Background: Falling numbers of maternal deaths have stimulated an interest in investigating cases of life threatening obstetric morbidity or near miss. The purpose of this study was to document the frequency and causes of near miss and maternal deaths in four hospitals in West Java, Indonesia. Methods: Cross sectional study in four hospitals in two districts in
Banten province, Indonesia. We reviewed registers and case notes to
identify the numbers and causes of near miss and death between November
2003 and October 2004. Near miss cases were defined based on organ
dysfunction, clinical and management criteria. Near miss were
categorized by whether or not the woman was at a critical state at
admission by reviewing the final signs at admission.
Results: The prevalence of near miss was much greater in public than in
private hospitals (17.3% versus 4.2%, p = 0.000). Hemorrhage and
hypertensive diseases were the most common diagnoses associated with
near miss, and vascular dysfunction was the most common criterion of
organ dysfunction. The occurrence of maternal deaths was 1.6%, with
non-obstetric complications as the leading cause. The majority (70.7%)
of near miss in public hospitals were in a critical state at admission
but this proportion was much lower in private hospitals (31.9%).
Conclusion: Close to a fifth of admissions in public hospitals were
associated with near miss; and the critical state in which the women
arrived suggest important delays in reaching the hospitals. Even though
the private sector takes an increasingly larger share of facility-based
births in Indonesia, managing obstetric emergencies remains the domain
of the public sector.
Adisasmita, A.; Deviany, P.E.; Nandiaty, F.; Stanton, C.; Ronsmans, C. Obstetric near miss and deaths in public and private hospitals in Indonesia. BMC Pregnancy and Childbirth (2008) 8 (1) 10. [DOI: 10.1186/1471-2393-8-10]
Obstetric near miss and deaths in public and private hospitals in Indonesia.