1. Confidential Enquiry into Maternal Deaths (CEMD) approach in maternal mortality review in a country with low delivery rate: first experience in Latvia
Rezeberga Dace 1,2,3, Maira Jansone 1,4, Inese Blodniece 2, Egils Lapins2, Vija Bthena2, Signe Irsa4,
1. Riga Stradiņš university
2. Riga Maternity hospital
3. Riga East Clinical University Hospital
4. P.Stradins clinical university hospital

2. Inhabitants in Latvia in 2017
1,306 m
1,946 m
2,834 m

3. Birth rate and mortality in Latvia (on 1000 inhabitants in 1946. -2010
Dabiskais pieaugums Latvijā jau kopš neatkarības atgūšanas ir ar negatīvu zīmi
Central statistic bureau

4. Number of deliveries in Latvia

5. Delivery departments in Latvia in 2016
1119
625
433
RUS
260
300
1936
1015
Balvii
586
282
7019
1755
261
Madona
Madona
1142
1086
381
482
590
Preiļi
710
528
927 5

6. Maternal mortality rate (per 100 000 live born)

8. Maternal mortality
Source:
KGZ – 1 in 390

9. Maternal mortality: direct and indirect causes (N)

10. Maternal and child health plan 2012 -2014
MM identified as a problem
In 2012 and 2013 training on tools for analysis of maternal morbidity and mortality was organized
CEMD expert group formed by Order of Ministry of health in 2012
The following specialists included in CEMD expert group: 2 gynecologists, 2 midwifes, 1 anesthesiologist, 1 pathologist, 1 emergency doctor, 1 neonatologist

11. CEMD Involves all levels of health system Enquiry by expert team
Comprehensive enquiry of all cases
Quantitative and qualitative data analyses
Enquiry by expert team
Focuses on professional perspective
Primary objectives:
Guidance for policy makers
General recommendations to health care providers

12. Materials and Methods
CEMD expert group performed confidential analyses of 20 maternal deaths cases in
In order to restore and understand the situation in each maternal death case anonymized medical records, questionnaires and anonymous written explanation of provided care obtained from staff involved in medical care were used.

13. Results: causes of maternal death in 2013 – 2015 (N=20)

15. Characteristic of patients who died due to post partum hemorrhage
All admitted without hemorrhage
High risk patients with no or minimal antenatal care
All multiparas
In all patients Oxytocine was used (unnecessary? over dosage?)
Underestimated blood loss
No stable venous access during childbirth
Too late blood transfusion started /only in one case O(I) Rh negative Er

16. Results: antenatal care (%)MM
Average in
in 15 cases problematic social adaptation was recognized resulting in limited access to health care services

17. Weakness in primary health care sector, insufficient focus on the safety of delivery services in hospitals as well as absent interdisciplinary collaboration in both ambulatory and hospital sector was recognized.

18. In several cases different management could influence the outcome.

19. CEMD experts faced difficulties to keep full confidentiality and describe the situation so delicate that patient’s data can’t be identified
Solution can be introduction of common framework in CEMD in all Baltic countries