A 6-Year Review Of Maternal Deaths In A Teaching Hospital In South-South, Nigeria

摘要

Objective: To establish the maternal mortality rate, identify causes of maternal deaths and recommend intervention measures to prevent them. Methods: The case notes of all maternal deaths at the University of Uyo Teaching Hospital, Uyo over a six year period were reviewed.Results: During the period of study, there were 3531 live births and 91 maternal deaths resulting in a maternal mortality ratio of 2,577/100,000 live births. Nulliparous women formed the largest single group (30.1%). 50.7% of the women were aged between 21-30 years while majority (83.6%) were in social classes IV and V. About 26.0% of the women booked for antenatal care, while 74.0% were unbooked. Most of the antenatal clinic defaulters (52.6%) and the unbooked women (81.5%) were brought from traditional birth attendants homes. Majority of the deaths occurred postpartum (72.6%) and within 24 hours of admission in hospital (63.0%). The most common causes of maternal deaths were eclampsia (28.8%), puerperal sepsis (17.8%) and obstetric haemorrhage (11.0%).Conclusion: Our maternal mortality rate is one of the highest in the country. Encouraging women in our environment to avail themselves of orthodox antenatal care, abolishing user fees for pregnant women and the training and integration of more professional midwives in our community are advocated. Introduction In spite of accumulated knowledge about why maternal deaths occur and what needs to be done to avert them, about 600,000 women are still dying each year from complications of pregnancy particularly in Africa, south of the Sahara12. Also, for every woman that dies, 15-30 more are disabled, sometimes permanently and often times to the extent that future reproductive capacity is either destroyed or put in great jeopardy1. Nigeria which has a population of about 135 million people is currently the 9th most populous country in the world and also Africa’s most populous country 3. However, with a maternal mortality ratio (MMR) of 1,000-1,500/100,000 live births, Nigeria’s MMR currently accounts for over 15% of the world’s maternal mortality estimates 2. These figures are alarmingly high particularly when compared with those from developed countries where long before the last decade of the last century, maternal deaths had become very rare events 1.In Nigeria, reports from several centres have shown regional variation in MMRs with those from the South-east and South-west ranging about 500/100,000 live births and those from Northwest and Northeast about 1,549/100,000-2,000,000 live births 4. Akwa Ibom State which has a total area of 7,081 square kilometres, a shoreline of 129 kilometres and a population of 3.92 million people 5 is located in the South-south geopolitical zone of Nigeria. Since its creation on the 23rd of September 1987, there has been no study reviewing maternal deaths in the state. Thus, this retrospective study which was carried out at the University of Uyo Teaching Hospital (UUTH), located in Uyo, the capital of Akwa Ibom State, aims to establish the MMR, identify causes of maternal deaths and recommend measures to prevent them. Materials And Methods The case notes of all maternal deaths that occurred at UUTH between 1st January 2000 and 31st December 2005 were retrieved from the medical records department for detailed study. Information abstracted included the women’s socio-demographic data, booking status, probable cause of death, period of death and duration of stay in hospital. The total number of deliveries was also obtained from the delivery register. The social classes of the women were determined using Olusanya’s classification which makes use of the educational status of the woman and her husband’s occupation 6. Generally, the women’s relatives refused the request for autopsy, thus the causes of death were based on clinical diagnosis in all cases. The data were analysed using tables and percentages and the results obtained formed the basis of the discussion. Results During the study per