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  • Title: A 10-year review of maternal mortality in Chon Buri Hospital, Thailand.
    Author: Pinchun P, Chullapram T.
    Journal: J Med Assoc Thai; 1993 Jun; 76(6):308-13. PubMed ID: 8083622.
    Abstract:
    1. The overall maternal mortality rate (MMR) in Chon Buri Hospital in the 10-yr period from 1982-1991 was 51.1/100,000 livebirths. 2. The top causes of death were abortion related complications, pregnancy induced hypertension, puerperal infection and postpartum hemorrhage. 3. What we have done is to improve the quantity and quality of obstetric and medical care, solve the problem of vital statistics reports in our hospital, contact doctor in nearby hospitals in referral and interhospital OB-GYN conferences to meet and discuss both knowledge and management problems. 4. What we still faced in the last 4-yr were deaths from abortion related complications, puerperal sepsis and postpartum hemorrhage. Most of the deaths were preventable. 5. So what we have to target to lessen the MMR is to improve the obstetric and medical care, improve the quality of medical personnel in our area in KAP aspect (knowledge, attitude, practice) especially in the field of family planning to prevent unwanted pregnancies, proper prevention and management of postpartum hemorrhage, and prevention and treatment of puerperal and postabortal infection. Retrospective data from records, reports, and charts were obtained from Chon Buri Hospital in Chon Buri province, Thailand, between January 1982 and December 1991 and analyzed. Maternal mortality was 27 deaths out of 52,805 births in the 10 year period (51.1 per 100,000 live births). Between 1982 and 1988 maternal mortality was 59.8 per 100,000; between 1988 and 1991 the rate was 39.7. Differences are not statistically significant. Nationally the maternal mortality rate declined from 494-1729 50 years ago to 30.9-184.2 in the last 15 years. In 1988 the national maternal mortality rate was 30.9. The age at death ranged from 17 years to 40 years with a mean of 28.7 +or- 7.3 years. 44.4% of deaths occurred between the ages of 20 and 29 years. 55.6% deaths occurred in the postpartum period. 74.1% died on the ICU or obstetrics wards. 33.3% of cases were referrals from community hospitals, of which 7 were dead on arrival (4 from postpartum hemorrhage, 1 from eclampsia, and 1 severe eclampsia with intracerebral hemorrhage and puerperal sepsis.) A higher proportion of referrals was found in deaths for the most recent four year period. 92.6% (25 cases) were direct maternal deaths. 70.4% were from abortion complications, puerperal infection, and postpartum hemorrhage. The causes of death changed very little over the 10 year period, with the exception of pregnancy induced hypertension which did not appear in the most recent four year period. The findings indicate an improvement in the quantity and quality of obstetric and medical care and some changes in record keeping. Conferences are held with doctors in nearby hospitals to discuss referral procedures and management problems. Most of the maternal mortality is preventable.
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