Faculty of Medicine, Islamic University of Gaza, P. O. Box 108, Gaza strip, Gaza, Palestine.
Faculty of Nursing, Islamic University of Gaza, P. O. Box 108, Gaza Strip, Gaza, Palestine.
BMC Pregnancy Childbirth. 2018 Oct 11;18(1):396. doi: 10.1186/s12884-018-2037-1.
Maternal mortality is an important health indicator for the overall health of a population. This study assessed the causes and contributing factors to maternal mortality that occurred in the Gaza-Strip between July 2014 and June 2015.
This is a retrospective study that used both quantitative and qualitative data. The data were collected from available medical records, investigation reports, death certificates, and field interviews with healthcare professionals as well as families.
A total of 18 maternal mortalities occurred in Gaza between 1st July 2014 and June 30th 2015. Age at time of death ranged from 18 to 44 years, with 44.4% occurring before the age of 35 years. About 22.2% were primiparous, while 55.6% were grand multiparous women. The most common causes of death were sepsis, postpartum haemorrhage, and pulmonary embolism. The most striking deficiency was very poor medical documentation which was observed in 17 cases (94%). In addition, poor communication between doctors and women and their families or among healthcare teams was noticed in nine cases (50%). These were repeatedly described by families during interviews. Further aspects surfacing in many interviews were distrust by families towards clinicians and poor understanding of health conditions by women. Other factors included socioeconomic conditions, poor antenatal attendance and the impact of the 2014 war. Low morale among medical staff was expressed by most interviewed clinicians, as well as the fear of being blamed by families and management in case of adverse events. Substandard care and lack of appropriate supervision were also found in some cases.
This study revealed deficiencies in maternity care, some of which were linked to the socioeconomic situation and the 2014 war. Others show poor implementation of clinical guidelines and lack of professional skills in communication and teamwork. Specialised training should be offered for clinicians in order to improve these aspects. However, the most striking deficiency was the extremely poor documentation, reflecting a lack of awareness among clinicians regarding its importance. Local policymakers should focus on systematic application of quality improvement strategies in order to achieve greater patient safety and further reductions in the maternal mortality rate.
孕产妇死亡率是衡量人口整体健康状况的一个重要指标。本研究评估了 2014 年 7 月至 2015 年 6 月间在加沙地带发生的孕产妇死亡的原因和促成因素。
这是一项回顾性研究，使用了定量和定性数据。数据来自现有的医疗记录、调查报告、死亡证明以及与医疗保健专业人员和家属的实地访谈。
2014 年 7 月 1 日至 2015 年 6 月 30 日期间，加沙地带共发生 18 例孕产妇死亡事件。死亡时的年龄在 18 至 44 岁之间，其中 44.4%发生在 35 岁之前。初产妇约占 22.2%，而 55.6%为多产妇。最常见的死亡原因是败血症、产后出血和肺栓塞。最引人注目的缺陷是非常差的医疗记录，在 17 例（94%）中都有观察到。此外，在 9 例（50%）中发现医生与妇女及其家属或医疗团队之间沟通不良。这些情况在家庭访谈中多次被描述。在许多访谈中还出现了不信任临床医生和对健康状况理解不足等问题。其他因素包括社会经济条件、产前护理不良以及 2014 年战争的影响。大多数接受访谈的临床医生都表达了医疗人员士气低落，以及在发生不良事件时害怕被家属和管理层指责的情况。在一些情况下还发现了服务标准不足和缺乏适当监督的情况。
本研究揭示了孕产妇保健方面的缺陷，其中一些与社会经济状况和 2014 年战争有关。其他缺陷则表明临床指南的执行不力以及在沟通和团队合作方面缺乏专业技能。应向临床医生提供专门培训，以改善这些方面。然而，最引人注目的缺陷是记录极其糟糕，反映了临床医生对其重要性的认识不足。地方政策制定者应专注于系统应用质量改进策略，以实现更大的患者安全和进一步降低孕产妇死亡率。
