Before and after: a review of the cascade of events before arrival and during admission for obstetric emergencies in Ilorin, Nigeria.

Abstract

Background: Obstetric emergencies are important contributor to adverse pregnancy outcome and the cascade of events before and after hospital arrival contribute to treatment outcomes in these women. Method: A prospective cross-sectional study was conducted at University of Ilorin Teaching Hospital, Ilorin, Nigeria between July and December 2019.Participants were 164 women admitted and managed as obstetric emergencies at the study centre. Primary outcome measures were the preadmission events (care received and mode of transportation), secondary outcomes werepromptness of emergency care and maternal outcome. Data was presented as descriptive statistics in tables with percentages. Results: The mean age of participants was 29±4 years, 124(75.6%) were of low social class, duration of the complication was <12hours in 82(50.0%) and 134(81.7%) received pre-admission care. There were134(92.5%) referred cases, 96(71.6%) were health-worker-initiated, 86(64.2%) presented with referral letter and the indications for referral included lack of competence to manage the cases in 68 (50.7%) and no improvement with treatment in 26(19.4%). Also, 132(80.5%) traveled >10km before arrival, transportation was with ambulance in 2(1.2%), 156(95.1%) received no care during transportation while duration from referral-to-arrival was >60minutes in 96(70.7%). Commonest diagnosis at presentation was severe pre eclampsia/eclampsia in 50 (30.5%), 132(80.5%) were attended to by a doctor within 10 minutes of arrival while maternal mortality was 61/1000 live birth. Conclusion: To further reduce maternal mortality, improved access to comprehensive emergency obstetric services through early referral, effective inter-facility communication and safe transportation should be prioritized.