Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola

Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical manage-ment reveal weaknesses in obstetric care and may serve as an instrument for future improvement (Afr. J. Reprod. Health 2010; 14[2]:55-62)

Audit of referral of obstetric emergencies in Angola: a tool for assessing quality of care

By auditing various aspects of referrals of obstetric emergencies, we wanted to study the effectiveness over time of a recently established network of peripheral birth units and two central hospitals in Luanda. 157 women referred for obstetric emergencies were studied regarding clinical outcome and process indicators like waiting time, partogramme quality and Caesarean section rate (CSR). After a change in routines at hospital admission and further partogramme education 92 referred women were compared with the former. Maternal mortality decreased from 17.8% to nil in the second. Total mean waiting time was reduced from 13.7 hours to 1.2 hours. Partogramme quality was significantly improved. CSR increased from 13 to 30%. Prolonged labour was the most common diagnosis.This study demonstrates the importance of clinic-based audit to enhance quality of care regarding referrals of patients with obstetric emergencies (Afr J Reprod Health 2009; 13[2]:75-85)

Audit of management of pregnant women with positive VDRL tests.

BACKGROUND: Syphilis is a preventable cause of foetal loss and congenital disease. Although the VDRL test is an integral part of routine antenatal care in India, little is known about the disease burden in pregnancy in India. Therefore, we carried out a study to determine the prevalence of VDRL positivity and syphilis among pregnant women in Vellore and to audit the management and outcome of VDRL-positive pregnancies. METHODS: A retrospective review of case records. RESULTS: Only 0.98% of pregnant women were positive by the VDRL test. However, foetal loss occurred in 16 (32%) of the 50 seropositive women; 15 of these did not receive antenatal care. Seventeen of the 34 seropositive multiparous women had had previous foetal losses. Only 16 women had received penicillin. CONCLUSION: Although the seroprevalence of syphilis in pregnancy is low, it is an unrecognized cause of foetal loss in Vellore. An audit of the testing and management of VDRL positivity in pregnancy provides valuable information on the quality of antenatal care in an area.

Avoidability of Maternal Death in Mozambique : Audit and Retrospective Risk Assessment in 106 Consecutive Cases

maternal mortality audit identified 106 cases of maternal death in Maputo (340 per 100 000 live births); caused by haemorrhage (31); hypertensive diseases of pregnancy (15); puerperal sepsis (12) and septic abortion (9). Puerperal uterine inertia (12) and malaria (9); respectively; were the most prevalent causes of direct and indirect maternal death. The maternal mortality audit analyses; indicated that health services research is fruitful in a more detailed; systematic study on maternal deaths at the community level wit ensuing analyses of avoidability aspects. Lack of transport and poor quality of antenatal and intrapartum care in peripheral maternity units implied that women with eclampsia; obstructed labor; post partum atonic haemorrhage and uterine rupture arrived late due to deficient transport.Shortage of blood and delay in access to operating theatre contributed significantly to fatal maternal outcome in several cases. The audit provided evidence that approximately 40of the deaths would have been avoidable with existing resources. It is particularly significant that the analysis of antenatal cards revealed that only 30had any high risk factors; implying that more than two thirds of women dying a maternal death are low risk women

Sexual History and Contraception among Women with Indused and Spontaneous Abortion in Dar es Salaam

The objective of this study was to create sexual history profiles of women with illegally induced abortion (IA) and women with spontaneous abortion (SA) and describe the women's knowledge of; attitude to; and practice of contraception. The study was carried out in two settings; Temeke District Hospital (TDH) and Muhimbili Medical Centre (MMC) in Dar es Salaam. At TDH 362/603 (60 per cent) were identified as IA and 241/603 (40 per cent) as SA. At MMC the figures were 68/220 (31 per cent) IA and 152/220 (69 per cent) SA. Both groups were well informed about modern contraception. As a contrast the rate of ever users of contraception was low in both groups; although significantly lower among IA women than among SA women. Outcome of first pregnancy had been an induced abortion in significantly higher proportion of IA than of SA women. In conclusion; sexual intercourse before marriage is common in the setting studied and contraceptive use in comparatively uncommon

Assessment and obstetric care quality in Mozambique by perinatal audit

The experiences of audit activities initiated in an interdepartmental collaboration between obstetrics and pediatrics in MaPuto 1982 are presented. While total perinatal mortality showed a significant but transient change during the observation period 1982-1991; intrapartum fetal mortality was significantly reduced from 10.9 to 3.4 per thousand. By providing the staff with a visible feed-back regularly staff members were sensitized towards immediate and longterm effects of implemented suveillance routines

The value of conjunctival pallor in the diagnosis of pregnancy anaemia in Mozambique

In a nation-wide study on maternal morbidity in Mozambique; pregnancy anaemia was given particular attention. The value of careful inspection in daylight of conjunctival pallor as a screening test for anaemia was assessed in a total of 596 pregnant women