Delays in receiving obstetric care and poor maternal outcomes : results from a national multicentre cross-sectional study
Pacagnella, Rodolfo C.; Cecatti, Jose G.; Parpinelli, Mary A.; Sousa, Maria H.; Haddad, Samira M.; Costa, Maria L.; Sousa, Joao P.; Pattinson, Robert Clive; Brazilian Network for the Surveillance of Severe Maternal Morbidity study group
BACKGROUND: The vast majority of maternal deaths in low-and middle-income countries are preventable. Delay in
obtaining access to appropriate health care is a fairly common problem which can be improved. The objective of
this study was to explore the association between delay in providing obstetric health care and severe maternal
METHODS: This was a multicentre cross-sectional study, involving 27 referral obstetric facilities in all Brazilian regions
between 2009 and 2010. All women admitted to the hospital with a pregnancy-related cause were screened, searching
for potentially life-threatening conditions (PLTC), maternal death (MD) and maternal near-miss (MNM) cases, according
to the WHO criteria. Data on delays were collected by medical chart review and interview with the medical staff. The
prevalence of the three different types of delays was estimated according to the level of care and outcome of the
complication. For factors associated with any delay, the PR and 95%CI controlled for cluster design were estimated.
RESULTS: A total of 82,144 live births were screened, with 9,555 PLTC, MNM or MD cases prospectively identified.
Overall, any type of delay was observed in 53.8% of cases; delay related to user factors was observed in 10.2%, 34.6% of
delays were related to health service accessibility and 25.7% were related to quality of medical care. The occurrence of
any delay was associated with increasing severity of maternal outcome: 52% in PLTC, 68.4% in MNM and 84.1% in MD.
CONCLUSIONS: Although this was not a population-based study and the results could not be generalized, there was a
very clear and significant association between frequency of delay and severity of outcome, suggesting that timely and
proper management are related to survival.
BACKGROUND : Septic incomplete miscarriages remain a cause of maternal deaths in South Africa. There was an
initial decline in mortality when a strict protocol based approach and the Choice of Termination of Pregnancy ...
Pattinson, Robert Clive; Vannevel, Valerie; Barnard, Dalene; Baloyi, S.; Gebhardt, G.S.; Le Roux, K.; Moran, N.; Moodley, J.(Health and Medical Publishing Group, 2018-02)
The need to perform assisted vaginal delivery (AVD) has been regarded as self-evident. In high-income countries, rates of AVD range
between 5% and 20% of all births. In South Africa, the rate of AVD is only 1%. This has ...
Pattinson, Robert Clive; Bergh, Anne-Marie; Ameh, C.; Makin, J.A.; Pillay, Y.; Van den Broek, N.; Moodley, J.(Health and Medical Publishing Group, 2019-04)
BACKGROUND. The institutional maternal mortality ratio (iMMR) in South Africa (SA) is still unacceptably high. A key recommendation
from the National Committee on Confidential Enquiries into Maternal Deaths has been to ...