Post-Delivery Complications and Quality of Birth Practice in District Hospitals in Rwanda: A cross-Sectional Study

BACKGROUND: The maternal mortality in Rwanda has decreased dramatically in the last 18 years but still remains high. Little is known about the post-delivery complications and the quality of care in district hospitals.
This study aims to determine the outcomes of complications of deliveries and the quality of childbirth in district hospitals referring to CHUK.
METHODS: A retrospective review of all obstetric patients with post-delivery complications was conducted for a 13-month the period from June 2016 to July 2017. We collected data on patients' age, insurance, length of stay, type of complications, and in-hospital mortality. The quality of care in district hospitals was evaluated by using a follow up questionnaire-based survey.
RESULTS: 340 women were transferred with 18.2% mortality. The most common cause of post vaginal complications was PPH (85.6%) due to atony (33%), tear (32%), and retained placenta (16%). On the other hand, the cesarean section (CS) complications were mainly due to peritonitis (63.8%) and PPH (30.3%). Age above 27 years, low social-economic status, and length of stay of < 9 days were associated with mortality with a p-value < 0.05. Gaps in the quality of care were found for cesarean section, emergency care for maternal complications, preeclampsia, and use of guidelines and protocol.
CONCLUSION: Despite a tremendous decrease in maternal mortality in Rwanda, post-delivery complications and deaths are still high amongst women transferred from district hospitals. Effective interventions to improve the quality of maternal care focusing on emergency obstetrical care and CS safety may improve the outcome.

Keywords
Quality of Maternal Care; Post-Delivery Complications; District Hospital