Major obstetric haemorrhage in Metro East, Cape Town, South Africa : a population-based cohort study using the maternal near-miss approach

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dc.contributor.authorHeitkamp, Ankeen_ZA
dc.contributor.authorAronson, Simcha Loten_ZA
dc.contributor.authorVan Den Akker, Thomasen_ZA
dc.contributor.authorVollmer, Lindaen_ZA
dc.contributor.authorGebhardt, Stefanen_ZA
dc.contributor.authorVan Roosmalen, Josen_ZA
dc.contributor.authorDe Vries, Johanna I.en_ZA
dc.contributor.authorTheron, Gerharden_ZA
dc.date.accessioned2020-01-15T06:29:07Z
dc.date.available2020-01-15T06:29:07Z
dc.date.issued2020-01-06
dc.date.updated2020-01-12T04:45:59Z
dc.descriptionCITATION: Heitkamp, A., et al. 2020. Major obstetric haemorrhage in Metro East, Cape Town, South Africa : a population-based cohort study using the maternal near-miss approach. Pregnancy and Childbirth, 20:14, doi:10.1186/s12884-019-2668-x.
dc.descriptionThe original publication is available at https://bmcpregnancychildbirth.biomedcentral.com
dc.description.abstractBackground: Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome. Methods: Women with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014–November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks’ gestation or occurring up to 42 days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of ≥5 units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death. Results: The incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4–7) and 3 (interquartile range 2–4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14]. Conclusions: Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.en
dc.description.urihttps://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2668-x
dc.description.versionPublisher's version
dc.format.extent8 pages
dc.identifier.citationHeitkamp, A., et al. 2020. Major obstetric haemorrhage in Metro East, Cape Town, South Africa : a population-based cohort study using the maternal near-miss approach. Pregnancy and Childbirth, 20:14, doi:10.1186/s12884-019-2668-x
dc.identifier.issn1471-2393 (online)
dc.identifier.otherdoi:10.1186/s12884-019-2668-x
dc.identifier.urihttp://hdl.handle.net/10019.1/107355
dc.language.isoen_ZAen_ZA
dc.publisherBMC (part of Springer Nature)
dc.rights.holderAuthors retain copyright
dc.subjectPlacenta -- Hemorrhage -- City of Cape Town (South Africa)en_ZA
dc.subjectLabor (Obstetrics) -- Complicationsen_ZA
dc.subjectMothers -- Mortality -- City of Cape Town (South Africa)en_ZA
dc.titleMajor obstetric haemorrhage in Metro East, Cape Town, South Africa : a population-based cohort study using the maternal near-miss approachen_ZA
dc.typeArticleen_ZA
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