Introduction Postnatal deaths account for about one-third of maternal mortality in Low- and middle-income countries (LMICs). Nearly half occur within the first 24 hours and are preventable through continuous inpatient monitoring. This study assessed maternal mortality within the first 24 postnatal hours; and the current postpartum monitoring practices, including the availability of monitoring charts and the frequency of vital sign assessments in eastern Uganda.

Methods This cross-sectional study reviewed the medical records of all postpartum women admitted at Mbale Regional Referral Hospital, Eastern Uganda, between August 2022 and February 2023. A semi-structured data extraction form was used. The outcome variable was postpartum monitoring; categorized as “No” for women with no vital signs monitored and “Yes” for those with at least one vital sign monitored. Descriptive analysis was performed using Stata Version 17.0, and Poisson regression was employed to explore the association between various factors and postpartum monitoring.

Results Medical records of 2,717 postpartum mothers were reviewed. The median (interquartile range) age was 25(20-30) years. A minority (34%; 910/2717) of mothers had vital sign observation charts in their medical records and very few (4%; 110/2717) had a fluid balance chart. About 24% (651/2717) of mothers had at least one vital sign recorded. Blood pressure was the most (16.8%; 456/2717) recorded vital sign followed by pulse rate (13.6%; 369/2717). Respiratory rate and temperature were the least monitored vital signs with 1.2% and 1.1% records respectively. Mothers who delivered by C-section had a 151% higher prevalence of postpartum monitoring compared to those who had a vaginal delivery (aPR: 2.51; 95% CI: 2.19–2.89). Maternal mortality rate on the first postpartum day was 8.8 per 1000, with postpartum hemorrhage accounting for 61%.

Conclusion Postpartum vital signs monitoring was low. LMICs need to devise means of automating the monitoring process.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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This study was conducted according to the Declaration of Helsinki and the principles of Good Clinical Practice and Human Subject Protection. We also sought permission from the hospital, maternity and postnatal ward in-charges, and the records offices of Mbale Regional Referral Hospital to access the participants’ charts. Patient-specific identifiers like Name and hospital ID were not captured. Ethical approval was sought and obtained from the Research Ethics Committees (REC) of Mbale Regional Referral Hospital No. MRRH-2023-300. Written informed consent was obtained from all subjects or participants and the consent form was approved by Mbale Regional Referral Hospital Research and Ethics Committee (REC), MRRH 2023-300

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