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REDUCING MATERNAL MORTALITY IN TURKEY: LESSONS LEARNED FROM

Year 2016, Volume: 49 Issue: 1, 6 - 9, 01.03.2016

Abstract

OBJECTIVE: To reduce maternal mortality in Turkey, efforts have gathered momentum recently. Our aim is to evaluate three delays model in maternal death cases of 2014 to understand the gaps.MATERIAL AND METHODS: In the present study, case files of all pregnancy-associated deaths recorded in Turkey in 2014 were reviewed. A death was classified as preventable by consensus of the expert committee. An event was considered preventable if one of the three delays was reported: Phase 1 delay; delay in deciding to seek appropriate medical help for an obstetric emergency, phase 2 delay; delay in reaching an appropriate health facility, phase 3 delay; delay in receiving adequate emergency obstetric care when a facility is reached. Data on maternal age, parity, cause of death and preventability were recorded.RESULTS: In Turkey, a total of 213 maternal deaths were recorded in 2014 which gives a maternal mortality rate of 15.2 per 100 000 live births. Delay in deciding to seek appropriate medical help for an obstetric emergency was noted in 56 cases 26 % . Delay in reaching an appropriate health facility only appeared to be significant in one 0.5 % . Delay in receiving adequate emergency obstetric care was observed in the deaths of 30 14 % women. Multiple delays were a factor in four 1.8 % cases. CONCLUSION: Over 40 % of maternal deaths in Turkey are preventable. Widespread adoption of clinical guidelines by the obstetric profession and careful attention to the delays may help to reduce maternal mortality rate favorably in future years

References

  • )Zureick-Brown S, Newby H, Chou D, Mizoguchi N, Say L, Suzuki E, Wilmoth J. Understanding global trends in ma- ternal mortality. Int Perspect Sex Reprod Health. 2013; 39: 41.
  • )Engin-Üstün Y, Çelen Ş, Özcan A, Sanisoğlu S, Karaahme- toğlu S, Gül R, et al. Maternal mortality from cardiac disease in Turkey: a population-based study. Journal of Maternal Fe- tal Neonatal Medicine. 2012; 25: 2451-2453.
  • )Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Social Science and Medicine. 1994; 38: 1091–1110.
  • )Pacagnella RC, Cecatti JG, Osis MJ, Souza JP. The role of delays in severe maternal morbidity and mortality: expan- ding the conceptual framework. Reprod Health Matters. ; 20: 155-163. )World Health Organization. 1993. Manual of the internati- onal statistical classification of diseases, injuries and causes of death, 10th revision, vol. 1. Geneva, Switzerland.
  • )Knight HE, Self A, Kennedy SH. Why are women dying when they reach hospital on time? A systematic review of the 'third delay'. PLoS One. 2013; 8: 63846.
  • )World Health Organization. 1993. Manual of the international statistical classification of diseases, injuries and causes of death, 10th revision, vol. 1. Geneva, Switzerland.

REDUCING MATERNAL MORTALITY IN TURKEY: LESSONS LEARNED FROM THREE DELAYS MODEL

Year 2016, Volume: 49 Issue: 1, 6 - 9, 01.03.2016

Abstract

AMAÇ: Türkiye’de maternal mortalite oranlarını düşürmek amacıyla son dönemlerde çalışmalar artmıştır. Çalışmanın amacı 2014 yılı Türkiye anne ölümlerini üç gecikme modeline göre değerlendirmektir.GEREÇ VE YÖNTEMLER: Bu çalışmada 2014 yılında Türkiye’de gerçekleşen gebelikle ilgili tüm anne ölümlerinin dosyaları retrospektif olarak incelendi. Anne ölümünün önlenebilir olup olmadığı uzman bir komisyon tarafından değerlendirildi. Anne ölümü üç gecikme modelinden herhangi biri mevcutsa önlenebilir olarak kabul edildi: Faz 1 gecikme; obstetrik acil durum için tıbbi destek aramama, faz 2 gecikme; uygun bir sağlık kuruluşuna ulaşmada gecikme, faz 3 gecikme; uygun acil obstetrik bakım alamama olarak tanımlandı. Maternal yaş, parite, ölüm nedeni ve önlenebilirlik durumu kaydedildi. BULGULAR: 2014 yılında Türkiye’de 213 anne ölümü gerçekleşti, maternal mortalite oranı 100000 canlı doğumda 15.2 olarak hesaplandı. Elli altı olgunun % 26 obstetrik acil durum için tıbbi destek aramadığı saptandı. Bir olgunun % 0.5 uygun bir sağlık kuruluşuna ulaşamadığı görüldü. Otuz olgunun % 14 uygun acil obstetrik bakım alamadığı tespit edildi.SONUÇ: Türkiye’de anne ölümlerinin % 40’ının önlenebilir olduğu görülmüştür. Klinik kılavuzların yaygın kullanımı ve üç gecikme modellerinin üzerinde durulması anne ölüm oranlarını gelecek yıllarda azaltacaktır

References

  • )Zureick-Brown S, Newby H, Chou D, Mizoguchi N, Say L, Suzuki E, Wilmoth J. Understanding global trends in ma- ternal mortality. Int Perspect Sex Reprod Health. 2013; 39: 41.
  • )Engin-Üstün Y, Çelen Ş, Özcan A, Sanisoğlu S, Karaahme- toğlu S, Gül R, et al. Maternal mortality from cardiac disease in Turkey: a population-based study. Journal of Maternal Fe- tal Neonatal Medicine. 2012; 25: 2451-2453.
  • )Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Social Science and Medicine. 1994; 38: 1091–1110.
  • )Pacagnella RC, Cecatti JG, Osis MJ, Souza JP. The role of delays in severe maternal morbidity and mortality: expan- ding the conceptual framework. Reprod Health Matters. ; 20: 155-163. )World Health Organization. 1993. Manual of the internati- onal statistical classification of diseases, injuries and causes of death, 10th revision, vol. 1. Geneva, Switzerland.
  • )Knight HE, Self A, Kennedy SH. Why are women dying when they reach hospital on time? A systematic review of the 'third delay'. PLoS One. 2013; 8: 63846.
  • )World Health Organization. 1993. Manual of the international statistical classification of diseases, injuries and causes of death, 10th revision, vol. 1. Geneva, Switzerland.
There are 6 citations in total.

Details

Primary Language Turkish
Journal Section Original Research Article
Authors

Yaprak Enginüstün This is me

Sema Sanisoğlu This is me

Bekir Keskinkılıç This is me

Dilek Uygur This is me

Ayşe Özcan This is me

Hüseyin Levent Keskin This is me

Selma Karaahmetoğlu This is me

Aysun Kabasakal This is me

İrfan Şencan This is me

Publication Date March 1, 2016
Published in Issue Year 2016 Volume: 49 Issue: 1

Cite

AMA Enginüstün Y, Sanisoğlu S, Keskinkılıç B, Uygur D, Özcan A, Keskin HL, Karaahmetoğlu S, Kabasakal A, Şencan İ. REDUCING MATERNAL MORTALITY IN TURKEY: LESSONS LEARNED FROM THREE DELAYS MODEL. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. March 2016;49(1):6-9.