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Arch Gynecol Obstet. 1990;247(3):131-8.

Maternal mortality audit in a Zimbabwean province.

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Gweru Provincial Hospital, Zimbabwe.


A maternal mortality audit was introduced in the Midlands Province (Zimbabwe) in order to identify which avoidable factors were involved most frequently. During the two-year study period, the maternal mortality rate was 137 per 100,000 total births. The main causes of death were uterine rupture, eclampsia, haemorrhage and caesarean section related accidents. An avoidable factor was identified among 87% of these deaths involving the health system in 57% of the cases and the patient in 33%. Access to the health facilities and transport problems only played a minor role.


An adult conducted of the 51,058 deliveries recorded in 1985-87 in Zimbabwe's Midlands Province identified 70 maternal deaths, for a maternal mortality rate of 137.1/100,000 births. The 4 leading causes of death were uterine rupture (18 deaths), hemorrhage (16 deaths ), eclampsia (13 deaths), and sepsis (12 deaths). 7 women died undelivered; the routes of delivery for the remaining cases included cesarean section (22 cases), instrumental delivery (12 cases), normal vaginal delivery (15 cases), and laparotomy (10 cases). Most significantly, the audit revealed that only 9 (13%) of the maternal deaths in this series were unavoidable. The avoidable deaths involved the health service in 57% of cases and the patient in only 33%. An estimated 35 (50%) maternal deaths could have been averted if the physician had taken more appropriate action (e.g., proper diagnosis of uterine rupture, undue delay before medical action, and avoidance of nonmandatory cesarean sections). The audit concluded that at least 11 of the 22 cesarean section deliveries )largely those performed due to fetal distress and breech presentation) were necessary. In the 23 cases where patient behavior was a contributory factor, considerable delay before seeking medical help during abnormal labor (despite easy access to a clinic) was most often involved. In only 3 maternal deaths (all from hemorrhage) was access to a medical facility a problem. Overall, these findings suggest that 3 measures--careful assessment of whether the patient is able to tolerate anesthesia and cesarean section, investigation of the possibility of uterine rupture, and aggressive management and early delivery of all women with eclampsia--could substantially reduce maternal mortality.

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