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Priorities in emergency obstetric care in Bolivia--maternal mortality and near-miss morbidity in metropolitan La Paz

Roost, M.; Altamirano, V. C.; Liljestrand, Jerker LU and Essen, B. (2009) In BJOG: An International Journal of Obstetrics & Gynaecology2000-01-01+01:00 116(9). p.1210-1217
Abstract
Objective To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. Design Facility-based cross-sectional study. Setting Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. Population All maternal deaths and women with near-miss morbidity. Methods Inclusion of near-miss using clinical and management-based criteria. Main outcome measures Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. Results MMR was 187/100 000 live births and SMR was 50/1000 live births, with a relatively low mortality index of... (More)
Objective To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. Design Facility-based cross-sectional study. Setting Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. Population All maternal deaths and women with near-miss morbidity. Methods Inclusion of near-miss using clinical and management-based criteria. Main outcome measures Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. Results MMR was 187/100 000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. Conclusions Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
severe maternal morbidity, near-miss, Bolivia, maternal mortality
in
BJOG: An International Journal of Obstetrics & Gynaecology2000-01-01+01:00
volume
116
issue
9
pages
1210 - 1217
publisher
Wiley-Blackwell
external identifiers
  • wos:000267879700010
  • scopus:68249158007
ISSN
1471-0528
DOI
10.1111/j.1471-0528.2009.02209.x
language
English
LU publication?
yes
id
f4a5d245-e8ad-4d85-9afd-9c6c9d9fe22c (old id 1462827)
date added to LUP
2009-08-31 11:02:55
date last changed
2017-10-22 04:05:32
@article{f4a5d245-e8ad-4d85-9afd-9c6c9d9fe22c,
  abstract     = {Objective To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. Design Facility-based cross-sectional study. Setting Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. Population All maternal deaths and women with near-miss morbidity. Methods Inclusion of near-miss using clinical and management-based criteria. Main outcome measures Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. Results MMR was 187/100 000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. Conclusions Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.},
  author       = {Roost, M. and Altamirano, V. C. and Liljestrand, Jerker and Essen, B.},
  issn         = {1471-0528},
  keyword      = {severe maternal morbidity,near-miss,Bolivia,maternal mortality},
  language     = {eng},
  number       = {9},
  pages        = {1210--1217},
  publisher    = {Wiley-Blackwell},
  series       = {BJOG: An International Journal of Obstetrics & Gynaecology2000-01-01+01:00},
  title        = {Priorities in emergency obstetric care in Bolivia--maternal mortality and near-miss morbidity in metropolitan La Paz},
  url          = {http://dx.doi.org/10.1111/j.1471-0528.2009.02209.x},
  volume       = {116},
  year         = {2009},
}