Responsiveness to life threatening obstetrical emergencies

Abstract

Background: While most pregnancies and births are uneventful, all pregnancies are at risk for complications. Approximately 15% of all pregnant women develop a potentially life-threatening complication that requires skilled emergency obstetric care. Objective: This study aimed at assessing the clinical practice in managing life threatening obstetrical emergencies in three large health facilities in Rwanda. Methodology: A prospective descriptive study design was conducted from October 2015 to December 2015 in three hospitals in Rwanda on all successive patients admitted with life-threatening obstetrical conditions (sepsis, surgical site infection (SSI), postpartum hemorrhage (PPH) and needing emergency cesarean delivery (CD) .Data was collected from both the patients’ records and interview using a structured questionnaire administered by midwives. . In instances where suboptimal patient outcomes (maternal mortality, prenatal mortality, maternal “near miss” event) were encountered, an attempt was made to determine whether the barrier to delivery of expeditious emergency care was primarily at the level of the patient, the providers, the system, or a combination of those three factors. For each poor outcome identified, an attempt was made to assign a relative weight to each of the three factors felt to have contributed to the adverse event .Statistical analysis was performed using SPSS for Windows. Results: A total of 405 patients with life threatening obstetrical conditions were admitted during the study period: 164(40.3%) are from Kigali Teaching Hospital 134 (33.3%) from Butare University Teaching Hospital and 107(26.4%) from Kibagabaga District hospital. At all of the sites, it was found that the emergency cesarean delivery was the most common emergency and represent 40% of all emergencies at admissions. Sepsis was the second most common obstetrical emergency. The mean time from admission to the first evaluation by physician was 21 minutes, range (0-240 minutes). The mean interval from decision to incision for cesarean section was 54.7 minutes range (10-150 minutes). In this study, it was found that it required 2.63 hours (1-3.5hours) to commence surgery in the setting of hemorrhage, and it took 6.43 hours (2-19hours) for surgery to begin in the setting of infection. If transfusion was required the average time to obtain blood was 71 (25-360 minutes) minutes. Among challenges encountered, It was found that systems issues, as opposed to provider issues or patient issues, accounted for over three quarters of the barriers to patients receiving timely emergency care. Conclusion: There were significant delays in initiating surgery in the setting of hemorrhage and sepsis, although CD was able to be begun relatively quickly in our setting.” then, “Our study data…point out the challenges encountered at the level of both patients, providers, and the health system, all of which need to be addressed in order to expedite emergency obstetric care and lower maternal mortality in our setting.