Maternal mortality at Mount Hope Women's Hospital, Trinidad
Roopnarinesingh, S.; Ramoutar, P.; Bassaw, B.
West Indian Medical Journal 40(3): 139-141
1991
ISSN/ISBN: 0043-3144 PMID: 1957523 Document Number: 317558
Obstetrical deaths at the Mount Hope Women's Hospital, Trinidad, were reexamined from records over 1981-1990, and discussed under the categories poor prenatal care, clinical management or provision of medical facilities. There were 19 obstetrical deaths out of 57,012 live births, giving a maternal mortality rate of 33.3/100,000 in this tertiary care hospital. Most of the deaths occurred in women aged 30-34, para 5 or more. 73.7% were related to hypertension in pregnancy, 8 with severe eclampsia and 6 with eclampsia, and the other 5 were due to placental abruption, postpartum hemorrhage, anesthesia complication, acute fatty liver and amniotic fluid embolism. Cases classified as substandard care included the 14 women with hypertensive disorders, none of whom had antenatal care at this specialized unit. In 3 referral by the practitioner was delayed, and 3 others did not comply. A woman listed under failed medical facilities had massive abruptio placenta, and no fresh blood was available, and another had an anaphylactic reaction to a mismatched blood transfusion. Other avoidable deaths were 3 associated with general anesthesia: one woman having emergency cesarean section for severe pre-eclampsia had anoxia and severe brain damage; another short, obese woman had cardiac arrest during a failed attempt at endotracheal intubation; a third died from aspiration of gastric fluid. The high mortality among women with hypertensive disorders is regrettable, considering lack of referral to this specialized unit, but the prognosis of eclamptics even with expert aggressive treatment is poor. This maternal mortality rate ranks midway between those of developed countries and developing countries. It is about four times that of the U.S.