…experts suggest improved emergency obstetric response
A 10 years autopsy-based investigation of maternal mortality in Lagos State University Teaching Hospital, Lagos, Nigeria, have identified bleeding after delivery (Postpartum Hemorrhage) as the major cause of maternal death in the hospital. These deaths could have been prevented with proper emergency obstetric response such as availability of adequate blood and effective referral system in the hospital, experts suggest.
The study was carried out by Professor John Obafunwa,Consultant Pathologist, Dr. Francis Faduyile, and others from the Department of Pathology and Forensic Medicine, LASUTH, Ikeja Lagos, and has been published recently in Nigeria Journal of Clinical Practise by Medical And Dental Consultants Association of Nigeria. The hospital is the only state-owned tertiary hospital and the main referral center in Lagos State.
The researchers, who are also pathologists at the hospital, studied the autopsy report of all maternal deaths seen in LASUTH from January 01, 2005 to December 31, 2014. According to them, autopsy records were taken from the death register and other information were extracted from the postmortem reports.
The result of the research showed that Postpartum hemorrhage was the most common cause of death followed by Eclampsia. They noted that direct causes such as haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour accounted for 60 per cent of maternal deaths with hemorrhage as the most common while cardiovascular related diseases are the most common indirect cause of maternal death.
“Most of the women were in the age group 26-30 years, followed by 31-35 years. The leading causes of death in this study- hemorrhage, cardiovascular disease and eclampsia are highly avoidable and treatable”, they said.
Based on this report, the doctors recommend that Lagos State government should focus more on having prompt obstetric emergency response such as availability of adequate blood in the hospitals and effective referral system. They also suggested that thorough cardiovascular management should be instituted during antenatal care.
According to a United Nations Population Fund (UNFPA) report, post-partum haemorrhage can kill a woman in less than two hours, while for other complications a woman has between six and twelve hours or more, to get life-saving emergency care. This makes timing critical in preventing maternal death and disability from haemorrhage.
Confirming this, an Obstetrics and Gynaecologist with Randle General Hospital, Dr. Adeleke Adesola Kaka, disclosed during a maternal health workshop by Development Communications Network (DEVCOMS), that most women’s death could be avoided and prevented if delays in accessing emergency care at hospitals were addressed.
According to him, delays can occur when there is ineffective referral system due to issues such as lack of bed space or ambulances.
Also, he explained that health workers often delay in transferring patient to the Emergency Room, ER when there is need for it due to trivial reasons such as inability of the patients to pay their bill or issues of compulsory blood donation.
While lamenting this lackadaisical attitude of health workers, he called on health facilities to pay more attention to saving the lives of women first before considering things such as hospital bills and compulsory blood donation.
“Some health facility do not have adequate blood in their bank, some may have and decide to hoard the one they have, insisting the patients should get their spouse for mandatory blood donation. While this might have its benefit, it can also result in delay in emergency care or prevent the woman from accessing the medical care, thereby resulting in complication and consequently death,” he further noted.
Aside this, the compulsory blood donation practiced at Lagos State owned hospitals is found to be driving away many pregnant women from accessing quality obstetric care at the hospital, according to an investigation by this reporter.
It was discovered that most of the women who left the government-owned hospital due to the compulsory blood donation, were often brought back in critical shape when it is almost too late to save their lives.
Explaining the reason behind this practice during this year’s blood donor day, The Lagos commissioner for Health, Dr. Jide Idris, said it was because government is not able to meet the demand for blood in hospitals, that it asked husbands of pregnant women to donate blood.
He explained that the arrangement was important in case the woman had haemorrhage and as a result, need blood.
However the Country Director, E4A Mamaye, Dr. Tunde Segun, said the mandatory blood donation is not ideal for saving the lives of women during child birth. According to him, blood should be free and easily accessible for emergency obstetric care.
“If we can handle postpartum haemorrhage, our maternal mortality will reduce drastically”, Maureen Ume, a gynaecologist with the National Hospital, Abuja, said.
According to Ume, women with multiple gestations (conception) and women who had had five or more previous pregnancies were inclined to experience PPH.
She, therefore, advised couples to go for family planning as it could play a role in tackling postpartum haemorrhage. She also said that expectant mothers could prevent postpartum haemorrhage if they sought proper antenatal attention at conception.
“We encourage our women to register for antenatal clinics early to avoid complications. Beginning antenatal clinic early will enable the obstetrician to sort out women who are at risk of postpartum haemorrhage,“ she said.