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BMC Pregnancy Childbirth. 2015 Sep 30;15:235. doi: 10.1186/s12884-015-0669-y.

Factors associated with postpartum hemorrhage maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey.

Author information

1
Research Institute for Development, Paris Descartes University, Sorbonne Paris Cité, MERIT - UMR 216, Paris, France. julie.tort@gmail.com.
2
UPMC University, Paris, France. julie.tort@gmail.com.
3
Paris Diderot University, Paris, France. julie.tort@gmail.com.
4
UMR 216, Faculté de Pharmacie, Laboratoire de Parasitologie, 4 Avenue de l'Observatoire, 75270, Paris Cedex 6, France. julie.tort@gmail.com.
5
Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France. prozenberg@chi-poissy-st-germain.fr.
6
EA7285, Clinical risk and safety in women's health and perinatal health, University of Versailles Saint-Quentin (UVSQ), St Quentin en Yvelines, France. prozenberg@chi-poissy-st-germain.fr.
7
URFOSAME, Referral health center of the Commune V, Bamako, Mali. mtraore133@gmail.com.
8
Research Centre of CHUM (CRCHUM), University of Montreal, Montreal, Canada. pierre.fournier@umontreal.ca.
9
Research Institute for Development, Paris Descartes University, Sorbonne Paris Cité, MERIT - UMR 216, Paris, France. alexandre.dumont@ird.fr.
10
UPMC University, Paris, France. alexandre.dumont@ird.fr.

Abstract

BACKGROUND:

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Sub-Saharan-Africa (SSA). Although clinical guidelines treating PPH are available, their implementation remains a great challenge in resource poor settings. A better understanding of the factors associated with PPH maternal mortality is critical for preventing risk of hospital-based maternal death. The purpose of this study was thus to assess which factors contribute to maternal death occurring during PPH. The factors were as follows: women's characteristics, aspects of pregnancy and delivery; components of PPH management; and organizational characteristics of the referral hospitals in Senegal and Mali.

METHODS:

A cross-sectional survey nested in a cluster randomized trial (QUARITE trial) was carried out in 46 referral hospitals during the pre-intervention period from October 2007 to September 2008 in Senegal and Mali. Individual and hospital characteristics data were collected through standardized questionnaires. A multivariable logistic mixed model was used to identify the factors that were significantly associated with PPH maternal death.

RESULTS:

Among the 3,278 women who experienced PPH, 178 (5.4%) of them died before hospital discharge. The factors that were significantly associated with PPH maternal mortality were: age over 35 years (adjusted OR = 2.16 [1.26-3.72]), living in Mali (adjusted OR = 1.84 [1.13-3.00]), residing outside the region location of the hospital (adjusted OR = 2.43 [1.29-4.56]), pre-existing chronic disease before pregnancy (adjusted OR = 7.54 [2.54-22.44]), prepartum severe anemia (adjusted OR = 6.65 [3.77-11.74]), forceps or vacuum delivery (adjusted OR = 2.63 [1.19-5.81]), birth weight greater than 4000 grs (adjusted OR = 2.54 [1.26-5.10]), transfusion (adjusted OR = 2.17 [1.53-3.09]), transfer to another hospital (adjusted OR = 13.35 [6.20-28.76]). There was a smaller risk of PPH maternal death in hospitals with gynecologist-obstetrician (adjusted OR = 0.55 [0.35-0.89]) than those with only a general practitioner trained in emergency obstetric care (EmOC).

CONCLUSIONS:

Our findings may have direct implications for preventing PPH maternal death in resource poor settings. In particular, we suggest anemia should be diagnosed and treated before delivery and inter-hospital transfer of women should be improved, as well as the management of blood banks for a quicker access to transfusion. Finally, an extent training of general practitioners in EmOC would contribute to the decrease of PPH maternal mortality.

PMID:
26423997
PMCID:
PMC4590311
DOI:
10.1186/s12884-015-0669-y
[Indexed for MEDLINE]
Free PMC Article

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