Reducing maternal mortality from ruptured uterus - the Sokoto initiative

Abstract

Uterine rupture is the most commo n cause of maternal mortality in our institution. Case fatality for the year 2001 was 47%. Health care including emergency obstetric care (EmOC) is not free, hence, delays in receiving care could occur in patients with limited resources. The objectives of the study were to promote access to emergency obstetric care through a loan scheme for indigent patients with rup tured uterus and determine the success or otherwise of the scheme. The scheme wa s initiated in January 2002, with the sum of thirty eight Thousand Naira (about 300 US dollars) by consultant obstetricians in the department. Funds were released to the patient only after assessment of her financial capability to enable her get emergency surgical packs. All that was required was a promise to pay back the loan before discharge. Following resuscitation, surgery was performed by one of the consultants. Eigh teen cases of ruptured uterus have been managed. Treat ment was initiated within 30 minutes of admission. Admis sion-laparotomy interval averaged 3.5 hours (±1.2). There were two maternal deaths, giving a case fatality of 11 % (2/ 18). The case fatality from a previous study from the same centre was 38% (16/42). There was a significant difference in case fatality between the two studies (P<0.05; confi dence limits arc-0.328 and -0.211). Of the seventeen pa tients that benefited from the scheme, 16 repaid the loan before discharge (94% loan recovery). Only one patient defaulted with five thousand Naira (40 US dollars). A loan scheme for indigent patients with ruptured uterus that enabled them receive emergency obstetric care reduced case fatality. Loan recovery was good. In our quest to reduce maternal mortality in low-income countries without health insurance policies, there might be a need to extend similar initiative to other obstetric emergencies.