BackgroundMajor obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence,... Show moreBackgroundMajor obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome.MethodsWomen with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20weeks' gestation or occurring up to 42days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of >= 5units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of >= 8units of packed red blood cells, hysterectomy or death.ResultsThe incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14].ConclusionsAssessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome. Show less
This thesis describes the results of the LEMMoN study, a nationwide prospective cohort study into severe maternal morbidity in the Netherlands in which all hospitals in the Netherlands participated... Show moreThis thesis describes the results of the LEMMoN study, a nationwide prospective cohort study into severe maternal morbidity in the Netherlands in which all hospitals in the Netherlands participated. The main objectives of the study were to assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Cases of severe maternal morbidity were collected during a two-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n=371,021). Special attention was paid to the ethnic background. Substandard care was assessed in selected cases during audit meetings. Severe maternal morbidity was reported in 2552 cases, overall incidence being 7.1 per 1000 deliveries. Incidences of ICU admission, uterine rupture, eclampsia and major obstetric haemorrhage were 0.24%, 0.06%, 0.06% and 0.45% per 1000, respectively. Non-Western immigrant women had a 1.3 fold increased risk of severe maternal morbidity as compared with Western women. Jehovah__s witnesses had a 3.1-fold increased risk. Overall case fatality rate was 1 in 53. Substandard care was found in 80% of assessed cases during clinical audit. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. Show less
