Background
Methods
Organ dysfunction | |
---|---|
Cardiac dysfunction | Pulmonary oedema, cardiac arrest, cardiac failure |
Pulmonary embolism | - |
Vascular dysfunction | Hypovolaemia requiring two or more units of blood, blood loss with hypovolaemic shock (systolic blood pressure < 90 mmHg or undetectable pulse), infusion and/or transfusion of > = 1 litre in 2 hours, free flow infusiona, massive haemorrhage recorded in notes |
Immunological dysfunction | Septic shock |
Respiratory dysfunction | Intubation or ventilation for reasons other than general anaesthesia, oxygen saturation on pulse oximetry < 90% leading to ventilation |
Renal dysfunction | Oliguria < 30 ml per hour or < 400 ml per 24 hours, shock not responsive to intravascular rehydration or diuresis, haemodialysis |
Liver dysfunction | Jaundice in pre-eclampsia, abnormal liver function tests |
Coagulation dysfunction | Acute thrombocytopenia, prolonged bleeding time, abnormal Activated Partial Thromboplastine Time (APTT) or Prothrombine Time (PT), coagulopathy |
Cerebral dysfunction | Coma, cerebral oedema, seizures other than eclampsia |
Management based criteria
| |
Intensive care admission, emergency hysterectomy, needs resuscitation, anaesthetic accident, referral to tertiary hospital | |
Clinical diagnosis
| |
Eclampsia, uterine rupture, ectopic pregnancy |
Results
ORGAN DYSFUNCTION
| N (%) |
---|---|
Any cardiac dysfunction
| 39 (5.1) |
Pulmonary oedema | 7 (0.9) |
Cardiac arrest | 7 (0.9) |
Cardiac failure | 27 (3.5) |
Pulmonary embolism
|
2 (0.3)
|
Any vascular dysfunction
|
593 (77.7)
|
Hypovolemia requiring 2 or more units of blood | 485 (63.6) |
Blood loss with hypovolemic shock | 227 (29.8) |
Infusion and/or transfusion of > = 1 litre per 2 hours | 38 (5.0) |
Free flow infusion | 278 (36.4) |
Massive haemorrhage recorded in notes | 221 (29.0) |
Immunological dysfunction
|
1 (0.1)
|
Septic shock | 1 (0.1) |
Respiratory dysfunction
|
1 (0.1)
|
Intubation or ventilation for reasons other than general anaesthesia | 1 (0.1) |
Oxygen saturation on pulse oximetry < 90% leading to ventilation | 1 (0.1) |
Renal dysfunction
|
34 (4.5)
|
Oliguria < 30 ml per hour or < 400 ml per 24 hours | 34 (4.5) |
Shock not responsive to intravascular rehydration or diuresis | 1 (0.1) |
Creatinine clearance test | 2 (0.3) |
Haemodialysis | 2 (0.3) |
Liver dysfunction
|
19 (2.5)
|
Jaundice in pre eclampsia | 1 (0.1) |
Abnormal liver function tests | 18 (2.4) |
Coagulation dysfunction
|
8 (1.0)
|
Acute thrombocytopenia | 3 (0.4) |
Prolonged bleeding time | 6 (0.8) |
Abnormal APTT or TT | 1 (0.1) |
Coagulopathy | 2 (0.3) |
Any Cerebral dysfunction
|
14 (1.8)
|
Coma | 9 (1.2) |
Cerebral oedema | 5 (0.7) |
Seizures other than eclampsia | 2 (0.3) |
MANAGEMENT BASED CRITERION
|
97 (12.7)
|
Intensive care admission | 38 (5.0) |
Emergency hysterectomy | 19 (2.5) |
Needs resuscitation | 14 (1.8) |
Anaesthetic accident | 1 (0.1) |
Referral to tertiary hospital | 35 (4.6) |
CLINICAL DIAGNOSIS
|
193 (25.3)
|
Eclampsia | 99 (13.0) |
Uterine rupture | 26 (3.4%) |
Ectopic pregnancy | 68 (8.9%) |
DISTRICT hospitalS | Private hospitals | |||||
---|---|---|---|---|---|---|
All | Near miss n (%) | Deaths n (%) | All | Near miss n (%) | Deaths n (%) | |
Early pregnancy loss
|
706
|
164 (23.2)
|
3 (0.4)
|
154
|
22 (14.6)
|
-
|
Abortion | 589 | 96 (16.3) | 1 (0.2) | 131 | 3 (2.3) | - |
Ectopic pregnancy | 49 | 48 (98.0) | 1 (2.0) | 19 | 19 (100.0) | - |
Hydatidiform mole | 68 | 20 (29.4) | 1 (1.5) | 4 | - | - |
Antepartum haemorrhage
|
276
|
112 (40.6)
|
7 (2.5)
|
26
|
6 (23.1)
|
-
|
Placenta praevia | 185 | 75 (40.5) | 3 (1.6) | 19 | 5 (26.3) | - |
Abruptio placentae | 45 | 27 (60.0) | 2 (4.4) | 2 | - | - |
Unspecified | 46 | 10 (21.7) | 2 (4.3) | 5 | 1 (20.0) | - |
Postpartum haemorrhage
|
442
|
182 (41.2)
|
9 (2.0)
|
168
|
10 (6.0)
|
-
|
Uterine atony | 24 | 17 (70.8) | - | 1 | 1 (100.0) | - |
Retained placenta | 117 | 56 (47.9) | 4 (3.4) | 6 | 1 (16.7) | - |
Tear | 163 | 20 (12.3) | 1 (0.6) | 147 | - | - |
Unspecified | 138 | 89 (64.5) | 4 (2.9) | 14 | 8 (57.1) | - |
Hypertensive diseases
|
468
|
151 (32.3)
|
22 (4.7)
|
95
|
12 (12.6)
|
-
|
Pre-eclampsia | 362 | 60 (16.6) | 7 (1.9) | 89 | 6 (6.7) | - |
Eclampsia | 106 | 91 (85.8) | 15 (14.2) | 6 | 6 (100.0) | - |
Dystocia
|
1194
|
72 (6.0)
|
10 (0.8)
|
494
|
17 (3.4)
|
1 (0.2)
|
Uterine rupture | 30 | 24 (80.0) | 6 (20.0) | 3 | 2 (66.7) | 1 (33.3) |
Bandl's ring | 19 | 5 (26.3) | - | 8 | - | - |
CPD and prolonged labour | 855 | 34 (4.0) | 2 (0.2) | 371 | 13 (3.5) | - |
Malpresentation | 290 | 9 (3.1) | 2 (0.7) | 112 | 2 (1.8) | - |
Infection
|
17
|
1 (5.9)
|
-
|
0
|
-
|
-
|
Non obstetric complications
|
89
|
12 (13.5)
|
12 (13.5)
|
29
|
2 (6.9)
|
-
|
Other complications*
|
472
|
-
|
-
|
126
|
-
|
-
|
Normal Delivery
|
351
|
-
|
-
|
562
|
-
|
-
|
All
|
4015
|
694 (17.3)
|
63 (1.6)
|
1654
|
69 (4.2)
|
1 (0.1)
|
DISTRICT hospitalS | Private hospitals | All hospitals | |||||||
---|---|---|---|---|---|---|---|---|---|
Near miss and death | Near miss n (%) | Deaths n (%) | Near miss and death | Near miss n (%) | Deaths n (%) | Near miss and death | Near miss n (%) | Deaths n (%) | |
Early pregnancy loss
|
167
|
164 (98.2)
|
3 (1.8)
|
22
|
22 (100.0)
|
-
|
189
|
186 (98.4)
|
3 (1.6)
|
Abortion | 97 | 96 (99.0) | 1 (1.0) | 3 | 3 (100.0) | - | 100 | 99 (99.0) | 1 (1.0) |
Ectopic pregnancy | 49 | 48 (98.0) | 1 (2.0) | 19 | 19 (100.0) | - | 68 | 67 (98.5) | 1 (1.5) |
Hydatidiform mole | 21 | 20 (95.2) | 1 (4.8) | - | - | - | 21 | 20 (95.2) | 1 (4.8) |
Antepartum haemorrhage
|
119
|
112 (94.1)
|
7 (5.9)
|
6
|
6 (100.0)
|
-
|
125
|
118 (94.4)
|
7 (5.6)
|
Placenta praevia | 78 | 75 (96.2) | 3 (3.8) | 5 | 5 (100.0) | - | 83 | 80 (96.4) | 3 (3.6) |
Abruptio placentae | 29 | 27 (93.1) | 2 (6.9) | - | - | - | 29 | 27 (93.1) | 2 (6.9) |
Unspecified | 12 | 10 (83.3) | 2 (16.7) | 1 | 1 (100.0) | - | 13 | 11 (84.6) | 2 (15.4) |
Postpartum haemorrhage
|
191
|
182 (95.3)
|
9 (4.7)
|
10
|
10 (100.0)
|
-
|
201
|
192 (95.5)
|
9 (4.5)
|
Uterine atony | 17 | 17 (100.0) | - | 1 | 1 (100.0) | - | 18 | 18 (100.0) | - |
Retained placenta | 60 | 56 (93.3) | 4 (6.7) | 1 | 1 (100.0) | - | 61 | 57 (93.4) | 4 (6.6) |
Tear | 21 | 20 (95.2) | 1 (4.8) | - | - | - | 21 | 20 (95.2) | 1 (4.8) |
Unspecified | 93 | 89 (95.7) | 4 (4.3) | 8 | 8 (100.0) | - | 101 | 97 (96.0) | 4 (4.0) |
Hypertensive diseases
|
173
|
151 (87.3)
|
22(12.7)
|
12
|
12 (100.0)
|
-
|
185
|
163 (88.1)
|
22 (11.9)
|
Pre-eclampsia | 67 | 60 (89.6) | 7 (10.4) | 6 | 6 (100.0) | - | 73 | 66 (90.4) | 7 (9.6) |
Eclampsia | 106 | 91 (85.8) | 15 (14.2) | 6 | 6 (100.0) | - | 112 | 97 (86.6) | 15 (13.4) |
Dystocia
|
82
|
72 (87.8)
|
10 (12.2)
|
18
|
17 (94.4)
|
1 (5.6)
|
100
|
89 (89.0)
|
11 (11.0)
|
Uterine rupture | 30 | 24 (80.0) | 6 (20.0) | 3 | 2 (66.7) | 1 (33.3) | 33 | 26 (78.8) | 7 (21.2) |
Bandl's ring | 5 | 5 (100.0) | - | - | - | - | 5 | 5 (100.0) | - |
CPD and prolonged labour | 36 | 34 (94.4) | 2 (5.6) | 13 | 13 (100.0) | - | 49 | 47 (95.9) | 2 (4.1) |
Malpresentation | 11 | 9 (81.8) | 2 (18.2) | 2 | 2 (100.0) | - | 13 | 11 (84.6) | 2 (15.4) |
Infection
|
1
|
1 (100.0)
|
-
|
-
|
-
|
-
|
1
|
1 (100.0)
|
-
|
Non obstetric complications
|
24
|
12 (50.0)
|
12 (50.0)
|
2
|
2 (100.0)
|
-
|
26
|
14 (53.8)
|
12 (46.2)
|
Other complications*
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
Normal Delivery
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
All
|
757
|
694 (91.7)
|
63 (8.3)
|
70
|
69 (98.6)
|
1 (1.4)
|
827
|
763 (92.3)
|
64 (7.7)
|
Near miss n (%) | Death n (%) | Other n (%) | All n (%) | |
---|---|---|---|---|
Hb < 6 g/dl
| 198 (26.0) | 8 (12.5) | 45 (0.9) | 251 (4.4) |
Hb 6 – 7.9 g/dl
| 232 (30.4) | 6 (9.4) | 236 (4.9) | 474 (8.4) |
Hb 8 – 9.9 g/dl
| 138 (18.1) | 10 (15.6) | 732 (15.1) | 880 (15.5) |
Hb > = 10 g/dl
| 93 (12.2) | 13 (20.3) | 1254 (25.9) | 1360 (24.0) |
No Hb, with clinical anaemia
| 17 (2.2) | 3 (4.7) | 13 (0.3) | 33 (0.6) |
No Hb, with no recorded clinical anaemia
| 85 (11.1) | 24 (37.5) | 2562 (52.9) | 2671 (47.1) |
All
| 763 (100.0) | 64 (100.0) | 4842 (100.0) | 5669 (100.0) |