Maternal Mortality at the University Teaching Hospital, Lusaka,1996
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Maternal mortality in developed countries has declined dramatically over the last 60 years, and is now very low. Women in industrialized countries have an average lifetime risk of dying from pregnancy-related causes of between 1 in 4000 and 1 in 10,000 pregnancies whereas women in developing countries have a risk that is between 1 in 10 and 1 in 50. In the developing world where maternal mortality is very high, the excess is likely to be due to a high mortality associated with haemorrhage and infection and reductions are most likely to come from reductions in these deaths (Duley, 1992). This study was undertaken to determine the number and causes of maternal mortalities at UTH in 1996 and also to study in depth factors leading to deaths due to haemorrhage.There were a total of 13,065 deliveries wdth 12 279 livebirths at UTH. In a hospital based retrospective audit of the 1996 files of maternal mortalities at UTH, it was found that there were 107 maternal mortalities in 1996 The 107 maternal deaths represent a maternal mortality ratio of 871 per 100,000 livebirths for UTH.There were 44 direct causes of maternal deaths and 63 indirect causes (41% and 59% respectively). The majority of the direct causes were due to haemorrhage (16 out of 44 -36%) with pre-eclampsia/eclampsia accounting for 10 of the 44 direct deaths (23%). The overwhelming number of indirect causes were attributed to malaria (32 out of 63 - 51%). Respiratory tract infection and TB accounted for 17 cases (27% of indirect causes). It was felt a number of indirect deaths could be attributed to AIDS.There was no statistical difference between the mean age and parity of those who died due to direct causes compared to indirect causes. However the gestation was higher among cases who died of direct compared to indirect causes of maternal death (31.8 weeks vs 26.9 weeks, p=.006). Among the indirect cases, the mean age and parity of those who died due to malaria was less than those who died of causes other than malaria. This reflected the susceptibility of young nulliparas. The 16 cases of death due to haemorrhage included 5 antepartum and 11 postpartum haemorrhage. Those who died of haemorrhage were older than those who died of other direct causes (30.4 vs 24.0 years, p=.001). However there was no statistical difference in the mean gestations (although those who died of haemorrhage tended to have higher parity). In most of the 16 cases, an important avoidable factor was determined to be the lack of blood for transfusion.Malaria and haemorrhage are still the leading causes of maternal death at UTH. A review of antimalarial prophylaxis and strengthened case recognition and management of malaria is needed. Availability of blood transfusion remains a cornerstone of preventing deaths due to haemorrhage.
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