Department of Obstetrics and Gynecology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda.
Obstetrics and Gynecology Department, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
PLoS One. 2018 Jun 26;13(6):e0195711. doi: 10.1371/journal.pone.0195711. eCollection 2018.
Assess the primary causes and preventability of maternal near misses (MNM) and mortalities (MM) at the largest tertiary referral hospital in Rwanda, Kigali University Teaching Hospital (CHUK).
We reviewed records for all women admitted to CHUK with pregnancy-related complications between January 1st, 2015 and December 31st, 2015. All maternal deaths and near misses, based on WHO near miss criteria were reviewed (Appendix A). A committee of physicians actively involved in the care of pregnant women in the obstetric-gynecology department reviewed all maternal near misses/ pregnancy-related deaths to determine the preventability of these outcomes. Preventability was assessed using the Three Delays Model.[1] Descriptive statistics were used to show qualitative and quantitative outcomes of the maternal near miss and mortality.
We identified 121 maternal near miss (MNM) and maternal deaths. The most common causes of maternal near miss and maternal death were sepsis/severe systemic infection (33.9%), postpartum hemorrhage (28.1%), and complications from eclampsia (18.2%)/severe preeclampsia (5.8%)/. In our obstetric population, MNM and deaths occurred in 87.6% and 12.4% respectively. Facility level delays (diagnostic and therapeutic) through human error or mismanagement (provider issues) were the most common preventable factors accounting for 65.3% of preventable maternal near miss and 10.7% maternal deaths, respectively. Lack of supplies, blood, medicines, ICU space, and equipment (system issues) were responsible for 5.8% of preventable maternal near misses and 2.5% of preventable maternal deaths. Delays in seeking care contributed to 22.3% of cases and delays in arrival from home to care facilities resulted in 9.1% of near misses and mortalities. Cesarean delivery was the most common procedure associated with sepsis/death in our population. Previous cesarean delivery (24%) and obstructed/prolonged labor (13.2%) contributed to maternal near miss and mortalities.
The most common preventable causes of MNM and deaths were medical errors, shortage of medical supplies, and lack of patient education/understanding of obstetric emergencies. Reduction in medical errors, improved supply/equipment availability and patient education in early recognition of pregnancy-related danger signs will reduce the majority of delays associated with MNM and mortality in our population.
评估卢旺达最大的三级转诊医院——基加利大学教学医院（CHUK）中产妇严重并发症的主要病因和可预防程度。
我们回顾了 2015 年 1 月 1 日至 12 月 31 日期间因妊娠并发症入住 CHUK 的所有女性的记录。所有产妇死亡和严重并发症（基于世界卫生组织严重并发症标准）均进行回顾（附录 A）。一个由积极参与妇产科孕妇护理的医生组成的委员会审查了所有的产妇严重并发症/妊娠相关死亡病例，以确定这些结果的可预防性。可预防性使用三延误模型进行评估。[1] 采用描述性统计方法展示产妇严重并发症和死亡率的定性和定量结果。
我们确定了 121 例产妇严重并发症和产妇死亡。产妇严重并发症和产妇死亡的最常见原因是败血症/严重全身感染（33.9%）、产后出血（28.1%）、子痫/严重子痫前期（18.2%）/并发症（5.8%）。在我们的产科人群中，产妇严重并发症和死亡的发生率分别为 87.6%和 12.4%。由于人为错误或管理不善（提供者问题）导致的医疗机构级别的延误（诊断和治疗延误）是最常见的可预防因素，分别占可预防产妇严重并发症和产妇死亡的 65.3%和 10.7%。缺乏用品、血液、药物、重症监护室空间和设备（系统问题）分别导致 5.8%的可预防产妇严重并发症和 2.5%的可预防产妇死亡。寻求治疗的延误导致 22.3%的病例，从家到治疗机构的延误导致 9.1%的严重并发症和死亡。剖宫产术是导致我们人群中败血症/死亡的最常见手术。既往剖宫产术（24%）和梗阻/延长产程（13.2%）导致产妇严重并发症和死亡。
产妇严重并发症和死亡的最常见可预防原因是医疗失误、医疗用品短缺和缺乏对产科急症的患者教育/认识。减少医疗失误、提高供应/设备可用性以及对妊娠相关危险信号的早期识别进行患者教育，将减少我们人群中与产妇严重并发症和死亡相关的大多数延误。
