{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T21:30:26Z","timestamp":1773351026064,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2007,7,5]],"date-time":"2007-07-05T00:00:00Z","timestamp":1183593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2007,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Objective<\/jats:italic>: To analyze the changing patterns of critical obstetric care over two consecutive 3\u2010year periods and identify the factors responsible for the trend through combined audits of near miss and maternal mortality at a Nigerian University hospital. <jats:italic>Methods<\/jats:italic>: Retrospective audit and comparison of \u201cnear misses\u201d and maternal deaths recorded in 1999\u20132001 and 2002\u20132004 at a tertiary care center in southwest Nigeria. The definition of near miss morbidity was based on validated disease\u2010specific criteria. For each near miss and maternal death, the local audit committee compared the actual management with local treatment protocols and explored avoidable factors. Case fatality rate was calculated for \u201ccritically ill obstetric patients\u201d (CIOP\u2010CFR) for both periods. The cause\u2010specific case fatality rate (CFR) was used to assess the trend in standards of care for life\u2010threatening obstetric conditions. Data were compared using the <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> or Fisher's exact test. <jats:italic>P<\/jats:italic> &lt; 0.05 was considered statistically significant. <jats:italic>Results<\/jats:italic>: There were 175 near misses and 27 maternal deaths in 1999\u20132001 and 211 near misses and 44 maternal deaths in 2002\u20132004. The CIOP\u2010CFRs for the two periods showed a declining (but non\u2010significant) trend in the standard of emergency obstetric care for life\u2010threatening conditions (13.4% to 17.3%, <jats:italic>P<\/jats:italic> = 0.250). The CIOP\u2010CFR for postpartum hemorrhage significantly increased from 3.1% to 21.1% in the 2nd period (<jats:italic>P<\/jats:italic> = 0.033), reflecting a decline in the standard of care. Lack of blood for transfusion became a more significant administrative problem in the 2nd period occurring in 17.8% of all critically ill patients managed in 2002\u20132004. There was a notable though statistically insignificant increase in the non\u2010adherence to treatment protocol among cases of maternal death in 2002\u20132004 compared with 1999\u20132001. <jats:italic>Conclusions<\/jats:italic>: The standard of critical obstetric care in this center is suboptimal with no evident improvement over the 6\u2010year period. This audit supports the feasibility of including near miss reviews in maternal death audits to provide insights into the trend in the quality of emergency services for severe maternal complications while highlighting factors associated with deficiency or improvement in care for specific maternal conditions.<\/jats:p>","DOI":"10.1016\/j.ijgo.2007.05.018","type":"journal-article","created":{"date-parts":[[2007,7,6]],"date-time":"2007-07-06T11:20:34Z","timestamp":1183720834000},"page":"278-284","source":"Crossref","is-referenced-by-count":22,"title":["Changing patterns of emergency obstetric care at a Nigerian University hospital"],"prefix":"10.1002","volume":"98","author":[{"given":"O.T.","family":"Oladapo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.J.","family":"Ariba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.L.","family":"Odusoga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2007,7,5]]},"reference":[{"key":"e_1_2_7_2_2","series-title":"Beyond the Numbers: Reviewing Deaths and Complications to Make Pregnancy Safer","first-page":"103","volume-title":"Reviewing severe maternal morbidity: learning from survivors from life\u2010threatening complications World Health Organization","author":"Ronsmans C.","year":"2004"},{"key":"e_1_2_7_3_2","first-page":"700","article-title":"Severe acute maternal morbidity and maternal death audit \u2014 a rapid diagnostic tool for evaluating maternal care","volume":"93","author":"Cochet L.","year":"2003","journal-title":"S Afr Med J"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2003.03044.x"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2005.00636.x"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(01)00558-9"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-1-3"},{"key":"e_1_2_7_8_2","volume-title":"Guidelines for monitoring the availability and use of obstetric services","author":"UNICEF","year":"1997"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2006.08.009"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(99)00199-X"},{"key":"e_1_2_7_11_2","series-title":"Tenth Revision","volume-title":"World Health Organization: ICD\u201010 International statistical classification of diseases and health\u2010related problems","year":"1993"},{"key":"e_1_2_7_12_2","volume-title":"Centers for Disease Control and Prevention (CDC) and World Health Organization Epi Info 2002 \u2014 Database and statistics software for public health professionals","year":"2002"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S0020729207003062?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S0020729207003062?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.ijgo.2007.05.018","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.ijgo.2007.05.018","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.ijgo.2007.05.018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T07:58:17Z","timestamp":1696406297000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1016\/j.ijgo.2007.05.018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,7,5]]},"references-count":11,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2007,9]]}},"alternative-id":["10.1016\/j.ijgo.2007.05.018"],"URL":"https:\/\/doi.org\/10.1016\/j.ijgo.2007.05.018","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,7,5]]}}}