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Maternal Characteristics and Clinical Diagnoses Influence Obstetrical Outcomes in Indonesia

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Abstract

This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic status, access to care and referral patterns. Reduced logistic models were constructed, and multivariate analyses used to assess association of risk variables to outcome. Using multivariate analysis, variables associated with risk of near-miss/death include postpartum hemorrhage (retrospective AOR 5.41, 95 % CI 2.64–11.08; prospective AOR 10.45, 95 % CI 5.59–19.52) and severe preeclampsia/eclampsia (retrospective AOR 1.94, 95 % CI 1.05–3.57; prospective AOR 3.26, 95 % CI 1.79–5.94). Associations with near-miss/death were seen for antepartum hemorrhage in retrospective data (AOR 9.34, 95 % CI 4.34–20.13), and prospectively for poverty (AOR 2.17, 95 % CI 1.33–3.54) and delivering outside the hospital (AOR 2.04, 95 % CI 1.08–3.82). Postpartum hemorrhage and severe preeclampsia/eclampsia are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital are significant risk factors. Prompt recognition of complications, timely referrals, standardized care protocols, prompt hospital triage, and structured provider education may reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective data provided valuable information about barriers to care and referral patterns.

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References

  1. World Health Organization (WHO). (2014). Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division. Geneva, World Health Organization. http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1. Retrieved November 11, 2014.

  2. World Health Organization (WHO). (2014). Maternal mortality Fact sheet No. 348, Geneva, World Health Organization. http://www.who.int/mediacentre/factsheets/fs348/en/. Retrieved November 7, 2014.

  3. Hill, K., Abou Zhar, C., & Wardlaw, T. (2001). Estimates of maternal mortality for 1995. Bulletin of the World Health Organization, 79, 182–193.

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S. M., et al. (2010). Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal. Lancet,. doi:10.1016/S0140-6736(10)60518-1.

    Google Scholar 

  5. Statistics Indonesia (Badan Pusat Statistik—BPS), National Population and Family Planning Board (BKKBN), and Kementerian Kesehatan (Kemenkes—MOH), and ICF International. (2013). Indonesia Demographic and Health Survey 2012. Jakarta: BPS, BKKBN, Kemenkes, and ICF International.

    Google Scholar 

  6. WHO and UNICEF. (2013). Accountability for maternal, newborn and child survival: The 2013 update. Geneva. http://www.countdown2015mnch.org/documents/2013Report/Countdown_2013-Update_withprofiles.pdf. Retrieved November 17, 2014.

  7. Ronsmans, C., Scott, S., Qomariyah, S. N., Achadi, E., Braunholtz, D., Marshall, T., et al. (2009). Professional assistance during birth and maternal mortality in two Indonesian districts. Bulletin of the World Health Organization, 87, 416–423.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hermiyanti S. The challenge of making safe motherhood a reality: Community midwives in Indonesia. 2008. Ahmedabad. http://209.61.208.233/LinkFiles/FCH_d3-7challenges-msm-ino.pdf. Retrieved December 10, 2013.

  9. Ronsmans, C, & Filippi, V. (2004). Reviewing severe maternal morbidity: learning from women who survive life threatening complications. In: G. Lewis (Ed.), Beyond the numbers. Reviewing maternal deaths and complications to make pregnancy safer, pp. 103–123. Geneva: World Health Organization. http://whqlibdoc.who.int/publications/2004/9241591838.pdf. Retrieved December 2, 2013.

  10. Badan Pusat Statistik-Statistics Indonesia (BPS) [Indonesia], ORC Macro. (2007). Indonesia demographic and health survey 2007. Calverton, Maryland: BPS and ORC Macro. http://www.measuredhs.com/pubs/pdf/FR218/FR218[27August2010].pdf. Retrieved December 17, 2013.

  11. Supratiko, G., Wirth, M. E., Achadi, E., Cohen, S., & Ronsman, S. C. (2002). A district-based audit of the causes and circumstances of maternal deaths in South Kalimantan, Indonesia. Bulletin of the World Health Organization, 80, 228–234.

    Google Scholar 

  12. Ministry of Health [Indonesia]. (2001). National strategic plan for making pregnancy safer (MPS) in Indonesia 2001–2010. Jakarta: Ministry of Health.

  13. Tuncalp, O., Hindin, M. J., Souza, J. P., Chou, D., & Say, L. (2012). The prevalence of maternal near miss: A systematic review. BJOG, 119, 653–661.

    Article  CAS  PubMed  Google Scholar 

  14. Oladapo, O. T., Sule-Odu, A. O., Olatunji, A. O., & Daniel, O. J. (2005). “Near-miss” obstetric events and maternal deaths in Sagamu, Nigeria: A retrospective study. Reproductive Health, 2, 9. doi:10.1186/1742-4755-2-9.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Mustafa, R., & Hashmi, H. (2009). Near-miss obstetrical events and maternal deaths. Journal of the College of Physicians and Surgeons Pakistan, 19, 781–785.

    PubMed  Google Scholar 

  16. Shrestha, N. S., Saha, R., & Karki, C. (2010). Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital. Kathmandu University Medical Journal, 8, 222–226.

    CAS  Google Scholar 

  17. Lotufo, F. A., Parpinelli, M. A., Haddad, S. M., Surita, F. G., & Cecatti, J. G. (2012). Applying the new concept of maternal near-miss in an intensive care unit. Clinics (Sao Paulo), 67, 225–230.

    Article  Google Scholar 

  18. Souza, J. P., Cecatti, J. G., Faundes, A., Morais, S. S., Villar, J., Carroli, G., et al. (2010). Maternal near miss and maternal death in the World Health Organization’s 2005 global survey on maternal and perinatal health. Bulletin of the World Health Organization, 88, 113–119.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Waterstone, M., Bewley, S., & Wolfe, C. (2001). Incidence and predictors of severe obstetric morbidity: Case control study. BMJ, 322, 1089–1094.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. World Health Organization. (2014). Global health observatory maternal mortality country profiles. http://www.who.int/gho/maternal_health/countries/en/. Retrieved November 24, 2014.

  21. WHO. (2011). Evaluating the quality of care for severe pregnancy complications: The WHO near-miss approach for maternal health. http://whqlibdoc.who.int/publications/2011/9789241502221_eng.pdf. Retrieved January 9, 2014.

  22. Pattinson, R. C., & Hall, M. (2003). Near-misses: A useful adjunct to maternal death enquiries. British Medical Bulletin, 67, 231–243.

    Article  CAS  PubMed  Google Scholar 

  23. Haddad, S. M., Cecatti, J. G., Souza, J. P., Sousa, M. H., Parpinelli, M. A., Costa, M. L., et al. (2014). Applying the maternal near miss miss approach for the evaluation of quality of obstetric care: A worked example from a Multicenter Surveillance Study. BioMed Research International. doi:10.1155/2014/989815.

    Google Scholar 

  24. Say, L., Souza, J. P., & Pattinson, R. C. (2009). Maternal near miss: towards a standard tool for monitoring quality of maternal health care. Best Practice and Research: Clinical Obstetrics and Gynaecology, 23, 287–296.

    Article  PubMed  Google Scholar 

  25. Adisasmita, A., Deviany, P. E., Nandiaty, F., Stanton, C., & Ronsmans, C. (2008). Obstetric near miss and deaths in public and private hospitals in Indonesia. BMC Pregnancy Childbirth, 8, 10.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Mantel, G. D., Buchmann, E., Rees, H., & Pattinson, R. C. (1998). Severe acute maternal morbidity: A pilot study of a definition of a near miss. BJOG, 105, 985–990.

    Article  CAS  Google Scholar 

  27. Oladapo, O. T., Adetoro, O. O., Fakeye, O., Ekele, B. A., Fawole, A. O., Abasiattai, A., et al. (2009). Nigerian Network for Reproductive Health Research and Training (NNRHRT). National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria. Reproductive Health, 6, 8.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Central Bureau of Statistics (CBS) [Indonesia], State Ministry of Population/National Family Planning Coordinating Board, Ministry of Health, and Macro International. (1998). Indonesia demographic and health survey 1997. Calverton, Maryland: CBS and Macro International. http://pdf.usaid.gov/pdf_docs/PNACD956.pdf. Retrieved December 4, 2013.

  29. Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: Wiley.

    Book  Google Scholar 

  30. Ministry of Health. (2001). Indonesia national household health survey (Surkesnas). Mortality Study. National Institute of Health Research and Development (NIHRD): Jakarta.

  31. Amaral, E., Souza, J. P., Surita, F., Luz, A. G., Sousa, M. H., Cecatti, J. G., et al. (2011). A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project. BMC Pregnancy Childbirth, 11, 9.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Supratikto, G., Wirth, M. E., Achadi, E., Cohen, S., & Ronsmans, C. (2002). A district-based audit of the causes and circumstances of maternal deaths in south Kalimantan,Indonesia. Bulletin of the World Health Organization, 80, 228–235.

    PubMed Central  PubMed  Google Scholar 

  33. Blum, J., Winikoff, B., Raghavan, S., Dabash, R., Ramadan, M. C., Dilbaz, B, et al. (2010). Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin: a double blind, randomized non-inferiority trial. Lancet 375-176-8.

  34. Winokoff, B., Dabash, R., Durocher, J., Darwish, E., Nguyen, T. N., León, W., et al. (2010). Treatment of postpartum hemorrhage with misoprostol versus oxytocin in women not exposed to oxytocin during labour: A double-blind, randomized, non-inferiority trial. Lancet, 375, 210–216.

    Article  Google Scholar 

  35. Calvert, C., Thomas, S. L., Ronsmans, C., Wagner, K., Adler, A. J., & Filippi, V. (2012). Identifying regional variation in the prevalence of postpartum haemorrhage: A systematic review and meta-analysis. PLoS One, 7(7), e41114. doi:10.1371/journal.pone.0041114.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Souza, J. P., Gülmezoglu, A. M., Vogel, J., et al. (2013). Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): A cross-sectional study. Lancet, 381, 1747–1755.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of John Snow, Inc. and do not necessarily reflect the views of USAID or the United States Government. This research was also supported [in part] by the Intramural Research Program of the NIH, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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Authors and Affiliations

  1. Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia

    Asri Adisasmita

  2. College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Carl V. Smith

  3. School of Public Health, City University of New York, New York, NY, USA

    Ayman A. E. El-Mohandes

  4. Center for Family Welfare, University of Indonesia, Depok, West Java, Indonesia

    Poppy Elvira Deviany

  5. John Snow, Inc., Arlington, VA, USA

    Judith J. Ryon & Quail Rogers-Bloch

  6. School of Public Health, City University of New York, 555 West 57th St., Room 1135, New York, NY, 10019, USA

    Michele Kiely

  7. Health Improvement Project, Dili, Timor Leste

    Reginald F. Gipson

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  1. Asri Adisasmita
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Correspondence to Michele Kiely.

Additional information

Judith J. Ryon was formerly at John Snow, Inc., Arlington, VA, USA.

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Adisasmita, A., Smith, C.V., El-Mohandes, A.A.E. et al. Maternal Characteristics and Clinical Diagnoses Influence Obstetrical Outcomes in Indonesia. Matern Child Health J 19, 1624–1633 (2015). https://doi.org/10.1007/s10995-015-1673-6

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  • DOI: https://doi.org/10.1007/s10995-015-1673-6

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