Factors associated with anaesthesia-related maternal mortality in a tertiary hospital in Nigeria

Maternal mortality related to anaesthesia is low compared with that resulting from obstetric factors in developed countries. The role of anaesthesia in maternal mortality in developing countries is obscure. The purposes of this study were to determine the incidence of maternal mortality related to anaesthesia, to analyse the causes and to suggest measures to improve anaesthetic safety for parturients. The hospital surgical registry was reviewed from 1 January 1991 to 31 December 2000 to identify patients who had undergone surgical procedures in pregnancy or puerperium. Data were obtained from the surgical registry in the Labour and Delivery Suite, Intensive Care Unit records and maternal mortality database to determine the demographic characteristics and anaesthetic technique. Maternal mortality after surgical procedures was further scrutinized to evaluate the anaesthetic care and the contribution of anaesthesia to mortality. A total of 12,394 deliveries occurred in the hospital during the period under review. Caesarean section accounted for 2323 deliveries (18.7%). Eighty-four maternal mortalities were recorded, with a maternal mortality rate of 678 per 100,000 deliveries. Infection, haemorrhage, pre-eclampsia/eclampsia and anaesthesia were the leading causes of maternal mortality. Anaesthesia was the sole cause of six maternal deaths. The patients received general anaesthesia for the surgical procedure. Difficult airway management during general anaesthesia, inadequate supervision of trainee anaesthetists and a lack of appropriate monitors were the major anaesthetic reasons for maternal mortality. Recommendations have been made to ensure that parturients and the unborn child receive the best anaesthetic care attainable in the hospital.