Investigation of risk factors for severe maternal morbidity and progression to mortality: a case control and follow up study in Mulago Hospital Complex Uganda
Maternal morbidity is physical ill health related
to
pregnancy and
childbirth or
any
maternal complication during pregnancy,
labour
and
puerperium.
Severe
maternal
morbidity is a life-threatening obstetric complication.
The importance
of severe
maternal morbidity is that it precedes maternal
mortality
and
is therefore
critical
in the
understanding of the factors that influence maternal
mortality.
The overall aim of the study was to investigate
risk
factors
associated
with
severe
maternal morbidity and progression to maternal mortality
in
Mulago
hospital,
Kampala,
Uganda. The study had two stages:
Stage
1
was
an unmatched
case-control study
of
severe maternal morbidity and Stage
2
was
a
follow-up
of all cases
from
Stage 1 to
discharge or death.
A total of 499 cases of severe maternal morbidity and
500
controls
(women
with normal
deliveries and no severe maternal morbidity)
were studied.
Both the
cases and controls
were interviewed to obtain information on socio
demographic factors,
previous
obstetric
outcomes and present obstetric performance.
Information
on obstetric
management was
extracted from clinical notes. All cases and controls were
tested for
HIV,
syphilis and
haemoglobin level. A total of 39 of the
499
severe maternal
morbidity
cases
died.
The causes of SMM were severe pre eclampsia
(25%),
severe
dystocia
(31%)
Post
partum haemorrhage (19%), ante partum
haemorrhage
(14%)
puerperal sepsis
(5%)
and
medical diseases (6%). The main risk
factors for
severe maternal
morbidity
were
low
socio economic class, long distance from home to
Mulago
hospital,
having
specific
medical conditions, having to request permission
to
attend
health
unit,
having
a
long
interval since the last birth, HIV positive status
and poor
quality
of care
during
antenatal
and delivery. Further details, plus separate analyses of
specific
causes
of
SMM
(eclampsia, post partum haemorrhage, severe
dystocia
and ante
partum
haemorrhage)
are presented. Determinants of progression to
maternal
death included low
socio
economic class, factors associated with management
of
labour,
and
HIV/AIDS.
The main conclusion from this work
is that improvements in the
social
and
economic
status of women, the level of HIV in
the
community,
and the
quality
of
care
offered
2 during pregnancy will reduce the burden of severe maternal
morbidity
and mortality
in
Kampala, Uganda. It is likely that these results
can
be
generalised to
other areas
of sub-Saharan Africa and usefully integrated into
Safe-Motherhood Programs there
