Operative obstetric mortality at Harare Central Hospital 1992-1994: an anaesthetic view

A prospective review of anaesthetic-associated deaths (AAD) was undertaken at the maternity unit of Harare Central Hospital, Zimbabwe, for the triennium 1992-1994. AAD was defined as death within 24 h of anaesthesia or failure to regain consciousness. Three groups of avoidable factors (obstetric, anaesthetic and administrative) were considered, and a scoring system used to allocate one avoidability point for each death with avoidable factors. Out of 9833 operative procedures (91% under general anaesthesia) there were 22 AADs. Avoidable factors were identified in 17 deaths (77%). Seven deaths were directly attributable to anaesthesia. Haemorrhage was the commonest cause of death, accounting for 10 cases. Common factors, identified in all instances of substandard anaesthetic and obstetric care, were emergency cases and lack of senior involvement. The problems are discussed and also viewed in the context of overall maternal mortality (outcome period 42 days). The mortality data are compared with those from the UK and some hospitals in South Africa. It is concluded that improvements in resources, education, guidelines and monitoring are necessary if the mortality rate is to be reduced.