Gandhi MN, Welz T, Ronsmans C. Severe acute maternal morbidity in rural South Africa.
Int J Gynaecol Obstet 2005;
87:180-7. [PMID:
15491577 DOI:
10.1016/j.ijgo.2004.07.012]
[Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Revised: 07/16/2004] [Accepted: 07/23/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE
Our objective was to identify the frequency, causes, and avoidable factors of severe acute maternal morbidity (SAMM) in four non-specialist hospitals in rural South Africa.
METHOD
We conducted a prospective audit using criteria for SAMM suited to the diagnostic and treatment facilities available in the primary hospital setting. For each case of SAMM, a local audit team assessed the standard of care against local management guidelines and examined avoidable factors. An external specialist also retrospectively examined avoidable factors.
RESULT
The facility-based incidence of SAMM was 541 cases per 100,000 births (95% CI 368-767). The commonest organ systems involved were cerebral (42%), coagulation (19%), and vascular dysfunctions (16%). The commonest obstetric diagnoses were eclampsia (39%) and obstetric haemorrhage (32%). Approximately 65% of cases were avoidable.
CONCLUSION
A qualitative case review audit of SAMM in a non-specialist rural setting appears feasible and sustainable, and provides valuable information towards improving deficiencies in maternal care.
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