- Email: [email protected]
P3.11.02 A two year review of the pattern of maternal mortality among migrants in Malaysia
WEDNESDAY,
P3.11
SEPTEMBER
6
MATERNAL MORBIDITY MORTALITY
109
AND
P3.11.01 A STEP FORWARD
ON THE PATHWAY TO MATERNAL AND PERINATAL SURVIVAL: GUATEMALA’S MOTHERCARE PROJECT (1994-98) E. Bocaletti, Institute of Tropical Medicine, VA, United States
Objectives: Guatemala has a Maternal Mortality Ratio of 248 per 100,000 live births, the third highest in the Western Hemisphere. The majority of births take place at home with traditional birth attendants. The MotherCare Project aimed to bring the communities and health facilities together to save the lives of women and newborns. Methods: Recognition of life-threatening complications and their danger signs and where to go for help were emphasized during TBA training, broadcast by radio to communities, formed the basis for counseling during prenatal care, and were a major focus in the discussions with women’s groups. Tutorial training followed by monthly supervisory visits, including sensitization to local birthing traditions strengthened their counseling and clinical skills. Outcome Measures & Results: Rural departments in project areas have witnessed increases in use rates of 50 to 77%. Met Need has doubled in project area hospitals (meaning a greater proportion of women having complications seek care). Equity has improved through increased use of EOC services by women. The confidence and skills of providers to perform high quality maternal and newborn care have significantly improved, and continues more than 2 years after completion of the training course. The trained providers and facility directors report an improved attitude toward providing care and working in a team, as well as providers’ enhanced ability to recognize problems early and to intervene skillfully. Conclusions: Nearly a third of the country has been reached by this community-based approach to reach women and newborns with essential obstetric services. The next steps are to sustain current activities and expand them across of the country.
P3.11.02 A TWO YEAR REVIEW OF THE PATTERN
OF MATERNAL MORTALITY AMONG MIGRANTS IN MALAYSIA Z. Shamsuddin, Dept. OBIGYN, Hospital Koala Lumpur, Koala Lumpur, Malaysia.
Objectives: The aims of the study were to investigate the pattern of maternal deaths among migrant mothers and to review its impact on the national maternal mortality statistics in Malaysia. Study Methods: This study was part of a detailed retrospective analysis of all maternal deaths occurring in Malaysia in 1995 and 1996 reported to the National Confidential Enquiries into Maternal Deaths. Deaths among migrants were identified and analyzed as a separate cohort. Results: In 1995 there were 251 maternal deaths with a MMR of 46.91/100,000 live births of which, 79 (15.5%) were migrant mothers. For 1996, 220 deaths were reported, with a MMR of 40.7/100,000, of which 40 (18%) were also migrants. Most of these deaths were Indonesians and Philippino migrants. Deaths were mainly from postpartum hemorrhage, obstetric pulmonary embolism and complications of pregnancy induced hypertension. Increased risks were associated with age 25-29, parity l-5, poor uptake of contraceptives, failure to obtain antenatal care and late transfer to hospital. Conclusion: While a migrant status-specific MMR was difficult to obtain due to the lack of known denominators. Almost a fifth of the maternal deaths in Malaysia were migrants. Migrant mothers were certainly at risk of dying from PPH, OPE and PIH. Socio-economic factors clearly influenced maternal mortality, overriding both geographical and cultural differences. Illegal entry and lack of valid travel documents prevented migrant mothers from seeking antenatal care for fear of deportation despite the health care authorities relative indifference to citizenship status.
P3.11.03 ACCURACY OF THE BLOOD LOSS ESTIMATION IN THE THIRD STAGE OF LABOR W. Prasertcharoensuk, U. Swadpanich, P. Lumbiganon, Dept. OBIGYN,
Faculty of Medicine, Khon Kaen University,
Khone Kaen, Thailand.
Objectives: The aims of the study were to assess the incidence of postpartum hemorrhage in vaginal delivery and to assess the diagnostic performance of visual estimation in detecting postpartum hemorrhage. Study Methods: 228 [regnant women who had vaginal delivery at Srinagarind Hospital from Dec. 1, 1996 to Mar. 1, 1997. Blood loss through vagina following vaginal delivery was visually estimated and also directly measured. Postpartum hemorrhage was defined as blood loss of at least 500 ml. Results: The mean visually estimated blood loss was 263.81 ml (SD=152.06) whilst the mean measured blood loss was 362.89 ml (SD=298.85). The incidence of postpartum hemorrhage by visual estimation and direct measurement were 5.70% and 27.63% respectively. Visual estimation resulted in a 88.88% underestimation of PPH. The sensitivity, specificity and accuracy of visually estimated blood loss in detecting postpartum hemorrhage were 15.87%, 98.18% and 75.43% respectively. Conclusions: Visual estimation primary is very insensitive in detecting postpartum hemorrhage. Obstetricians should be aware of this underestimation and use other signs and symptoms in the management of third stage labor.
P3.11.04 BURDEN OF ILLNESS-CHRONIC SEVERE ANAEMIA IN OBSTETRIC PATIENTS IN RURAL NORTH INDIA A.H. Khosla, K. Sangwan. Dept. OBIGYN. PGIMS, Rohtak, Haryana,
India. Objectives: To collect relevant information about chronic severe anaemia (CSA) in the obstetric population of rural North India (Haryana) with a view to devise strategies which wil reduce maternal morbidity and mortality by focusing on the high risk population. Study Methods: A prospective study (Jan. to Dec. 1998) in which all pregnant patients with haemoglobin 5 6 grams/d1 excluding those with acute blood loss i.e., abortions, antepartum and postpartum haemorrhage admitted to the department of obstetrics an gynaecology, PGIMS, Rohtak (Haryana) India were interviewed. Results: There were 5124 deliveries at PGIMS, Rohtak in the study period. There were 386 patients (7.53%) of CSA admitted who received a total of 1083 units of blood (mean 2.80 per patient). There were 2 maternal deaths due to CSA. A total of 246 of the 386 women could be interviewed in detail. The demographic features of these women (anaemic group) were compared with 100 pregnant women with haemoglobin s-10 grams/d1 (non anaemic group). In the amaemic group 81.7% were illiterate, 62.1% had no antenatal check up, 78.8% had no access to safe drinking water, 90.6% had no toilet facilities and used open fields for defecation; 63.0% reported having diarrhoea and abdominal pain off and on during pregnancy and 20.73% gave history passage of worms in the stools. 82% had no regular income and had a diet poor in protein, calories iron and calcium. All were vegetarians. The figures for the non anaemic group were illiterate 34%, antenatal check up in 76%, no toilet facilities in 55%, no safe drinking water in 38%, diarrhoea 6%, history of passage of worms in stool 2%. Conclusions: Pregnant women with no regular source of income, illiterate, without any public health facilities should be the beneficiaries of any programs for women and child health. These health interventions would be more cost effective comparing the cost of hospitalization, blood transfusions and DALYs (Disability Adjusted Life Years).
P3.11.05 CONSERVATIVE ABORTION
MANAGEMENT
OF SPONTANEOUS
P. Busacchi, T.Perri, P.Pocognoli, C.Oliverio, C.Flamigni, Bologna, Via Massarenti, 9, Bologna, BO, Italy, 40138.
University
of
Objectives: The aim of the study was to evaluate the benefit of a conservative therapy in spontaneous abortion. Study methods: We recruited 27 pregnancy patients admitted to our hospital with the diagnosis of spontaneous abortion. Their mean age was
P3.11
SEPTEMBER
6
MATERNAL MORBIDITY MORTALITY
109
AND
P3.11.01 A STEP FORWARD
ON THE PATHWAY TO MATERNAL AND PERINATAL SURVIVAL: GUATEMALA’S MOTHERCARE PROJECT (1994-98) E. Bocaletti, Institute of Tropical Medicine, VA, United States
Objectives: Guatemala has a Maternal Mortality Ratio of 248 per 100,000 live births, the third highest in the Western Hemisphere. The majority of births take place at home with traditional birth attendants. The MotherCare Project aimed to bring the communities and health facilities together to save the lives of women and newborns. Methods: Recognition of life-threatening complications and their danger signs and where to go for help were emphasized during TBA training, broadcast by radio to communities, formed the basis for counseling during prenatal care, and were a major focus in the discussions with women’s groups. Tutorial training followed by monthly supervisory visits, including sensitization to local birthing traditions strengthened their counseling and clinical skills. Outcome Measures & Results: Rural departments in project areas have witnessed increases in use rates of 50 to 77%. Met Need has doubled in project area hospitals (meaning a greater proportion of women having complications seek care). Equity has improved through increased use of EOC services by women. The confidence and skills of providers to perform high quality maternal and newborn care have significantly improved, and continues more than 2 years after completion of the training course. The trained providers and facility directors report an improved attitude toward providing care and working in a team, as well as providers’ enhanced ability to recognize problems early and to intervene skillfully. Conclusions: Nearly a third of the country has been reached by this community-based approach to reach women and newborns with essential obstetric services. The next steps are to sustain current activities and expand them across of the country.
P3.11.02 A TWO YEAR REVIEW OF THE PATTERN
OF MATERNAL MORTALITY AMONG MIGRANTS IN MALAYSIA Z. Shamsuddin, Dept. OBIGYN, Hospital Koala Lumpur, Koala Lumpur, Malaysia.
Objectives: The aims of the study were to investigate the pattern of maternal deaths among migrant mothers and to review its impact on the national maternal mortality statistics in Malaysia. Study Methods: This study was part of a detailed retrospective analysis of all maternal deaths occurring in Malaysia in 1995 and 1996 reported to the National Confidential Enquiries into Maternal Deaths. Deaths among migrants were identified and analyzed as a separate cohort. Results: In 1995 there were 251 maternal deaths with a MMR of 46.91/100,000 live births of which, 79 (15.5%) were migrant mothers. For 1996, 220 deaths were reported, with a MMR of 40.7/100,000, of which 40 (18%) were also migrants. Most of these deaths were Indonesians and Philippino migrants. Deaths were mainly from postpartum hemorrhage, obstetric pulmonary embolism and complications of pregnancy induced hypertension. Increased risks were associated with age 25-29, parity l-5, poor uptake of contraceptives, failure to obtain antenatal care and late transfer to hospital. Conclusion: While a migrant status-specific MMR was difficult to obtain due to the lack of known denominators. Almost a fifth of the maternal deaths in Malaysia were migrants. Migrant mothers were certainly at risk of dying from PPH, OPE and PIH. Socio-economic factors clearly influenced maternal mortality, overriding both geographical and cultural differences. Illegal entry and lack of valid travel documents prevented migrant mothers from seeking antenatal care for fear of deportation despite the health care authorities relative indifference to citizenship status.
P3.11.03 ACCURACY OF THE BLOOD LOSS ESTIMATION IN THE THIRD STAGE OF LABOR W. Prasertcharoensuk, U. Swadpanich, P. Lumbiganon, Dept. OBIGYN,
Faculty of Medicine, Khon Kaen University,
Khone Kaen, Thailand.
Objectives: The aims of the study were to assess the incidence of postpartum hemorrhage in vaginal delivery and to assess the diagnostic performance of visual estimation in detecting postpartum hemorrhage. Study Methods: 228 [regnant women who had vaginal delivery at Srinagarind Hospital from Dec. 1, 1996 to Mar. 1, 1997. Blood loss through vagina following vaginal delivery was visually estimated and also directly measured. Postpartum hemorrhage was defined as blood loss of at least 500 ml. Results: The mean visually estimated blood loss was 263.81 ml (SD=152.06) whilst the mean measured blood loss was 362.89 ml (SD=298.85). The incidence of postpartum hemorrhage by visual estimation and direct measurement were 5.70% and 27.63% respectively. Visual estimation resulted in a 88.88% underestimation of PPH. The sensitivity, specificity and accuracy of visually estimated blood loss in detecting postpartum hemorrhage were 15.87%, 98.18% and 75.43% respectively. Conclusions: Visual estimation primary is very insensitive in detecting postpartum hemorrhage. Obstetricians should be aware of this underestimation and use other signs and symptoms in the management of third stage labor.
P3.11.04 BURDEN OF ILLNESS-CHRONIC SEVERE ANAEMIA IN OBSTETRIC PATIENTS IN RURAL NORTH INDIA A.H. Khosla, K. Sangwan. Dept. OBIGYN. PGIMS, Rohtak, Haryana,
India. Objectives: To collect relevant information about chronic severe anaemia (CSA) in the obstetric population of rural North India (Haryana) with a view to devise strategies which wil reduce maternal morbidity and mortality by focusing on the high risk population. Study Methods: A prospective study (Jan. to Dec. 1998) in which all pregnant patients with haemoglobin 5 6 grams/d1 excluding those with acute blood loss i.e., abortions, antepartum and postpartum haemorrhage admitted to the department of obstetrics an gynaecology, PGIMS, Rohtak (Haryana) India were interviewed. Results: There were 5124 deliveries at PGIMS, Rohtak in the study period. There were 386 patients (7.53%) of CSA admitted who received a total of 1083 units of blood (mean 2.80 per patient). There were 2 maternal deaths due to CSA. A total of 246 of the 386 women could be interviewed in detail. The demographic features of these women (anaemic group) were compared with 100 pregnant women with haemoglobin s-10 grams/d1 (non anaemic group). In the amaemic group 81.7% were illiterate, 62.1% had no antenatal check up, 78.8% had no access to safe drinking water, 90.6% had no toilet facilities and used open fields for defecation; 63.0% reported having diarrhoea and abdominal pain off and on during pregnancy and 20.73% gave history passage of worms in the stools. 82% had no regular income and had a diet poor in protein, calories iron and calcium. All were vegetarians. The figures for the non anaemic group were illiterate 34%, antenatal check up in 76%, no toilet facilities in 55%, no safe drinking water in 38%, diarrhoea 6%, history of passage of worms in stool 2%. Conclusions: Pregnant women with no regular source of income, illiterate, without any public health facilities should be the beneficiaries of any programs for women and child health. These health interventions would be more cost effective comparing the cost of hospitalization, blood transfusions and DALYs (Disability Adjusted Life Years).
P3.11.05 CONSERVATIVE ABORTION
MANAGEMENT
OF SPONTANEOUS
P. Busacchi, T.Perri, P.Pocognoli, C.Oliverio, C.Flamigni, Bologna, Via Massarenti, 9, Bologna, BO, Italy, 40138.
University
of
Objectives: The aim of the study was to evaluate the benefit of a conservative therapy in spontaneous abortion. Study methods: We recruited 27 pregnancy patients admitted to our hospital with the diagnosis of spontaneous abortion. Their mean age was