FACTORES AMBIENTALES A EVALUARSE 1 DESECHOS SÓLIDOS

There were 7.9% (12/151) MDs for whom underlying cause of death could not be determined by the panel of experts, [Table 7.3]. Among these 12 deaths, 9 occurred outside the health facilities. They were 5 antenatal and 7 postnatal deaths. The majority of the deaths (7/12) which occurred in community were postnatal deaths. The available details of MDs with unspecified cause of death are provided in Table 7.4.

Table 7.3: Underlying cause of maternal deaths by panel of experts using ICD-MM

Type and group name

Total number of MDs in sub- category (%) Total number of MDs (n=151) (%)

A. Maternal death: Direct 113 (74.8%)

1. Pregnancies with abortive outcome 15 (9.9%)

 Spontaneous abortion, incomplete, complicated with genital tract and pelvic infection - 003.0

5 (33.3%) 57% 23% 8% 8% 4% Malaria AIDs-related Meningitis Tuberculosis Pneumonia

 Spontaneous abortion, incomplete complicated by excessive haemorrhage - 003.1

8 (53.3%)

 Induced abortion - 006 2 (13.3%)

2. Hypertensive disorders in pregnancy, childbirth

and the pueperium 19 (12.6%)

- Eclampsia in pregnancy - 015.0 4 (21.1%) - Eclampsia in labour - 015.1 4 (21.1%) - Eclampsia in the puerperium - 015.2 8 (42.1%) - Severe Pre-Eclampsia - 014.1 3 (15.7%)

3. Obstetric Haemorrhage 54 (35.8%)

 Placenta praevia with haemorrhage - 044.1 2 (3.7%)

 Placenta abruption - 045 2 (3.7%)

 Antepartum haemorrhage not specified - 046 1 (1.9%)

 Retained placenta - 072.0 17 (31.5%)

 PPH following placenta delivery (atonic PPH) - 072.1

14 (25.9%)  Postpartum haemorrhage - 072 3 (5.6%)  Ruptured uterus during labour - 071.1 14 (25.9%)

 Obstetric laceration of cervix - 071.3 1 (1.9%)

4. Pregnancy-related Infections 22 (14.6%)

 Puerperal sepsis - 085 17 (77.3%)

 Puerperal sepsis after caesarean section - 086.0 5 (22.7%)

5. Other obstetric Complications 2 (1.3%)

Amniotic fluid Embolism - 088.1 1 (50%)

Pulmonary embolism - 088.2 1 (50%)

6. Unanticipated complications of management 1 (0.7%)

 Complications of anaesthesia during labour and delivery -074

1 (100%)

B. Maternal death indirect 26 (17.3%)

7. Non-obstetric complications

 AIDS related 0.98.7 6 (23.1%)

 Tuberculosis complicating pregnancy, childbirth and the puerperium - 098.0

2 (7.6%)  Other maternal infections and parasitic diseases,

complicating pregnancy, childbirth and the puerperium - 098.8 o Malaria o Pneumonia o Meningitis 18 (69.2%) 15 (83.3%) 1 (5.6 %) 2 (11.1%)

C. Maternal death: unspecified 12 (7.9%)

8. Unknown/Undetermined

 Maternal deaths from unspecified cause occurring during pregnancy, childbirth or the puerperium - 095

12 (100%)

Total 151 (100%)

Table 7.4: Details of maternal deaths with unknown/undetermined cause of death (n=12)

Id Pregnancy state

at time of death

Place of death Summary of the case

12 antenatal Health facility Gravida 3 para 2 was 32 weeks gestation, complained of heart palpitations and died on arrival at the health centre. No history of vaginal bleeding, fever, anaemia or high blood pressure prior to death. She did not receive antenatal care.

24 antenatal Health facility Gravida 3 para 2 at 20 weeks gestation. Had negative test for malaria, convulsions, no fever and was bleeding vaginally. Blood pressure was 120/84. No history of high blood pressure, eclampsia or pre-eclampsia during the previous pregnancies. Her HIV status was unknown.

Mgawadere F. - University of Liverpool – 2014 153 372 antenatal Health facility Gravida 2 para 1, 34 weeks gestation, had severe anaemia in

pregnancy, coughing, malaria test (RDT) negative, reported to facility in a critical condition. Relatives said she convulsed three times at home before coming to the hospital. B.P: 110/75. HIV status was not known. She died within 30 minutes of admission. 26 postnatal Outside health

facility

Para 4, was HIV positive on HAART for one year, she had fever, was coughing and complained of abdominal pains and leg pains. Relatives reported she looked pale before she died. She died 24 days at home after caesarean section (C/S). Her C/S wound healed well. She died suddenly in her sleep.

34 postnatal Outside health facility

Para 3, died at home 26 days after delivery with history of general body pains and heart palpitations and backache. She lost consciousness and was groaning on the day of death and relatives thought she was bewitched.

265 antenatal Outside health facility

Gravida 1 para 0, divorced, at 24 weeks’ gestation, with severe cough for more than three weeks, puffy face, breathlessness swelling of hands and legs and was pale. General body pains and no fever. Relatives reported she had distended abdomen. Crying sometimes. HIV status not known

291 postnatal Outside health facility

Para 6 delivered a full term baby with history of shingles, weight loss, pale, chills, paralysis of legs and arms, not speaking. She was on HAART. Died at home 5 days after delivery.

150 Post abortion Outside health facility

Gravida 3 para 2+1_{, 20 weeks gestation, ?induced abortion at}

home and died 18 days after abortion, complained of headache and general body pains, chills , no fever and sleeplessness, she was also talking to herself (confused).

179 postnatal Outside health facility

Para 3, who delivered at 38 weeks gestation, complained of general body pains, fever, and headache 30 days after delivery. Was HIV positive on HAART, was not eating and showed signs of wasting.

10 antenatal Outside health facility

Gravida 2 para 1. Died at home at 24 weeks gestation had puffy face, blurred vision and oedematous limbs. She was confused at times She had no food in her house because her husband divorced her while pregnant, relatives thought she was bewitched. Was crying at times.

131 postnatal Outside health facility

Para 5, delivered at home and had fever on and off after

delivery, coughing, general body pains and pale. One side of the arm was not functioning. Had history of shingles. Went to traditional healer for treatment. She died 3 weeks after delivery. 293 postnatal Outside health

facility

Para 3 delivered a macerated still birth at 38 weeks at home. She had a puffy face, fever, headache, pale and one arm not

functioning. HIV status was not known. Went to a traditional healer