Postpartum hemorrhage (PPH) is the leading cause of maternal
mortality in Sub-Saharan-Africa (SSA). Although clinical guidelines treating
PPH are available, their implementation remains a great challenge in resource
poor settings. A better understanding of the factors associated with PPH
maternal mortality is critical for preventing risk of hospital-based maternal
death. The purpose of this study was thus to assess which factors contribute to
maternal death occurring during PPH. The factors were as follows: women’s
characteristics, aspects of pregnancy and delivery; components of PPH
management; and organizational characteristics of the referral hospitals in
Senegal and Mali.
A cross-sectional survey nested in a cluster randomized
trial (QUARITE trial) was carried out in 46 referral hospitals during the
pre-intervention period from October 2007 to September 2008 in Senegal and
Mali. Individual and hospital characteristics data were collected through
standardized questionnaires. A multivariable logistic mixed model was used to
identify the factors that were significantly associated with PPH maternal
death.
Among the 3,278 women who experienced PPH, 178 (5.4 %)
of them died before hospital discharge. The factors that were significantly
associated with PPH maternal mortality were: age over 35 years,
living in Mali, residing outside the
region location of the hospital, prepartum severe anemia, forceps or vacuum
delivery, birth weight greater than
4000 grs, transfusion, transfer to
another hospital. There was a smaller risk
of PPH maternal death in hospitals with gynecologist-obstetrician than those with
only a general practitioner trained in emergency obstetric care (EmOC).
Our findings may have direct implications for preventing PPH
maternal death in resource poor settings. In particular, we suggest anemia
should be diagnosed and treated before delivery and inter-hospital transfer of
women should be improved, as well as the management of blood banks for a
quicker access to transfusion. Finally, an extent training of general
practitioners in EmOC would contribute to the decrease of PPH maternal
mortality.
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