Obstetric delays in patients with potentially life-threatening conditions in a referral maternity hospital

Authors

DOI:

https://doi.org/10.59464/2359-4632.2025.3345

Keywords:

Maternal health, Morbidity, Pregnancy complications

Abstract

Objective: To identify the types of obstetric delays in patients with potentially life-threatening conditions in a referral maternity hospital in a city in northeastern Brazil.Method: Cross-sectional study carried out in the wards of the Sant’Ana Maternity sector, from January to May 2022, with 108 postpartum women admitted to the sector who were in the puerperal period up to 42 days and who suffered some potentially life-threatening condition (PLC), such as hypertensive syndromes and hemorrhagic syndromes. The data collection instrument was a questionnaire prepared by the author of the research, which categorized Delay I – In the decision to seek care (family members/patient); Delay II – For access to care/access; Delay III – For receiving care in the health service. The data were analyzed using Microsoft Excel 2019 and R version 4.1.0 software, and the frequency, mean, and standard deviation of the variables were described. Results: There was a prevalence of delay III, to receive care in the health service, with 33 (30.56%) of the cases, followed by obstetric delay I, decision to seek care (family and patient), in 25 (23.15%) of the participants and obstetric delay II, to access care/service, in 18 (16.67%) of the cases. Conclusion: There was a predominance of delays III and I in the findings of this study; therefore, the reduction of delays, such as the provision of supplies and equipment, a better referral system and the availability of transportation could contribute to the reduction of CPAV, serious maternal outcomes and even maternal deaths.

References

World Health Organization (WHO). Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: WHO; 2023.

Ministério da Saúde (BR). Boletim Epidemiológico - Casos graves e óbitos por dengue no Brasil, 2019 a 2022. Brasília (DF): Ministério da Saúde; 2022; 53(20).

Wanaka S, Hussen S, Alagaw A, Tolosie K, Boti N. Maternal Delays for Institutional Delivery and Associated Factors Among Postnatal Mothers at Public Health Facilities of Gamo Zone, Southern Ethiopia. Int J Womens Health. 2020;12:127-38. DOI: https://doi.org/10.2147/IJWH.S240608

Assefa EM, Berhane Y. Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study. BMJ Open. 2020;10(6):e033771. DOI: https://doi.org/10.1136/bmjopen-2019-033771

Pandit R, Jain V, Bagga R, Sikka P. Using Near Miss Model to Evaluate the Quality of Maternal Care at a Tertiary Health-Care Center: A Prospective Observational Study. J Obstet Gynaecol India. 2019;69(5):405-11. DOI: https://doi.org/10.1007/s13224-019-01237-z

Santana D, Guida JPS, Pacagnella RC, Cecatti JG. Near miss materno - entendendo e aplicando o conceito. Rev Med (São Paulo). 2018;97(2):187-94. DOI: https://doi.org/10.11606/issn.1679-9836.v97i2p187-194

Andrade MS, Bonifácio LP, Sanchez JAC, Oliveira-Ciabati L, Zaratini FS, Franzon ACA, et al. Morbidade materna grave em hospitais públicos de Ribeirão Preto, São Paulo, Brasil. Cad Saude Publica. 2020; 36(7):1-15. DOI: https://doi.org/10.1590/0102-311X00096419

Tiruneh GA, Asaye MM, Solomon AA, Arega DT. Delays during emergency obstetric care and their determinants among mothers who gave birth in South Gondar zone hospitals, Ethiopia. A cross-sectional study design. Glob Health Action. 2021; 14(1):p 1-7. DOI: https://doi.org/10.1080/16549716.2021.1953242

Daniels AA, Abuosi A. Improving emergency obstetric referral systems in low and middle income countries: a qualitative study in a tertiary health facility in Ghana. BMC Health Serv Res. 2020; 20(32):1-10. DOI: https://doi.org/10.1186/s12913-020-4886-3

Zewde HK. Quality and timeliness of emergency obstetric care and its association with maternal outcome in Keren Hospital, Eritrea. Sci Rep. 2022;12(14614):1-10. DOI: https://doi.org/10.1038/s41598-022-18685-9

Alobo G, Ochola E, Bayo P, Muhereza A, Nahurira V, Byamugisha J. Why women die after reaching the hospital: a qualitative critical incident analysis of the 'third delay' in postconflict northern Uganda. BMJ Open. 2021;11(3):e042909. DOI: https://doi.org/10.1136/bmjopen-2020-042909

Mohammed MM, Gelany SE, Eladwy AR, Ali EI, Gadelrab MT, Ibrahim EM, et al. A ten years analysis of maternal deaths in a tertiary hospital using the three delays model. BMC Pregnancy Childbirth. 2020; 20(585):1-8. DOI: https://doi.org/10.1186/s12884-020-03262-7

Mitikie KA, Wassie GT, Beyene MB. Institutional delivery services utilization and associated factors among mothers who gave birth in the last year in Mandura district, Northwest Ethiopia. PLoS One. 2020;15(12):1-17. DOI: https://doi.org/10.1371/journal.pone.0243466

Teshome HN, Ayele ET, Hailemeskel S, Yimer O, Mulu GB, Tadese M. Determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia: A case-control study. Front Public Health. 2022;10:996885. DOI: https://doi.org/10.3389/fpubh.2022.996885

Sk MIK, Paswan B, Anand A, Mondal NA. Praying until death: revisiting three delays model to contextualize the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India. BMC Pregnancy Childbirth. 2019;19(314):1-11. DOI: https://doi.org/10.1186/s12884-019-2458-5

Aden JA, Ahmed HJ, Östergren Per-Olof. Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach. Glob Health Action. 2019;12(1):1-11. DOI: https://doi.org/10.1080/16549716.2019.1672314

Ferreira GE, Fernandes ITGP, Flores PCB, Conceição KM, Caetano SA, Souza LN. A atenção do enfermeiro na assistência ao pré-natal de baixo risco. Braz J Dev . 2021;4(1):2114-27. DOI: https://doi.org/10.34119/bjhrv4n1-172

Magalhães DL, Matos RS, Souza AO, Neves RF, Costa MMB, Rodrigues AA, et al. Access to health and quality of life in the rural area. Res Soc Dev. 2022;11(3):1-12. DOI: https://doi.org/10.33448/rsd-v11i3.26906

Greenspan JA, Chebet JJ, Mpembeni R, Mosha I, Mpunga M, Winch PJ, et al. Men’s roles in care seeking for maternal and newborn health: a qualitative study applying the three delays model to male involvement in Morogoro Region, Tanzania. BMC Pregnancy Childbirth. 2019;19(293). DOI: https://doi.org/10.1186/s12884-019-2439-8

Soares FM, Guida JP, Pacagnella RC, Souza JP, Parpinelli MÂ, Haddad SM, et al. Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study. Rev Bras Ginecol Obstet. 2020;42(3):124–32. DOI: https://doi.org/10.1055/s-0040-1708095

Hummel JR, Busanello J, Hatmann AE, Evaldt RCFS, Cabral TS. Emergências obstétricas: estudo de caso múltiplo em terapia intensiva. J. nurs. health. 2022;12(2):1-13. DOI: https://doi.org/10.15210/jonah.v12i2.3405

Tiruneh GA, Asaye MM, Solomon AA, Arega DT. Delays during emergency obstetric care and their determinants among mothers who gave birth in South Gondar zone hospitals, Ethiopia. A cross-sectional study design. Glob Health Action. 2021;14(1):1953242. DOI: https://doi.org/10.1080/16549716.2021.1953242

Chainani EG, Nandanwar YS. An analysis of the levels of delay seen in maternal near miss cases in India. Int J Reprod Contrac Obstet Gynecol. 2022; 11(4):1122-6. DOI: https://doi.org/10.18203/2320-1770.ijrcog20220890

Habte A, Wondimu M. Determinants of maternal near miss among women admitted to maternity wards of tertiary hospitals in Southern Ethiopia, 2020: A hospital-based case-control study. PLoS One. 2021;16(5):e0251826. DOI: https://doi.org/10.1371/journal.pone.0251826

Dessalegn FN, Astawesegn FH, Hankalo NC. Factors Associated with Maternal Near miss among Women Admitted in West Arsi Zone Public Hospitals, Ethiopia: Unmatched Case-Control Study. J Pregnancy. 2020;2020:6029160. DOI: https://doi.org/10.1155/2020/6029160

Kanyesigye H, Kabakyenga J, Mulogo E, Fajardo Y, Atwine D, MacDonald NE, et al. Improved maternal–fetal outcomes among emergency obstetric referrals following phone call communication at a teaching hospital in south western Uganda: a quasi-experimental study. BMC Pregnancy Childbirth. 2022;22(648)1-10. DOI: https://doi.org/10.1186/s12884-022-05007-0

Chavane LA, Bailey P, Loquiha O, Dgedge M, Aerts M, Temmerman M. Maternal death and delays in accessing emergency obstetric care in Mozambique. BMC Pregnancy Childbirth. 2018;18(71):1-8. DOI: https://doi.org/10.1186/s12884-018-1699-z

Kasahun AW, Wako WG. Predictors of maternal near miss among women admitted in Gurage zone hospitals, South Ethiopia, 2017: a case control study. BMC Pregnancy Childbirth. 2018; 18(260):1-9. DOI: https://doi.org/10.1186/s12884-018-1903-1

Worke MD, Enyew HD, Dagnew MM. Magnitude of maternal near misses and the role of delays in Ethiopia: a hospital based cross-sectional study. BMC Res Notes. 2019;12(585):1-6. DOI: https://doi.org/10.1186/s13104-019-4628-y

Published

2025-02-12

How to Cite

Araújo, L. M. de ., Rios, A. J. S. ., Ripardo, N. D. ., Maciel, N. de S., Carvalho, F. H. C. ., Monte, A. S. ., Costa, C. C. da ., & Damasceno, A. K. de C. . (2025). Obstetric delays in patients with potentially life-threatening conditions in a referral maternity hospital. Revista Científica Integrada, 8(1), e202510. https://doi.org/10.59464/2359-4632.2025.3345