1. Severe maternal morbidity among women with a history of cesarean section at a tertiary referral teaching hospital in the southeast of Iran.
- Author
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Moudi, Z., Arabnezhad, L., Ansari, H., and Tabatabaei, S.M.
- Subjects
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ACADEMIC medical centers , *ANEMIA , *CESAREAN section , *CHILDBIRTH , *CONFIDENCE intervals , *DISEASES , *ECLAMPSIA , *HEMOGLOBINS , *HEMORRHAGE , *INFECTION , *MEDICAL quality control , *MATERNAL mortality , *MULTIVARIATE analysis , *PLACENTA diseases , *PREECLAMPSIA , *SEPSIS , *WOMEN'S health , *LOGISTIC regression analysis , *RESIDENTIAL patterns , *CROSS-sectional method , *ODDS ratio , *DISEASE complications , *PREGNANCY ,PREGNANCY complication risk factors - Abstract
Although the cesarean section (C-section) is known as a lifesaving procedure, it can also increase the risk of maternal mortality and morbidity. This study was conducted to achieve two objectives: (1) determination of maternal near miss (MNM) indicators and pregnancy outcomes among women with a history of C-section and (2) investigation of the women's experience of near miss events during childbirth to provide a deeper understanding of the weaknesses of care delivery process. The present study was conducted using a prospective cross-sectional study using the World Health Organization (organ system dysfunction–based) criteria. All subjects were women at more than 22 weeks of gestation who gave birth in Ali ibn Abi Talib Hospital, Zahedan, Iran, and were referred to this hospital for childbirth or those within 42 days of pregnancy termination. Logistic regression was used to predict the risk factors for severe maternal outcomes (SMOs). Nearly 58% of all MNM cases were related to women with a history of C-section. The MNM ratio was estimated at 8.04 per 1000 live births. Moreover, the frequent causes of SMOs were reported as severe hemorrhage (58.3%), severe pre-eclampsia/eclampsia (27.8%), medical condition (8.3%), and sepsis or severe systemic infection (5.6%). Abnormally invasive placenta (61%) was the most common cause of severe hemorrhage. After adjustment for potential confounder variables, the hemoglobin level of <11 g/dl (odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.09–0.36) and place of residence (OR = 0.41, 95% CI = 0.19–0.90) remained as independent risk factors for SMOs in the final model of multivariate analysis. A risk assessment system is needed to diagnose and manage the risk factors for SMOs during prenatal care. In addition, there should be a continuous audit of the indication and number of C-sections performed across health facilities. • Fifty-eight percent of all maternal near miss (MNM) cases were related to women with a history of cesarean section. • Abnormally invasive placenta was the most common cause of sever hemorrhage. • Anemia and living in rural areas were the determinants of severe maternal outcomes. • Delay in providing care and harmful practices were contributed to MNM incidence. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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