A ten year analysis of maternal deaths in a tertiary hospital using the three delays model (original) (raw)
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Nursing Communications
Background: Maternal mortality is a prevalent issue in healthcare provision worldwide. It is particularly common in developing and underdeveloped countries, where maternal deaths during childbirth or pregnancy occur frequently. Various internal and external factors contribute to the high maternal mortality rate in specific regions. One model, known as the three delays model approach, examines three distinct causes that contribute to this problem. The first delay is the lack of awareness in seeking timely healthcare, the second delay involves obstacles in reaching healthcare facilities on time, and the third delay relates to poor or inadequate healthcare provision in tertiary care facilities. These delays are responsible for the elevated maternal mortality rates, with the prevalence of each delay varying across regions. Objective: The objective of this literature review is to examine and critically evaluate existing literature on perceptions and investigations regarding maternal mortality in Southeast Asia, Europe and Africa, utilizing the three delays model approach as a categorization framework. Method: This literature review followed BEME guide No. 3. A total of 18 articles were included in the sample after conducting a thorough search of various databases and search engines. A Prisma flowchart was created, and the articles were critically appraised. Results: A total of 18 articles focusing on different regions were analyzed. The findings revealed that in countries of Southeast Asia, the primary cause of maternal mortality is the first delay, which refers to the lack of awareness in seeking medical care. On the other hand, in Africa and other European countries, the second and third delays are more prominently associated with maternal mortality. Conclusion: Inadequate care is one of the major causes of maternal mortality in majority of regions acrossthe globe. Multiple factors can hinder access to appropriate healthcare. The three delays model plays a significant role in the higher maternal mortality rate. By raising awareness among women and their families about the importance of seeking healthcare, the risk of fatality can be reduced. Similarly, in developing regions, it is crucial to ensure that healthcare facilities are easily accessible and provide high-quality emergency obstetric care to meet the needs of pregnant women in critical situations.
Three delay model: to find out the reason for maternal deaths
International Journal of Research in Medical Sciences, 2020
Background: Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million new-born deaths occur each year. A woman dies as a result of complication arising during pregnancy and childbirth every 90 seconds in the world, and every 7 minutes in India. The three delay model can be used to find the causes of delays in relation to maternal deaths.Methods: A retrospective study was carried out in a tertiary care centre. All cases of maternal mortality between July 2010 to June 2016 were included in the study. Then data analysis was done.Results: Out of the total 382 maternal deaths, Majority of maternal deaths 43% were due to type 1 delay. 150 patients had delay in seeking help, 9 patients refused treatment and 5 patients refused admission to health care centre. 13% maternal deaths were due to type 3 delay which include delay in receiving adequate treatment, Delay in diagnosis and interventi...
Third delay of Maternal Mortality in a tertiary hospital
2007
Objective: To assess the magnitude, causes and substandard care factors responsible for the third delay of maternal mortality seen in our unit III, Department of Obstetrics and Gynecology, Civil Hospital, Karachi. Methods: This Cross-sectional, retrospective study was carried out on 152 mothers who died over a period of eight years from 1997 to 2004 at Civil Hospital Karachi. Death summaries of all maternal deaths were reviewed from death registers and were studied for substandard care factors which could have been responsible for the third delay of maternal mortality. Results: The frequency of maternal mortality was 1.3 per 100 deliveries. The mean age was 29±6.49 years and mean parity was 3.24±3.25.The main causes of death were hypertensive disorders in 52/152 (34.21%), hemorrhage in 40/152 (26.31%), unsafe abortion in 16/152 (10.52%), puerperal sepsis in 14/152 (9.21%) and obstructed labor in 11/152 (7.2%) cases. Substandard care factors were present in 76.7% of patients, which i...
Factors associated with maternal mortality in Malawi: application of the three delays model
BMC Pregnancy and Childbirth, 2017
Background: The three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care. Previously, the majority of women who died were reported to have experienced type 1 and 2 delays. With increased coverage of healthcare services, we sought to explore the relative contribution of each type of delay. Method: 151 maternal deaths were identified during a 12-month reproductive age mortality survey (RAMOS) conducted in Malawi; verbal autopsy and facility-based medical record reviews were conducted to obtain details about the circumstances surrounding each death. Using the three delays framework, data were analysed for women who had; 1) died at a healthcare facility, 2) died at home but had previously accessed care and 3) died at home and had not accessed care. Results: 62.2% (94/151) of maternal deaths occurred in a healthcare facility and a further 21.2% (32/151) of mothers died at home after they had accessed care at a healthcare facility. More than half of all women who died at a healthcare facility (52.1%) had experienced more than one type of delay. Type 3 delays were the most significant delay for women who died at a healthcare facility or women who died at home after they had accessed care, and was identified in 96.8% of cases. Type 2 delays were experienced by 59.6% and type 1 delays by 39.7% of all women. Long waiting hours before receiving treatment at a healthcare facility, multiple delays at the time of admission, shortage of drugs, non-availability and incompetence of skilled staff were some of the major causes of type 3 delays. Distance to a healthcare facility was the main problem resulting in type 2 delays. Conclusion: The majority of women do try to reach health services when an emergency occurs, but type 3 delays present a major problem. Improving quality of care at healthcare facility level will help reduce maternal mortality.
Three-Delay Model on Maternal Mortality Cases in Tertiary Referral Hospital in Indonesia
eJournal Kedokteran Indonesia
Maternal mortality remains a worldwide concern to this day. Three main causes of maternal mortality during 2010–2013 were hemorrhage, hypertension, and infection, which all of them are the direct causes. The high MMR is also due to the presence of 3 delay which is Delay in seeking assistance (type–1), delay in identifying and accessing medical center (type–2) and delay in having prompt treatment (type–3) . Therefore, this study aims to describe maternal mortality cases in tertiary hospital which is Cipto Mangunkusumo Hospital (CMH) so that the root of problems in maternal deaths can be discovered and improvements can be done in the future. This was a descriptive study conducted in the Department of Obstetrics and Gynecology at CMH, Jakarta. Data collection was taken from 2016 – 2018 where subjects were taken from secondary data on maternal mortality. Based on the data that has been collected in CMH total live births in Emergency Department CMH during 2016-2018 which was 4.226 cases....
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Maternal deaths are the social indicators of the human development and hence their place in MDGs and now in SDGs. Even though India has made a great stride in reducing maternal deaths, the differentials in the states are huge ranging from 46 to 237 maternal deaths per 100000 live births. The three delay model assesses the issues in the emergency obstetric care and upon which the interventions can be based to improve maternal health indicators.Methods: Retrospective record based observational study was carried out at an obstetrics and gynecology department of a tertiary care hospital located at Northern Maharashtra region. The records of deliveries, maternal deaths, age of the mothers, their time of presentation with obstetric complication, level of delay and the reason for delay were extracted for the period of 2011 to 2016. Three delays being, level I - delay in decision to seek care, level II - delay in identifying and reaching medical facility, level III - delay in re...
Socio-demographic characteristics and the three delays of maternal mortality
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2009
OBJECTIVE To describe the socio-demographic characteristics and the three delays of maternal mortality in a tertiary teaching hospital. STUDY DESIGN Retrospective, observational study. PLACE AND DURATION OF STUDY Department of Obstetrics and Gynaecology, Unit III, Civil Hospital, Karachi, from April 2005 to May 2008. METHODOLOGY One hundred and four consecutive maternal deaths were reviewed. Data regarding age, parity, sociodemographic characteristics, booking status, referral source, cause of death and the three delays was collected on structured proformas, analyzed by the statistical software, SPSS version 13, and presented in the form of frequencies and percentages. RESULTS The projected maternal mortality ratio was 1650/100,000 live births. The mean age was 28+/-6.2 years and median parity was two. Seventy-one women (68%) were uneducated, 65 (62.5%) belonged to lower socioeconomic class and 60 (58%) had received no antenatal care. Ninety-eight women (94%) had one or more delays,...
Maternal mortality: a tertiary care hospital experience in Upper Egypt
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: Maternal mortality is one of the major challenges which face the developing countries throughout the world. The aim of the study is to assess the causes of maternal mortality at Women Health Hospital, Assiut University, Egypt, and to identify the avoidable ones. Methods: Data were collected from records of patients who presented to and/or delivered at Women Health Hospital between 2009 and 2014. Only cases of maternal mortality were included in this study. In our study, we found 213 maternal deaths at our hospital between 2009 and 2014. Results: The maternal mortality ratio decreased progressively from 2009 to 2014 (228 and 89 per 100000 live birth respectively). Moreover, we found that the indirect causes of maternal mortality accounted for 24.9 % of all mortalities. As regards the direct causes of maternal mortality, preeclampsia remained the primary cause and represented 27.7 % of the avoidable causes. The second most frequent cause of direct maternal mortality was postpartum hemorrhage (PPH), which represented 26.8 %. Conclusions: Preeclampsia and PPH, as well as their complications are the leading causes of death in one of the biggest tertiary care university hospitals in Egypt. However, there are other important avoidable predisposing factors that should be dealt with including lack of patient education, delayed transfer from other hospitals, and substandard practice.