Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark.
Trop Med Int Health. 2010 Aug;15(8):894-900. doi: 10.1111/j.1365-3156.2010.02554.x. Epub 2010 Jun 9.
(i) To identify clinical causes of maternal deaths at a regional hospital in Tanzania and through confidential enquiry (CE) assess major substandard care and make a comparison to the findings of the internal maternal deaths audits (MDAs); (ii) to describe hospital staff reflections on causes of substandard care.
A CE into maternal deaths was conducted based on information available from written sources supplemented with participatory observations and interviews with staff. The compiled information was summarized and presented anonymously for external expert review to assess for major substandard care. Hospital based maternal deaths between 2006 and 2008 (35 months) were included. Of 68 registered maternal deaths sufficient information for reviewing was retrieved for 62 cases (91%). As a supplement, in-depth interviews with staff about the underlying causes of substandard care were performed.
The causes of death were infection (40%), abortion (25%), eclampsia (13%), post-partum haemorrhage (12%), obstructed labour (6%) and others (4%). The median time available for hospital staff to manage the fatal complication was 47 h. The CE identified major substandard care in 46 (74%) of the 62 cases reviewed. During the same time period MDA identified substandard care in 18 cases. Staff perceived poor organization of work and lack of training as important causes for substandard care. Local MDA was considered useful although time-consuming and sometimes threatening, and staff dedication to the process was questioned.
Quality assurance of emergency obstetric care might be strengthened by supplementing internal MDA with external CE.
(i) 在坦桑尼亚的一家地区医院，通过机密调查（CE）确定产妇死亡的临床原因，并评估主要的护理不足，并将其与内部产妇死亡审核（MDA）的结果进行比较；(ii) 描述医院工作人员对护理不足原因的反思。
根据书面资料提供的信息，结合参与性观察和与工作人员的访谈，进行产妇死亡的 CE。收集到的资料进行总结，并匿名提交给外部专家审查，以评估主要的护理不足。包括 2006 年至 2008 年（35 个月）期间在医院登记的产妇死亡。在 68 例登记的产妇死亡中，有 62 例（91%）有足够的信息可供审查。作为补充，对工作人员进行了关于护理不足根本原因的深入访谈。
死亡原因是感染（40%）、流产（25%）、子痫（13%）、产后出血（12%）、产程梗阻（6%）和其他（4%）。医院工作人员有 47 小时的时间来处理致命并发症。CE 确定了在 62 例审查的病例中有 46 例（74%）存在主要护理不足。在同一时期，MDA 确定了 18 例护理不足。工作人员认为工作组织不善和缺乏培训是护理不足的重要原因。当地 MDA 被认为是有用的，尽管耗时且有时具有威胁性，并且工作人员对该过程的奉献精神受到质疑。
通过内部 MDA 与外部 CE 相结合，加强紧急产科护理的质量保证。
