Effect of audit on critically ill pregnant women

Abstract

Purpose – The purpose of this research is to ascertain whether there has been a change in the outcome of critically ill pregnant women from the indigent South African population from a clearly defined region in Pretoria, after the introduction of new management protocols supported by regular audit and feedback.

Design/methodology/approach – A comparison of outcome of all women with severe acute maternal morbidity or maternal deaths was made between 1997/1998 (original protocol) and 2002/2004 (new protocol) was performed.

Findings – It was found that there was a significant increase in the prevalence of critically ill pregnant women between 1997/1998 (8.40/1,000 births) and 2002/2004 (10.22/1,000 births; p<0.014), but a reduction in the MMR 133.2/100,000 births to 104.9/100,000 births (Odds Ratio 0.79, 95 Confidence Intervals 0.51 and 1.2) and in the mortality index from 15.9 per cent to 10.3 per cent (Odds Ratio 0.61, 95 per cent Confidence intervals 0.39 and 0.96). The pattern of primary obstetric causes of critically ill pregnant women has remained unchanged during the study period, but the prevalence of each disease category increased. The average number of dysfunctional organ systems per patient declined from 1.41 in 1997/1998 to 1.19 in 2002/2004. There were significant reductions in the number of critically ill pregnant women with renal dysfunction, metabolic dysfunction and cerebral dysfunction. The number of patient related, administrative related and medical personnel avoidable factors all decreased.

Originality/value – The new protocols, audit and feedback have been associated with a reduction in the number of preventable and manageable complications experienced by critically ill pregnant women over the past five years.