Maternal Mortality and Near Miss Morbidity at the University Teaching Hospital in Kigali, Rwanda

Objective: To evaluate maternal mortality and near-miss morbidity at the University Teaching Hospital (CHUK) in Kigali, Rwanda, a tertiary referral hospital.
Methods: A retrospective chart review was performed. All cases of maternal mortality and near-miss maternal morbidity at CHUK from October 1, 2012-October 31, 2013 were analyzed. All maternal intensive care unit admissions were determined to be near-miss maternal morbidity events. Charts were obtained through medical records and manual data extraction performed.
Results: There were 80 deaths during the study period. The three major sources of maternal mortality were sepsis (32%), hemorrhage (20%), and hypertensive disease (12%). Of interest, 46% of sepsis cases resulting in death were status post cesarean section. The most common causes of near-miss morbidity (n=53) were also sepsis (30%), hemorrhage (21%), and hypertensive disease (17%). Overall, 96% of total cases (death and near miss) were transfers from district hospitals. Seventy one percent of total patients had abnormal vital signs on admission.
Conclusion: Sepsis was the most common cause of maternal mortality and near-miss morbidity for the study period. This data set is being used to actively improve maternal outcomes not only at CHUK but also across Rwanda. Educational campaigns focused on the specific problem areas noted could result in dramatically decreased morbidity and mortality.