Egypt P rof Dr Amina El Nemer Womans Health and Midwifery Nursing Dep Faculty of Nursing Egypt Nursing amp Healthcare Nov17192014 Chicago USA Train bridge reflection on the Nile ID: 1044644
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1. Quality of Maternal Health Care: Maternal Near –Misses in a University Hospital , EgyptProf. Dr. Amina El-Nemer Woman’s Health and Midwifery Nursing Dep. Faculty of Nursing Egypt
2. Nursing & Healthcare, Nov.17-19,2014, Chicago, USATrain bridge reflection on the Nile, Mansoura11/18/20142
3. University Campus, Hospital, Nursing ConferenceNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/20143
4. Nursing & Healthcare, Nov.17-19,2014, Chicago, USAIntroduction and background Maternal mortality is estimated at 287 000 women died in 2010. WHO reports that 10-15 million women experience sever illness and disabilitiesFive percent of maternal deaths occur in Arab countries and 390.000 women in Middle East are suffering of severe long lasting complications caused be pregnancy and delivery.11/18/20144
5. One of the Millennium Development Goals is to reduce maternal mortality ratio by 3/4 by 2015 especially in the sub-Saharan areas where the problem is more tragically.Recently Maternal Near Miss (MNM) indicator is increasingly being recognized as a potentially useful tool in assessing the quality of healthcare as it reflects the scope of complications during pregnancy and childbirth. Nursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/20145
6. Maternal Near Miss (MNM) Is “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. WHONursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/20146
7. Despite all the efforts done by Egyptian government to achieve the Millennium Development goals, there is a question regarding the quality of care provided to the Egyptian women during pregnancy and delivery. Nursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/20147
8. Objective To identify Maternal Near Miss in a teaching University hospital (MUH). A retrospective descriptive study.80 women with potential life threatening conditions was reviewed to identify MNMNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/20148
9. Characteristics of Suspected Women with Potential Life Threatening Conditions. Mean (Minimum-maximum)Characteristics22.8 (19-40)Women's age29.2 (18-43)Gestational age3 (1-5)Previous CS (18, 22.5)Referrals (67, 83.75)20 (29.6)Private Obstetricians30 (44.8)MOH Hospitals10 (15.1)Private Hospitals7 (10.5)OthersNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/20149
10. Time and Types of Morbidity ConditionsDeveloped after 12 hoursAt arrival or within 12 hoursMorbidity conditions%No%No1. Women with potentially life-threatening conditions12.5102520Severe postpartum haemorrhage3.7351.341Severe pre-eclampsia0.005.04Eclampsia0.002.52Sepsis or severe systemic infection0.000.00Ruptured uterus16.21383.867 Total women with severe complicationsNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201410
11. Morbid Women Undergoing Critical Interventions%No2. Women undergoing critical Interventions43.835Use of blood products16.313LaparotomyAdmission to intensive care unit (65, 81.25)53.829.27.76.23.13519542Sever preeclampsia/EclampsiaSever PPHAnemiaMultiple organ dysfunctionsHystrectomy + AnemiaNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201411
12. MNM and dead women who experienced organ dysfunctions. Near Miss Cases (67)Organ Dysfunctions%No29.820Cardiovascular dysfunction13.49Respiratory dysfunction7.55Renal dysfunction11.98Coagulation/haematologic dysfunction7.55Hepatic dysfunction7.55Neurologic dysfunction32Uterine dysfunction/hysterectomy64Multiple organ dysfunctions/died women86.658Total Nursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201412
13. Causes of life-threatening conditionsNear Misses 1. Underlying causes%No=633.22Pregnancy with abortive outcome31.720Obstetric haemorrhage55.535Hypertensive disorders3.22Pregnancy-related infection7.95Other obstetric disease or complication19.111Medical/Surgical/Mental disease or complication7.95Unanticipated complications of managementNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201413
14. Contributory Causes44.428Anemia23.815Previous caesarean section7.95Prolonged / obstructed labourNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201414
15. End of pregnancy and pregnancy outcome%NoPregnancy out comes3.22Vaginal delivery93.659Caesarean Section3.22Complete abortion1.61Laparotomy for ectopic pregnancyNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201415
16. Process and outcome indicators among MNMNursing & Healthcare, Nov.17-19,2014, Chicago, USAPrevention of PPH41.326Oxytocina use58.737Use of any uterotonic (including oxytocin)TTT of sever PPH (20)65.013Oxytocina use95.019Ergometrine20.04Misoprostol20.04Removal of retained products45.09Artery ligation10.02HysterectomyAnticonvulsants for eclampsia (45)88.940Magnesium sulfate 11/18/201416
17. Process and outcome indicators among MNM%NoIndicatorsPrevention of caesarean section related infection (59)10059Antibiotics98.456Prophylactic antibiotic during caesarean sectionTreatment of sepsis (2)1002Prenatal therapeutic antibioticsPreterm birth (6)1006Corticosteroids for fetal lung maturationNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201417
18. Conclusion The main life threatening conditions were severe pre eclampsia, severe hemorrhage, eclampsia and sepsis.More than 80% of cases went through critical Intervention such as ICU, blood products and laparotomy (87.8). Nursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201418
19. Conclusion 79% of cases experienced organs dysfunction.5% of women with life threatening conditions were died.Also, study revealed several issues regarding quality of obstetric care that need urgent attention and improvement to reduce maternal morbidity. .11/18/2014Nursing & Healthcare, Nov.17-19,2014, Chicago, USA19
20. RecommendationsWHO auditing tool providing a thorough evaluation of the quality of healthcare and suggesting improvements in maternal outcomes. The results may help establish public healthcare policies and strategies aimed at tackling the issue of maternal morbidity and mortality. Nursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201420
21. Qualitative prospective studies should be conducted to acquire further information on the profile of cases and on the risk factors for MNM. Applying standardized protocols and guidelines in emergency and admission rooms. Nursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201421
22. Thank you from EgyptPNursing & Healthcare, Nov.17-19,2014, Chicago, USA11/18/201422