM events and 13% (95% CI 6.4-23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12-37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8-12) (risk ratio 3.2, 95% CI 1.5-6.6).CONCLUSIONS:The occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS.
*653  $aMedical and Health Sciences$aHealth Sciences$aPublic Health, Global Health, Social Medicine and Epidemiology
*653  $aMedicin och hälsovetenskap$aHälsovetenskaper$aFolkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
*653  $aMedical and Health Sciences$aClinical Medicine$aObstetrics, Gynecology and Reproductive Medicine
*653  $aMedicin och hälsovetenskap$aKlinisk medicin$aReproduktionsmedicin och gynekologi
*653  $aMaternal near-miss; Maternal death; Caesarean section; Low-income country
*7001 $aKidanto, Hussein L,$uUppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell kvinno- & mödrahälsovård och migration/Essén$4aut$0(SwePub:)
*7001 $aRööst, Mattias,$uUppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell kvinno- & mödrahälsovård och migration/Essén$4aut$0(SwePub:uu)matro877
*7001 $aAbeid, Muzdalifat,$d1973-,$uUppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell sexuell och reproduktiv hälsa/Larsson$4aut$0(SwePub:uu)muzab472
*7001 $aNyström, Lennarth,$uDepartment of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden$4aut$0(SwePub:)
*7001 $aEssén, Birgitta,$d1961-,$uUppsala universitet, Internationell mödra- och barnhälsovård (IMCH), Internationell kvinno- och mödrahälsovård och migration/Essén$4aut$0(SwePub:uu)bires412
*7102 $aUppsala universitet.$bMedicinska och farmaceutiska vetenskapsområdet.$bMedicinska fakulteten.$bInstitutionen för kvinnors och barns hälsa.$bInternationell mödra- och barnhälsovård (IMCH).$4org$0(SwePub:uu)1360
*7102 $aUmeå universitet.$bMedicinska fakulteten.$bInstitutionen för folkhälsa och klinisk medicin.$bEpidemiologi och global hälsa.$4org$0(SwePub:umu)5303
*7730 $tBMC Pregnancy and Childbirth$x1471-2393$g14:1, s. 244$q14:1<244
*85640$uhttp://uu.diva-portal.org/smash/get/diva2:738503/FULLTEXT01.pdf$zFULLTEXT$xfree
*85640$uhttp://umu.diva-portal.org/smash/get/diva2:738617/FULLTEXT01.pdf$zFULLTEXT$xfree
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