The Three Delays of Maternal Mortality in a Public-Sector Tertiary Teaching Hospital: Is There a Paradigm Shift?

Abstract

Objective: To describe the three delays of maternal mortality in a public-sector tertiary teaching hospital in one year.
Study Design: Retrospective, observational study. Place and Duration of Study: Minia Maternity & Children’s University Hospital, Department of Obstetrics and Gynaecology, Unit A, El Minya city, Egypt, from January 2014 to December 2014.
Methodology: 8915 of deliveries during the study period were reviewed and all causes of maternal deaths were analysed. Data regarding age, parity, sociodemographic characteristics, booking status, referral source, cause of death and the three delays was collected on structured proformas, analysed by the statistical software, SPSS version 16, and presented in the form of frequencies and percentages.
Results: The projected maternal mortality ratio was 89.7/100,000 live births. The mean age of women was 23±7.2 years and median parity was 4 (ranging from 0-11). 4 cases (50%) of the women had received no formal education and 5(62.5%) belonged to a lower socioeconomic class. Two cases (25%) of the women received no antenatal care while four cases (50%) received less than four antenatal visits during the whole pregnancy and classified as poor ante natal care attendee. Direct causes were responsible for 62.5% of maternal deaths, 37.5% of deaths were due to indirect causes. The third delay was found to be the most frequent (79%) followed by the first delay (71%) while the least one was the second delay (40%).
Conclusion: There is a paradigm shift of delays toward the third delay rather than the first or second delays which might be related to chronically under-resourced health facilities which are still unable to cope effectively with serious obstetric complications. Better understanding of the third delay co-factors could lead to significant improvement in the quality of care in our communities.