The Impact of Audits of Maternal Deaths and Near Miss at University Hospital of Mother and Child Lagoon (Benin)

Abstract

Introduction: The maternal deaths audit is one of the three major strategies recommended by WHO for the reduction of maternal and neonatal mortality. Objective: To measure the impact of maternal death and nears miss review on maternal mortality and morbidity after 7 years of practice at the University Hospital of Mother and Child “Lagoon” of Cotonou. Methodology: It was a transversal, descriptive, and analytical study with retrospective data from 1st January 2007 to 31st December 2013. The studied population consisted of maternal deaths cases and of near miss occurred in the hospital during the study period. Results: During the study period, the hospital registered a total of 321 maternal deaths, 3825 perinatal deaths and 3827of near miss. The frequency of maternal death review was 18.7%, the perinatal death of 0.2% and the near miss 0.4%. The most frequent disorders were inadequate reference (69.7%), inadequate treatment (53%), poor supervision (62.1%) and poor files documentation (49.9%). Globally, the period of conducting clinical review was significantly associated with decreased postpartum hemorrhage (p<0.001), pre-eclampsia and eclampsia episodes (p<0.001) and the occurrence of uterine rupture (p=0.02). The occurrence of HRP decreased from 2007 to 2013, but this decrease was not statistically significant (p=0.09). However, there was a significant decrease between 2006 and 2007 (reference period), between 2008 and 2006 and between 2010 and 2006. There is a tendency to lower placenta praevia episodes from 2008-2013 but this decrease does is not statistically significant (p=0.18). Moreover, a significant increase in cases of placenta praevia is observed between 2006 and 2007 (p=0.02). Conclusion: The introduction of maternal death audits is a good approach to reducing maternal mortality and morbidity. However the decrease in indicators of our study can’t be solely attributed to the effect of audits.