Umeora O U J, Egwuatu V E
Department of Obstetrics and Gynaecology, Ebonyi State University, Abakaliki, Nigeria.
Trop Doct. 2010 Jan;40(1):13-7. doi: 10.1258/td.2009.080207. Epub 2009 Dec 11.
Many pregnant women see unorthodox medical providers in labour before presentation to the modern medical facilities after obstetric complications have arisen. This study evaluates the contribution of unorthodox medical facilities to the delays subsisting maternal mortality in a rural, poor and illiterate community. Data was collected prospectively on all referrals from outside the St. Vincent's hospital, over a three-year period. Seven hundred and fifty women were referred to the hospital and there were a total of thirty maternal deaths out of the 1268 live births, giving a maternal mortality ratio of 2366/100,000. Most of the referrals were patient-driven and verbal and came from traditional birth attendants (TBAs). The majority of the patients (86.7%) came in poor clinical conditions and some were moribund. The TBAs contributed most to maternal deaths. Prolongation of labour for more than 24 hours correlated positively with maternal mortality. Ruptured uterus complicating obstructed labour (34.8%) and haemorrhage (30.4%) were the leading causes of death in this series. The mortal delay suffered by pregnant women in accessing unorthodox medical attention deserves further attention in issues of maternal mortality in the underserved rural communities of Nigeria.
许多孕妇在出现产科并发症后前往现代医疗设施就诊之前，会在分娩时寻求非正规医疗服务提供者的帮助。本研究评估了非正规医疗设施对一个农村贫困文盲社区孕产妇死亡持续延误情况的影响。在三年时间里，前瞻性收集了圣文森特医院以外所有转诊病例的数据。750名妇女被转诊至该医院，在1268例活产中共有30例孕产妇死亡，孕产妇死亡率为2366/10万。大多数转诊是由患者主动提出且为口头转诊，来自传统接生员。大多数患者（86.7%）就诊时临床状况较差，有些已奄奄一息。传统接生员对孕产妇死亡的影响最大。产程延长超过24小时与孕产妇死亡率呈正相关。子宫破裂并发梗阻性分娩（34.8%）和出血（30.4%）是该系列病例中的主要死亡原因。在尼日利亚农村医疗服务不足的社区，孕妇在寻求非正规医疗救治时所遭受的死亡延误，在孕产妇死亡问题上值得进一步关注。
