Maternal death review in Sudan [2010 - 2012]: achievements and challenges

Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing mortality estimates remain a challenge. Maternal death review [MDR] is a tool used to measure maternal mortality ratio [MMR] and to improve quality of obstetric care. This study was done to assess maternal mortality and to identify underlying causes during 2010-2013. Facility and community- based maternal death review was conducted during three years in Sudan to study maternal mortality. National and states' maternal death review committees were established. A focal person for each state, health facility and locality was nominated. Notification of maternal deaths was done by telephone, followed by review of all notified maternal deaths using a structured format. Data was analyzed using microcomputer, with SSPS, version 18.0. Over three years, 2933 maternal deaths were notified, out of 1509354 Live births [LB]. MMR was 194/ 100000 LB, with different variation between states. Facility maternal deaths were 2503 [85.3%] and community deaths were 430 [14.7%], reviewed formats were 2859 [97.5%]. Direct obstetric deaths were 1845 [64.5%], mainly due to haemorrhage 884 [30.9%], eclampsia 383 [13.4%] and sepsis 321 [11.2%]. Indirect causes were 1014 [35.5%], 363 [12.7%] due to hepatitis and 197 [6.9%] to anemia. Most of hospital deaths 1947 [77.9%]; admitted late from home, 2462 [73.4%] were critically ill and 1484 [60.3%] died within 24 hours. Home delivery, late presentation, unavailability of blood and poor referral system, are the main factors behind maternal deaths. Maternal death review has to be integrated within the health management information system [HMIS] with strong commitment of various stakeholders

Association of placenta praevia with repeat cesarean section in Omdurman Maternity Hospital, Sudan 2010- 2012

Several risk factors for placenta praevia exist, including previous cesarean section [C/S]. This association has been investigated long time ago, however in this hospital there is no documented evidence. This study was done to assess the risk of placenta praevia based on number of previous cesarean sections. A hospital-based study, at Omdurman maternity hospital- OMH during; January 2010- December 2012. Deliveries in OMH were reviewed by trained registrars. Patients diagnosed prenatally or during delivery as placenta praevia were included. All women operated were followed till discharge from hospital. Total number of deliveries during the study period is 94758.Of them 68415 [72.2%] delivered vaginally and 26343 [27.8%] by C/S.Of the latter 10643 [40.4%] underwent elective and 15700 [59.6%] emergency CS.448 [0.5%] were diagnosed as placenta praevia. Placenta praevia was more common in patients with scarred uterus being found a 250 out of 9853 CS [2.5%]. Its frequency increased with the number of uterine scars: one scar; [1.7%], [RR = 1.45, CI= 1.12- 1.88], 2-4 scars [2.8%], [RR = 2.32, CI= 1.87-2.87] and five or more scars; [12.7%], [RR = 10.54, CI= 7.34-15.13]. Nineteen patients [7.6%] had adherent placenta, [RR = 42.41, CI =5.69-315.83], 68[15.2%] had history of dilatation and curettage [D and C] or evacuation,[RR = 1.5, CI = 1.18- 1.94], 37 [8.3%] had previous history of placenta praevia, [RR= 8.30, CI = 6.17- 11.19]. Three maternal deaths were encountered [0.7%]. The frequency of placenta praevia in this study increased with increasing number of previous C/S, and was associated with adverse feto-maternal outcome. This study provides a reason to reduce primary C/S and encouraging vaginal birth after C/S [VBAC]

Impact of female genital mutilation on second stage of labour in primigravida at Omdurman Maternity Hospital, Sudan 2010

To find out the impact of female genital mutilation [FGM] on the second stage of labour at Omdurman Maternity Hospital [OMH]. A descriptive cross-sectional study, for primigravidae delivered vaginally in 2010. After an informed consent circumcised women, were included as study group and uncircumcised ladies as control group. Data was collected by trained registrars using a structured questionnaire to collect frequency of postpartum haemorrhage [PPH], perineal tear, birth asphyxia, neonatal death and hospital stay. A total of 1961 primigravidae, delivered in 2010 at OMH, 629[32.1%] were circumcised and 1332[67.9%] were uncircumcised. There was no significant difference in the mode of delivery and episiotomy. FGM places women at a greater risk during childbirth, endangering their health and their babies compared to uncircumcised.