The use of audit to identify maternal mortality in different settings: is it just a difference between the rich and the poor?

Objective: To illustrate how maternal mortality audit identifies different causes of and contributing factors to maternal deaths in different settings in low- and high-income countries and how this can lead to local solutions in reducing maternal deaths.

Design: Descriptive study of maternal mortality from different settings and review of data on the history of reducing maternal mortality in what are now high-income countries.

Settings: Kalabo district in Zambia, Farafenni division in The Gambia, Onandjokwe district in Namibia, and the Netherlands.

Nearly fatal uterine rupture during manual removal of the placenta: a case report.

Background: A uterine scar is a well-known riskfactorfor both abnormal placentation and uterine rupture, both of which may lead to a serious obstetric hemorrhage.

Case: A 23-year-old woman, gravida 2, para 0 with a history of first-trimester dilatation and curettage (D&C) experienced a life-threatening obstetric hemorrhage due to uterine rupture during manual removal of a placenta increta. Cessation of the bleeding occurred only following secondary embolization after hysterectomy.

Partogram use in the Dar es Salaam perinatal care study.

Objective: To assess the quality of partograms used to monitor labor in Dar es Salaam hospitals, Tanzania.

Methods: The study team reviewed the records of the parameters of labor, and maternal and fetal conditions in 367 partograms, and interviewed 20 midwives.

Results: All midwives interviewed had been previously trained to use the partogram.

Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe.

Background: The EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System (EUPHRATES) is a set of five linked projects, the first component of which was a survey of policies for management of the third stage of labour and immediate management of postpartum haemorrhage following vaginal birth in Europe.

Objectives: The objectives were to ascertain and compare policies for management of the third stage of labour and immediate management of postpartum haemorrhage in maternity units in Europe following vaginal birth.

Design: Survey of policies.

[Diagnostic image (320). A new mother with opisthotonus and extensor spasms].

A 21-year-old woman was admitted to a rural hospital in Tanzania after a home delivery one week before. She had signs of general body rigidity due to maternal tetanus.

The use of audit to identify maternal mortality in different settings: is it just a difference between the rich and the poor?

Objective: To illustrate how maternal mortality audit identifies different causes of and contributing factors to maternal deaths in different settings in low- and high-income countries and how this can lead to local solutions in reducing maternal deaths.

Design: Descriptive study of maternal mortality from different settings and review of data on the history of reducing maternal mortality in what are now high-income countries.

Settings: Kalabo district in Zambia, Farafenni division in The Gambia, Onandjokwe district in Namibia, and the Netherlands.

Maternal deaths after elective cesarean section for breech presentation in the Netherlands.

Background And Methods: The cesarean section rate for term singleton breech babies in the Netherlands rose from 57 to 81% after the Term Breech Trial in 2000. The Dutch Maternal Mortality Committee registered and evaluated maternal mortality due to elective cesarean section for breech.

Results: Four maternal deaths after elective cesarean section for breech presentation, from 2000 to 2002 inclusive, were registered, 7% of total direct maternal mortality in that period.

Caesarean section in a semi-rural hospital in Northern Namibia.

Background: Increasing caesarean sections rates (CSR) are a major public health concern and the prevention of the first caesarean section, which often leads to repeat operations, is an important issue. Analyzing caesarean sections can help to identify factors associated with variations in CSR and help to assess the quality of clinical care.

Methods: In a retrospective observational study, during a two year period, indications of 576 caesarean sections were analyzed using intra-operative internal pelvimetry and a record keeping system in a semi-rural hospital in Northern Namibia.

Maternal mortality in the Greater Accra region in Ghana: assessing completeness of registration and data quality.

Objective: To assess the completeness of registration of maternal mortality by comparing various data sources and to review the quality of information pertaining to individual cases.

Data Source And Methods: Female deaths aged 10-50 years in the Greater Accra region in Ghana from January 1, 2000 to December 31, 2000 were recorded. Identified maternal deaths (International Classification of Diseases, 9th revision) in four major hospitals in the region were compared with those registered in the civil registers.

Severe anemia in pregnancy in rural Ghana: a case-control study of causes and management.

Background: Various factors contribute to severe anemia in pregnancy in low-income countries. This study assesses which of these are of importance in rural Ghana, and evaluates management.

Methods: Prospective case-control study in two (sub)district hospitals in rural Ghana among 175 severely anemic pregnant women (Hb < 8.

Postpartum care attendance at a rural district hospital in Zambia.

Postpartum care is an important tool in both preventive and promotive maternal health care. We studied the postpartum care attendance rate in 540 women who delivered at a district hospital in Zambia. Forty-two percent of the women attended postpartum care within six weeks of delivery.

Influence of a TiCl4 post-treatment on nanocrystalline TiO2 films in dye-sensitized solar cells.

In this study, the influence of the TiCl(4) post-treatment on nanocrystalline TiO(2) films as electrodes in dye-sensitized solar cells is investigated and compared to nontreated films. As a result of this post-treatment cell efficiencies are improved, due to higher photocurrents. On a microscopic scale TiO(2) particle growth on the order of 1 nm is observed.

[The UN Millennium Project; especially the prevention and treatment of the HIV-virus and AIDS in order to reduce child and maternal mortality].

Reducing child and maternal mortality are important UN Millennium Development Goals. The AIDS epidemic, which is targeted in another Millennium Development Goal, has a negative influence on child and maternal health. Although on a mondial level, the influence of HIV/AIDS on child and maternal mortality appears to be slight, HIV/AIDS constitutes a significant factor in Sub-Saharan Africa.

[No caesarean section on demand without a proper indication].

The risk/benefit ratio of caesarean section versus vaginal birth does not justify performing the operation solely on demand of the woman without a medical indication. Underlying fear of childbirth should be addressed by other means rather than simply performing the operation. These considerations should not be outweighed by women's freedom to decide.

Maternal and fetal outcome after severe anemia in pregnancy in rural Ghana.

Background: Anemia in pregnancy contributes to poor outcome for mother and child in low-income countries. This study analyzes adverse maternal and fetal outcome after severe anemia in pregnancy in rural Ghana.

Methods: A cohort study in two (sub)district hospitals, including 157 pregnant women exposed to severe anemia (Hb < 8.

Obstetric intensive care admissions: a 12-year review in a tertiary care centre.

Objective: To review all pregnant women who required admission to an Intensive Care Unit (ICU) during pregnancy, childbirth or puerperium.

Study Design: Retrospective follow-up study in a tertiary care centre in The Netherlands. The files of all obstetric ICU admissions over the period 1990-2001 were reviewed.