Browsing by Author "Umezulike, A.C"

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    Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey
    (Royal College of Obstetricians and gynaecologists, 2019-03-21) Adeniran, Abiodun; Ocheke, Amaka; Nwachukwu, Dumm; Adewole, Nathaniel; Ageda, Ben; Onile, Temitope; Umezulike, A.C; Aboyeji, Peter; Oladapo, Olufemi
    Objective To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals. Design Secondary analysis of a nationwide cross-sectional study. Setting Forty-two tertiary health facilities. Population Women admitted with complications during pregnancy, childbirth or puerperium. Methods All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria. Main outcome measures Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). Results Of 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe non- obstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO. Conclusion Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications.
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    When getting there is not enough: a nationwide cross-sectional study of 99 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country
    (Royal College of Obstetricians and Gynaecologists, 2015-05-14) Oladapo, Olufemi; Adetoro, O.O; Ekele, Bisalla; Chama, Calvin; Etuk, Saturday; Aboyeji, Peter; Onah, H.E; Abasiattai, A.M; Adamu, A.N; Adegbola, O; Adeniran, Abiodun; Aimakhu, C.O; Akinsanya, O; Aliyu, L.D; Ande, A.B; Ashimi, A; Bwala, M; Fabanwo, A; Giedam, A.D; Ikechebelu, J.I.; Imaralu, J.O; Kuti, O; Nwachukwu, D; Omo-Aghoja, L; Tunau, K; Tukur, J; Umeora, O.U.J; Umezulike, A.C; Dada, O.A; Tuncalp, O; Vogel, Joshua; Gulmezoglu, A.M
    Objective To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. Design Nationwide cross-sectional study. Setting Forty-two tertiary hospitals. Population Women admitted for pregnancy, childbirth and puerperal complications. Methods All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. Main outcome measures Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). Results Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were preeclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21–215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and nonavailability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. Conclusions Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.