MATERNAL NEAR MISS IN SUDAN Geneva Foundation for Medical Education and Research GFMER Sudan 2012 Forum No: ( 1 )
Name of presentersName Position InstitutionAida Ahmed Head, Department Obstetrics & UMST Gynaecology NursingAmal Khalil Coordinator, Reproductive & Child UMST Health Research Unit Name of contributorsName Position InstitutionAida Ahmed Head, Department Obstetrics & UMST Gynaecology NursingAmal Khalil Coordinator, Reproductive & Child UMST Health Research Unit
Contents of the presentation1. Definition2. Maternal morbidity rate3. Health system failures in relation to obstetric care4. MDGs5. Severe life threatening obstetric complication6. Sudan policy and identification criteria for near miss
Maternal Near Miss is: a severe life threatening obstetric complicationnecessitating an urgent medical intervention in order toprevent likely death of the mother. any pregnant or recently delivered woman, in whomimmediate survival is threatened and who survives by chanceor because of the hospital care she received. Women who experienced and survived a severe healthcondition during pregnancy, childbirth or postpartum areconsidered as near miss or severe acute maternal morbidity(SAMM) cases.
Why maternal near miss? two decades ago. In low maternal mortality settings morbidity useful indicator of obstetric care in recent years analyzing near miss/SAMM cases understanding health system failures in relation to obstetric care
Why maternal near miss? Near miss/SAMM cases share many characteristicswith maternal deaths and can directly inform onobstacles that had to be overcome after the onset of anacute complication. Corrective actions for identified problems can betaken to reduce related mortality and long-termmorbidity.
Moreover, countries are increasingly adopting policies thatencourage births in institutions. Instruments must therefore,be available to assess the quality of care within theinstitutions. Routine assessments of maternal near misscases will help answer that need.
It is expected that the implementation of thematernal near miss process provide an importantcontribution to assessing and improving quality ofobstetric care and to the reduction of maternaldeaths.
The advantages The care of critically ill women will be analyzed, not onlydeaths. This is important given the emphasis that emergencyobstetric care is currently receiving, and allows for monitoringthe quality of these programs. A proportion of women with life-threatening conditionssurvive. They can be interviewed and areas of breakdown inthe health system can be identified. Indicators of maternal near miss and maternal deaths asexemplified in can allow for comparison between institutionsand countries and changes over time.
maternal morbidity rateMedical complications in a woman caused by pregnancy , labor , or delivery
severe life threatening obstetric complication Obstetric Haemorrhage Eclampsia Sepsis Pulmonary embolism Ruptured uterus Anemia related conditions & Heart Failure Abortion Malaria Anesthesia Amniotic fluid embolism ruptured ectopic pregnancy Fever and convulsionsJaundice
5th MDG is callingfor improving maternal health World wide.
Sudan policy and identification criteria for near miss
Health system failures inrelation to obstetric care
Maternal near-miss in a rural hospital in Sudan The first report of maternal near-miss in Sudan Medical files of pregnant women and who delivered recently at Kassala Maternity Hospital from January 2008 to December 2010 were studied.
Conclusion high frequency of maternal morbidity and mortality at the level of this facility. Therefore maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating maternal- near miss events (hemorrhage, infections, hypertension and anemia) at all care levels including primary level.
Qualitative StudyDeterminants of maternal morbidity andmortality in post conflict areas.
Aim to gain in-depth understanding of the interacting determinants behind maternal mortality to investigate the methods of survival of maternal near miss in crises without professional health care.
Method Qualitative study design using Critical Incident Technique [CIT]. 11 near miss events. Interviews were conducted with husbands, mothers, in laws, sisters, midwives of the deceased and in case of survival the maternal near misses.
Results Socio-demographic: education, family, age at marriage, poverty Cultural: perceptions about pregnancy and delivery Health facilities: willingness to pay, unacceptability Conflict/ post conflict: fear, insecurity, weak infrastructure, lack of transportation.
Their stories… Maternal Near Miss PPH
A house-wife & mother of four childrenstarted her story “It happened 5 years ago.First of all I had pain in my tummy/belly. Isent my mother to the village midwife. Inever deliver by a traditional birthattendant ever. The VMW examined me &said this is labour! We waited for 2 hoursbut the baby didn’t come& after 3 hoursthe baby came. I delivered & the bleedingstarted & the placenta didn’t come out”.
She was rolling in pain, bleeding and started to getweak and restless. By then her husband decided to takeher to Renk. It was the rainy season autumn; he wentto fetch a car. Luckily he found a pickup truckimmediately that charged a ridiculous amount ofmoney SDG100. It was a long and bumpy trip on thedirt road to Renk taking them 4 hours to reach thehospital from their village Gabarona.The minute she entered the maternity ward safelydelivered the placenta. She was discharged after aweek diagnosed as having Malaria and was onmedication. Later on they moved to Renk where she went toantenatal care/ follow up and delivered her children atthe hospital.