A glance into the hidden burden of maternal morbidity and patterns of management in a Palestinian governmental referral hospital.
BACKGROUND
Little is known about the burden and patterns of maternal morbidity during childbirth, particularly in the Middle East Region. Investigating the patterns of maternal morbidity can be useful in guiding improvement in the quality of maternal services, and informing policy debates on women's health.


OBJECTIVE
To examine the incidence, types and patterns of management of severe and non-severe maternal morbidities of Palestinian women during pregnancy, labour, delivery and up to seven days postpartum in one Palestinian hospital.


METHODS
A prospective hospital-based study was conducted for a 3-month period in 2011-2012, reviewing hospital records for all pregnant women (1.583) admitted to the governmental hospital in Ramallah, Palestine.


RESULTS
Of all pregnant women included in this analysis (1.558), 419 (26.9%) women experienced one or more maternal morbidities and 15 (0.96%) women survived a life-threatening complication (near miss). Of all women who suffered morbidities, 69 (16.5%) had vaginal deliveries, 61 (14.6%) had cesarean sections, 179 (42.7%) had abortions/miscarriage, and 110 (26.3%) experienced complications during pregnancy or the post-partum. Hemorrhage during pregnancy, birth or postpartum was the most common morbidity. Of those who gave birth, women who gave birth by cesarean sections were three times more likely to suffer from morbidities than those who had vaginal delivery.


CONCLUSIONS
The burden of maternal morbidity for Palestinian women between the ages of 16 and 48 is high. In Palestine, maternal morbidity can be prevented by promoting a rational use of cesarean section, avoiding unnecessary medicalization, reducing unwanted pregnancies and updating practices of providers related to abortion/miscarriage care.
Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine. Electronic address: saharjhassan@gmail.com.
Sahar J
SJ
Hassan
Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine. Electronic address: lwick@birzeit.edu.
Laura
L
Wick
American University of Beirut, Faculty of Health Sciences, Lebanon. Electronic address: jd16@aub.edu.lb.
Jocelyn
J
DeJong
D000328:Adult; D018912:Arabs; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007861:Lebanon; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality / Q000208:ethnology*; D009017:Morbidity; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D036801:Parturition; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D012017:Referral and Consultation
Burden; Childbirth; Maternal morbidity; Palestine; Patterns of management