Obstetric complications: To avoid saying "unfortunate" things

(Baonghean)The recent series of maternal deaths reported by the press has heated up public opinion about the cause as well as raised concerns among many women who are about to give birth. As a large, populous province, there are about 45,000 births each year, with a maternal mortality rate of about 76/100,000 live births (according to a survey in 2009, 2010), obstetric complications are becoming an urgent issue in the health sector.

Maternal mortality and “regrets”

Before entering the delivery room, she was still very healthy, but a few minutes later, Ms. NMH was given emergency treatment by the doctors of the Obstetrics Department - Provincial General Hospital of Friendship in a state of cyanosis, respiratory failure, circulatory failure and she died not long after. Having lost his wife and his first child, the husband of the pregnant woman M. still tried to comfort his mother-in-law who was fainting, questioning the negligence of the doctors and nurses in the face of the sudden death of his child and grandchild, because more than anyone else, as a person in the industry, he understood the unfortunate condition of "amniotic fluid embolism" that had happened to his wife.

Ms. M's condition is an unpredictable obstetric complication that occurs during the mother's labor, with a rate of about 7-8/100,000 births, cannot be prevented and causes immediate death for both mother and baby. This can be considered a very severe anaphylactic shock. After listening to detailed explanations from doctors and her son-in-law, over the years, Ms. M's mother has somewhat calmed down.

While the case of Ms. M with the cause of death due to amniotic embolism is quite rare and death is inevitable, there are many cases of maternal death that are "really regrettable", because they can be saved if detected early, closely monitored or have adequate means of transportation and emergency care. The case of Ms. N (Thanh Chuong) is an example.

Two years ago, Ms. N went into labor on a rainy and flooded day. Suffering from postpartum hemorrhage, Ms. N received an emergency transfusion of more than 300 cc of blood from her family at the District Hospital and was immediately transferred to the Provincial Hospital. Due to the rainy and flooded weather, the ambulance had to take a long detour, so when it arrived at the Provincial Hospital gate, Ms. N died from blood loss. Doctors said that if they had arrived a few minutes earlier and had received a timely blood transfusion, Ms. N's life would have been saved.

Among the 5 maternal deaths in the province since the beginning of the year, there have been many unfortunate cases. Except for the case of Ms. Phan Thi L, 39 years old (Vo Liet, Thanh Chuong) who showed signs of acute pulmonary edema and heart failure after giving birth for the first time with a serious and complicated disease progression (at the Department of Obstetrics - Provincial General Hospital), the remaining deaths could have been overcome if there were enough emergency equipment and experienced obstetricians. Such as the case of the mother Cut Me Th. in Muong Ai, Ky Son who died while giving birth for the first time... at home, the case of Ms. Lo Thi T. in My Ly, Ky Son who was 5 weeks pregnant with an ectopic pregnancy and died on the way to the provincial hospital, Ms. Bui Thi H. in Thanh Chuong died due to hemorrhage and anemia after transfusion at the district hospital, Ms. Hoang Thi Ng. in Nam Dan also died on the way to the provincial hospital for emergency treatment due to uterine atony after giving birth, shock that did not recover...

Maternal deaths are often classified according to direct and indirect causes. Direct causes are diseases or complications that only occur during pregnancy and childbirth, such as bleeding before, during and after childbirth, postpartum infection, pregnancy poisoning, abortion, and difficult labor. Indirect causes include diseases that may be contracted before or during pregnancy, but are aggravated by pregnancy, such as heart disease, tuberculosis, malaria, etc. In addition to medical causes, there are other causes such as failure in health care, lack of transportation, etc.

Common obstetric complications that cause maternal and child deaths are recommended as: eclampsia, uterine rupture, postpartum bleeding, obstetric infections and neonatal tetanus. Recently, the rate of neonatal asphyxia and abortion complications is also one of the major concerns. This is because neonatal asphyxia is a development after the birth of the fetus that can cause serious consequences, in severe cases can lead to death in the first days after birth; some other cases cause upper respiratory tract infections, intellectual disability affecting the physical and mental development of the child later. In addition, abortion complications also cause a high mortality rate every year with about 60-70 deaths per year nationwide. In Nghe An alone, maternal deaths due to unsafe abortion account for 5% of maternal deaths. In addition, unsafe abortion also leaves other serious consequences such as physical and mental effects, causing infertility... for women.

According to specialist doctor II Nguyen Ba Tan - Director of the Provincial Center for Reproductive Health Care, obstetric complications are inevitable (there is an acceptable rate for the health sector). Among them, complications due to amniotic embolism are considered "certain death". Most other causes can be predicted, prevented or limit the mortality rate.

Can be limited and prevented

It can be said that in recent years, Nghe An has paid much attention to reproductive health care. The biggest evidence is the establishment of the Obstetrics and Pediatrics Hospital. In addition, there are other advantages such as the health system from the village to the commune, district, province... all have developed expertise in obstetrics, especially with the support of a number of projects: GTZ, GIZ, JICA... Our province has a team of midwives, obstetrics and pediatric nursing bachelors at the commune health station down to the village. The obstetrics and gynecology departments at the district level can undertake obstetric emergencies, from common to complex surgeries.

In addition, there are also special and specific difficulties, causing the maternal mortality rate to remain quite high. First of all, it is the large area, difficult traffic routes, and rudimentary means of transportation, especially in the 5 mountainous districts. Many mothers have died due to the custom of giving birth at home, in huts in the forest (mainly ethnic minorities) due to bleeding and infection. There are cases due to weak medical staff, not being able to predict the progress of the birth, combined with lack of equipment at the grassroots level. Most of the maternal deaths at the district level are due to lack of blood transfusion.

According to doctors, if blood is available, most maternal deaths can be saved. Apart from the Provincial General Hospital, which has a reserve blood source at the Hematology and Blood Transfusion Center, the lower level hospitals have not been able to meet the needs of cases requiring blood transfusion. Currently, only the Northwestern Regional General Hospital has developed a fairly effective live blood bank, saving many serious cases in time. This is also a typical unit that does a good job of voluntary blood donation.

According to Dr. Nguyen Ba Tan, to limit obstetric complications, the first thing to pay attention to is to strengthen pregnancy management. Pregnant women must be managed according to the list from the village and hamlet and have regular pregnancy check-ups, be given a monitoring book and be examined. Pregnancy check-ups must be done at least 3 times in 3 pregnancy cycles, pregnancy check-ups must be accompanied by full body check-ups and pregnancy screening, ultrasound and screening at 12-22-32 weeks of pregnancy.

During the last 3 months of pregnancy, medical staff must carefully predict the birth and advise the mother on the place of birth to ensure safety. Vaccinate the mother against tetanus according to regulations to avoid postpartum infection. Medical facilities with delivery services must carefully prepare delivery, emergency and transfer equipment when necessary, and follow the technical classification prescribed by the Ministry of Health. All levels must be ready with conditions such as ambulances and emergency surgery teams to support lower levels in emergency care. Ambulances should give absolute priority to emergency patient care and avoid using them for other purposes. In particular, prepare blood and replacement solutions. For district levels that do not have a blood reserve, there should be a plan for emergency blood transfusion such as a live blood bank and blood transfusion of the same bloodline.

And an indispensable important factor, the health sector needs to improve the quality of the obstetrics and gynecology team, both in terms of skills and medical ethics. Doctors and nurses need to uphold their sense of responsibility, closely monitor each birth, labor factors to examine and correctly predict the birth, decide on normal delivery or cesarean section. Even during delivery, attention must be paid to technical factors to ensure that each child is born healthy, avoiding the mother losing a lot of blood, affecting her health and recovery later. Another point emphasized by Dr. Tan is that the situation of unsafe abortion needs to be warned more in the community.

Thuy Vinh