Obstetric hemorrhage and adverse maternal outcomes: experience of a private teaching hospital in Southwestern Nigeria

Abstract

Background: Obstetric hemorrhage (OH) has remained the leading cause of maternal mortality, despite concerted National efforts. This audit was conducted to determine its contribution to Adverse Maternal Outcomes and determinants of survival at a private Teaching Hospital, which had provided comprehensive essential obstetric care for 3 years.
Methods: A retrospective review of all Severe Maternal Outcomes (SMO) due to OH using the Near-Miss approach.
Results: There were 682 deliveries, 101 (14.8%) were SMOs; composed of 97 Maternal Near Misses (MNM) and 4 Maternal Deaths (MD). OH accounted for 37/101(36.6%) of the total SMO and 33/97 (34.0%) of the total MNM observed. All MD were due to Obstetric hemorrhage, n=4(100%), with a Case Fatality Rate (CFR) of 3.3%. Coagulopathy (CFR=25%) and ruptured uterus (CFR=20%) were major causes of MD. Most of the MNM 19/33 (57.6%) and MD 3/4 (75%) were unbooked referrals; with MD more likely when a referred patient lived >5km from the hospital (OR=3.53). Significantly more MD (p=0.021, OR= 1.36, CI=1.005-1.850), were associated with deviations from standard management protocol.
Conclusion: Obstetric Hemorrhage, caused most of the Adverse Maternal Outcomes. Survival however depended on the quality of antenatal care, pre-referral care and adherence to standard management protocol for definitive care.

Keywords: Pregnancy, hemorrhage, maternal, near-miss, Nigeria

Afr J Health Sci. 2016; 29(2):105-118