<<Print>>

Imagine a pregnant woman having to queue for a caesarean section. That is a sad situation to imagine but that is what pertains at the nation�s premier teaching hospital, Korle Bu. Although all three operating theatres at the obstetrics and Gynecology Department are functioning, the lack of anesthetists, theatre nurses, labourers, among others, has made it impossible for all three theatres to be used simultaneously. �What is happening is that we are using them alternatively; we use one for an operation now and then move on to use another. This is not the best and it creates a bit of queuing for pregnant women who need this service,� Prof Samuel A. Obed, the Head of the O&G Department, said. �As of August this year, it was only one operating theatre that was operating and so one could imagine the queue. Although the situation has improved, the lack of human resource and government�s freeze on new employment are not helping the situation. It is not making it easier for women and their babies who are at risk of dying to have caesarean section,� he said. What is maternal death? It is the death of a woman while she is pregnant or six weeks after delivery. It can also be described as the death of a pregnant woman up to 42 days after the end of a pregnancy. Prof Obed said there were two types of maternal deaths-direct and indirect. Direct This is the death of a woman due to pregnancy, labour and delivery or a condition that occurred or worsened during the pregnancy. For instance, this could be due to excessive bleeding, hypertension, abortion or infections that occurred in the pregnancy during labour. Indirect This refers to medical conditions existing before pregnancy and worsened during pregnancy, such as sickle cell disease, anaemia, HIV and AIDS, tuberculosis and heart problems. Maternal mortality ratio This is the number of deaths divided by 100,000 live births. However, Prof Obed noted that it was not a perfect ratio because it was difficult to have the total number of pregnancies in a community. Statistics over the years At Korle Bu, the first half of 2013 recorded 45 maternal deaths; 5,487 live births with maternal mortality ratio of 820 per 100,000 live births. In 2012, there were 85 maternal deaths, 10,103 live births and a maternal mortality ratio of 841, as compared to 119 maternal deaths in 2011, 10,455 live births and a maternal mortality ratio of 1,138. Eighty maternal deaths were recorded in 2010, as against 11,287 live births, giving a maternal mortality ratio of 709. In 2009 there were 86 maternal deaths, 10,502 live births and a maternal mortality ratio of 819, while 2008 sowed 77 maternal deaths, 10,195 live births and maternal mortality ratio of 755. Story behind the figures In 2012, 63 of the maternal deaths were due to direct causes, while the remaining 22 were from indirect causes. For the direct causes, 26 of the deaths were due to hypertensive disorders, 20 were as a result of haemorrhage, eight were abortions. Ruptured ectopic pregnancies accounted for five deaths, two deaths were as a result of infection of the birth canal after delivery, while obstructed labour caused one death and amniotic fluid embolism also caused another. Regarding indirect causes, seven deaths were attributed to sickle cell disease, seven as a result of HIV/Aids, while severe anaemia accounted for five deaths, with hepatitis, tuberculosis and meningitis causing one death each. Referrals too late? According to Prof Obed, out of the 85 maternal deaths recorded at the hospital in 2012, 82 were referrals from all sorts of places across the country to the hospital. The remaining three were actual Korle-Bu attendants. �If we receive referrals early enough, the situation may be different. Apart from the 85 maternal deaths recorded in 2012, 11 people were actually brought to the hospital dead,� he said. Twenty-seven people died before 24 hours of being sent to the hospital and another 27 died within two days. Seven people died within three days; five in four days; three in five days; six people died within six days while eight people died beyond seven days of being referred to Korle-Bu. Poverty, ignorance-bane of maternal deaths He said a lot of studies, including those he had been involved in, showed that poverty and ignorance were pivotal in maternal deaths. �Although pregnancy may come with a lot of complications, it is rare for a woman with good education to die from pregnancy,� he said. He said a well-educated woman was most likely to empower herself economically, would not be ignorant but understand issues at stake and follow good and healthy practices. According to Prof Obed, for Ghana to move forward, it was important for the country to address poverty and ignorance by giving girl-child education all the attention it deserved. Additionally, it was important for women to report early to clinic when they got pregnant. Obviously, the next step will also be to address institutional challenges. Prof Obed called for a fair distribution in health institutions in terms of retooling and personnel. Interventions at Korle Bu Excessive bleeding is one of the major causes of maternal deaths. In view of this, the O&G Department, at the beginning of this year, has established a blood bank and so does not have to rely on the hospital�s central bank. Hypertensive disorders and other medical conditions in pregnancy such as diabetes and anaemia also have dire consequences for pregnant women. Consequently, Prof Obed said the department was collaborating with physician specialists at the Department of medicine to have joint clinics to see pregnant women with hypertension, diabetes, cardiac and kidney problems, instead of referring patients to them at the Department of Medicine. This joint clinic arrangement is to enable the department to manage pregnant women, so that factors leading to maternal deaths can be controlled. A joint clinic for sickle cell in pregnancy has also started. Another intervention Prof Obed said the department was looking at was seeing women before they became pregnant, a practice known as pre-pregnancy clinic. That, he said, was to make sure that the woman was stable and optimize her condition before she becomes pregnant.