Emergency Obstetric Care and Quality of Care Unit, WHO collaborating Centre for Research and Training in Maternal and Newborn Health, International Public Health Department, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of Obstetrics and Gynecology, Kenya.
Int J Gynaecol Obstet. 2022 Jun;158 Suppl 1(Suppl 1):14-22. doi: 10.1002/ijgo.14270.
To describe maternal deaths from postpartum hemorrhage (PPH) in Kenya by secondary analysis of the Kenya Confidential Enquiry into Maternal Deaths (CEMD) database and clinical audit of a sample of those deaths, and to identify the perceived challenges to implementing country-specific PPH guidelines.
A retrospective descriptive study using the Kenyan CEMD database and anonymized maternal death records from 2014-2017. Eight standards from the Kenya National Guidelines for Quality Obstetric and Perinatal Care were selected to perform clinical audit. The process of supporting eight Sub-Saharan African countries to develop country-specific PPH guidelines was described and perceived challenges implementing these were identified.
In total, 725 women died from PPH. Most women attended at least one antenatal care visit (67.2%) and most did not receive iron and folate supplementation (35.7%). Only 39.0% of women received prophylactic uterotonics in the third stage of labor. Factors significantly associated with receiving prophylactic uterotonics were place of delivery (χ = 43.666, df = 4; P < 0.001), being reviewed by a medical doctor (χ = 16.905, df = 1; P < 0.001), and being reviewed by a specialist (χ = 49.244, df = 1; P < 0.001). Only three of eight standards had a greater percentage of met cases in comparison to unmet cases. Key concerns about implementation of the new WHO PPH guidance included use of misoprostol by unskilled health personnel, availability of misoprostol and tranexamic acid (TXA) at primary healthcare level, lack of availability of heat-stable carbetocin (HSC) due to cost, lack of awareness and education about HSC and TXA, and lack of systems to ensure quality oxytocin is available at point of care.
There is a need for improved quality of care for women to minimize the risk of mortality from PPH, by implementing updated clinical guidelines combined with focused health system interventions.
通过对肯尼亚母婴死亡机密调查（CEMD）数据库的二次分析以及对部分死亡病例的临床审核，描述肯尼亚因产后出血（PPH）导致的产妇死亡情况，并确定实施特定国家 PPH 指南所面临的挑战。
本研究采用回顾性描述性研究方法，使用肯尼亚 CEMD 数据库和 2014-2017 年期间的匿名产妇死亡记录。选择了肯尼亚国家优质产科和围产期保健指南中的八项标准进行临床审核。描述了支持 8 个撒哈拉以南非洲国家制定特定国家 PPH 指南的过程，并确定了实施这些指南所面临的挑战。
共有 725 名妇女死于 PPH。大多数妇女至少接受过一次产前保健就诊（67.2%），但只有 35.7%的妇女接受了铁和叶酸补充。只有 39.0%的妇女在第三产程中接受了预防性宫缩素。与接受预防性宫缩素有显著关联的因素包括分娩地点（χ ²=43.666，df=4；P<0.001）、由医生审查（χ ²=16.905，df=1；P<0.001）和由专家审查（χ ²=49.244，df=1；P<0.001）。在 8 项标准中，只有 3 项符合标准的比例大于不符合标准的比例。实施新的世卫组织 PPH 指南的主要关注点包括非熟练卫生人员使用米索前列醇、初级卫生保健层面米索前列醇和氨甲环酸（TXA）的供应情况、由于成本原因无法获得热稳定卡贝缩宫素（HSC）、对 HSC 和 TXA 的认识和教育不足，以及缺乏确保治疗点获得优质催产素的系统。
需要通过实施更新的临床指南并结合重点卫生系统干预措施，提高妇女护理质量，以最大程度降低 PPH 导致的死亡率。
