BackgroundInvestigating cases of severe maternal morbidity (SMM) and severe maternal outcome (SMO) and the quality of maternal health care using near-miss approach has become popular over recent years. The aim of this study was to determine facility based incidence and the determinants of severe maternal outcome (SMO) using this approach.MethodsProspective cross-sectional study among all mothers who presented to study facility while pregnant, during child birth and/or within 42 days after termination of pregnancy seeking care and found to have SMM and SMO during the study period was carried out.ResultsThere were total of 2737 live births, 202 SMM and 162 SMO (138 maternal near-misses (MNM) and 24 maternal deaths (MD)) cases. The SMO ratio was 59.2 per 1000 live births and the MNM mortality ratio, mortality index (MI) and maternal mortality ratio (MMR) were: 5.8:1, 14.8% and 876.9 per 100,000 live births respectively. Close to three-fourth of all women with SMO had evidence of organ dysfunction on arrival or within 12 h of hospitalization. The commonest underlying causes for SMO were uterine rupture 27%, followed by hypertensive disorders 24% and obstetric hemorrhage 24%. The highest case fatality rate was found to be associated with eclampsia 28%. Maternal age, residential area, educational status and occupation were associated with SMO (P < 0.0001). On binary multivariable logistic regression the occurrence of any delay, intrapartal detection of complication, the mode of delivery and duration of hospitalization had statically significant association with SMO (p < 0.05). Optimal number of antenatal care (ANC) visits and delivery by emergency cesarean section (C/S) were found to be protective of SMO.ConclusionThe occurance SMO in the facility thus in the population served was high. Most of these factors associated with SMO are modifiable; some amenable to social change and the others are within the control of the health system. Thus the finding of this research calls for planning for such changes which can enhance timely and proper detection and management of pregnancy related complications.

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Background Perinatal mortality remains a challenge worldwide, particularly in developing countries. Although significant achievements have been made to reduce neonatal mortality worldwide, in the last two decades there was a total of 5.3 million neonatal deaths and stillbirths each year. This study aims to assess the magnitude of perinatal mortality and its contributing factors among births at the Jimma University Medical Centre in Ethiopia. Method A facility-based cross-sectional study was conducted between January and April 2017. Convenience sampling was used to select study participants and data were collected using interviewer-administered pretested structured questionnaires. Descriptive statistics were used to analyse the data, with the chi-square test used to assess the relationship between each factor and outcome. Statistical significance was set at P<0.05. Results The rate of perinatal death was 107 per 1000 births, of which 39.2%, 25.9% and 34.9% were fresh stillbirths, macerated stillbirths and early neonatal deaths respectively. The majority (77.8%) of stillbirths occurred before the study participant reached the hospital and 64.3% of stillbirths had low birth weight. Hyaline membrane disease (27.6%) and meconium aspiration syndrome (20.7%) were the two most common causes of early perinatal death. Obstetric complications contributed to 89.6% of perinatal deaths. Stillbirth was significantly associated with a lack of education (P=0.036). The rate of perinatal mortality was high among women with their first pregnancy (53.0%) and those who had no previous pregnancy-related problems (79.5%), and was significantly associated with mechanical causes and antepartum haemorrhage (P=0.015). Conclusions The findings indicated that the rate of perinatal mortality was high at the Himma University Medical Centre. Improving maternal education and health services in rural areas are important steps to prevent poor perinatal outcomes. Facilitating transport and improving referral procedures may help to prevent mechanical complications, which are the most common cause of perinatal death, particularly fresh stillbirths which, in the present study, often occurred before a participant arrived at the hospital.