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

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...

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Bibliographic Details
Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 116; no. 9; pp. 1210 - 1217
Main Authors:	Rööst, M, Altamirano, VC, Liljestrand, J, Essén, B
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-08-2009 Blackwell Wiley Subscription Services, Inc
Subjects:	Adult Biological and medical sciences Bolivia Bolivia - epidemiology Clinical Medicine Cross-Sectional Studies Delivery. Postpartum. Lactation Emergency Service, Hospital - organization & administration Emergency Treatment - mortality Emergency Treatment - statistics & numerical data Female Gynecology. Andrology. Obstetrics Health Priorities Hemorrhage Hospitalization Hospitalization - statistics & numerical data Hospitals, Maternity Hospitals, Urban Humans Hypertension Klinisk medicin Maternal Mortality Medical and Health Sciences Medical sciences MEDICIN Medicin och hälsovetenskap MEDICINE Metropolitan areas Morbidity Mortality Mothers near-miss Obstetrics, Gynecology and Reproductive Medicine Pregnancy Pregnancy Complications - mortality Pregnancy Complications - therapy Prenatal Care - organization & administration Reproduktionsmedicin och gynekologi Sepsis severe maternal morbidity Socioeconomic Factors Urban Health South America Bolivia America La Paz Bolivia Pregnancy Prognosis Gynecology Mortality Delivery Emergency Maternal diseases Epidemiology Obstetrics
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1470-0328 1471-0528 1471-0528
DOI:	10.1111/j.1471-0528.2009.02209.x