Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia.
Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia.
PLoS One. 2022 Sep 29;17(9):e0274866. doi: 10.1371/journal.pone.0274866. eCollection 2022.
Obstetric hemorrhage is defined as active bleeding of more than 500 ml in vaginal delivery or 1000ml following cesarean delivery. It is the leading cause of maternal death, which contributes to up to 50% of maternal deaths in Ethiopia. This study aims to assess the relationships between adverse maternal health exposure (personal and medical factors) and delay in health care (hesitancy in opting to seek care, lag in reaching a health facility, and wait in receiving health care at the facility) and adverse outcomes of obstetric hemorrhage among reviewed maternal deaths in Ethiopia.
This study utilizes 4530 reported maternal death surveillance data obtained from Ethiopian maternal death surveillance and response (MDSR) system between 2013 to 2020. Latent class analysis was applied to identify underlying patterns of adverse maternal health exposures. Furthermore, the associations between latent classes and adverse outcomes of obstetric hemorrhage were analyzed using multilevel logistics regression model adjusted for clustering within reporting provinces.
Nearly 56% of the reviewed maternal deaths were due to the adverse outcome of obstetric hemorrhage, among which nearly 75% died during the postpartum period. The study identified six separate sub-groups of women based on their vulnerability to adverse maternal health conditions. The six subgroups identified by this study are 1) women who travelled for a long duration to reach a health care provider, 2) those who had no access to a health facility (HF) within a 5Km radius, 3) those who failed to decide to go to a health facility: 4) those with multiparity,5) those who were injured during delivery with history of coagulopathy, and 6) those who got injured during delivery and failed to decide to go to a health facility. Women in the class of grand multipara have demonstrated the highest risk of death due to the adverse outcomes of obstetric hemorrhage (β = 1.54, SE = 0.09, p<0.0001).
The study has attempted to identify women that are at a higher risk for the adverse outcomes of obstetric hemorrhage. Henceforth, targeted intervention should be taken on women of reproductive age group, and those identified as at a higher risk, to reduce the high rate of maternal death due to obstetric hemorrhage.
产科出血是指阴道分娩出血量超过 500 毫升或剖宫产出血量超过 1000 毫升。它是导致产妇死亡的主要原因，在埃塞俄比亚约占产妇死亡的 50%。本研究旨在评估产妇不良健康暴露（个人和医疗因素）与医疗延误（不愿寻求医疗、到达医疗机构的延迟、在医疗机构接受医疗的等待）之间的关系，并评估产科出血不良结局在埃塞俄比亚审查的产妇死亡中的关系。
本研究利用 2013 年至 2020 年期间从埃塞俄比亚产妇死亡监测和应对系统（MDSR）获得的 4530 份报告的产妇死亡监测数据。应用潜在类别分析识别不良产妇健康暴露的潜在模式。此外，使用多水平逻辑回归模型分析潜在类别与产科出血不良结局之间的关联，并针对报告省份内的聚类进行调整。
在审查的产妇死亡中，近 56%是由于产科出血的不良结局，其中近 75%是在产后期间死亡的。研究根据产妇易患不良健康状况的情况，确定了六个不同的妇女亚组。本研究确定的六个亚组是 1）前往医疗机构的旅程较长的妇女，2）在 5 公里半径内无法获得医疗设施的妇女，3）无法决定前往医疗设施的妇女：4）多产妇，5）分娩时受伤且有凝血功能障碍史的妇女，6）分娩时受伤且无法决定前往医疗设施的妇女。多胎产妇组的妇女死于产科出血不良结局的风险最高（β=1.54，SE=0.09，p<0.0001）。
本研究试图确定处于产科出血不良结局风险较高的妇女。因此，应该对育龄妇女和那些被确定为风险较高的妇女采取有针对性的干预措施，以降低因产科出血导致的高产妇死亡率。
