Details:

Alternative Title:
BMC Pregnancy Childbirth
Personal Author:
Boyd, Andrew T. ; Hulland, Erin N. ; Grand’Pierre, Reynold ; Nesi, Floris ; Honoré, Patrice ; ... More +
Boyd, Andrew T. ; Hulland, Erin N. ; Grand’Pierre, Reynold ; Nesi, Floris ; Honoré, Patrice ; Jean-Louis, Reginald ; Handzel, Endang Less -
Description:
Background

Accurate assessment of maternal deaths is difficult in countries lacking standardized data sources for their review. As a first step to investigate suspected maternal deaths, WHO suggests surveillance of “pregnancy-related deaths”, defined as deaths of women while pregnant or within 42 days of termination of pregnancy, irrespective of cause. Rapid Ascertainment Process for Institutional Deaths (RAPID), a surveillance tool, retrospectively identifies pregnancy-related deaths occurring in health facilities that may be missed by routine surveillance to assess gaps in reporting these deaths.

Methods

We used RAPID to review pregnancy-related deaths in six tertiary obstetric care facilities in three departments in Haiti. We reviewed registers and medical dossiers of deaths among women of reproductive age occurring in 2014 and 2015 from all wards, along with any additional available dossiers of deaths not appearing in registers, to capture pregnancy status, suspected cause of death, and timing of death in relation to the pregnancy. We used capture-recapture analyses to estimate the true number of in-hospital pregnancy-related deaths in these facilities.

Results

Among 373 deaths of women of reproductive age, we found 111 pregnancy-related deaths, 25.2% more than were reported through routine surveillance, and 22.5% of which were misclassified as non-pregnancy-related. Hemorrhage (27.0%) and hypertensive disorders (18.0%) were the most common categories of suspected causes of death, and deaths after termination of pregnancy were statistically significantly more common than deaths during pregnancy or delivery. Data were missing at multiple levels: 210 deaths had an undetermined pregnancy status, 48.7% of pregnancy-related deaths lacked specific information about timing of death in relation to the pregnancy, and capture-recapture analyses in three hospitals suggested that approximately one-quarter of pregnancy-related deaths were not captured by RAPID or routine surveillance.

Conclusions

Across six tertiary obstetric care facilities in Haiti, RAPID identified unreported pregnancy-related deaths, and showed that missing data was a widespread problem. RAPID is a useful tool to more completely identify facility-based pregnancy-related deaths, but its repeated use would require a concomitant effort to systematically improve documentation of clinical findings in medical records. Limitations of RAPID demonstrate the need to use it alongside other tools to more accurately measure and address maternal mortality.


Subjects:
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Adolescent Adult Female Hospital Mortality Hospitals, Maternity Humans Maternal Mortality Population Surveillance Pregnancy Pregnancy Complications Retrospective Studies Tertiary Care Centers Young Adult
Source:
BMC Pregnancy Childbirth. 17.
Pubmed ID:
28511722
Pubmed Central ID:
PMC5434572
Document Type:
Journal Article
Place as Subject:
Haiti
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:9f32468e8033c6e539a6b713c2b7de70ced8a5634779c0ad2692560fc4ff38e4
Download URL:
https://stacks.cdc.gov/view/cdc/45846/cdc_45846_DS1.pdf
File Type:

Supporting Files

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