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  • Title: Maternal mortality at Goroka Base Hospital.
    Author: Campbell GR.
    Journal: P N G Med J; 1974 Dec; 17(4):335-41. PubMed ID: 4534253.
    Abstract:
    Over the ten year period 1964-73, the causes of the high maternal mortality rate (21.6/1000) at the Goroka Base Hospital are reviewed. The leading causes of maternal mortality are sepsis and obstructed labour followed by ruptured uterus and abortion. Although it will be difficult to reduce the maternal mortality, some relevant recommendations are made. The causes of the high maternal mortality rate (21.6/1000) at the Goroka Base Hospital in Papua New Guinea are reviewed for the 1964-1973 period. This study covers deaths directly due to pregnancy and childbirth and deaths due to other causes occurring in association with pregnancy and childbirth (referred to as associated deaths). The definition of parity in this study is the number of previous pregnancies that have lasted 28 weeks or more. During the 10-year period, 6031 public patients were admitted for confinement and 542 public patients were admitted following delivery elsewhere. For the purpose of deriving the maternal mortality rate (MMR), only direct maternal deaths are considered. The MMR was much higher (97.8) for patients admitted after delivery than for those admitted before delivery. The parity of 74 of the patients who died from direct obstetric causes was recorded: para 0, 52.7%; para 1-4, 40.5%; and para 5 or more, 6.8%. Autopsy confirmed the cause of death in 33 (23.2%) of the 142 maternal deaths. In most patients, sufficient clinical data was available to establish the diagnosis. Sepsis was the predominant cause of death, accounting directly for 44 (38.3%) of the deaths. Obstructed labor accounted for 29 deaths (25.2%) with the uterus intact. Of patients whose parity was recorded, 15 (60%) were primigravida, 8 (32%) were multigravida, and 2 (8%) were multigravida. Of 45 patients admitted to Goroka Base Hospital with the diagnosis of ruptured uterus, the mortality was 28.9%. The incidence of ruptured uterus declined from 1.4% to 0.4% over the 10-year review period. Abortion was the cause of 14 deaths. Criminal interference was admitted in 9 patients and may have occurred in the others. The cause of death of 4 women was toxemia of pregnancy; 2 of these patients were referred from other hospitals, each after treatment for pre-eclampsia. Pulmonary embolism was responsible for 1 death as was extrauterine pregnancy. There were 29 deaths in patients delivered by caesarean section. Additionally, 3 women died after referral following caesarean section at other hospitals. The average duration of hospitalization for patients with peritonitis at or developing after caesarean section was 17.7 days. 27 deaths were associated with pregnancy, and the conditions responsible are listed in a table. Continuing education is necessary to reduce maternal morbidity and mortality. Simple proposals for health education purposes are identified.
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