Investigation of maternal death, Manhyia North Sub Metropolis, Ashanti Region, Ghana - 2019

  • Maternal and child health
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Background:
Maternal mortality remains unacceptably high as a major public health problem globally. Approximately 830 women die daily from preventable causes related to pregnancy and childbirth. In 2018, maternal mortality rate in Ghana was 319 per 100,000 live births. On 10th April 2019, a maternal death occurred at a local hospital in Manhyia North sub metropolis of the Ashanti Region. We conducted an investigation to determine the cause of death and factors contributing to the death.
Methods:
We conducted a maternal death audit on 17th April 2019 at the hospital using the Ghana Health Service standard maternal audit form. The maternal death audit committee comprised of two medical officers, one principal mid- wife, three midwives, two public health nurses, a nurse manager, a biomedical scientist, a pharmacist, a physician assistant and the hospital administrator. The patients’ folder, antenatal clinic (ANC) and inpatient records were reviewed. We also interviewed staff who managed the case.
Results:
Patient was 25-years old woman who had had two previous vaginal births. She made her 11th ANC visit on 9th April 2019 at 41 weeks gestation and was admitted on same day for induction of labour on account of postdate pregnancy. Her blood pressure on admission was 120/80mmHg. Labour was induced with two doses of 50mcg misoprostol at 4 hours interval. Patient was referred to a referral hospital the following morning on account of abdominal pains, collapsed veins and a weakened thread pulse. Blood pressure at the time of referral was 60/40mmHg. Patient died on arrival at referral hospital on account of ruptured uterus.
Conclusion
Cause of this maternal death was hemorrhagic shock secondary to uterine rupture. Human error in lifesaving skills and organizational issues such as absence of a specialist and delay in reaching the referral facility were contributory factors. We instituted a permanent maternal death audit committee. Health facility staff were taken through a three day lifesaving skills training for proper case management of maternal cases.

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