Thomas Tete K, Umeokonkwo Chukwuma David, Sesay Himiede W, Adewuyi Peter, Babalola Obafemi J, Wachekwa Ian, Amo-Addae Maame P
Liberia Field Epidemiology Training Program, Liberia.
John F. Kennedy Medical Center, Monrovia, Liberia.
Heliyon. 2024 Mar 17;10(6):e28001. doi: 10.1016/j.heliyon.2024.e28001. eCollection 2024 Mar 30.
Anecdotal evidence showed increased maternal deaths at the major tertiary hospital over the past two years (2020-2021). We reviewed the maternal death audit data, identified the main causes of maternal death, and associated risk factors. Findings were shared with policymakers to help reduce maternal mortality.
We conducted a secondary data review and descriptive analysis of maternal death at the tertiary hospital located in Monrovia.
The maternal death data were extracted from patient medical records, including death certificates and maternal audit records. The record of live births was obtained from the delivery register. Data were analyzed using Epi Info version 7.2 Maternal mortality ratio (MMR) was estimated, the leading direct and indirect causes of maternal death were identified, and the factors associated with maternal death were explored using logistic regression at a 5% level of significance.
There are a total of 233 maternal deaths and 14, 879 live births giving a maternal mortality ratio (MMR) of 1565 per 100,000 live births during the period under review. The median age of the mothers at death was 29 (14-45) years. About 40.3% (94/233) of cases died within <1 day of admission, referrals accounted for 59% (137/233) of the cases. Direct causes of death accounted for 66% (147/223). Hemorrhage [30.6% (45/147)], Eclampsia [(30/147) 20.6%] and Sepsis [(30/147) 20.6%] were the main direct causes of death while cardiovascular-related [18.4% (14/76)] and HIV/AIDS [16% (12/76)] were the leading indirect cause of death. Patients from referred other facilities were 7.9 times more likely to die as compared to non-referral (pOR:7.9, 95%CI: 5.9-10.6, p < 0.001).
The maternal mortality ratio remained high. Referrals were done late. The Liberia Ministry of Health should equip more secondary-level health facilities and tertiary hospitals to handle maternal emergencies and sensitize the populace and healthcare workers on prompt identification and referral of obstetric emergencies. The MoH also needs to improve the blood transfusion services to help in the management of postpartum hemorrhage.
轶事证据显示，在过去两年（2020 - 2021年），这家大型三级医院的孕产妇死亡人数有所增加。我们回顾了孕产妇死亡审计数据，确定了孕产妇死亡的主要原因及相关风险因素。研究结果已与政策制定者分享，以帮助降低孕产妇死亡率。
我们对位于蒙罗维亚的三级医院的孕产妇死亡数据进行了二次数据回顾和描述性分析。
从患者病历中提取孕产妇死亡数据，包括死亡证明和孕产妇审计记录。活产记录从分娩登记册中获取。使用Epi Info 7.2版本进行数据分析。估计孕产妇死亡率（MMR），确定孕产妇死亡的主要直接和间接原因，并使用逻辑回归在5%的显著性水平下探索与孕产妇死亡相关的因素。
在审查期间，共有233例孕产妇死亡和14879例活产，孕产妇死亡率为每10万例活产1565例。死亡母亲的中位年龄为29岁（14 - 45岁）。约40.3%（94/233）的病例在入院后<1天内死亡，转诊病例占59%（137/233）。直接死因占66%（147/223）。出血[30.6%（45/147）]、子痫[（30/147）20.6%]和败血症[（30/147）20.6%]是主要直接死因，而心血管相关疾病[18.4%（14/76）]和艾滋病毒/艾滋病[16%（12/76）]是主要间接死因。与未转诊患者相比，从其他机构转诊来的患者死亡可能性高7.9倍（比值比：7.9，95%置信区间：5.9 - 10.6，p < 0.001）。
孕产妇死亡率仍然很高。转诊较晚。利比里亚卫生部应加强更多二级医疗机构和三级医院的建设，以应对孕产妇紧急情况，并提高民众和医护人员对产科紧急情况的及时识别和转诊意识。卫生部还需要改善输血服务，以帮助处理产后出血。
