Discussion on Provincial Evaluation Results of Maternal Mortality in Terms of Preventability: Commission Decision Differences in Konya
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CitationDurduran, Y., Soysal, S., Acar, A., Başaran, M., Çelik, Ç., Doğan, C., Kaya, H. M., İzgi, Ş. Öznavruz, H. (2018). Discussion on provincial evaluation results of maternal mortality in terms of preventability: Commission decision differences in Konya. Turkiye Klinikleri Jinekoloji Obstetrik, 28, 2, 35-43.
Objective: The objective of this study was to investigate the risk factors of maternalmortality in Konya province, as well as the preventability of deaths in cases where the central andlocal commissions differed in their decisions. Material and Methods: Maternal mortality between2009 and 2014 in the Konya province was screened for the cases, where the central and local MaternalMortality Investigation Commissions gave different decisions. These differences pertain towhether the deaths were ‘preventable’ or ‘not-preventable’, differences in the first, second andthird delay models, and indirect, direct and incidental deaths. The data were evaluated electronicallyalong with a descriptive statistical analysis, differences in the decisions and compliance inthe mortality rates were evaluated. Results: The median age of the deceased mothers was 28 (21–44) years and 83.3% of the mothers had at least one mortality risk factor. While the overall maternalmortality rate was 36.7% within the first 48 h after birth, the rates were highest within thefirst 48 h after birth (26.7%) and between the 1st and 42nd day after birth (26.7%) in indifferentlyassessed cases. The cause in 30% of all deaths and 33.3% of deaths with differential assessmentswas postpartum hemorrhage, as per the results of central Maternal Mortality InvestigationCommissions. The decisions of the central and local commissions differed in terms of preventability,delay models or death classification in 50% of the deaths. Taken together, the compliancebetween central and local decisions was not precise in investigating maternal mortality. Conclusion:The first 48 h after birth and the postpartum period are particularly critical. The causes ofdeath, particularly postpartum hemorrhage, should be thoroughly investigated. We recommendperiodic re-evaluations of cases where different decisions were made, in order to lower the rate ofpreventable maternal mortality.
SourceJournal of Clinical Obstetrics & Gynecology