When getting there is not enough: a nationwide cross‐sectional study of 998 maternal deaths and 1451 near‐misses in public tertiary hospitals in a low‐income country

Oladapo, OT; Adetoro, Olalekan O.; Ekele, BA; Chama, Calvin; Etuk, SJ; Aboyeji, AP; Onah, HE; Abasiattai, AM; Adamu, AN; Adegbola, Omololu; Adeniran, AS; Aimakhu, CO; Akinsanya, Olufemi; Aliyu, Labaran Dayyabu; Ande, Adedapo; Ashimi, Adewale; Bwala, Manu; Fabamwo, Adetokunbo Olusegun; Geidam, Ado Danazumi; Ikechebelu, JI; Imaralu, John Osaigbovoh; Kuti, Oluwafemi; Nwachukwu, D; Omo-Aghoja, LO; Tunau, K; Tukur, Jamilu; Umeora, Ouj; Umezulike, AC; Dada, OA; Tunçalp, Özge; Vogel, Joshua P.; Gülmezoglu, A Metin

doi:10.1111/1471-0528.13450

Cited by 176 publications

(157 citation statements)

References 20 publications

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“…The increasing proportion of facility births, however, has not been matched with improvements in the quality of intra-facility labour care [6, 7]. Notably, reports from referral hospitals in sub-Saharan Africa suggest ample room for improvement even at the tertiary level of the health care sector [8–11]. Importantly, these are the facilities where most of the countries’ future health care workers are trained, and if quality of care was improved, they could possibly be a lever for achieving nationwide health care improvements.…”

Section: Introductionmentioning

confidence: 99%

Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

Maaløe

Housseine

Bygbjerg

et al. 2016

BMC Pregnancy Childbirth

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BackgroundTo study determinants of stillbirths as indicators of quality of care during labour in an East African low resource referral hospital.MethodsA criterion-based unmatched unblinded case-control study of singleton stillbirths with birthweight ≥2000 g (n = 139), compared to controls with birthweight ≥2000 g and Apgar score ≥7 (n = 249).ResultsThe overall facility-based stillbirth rate was 59 per 1000 total births, of which 25 % was not reported in the hospital’s registers. The majority of singletons had birthweight ≥2000 g (n = 139; 79 %), and foetal heart rate was present on admission in 72 (52 %) of these (intra-hospital stillbirths). Overall, poor quality of care during labour was the prevailing determinant of 71 (99 %) intra-hospital stillbirths, and median time from last foetal heart assessment till diagnosis of foetal death or delivery was 210 min. (interquartile range: 75–315 min.). Of intra-hospital stillbirths, 26 (36 %) received oxytocin augmentation (23 % among controls; odds ratio (OR) 1.86, 95 % confidential interval (CI) 1.06–3.27); 15 (58 %) on doubtful indication where either labour progress was normal or less dangerous interventions could have been effective, e.g. rupture of membranes. Substandard management of prolonged labour frequently led to unnecessary caesarean sections. The caesarean section rate among all stillbirths was 26 % (11 % among controls; OR 2.94, 95 % CI 1.68–5.14), and vacuum extraction was hardly ever done. Of women experiencing stillbirth, 27 (19 %) had severe hypertensive disorders (4 % among controls; OR 5.76, 95 % CI 2.70–12.31), but 18 (67 %) of these did not receive antihypertensives. An additional 33 (24 %) did not have blood pressure recorded during active labour. When compared to controls, stillbirths were characterized by longer admissions during labour. However, substandard care was prevalent in both cases and controls and caused potential risks for the entire population. Notably, women with foetal death on admission were in the biggest danger of neglect.ConclusionsIntrapartum management of women experiencing stillbirth was a simple yet strong indicator of quality of care. Substandard care led to perinatal as well as maternal risks, which furthermore were related to unnecessary complex, time consuming, and costly interventions. Improvement of obstetric care is warranted to end preventable birth-related deaths and disabilities.Trial registrationThis is the baseline analysis of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1142-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

Maaløe

Housseine

Bygbjerg

et al. 2016

BMC Pregnancy Childbirth

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“…Значение здоровья женщин для «почечного здоровья» в настоящем и будущем Что мы знаем ПЭ признается основной причиной ОПП и ма-теринской смертности в развивающихся стра-нах [2,17]. Беременность -самая частая причина ОПП у женщин детородного возраста [10,18,19].…”

Section: что мы знаем и чего мы не знаемunclassified

What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

et al. 2018

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“…What we know PE is the principal cause of AKI and maternal death, particularly in developing countries [2,17]. Pregnancy is the most common cause of AKI in women of childbearing age [10,18,19].…”

Section: Pregnancy Preeclampsia Pregnancy-induced Hypertensive Disomentioning

confidence: 99%

What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

Piccoli

Alrukhaimi

Liu

et al. 2018

World J Nephrol Urol

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Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learning more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

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When getting there is not enough: a nationwide cross‐sectional study of 998 maternal deaths and 1451 near‐misses in public tertiary hospitals in a low‐income country

Cited by 176 publications

References 20 publications

Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

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