Deviations from midwifery routines during delivery and possible impact on postpartum hemorrhage and neonatal outcome in Buea Regional Hospital, Buea, Cameroon

Abstract

Degree Project Thesis, Programme in Medicine. TITLE: Deviations from midwifery routines during delivery and possible impact on postpartum hemorrhage and neonatal outcome in Buea Regional Hospital, Buea, Cameroon. Background: The maternal mortality ratio in Cameroon is one of the highest in the world, 590 per 100 000 live births, and has increased during the past decade. Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. The neonatal mortality is also very high, 28 per 1 000 live births. WHO have published recommendations for treatment and prevention of PPH and for monitoring of the fetus during delivery. Aim of the study: To evaluate the local application of the WHO recommendations to prevent and treat PPH and to monitoring the fetus during delivery. Furthermore the aim was to compare annual statistics at Buea Regional Hospital (BRH) with the national data in Cameroon, thereby highlighting the situation and hopefully pave the way for improvements. Method: Data was collected during seven weeks at BRH. Deliveries were observed and a protocol based on the WHO recommendations was filled in for every delivery. An additional case-control study was conducted collecting data, based on WHO recommendations, from the files of 20 PPH-cases over the last 7 months at BRH. The data was compared with 20 controls from the same period. Annual statistics was collected from BRH. Results and discussion: The routines at BRH followed the WHO recommendations with some exceptions. Auscultation of the fetal heart rate was insufficient. Late cord clamping was in general not performed, the uterine tonus was not controlled as often as recommended and uterotonics was not given in correct order. Problems with the use of partogram and a poor documentation of medical records was observed. Concerning BRH as a Regional hospital, annual statistics showed high rates of maternal and neonatal deaths, compared to the average in Cameroon. Conclusion: A better pliability to the WHO recommendations at Buea Regional Hospital could decrease the number of PPH-cases, as well as maternal and neonatal deaths. Keywords: Cameroon, Buea Regional Hospital, maternal mortality, neonatal mortality, WHO, postpartum hemorrhage, fetal heart rate.