Table 4.
Distribution of the contributing factors of maternal deaths associated with HDP according to the “Three delays model”, West Azerbaijan Province, Iran, 2002-2011
| Contributing factor of HDP | n(%) |
|---|---|
| DELAY 1: Deciding to request care | |
| No delay 1 | 32/47 (68.1) |
| Delay for cultural reasons (women’s status & autonomy and husband’s permission) | 7/47 (14.9) |
| Inability to recognize the HDP as a life-threatening complication | 5/47 (10.6) |
| Negative attitude of the woman toward healthcare services | 2/47 (4.3) |
| DELAY 2: Reaching a medical facility | |
| No delay 2 | 30/47 (63.8) |
| Delay for geographic reasons (distance) | 7/47 (14.9) |
| Delay for transportation reasons (availability and efficiency) | 5/47 (10.6) |
| Delay for economic reasons | 4/47 (8.5) |
| DELAY 3: Receiving adequate treatment | |
| Medical errors in diagnosis of HDP | |
| Delay in suspecting HDP | 23/42 (54.8) |
| Delay in performing laboratory tests | 26/39 (66.7) |
| Substandard physical examination | 25/35 (71.4) |
| Medical errors in clinical monitoring | |
| Inadequate monitoring of the HDP’s signs in the postpartum period | 18/38 (47.4) |
| Incomplete laboratory tests | 22/40 (55.0) |
| Postpartum bleeding not quantified | 9/16 (56/2) |
| Failure to recognize and treat pulmonary edema | 8/10 (80.0) |
| Medical errors in treatment | |
| Lack of emergency administration of antihypertensive drugs | 26/42 (61.9) |
| Inadequate administration of prophylactic mag. sulfate to prevent eclampsia | 15/40 (37.5) |
| Inadequate administration of mag. sulfate in a patient with eclampsia | 8/17 (47.1) |
| Inadequate management of intravenous fluids | 24/42 (57.1) |
| Non-admission to an intensive care unit when indicated | 21/35 (60.0) |
| Inadequate administration of prophylactic mag. sulfate to prevent eclampsia in the postpartum | 16/41 (39.0) |
| Medical errors in clinical decisions | |
| Retaining the patient at a health facility which was inappropriate for her condition | 9/24 (37.5) |
| Untimely referral | 18/33 (54.5) |
| Discharge before 48 hours | 6/38 (15.8) |
| Administrative and health care management errors | |
| Inadequate resources at the health facility | 17/42 (40.5) |
| Inadequate referral conditions | 16/33 (48.5) |
| Substandard teamwork | 17/40 (42.5) |
| Administrative difficulties that hampered care | 22/42 (52.4) |