Department of Obstetrics and Gynaecology, Benjamin Carson (Snr) School of Medicine, Babcock University, Ilishan-Remo, Nigeria.
Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ido-Ekiti, Nigeria.
BJOG. 2019 Jun;126 Suppl 3:19-25. doi: 10.1111/1471-0528.15624. Epub 2019 Mar 21.
To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to life-threatening postpartum haemorrhage (PPH) in Nigerian public tertiary hospitals.
Secondary analysis of a nationwide cross-sectional study.
Forty-two tertiary hospitals.
Women admitted for pregnancy, childbirth or puerperal complications.
All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period.
Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/SMO).
Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH.
Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH.
The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study.
One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year.
调查尼日利亚公立三级医院与危及生命的产后出血（PPH）相关的严重产妇结局（SMO）的负担和卫生服务事件。
全国性横断面研究的二次分析。
42 家三级医院。
因妊娠、分娩或产褥期并发症而住院的妇女。
在一年期间，使用世卫组织标准前瞻性识别所有因 PPH 导致的 SMO[产妇接近死亡（MNM）或产妇死亡（MD）]病例。
SMO 的发生率、卫生服务事件、病死率（CFR）和死亡率指数（MI：死亡/SMO 的百分比）。
在研究期间记录的 94835 例分娩中，有 2087 例（2.2%）发生了产后出血。共有 354 名（0.3%）妇女发生了 SMO（103 例 MD；251 例 MNM）。这是医院中最常见的产科出血性并发症。PPH 的孕产妇死亡率比最高（每 100000 例活产 112 例），记录的 MI（29.1%）和 CFR（4.9%）仅次于子宫破裂。约 83%的 SMO 妇女入院时病情危急，超过 50%的妇女被转院。当 PPH 导致神经系统（80.8%）、肾脏（73.5%）或呼吸（58.7%）器官功能障碍时，更有可能发生 MD。尽管 MD 和 MNM 病例的救生干预时机在统计学上没有差异，但近四分之一的死亡妇女在诊断为危及生命的 PPH 后至少 4 小时才接受关键干预。
产后出血是尼日利亚医院产科出血和 SMO 的重要原因。应在较低的医疗服务提供水平上加强紧急产科服务，以减少因 PPH 导致的可避免死亡。
本二次分析所使用的数据来自最初的研究，该研究及其二次分析的发表由联合国开发计划署/联合国人口基金/联合国儿童基金会/世界卫生组织/世界银行人类生殖研究、发展和研究培训特别方案（HRP）资助，该方案由世界卫生组织共同赞助。我们的研究没有其他资金问题需要申报。
在 1 年内，42 家尼日利亚三级医疗机构共有 103 例产妇死亡和 251 例接近死亡的病例由 PPH 导致。
