Emergency obstetric performance with emphasis on operative delivery outcome: Does it reflect the quality of care?
AbstractBackground: In Ethiopia, in the previous studies, the rates of perinatal and maternal mortality were reported as one of the highest in the world. Objective: The purpose of the study was to analyze the rates of variables-specific perinatal deaths, maternal and perinatal case fatality rates and to determine common indications of operative deliveries with their out come indicators.
Method: A retrospective one-year medical record review of major emergency obstetric performance was conducted in Tikur Anbessa specialized hospital.
Result: During the study period, 3897 women with pregnancy related problems were admitted and managed as an emergency cases: 92% with gestational age of 28 weeks & above, 5.8% abortion, 2.0% ectopic pregnancy and 0.2% gestational trophoblastic disease. The 3583 women gave birth to 3672 babies, of which, 337 were perinatal deaths, making the gross perinatal and early neonatal mortality rates 91.8 and 26.1/1000 births each, respectively. The three leading causes of perinatal mortality were malpresentation (13.1%), uterine rupture (12.5%) and obstructed labor (11.9%), with obstructed labor and eclampsia the highest case-fatality rates (86.9-100% and 72.7%, respectively). The maternal mortality ratio was 1107.5/100,000 live births and the top three-implicated causes were postabortal complications (28.9%), eclampsia (21.1%) and ruptured uterus (15.8%). Operative (abdominal or vaginal) deliveries were performed for 43.1% babies. Fetal distress was the commonest indication for operative deliveries (32.5%) as well as the commonest cause of low Apgar scores at the 1st minute (61.4%).
Conclusion: Three-fourths of the total perinatal deaths were stillbirths, 94.2% referred. About half (48.9%) of the total causes of perinatal deaths were mechanical factors, predominantly obstructed labor that could have been totally averted if the system of basic obstetric care was properly established. Preventable obstetric complications such as abortion, eclampsia and uterine rupture are still the foremost causes of maternal deaths. [Ethiop.J.Health Dev. 2004;18(2):96-106]