"Near-miss" obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study

Abstract

Aim: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre. Methods:Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss case definition was based on validated disease-specific criteria, comprising of five diagnostic categories: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. The near-miss morbidities were compared with maternal deaths with respect to demographic features and disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for life-threatening obstetric conditions. The maternal death to near-miss ratios for the three years were compared to assess the trend in the quality of obstetric care.Results: There were 1501 deliveries, 211 near-miss cases and 44 maternal deaths. The total near-miss events were 242 with a decreasing trend from 2002 to 2004. Demographic features of cases of near-miss and maternal death were comparable. Besides infectious morbidity, the categories of complications responsible for near-misses and maternal deaths followed the same order of decreasing frequency. Hypertensive disorders in pregnancy and haemorrhage were responsible for 61.1% of near-miss cases and 50.0% of maternal deaths. More women died after developing severe morbidity due to uterine rupture and infection, with mortality indices of 37.5% and 28.6%, respectively. Early pregnancy complications and antepartum haemorrhage had the lowest mortality indices. Majority of the cases of near-miss (82.5%) and maternal death (88.6%) were unbooked for antenatal care and delivery in this hospital. Maternal mortality ratio for the period was 2931.4 per 100,000 deliveries. The overall maternal death to near-miss ratio was 1: 4.8 and this remained relatively constant over the 3-year period. Conclusion:The quality of care received by critically ill obstetric patients in this centre is suboptimal with no evident changes between 2002 and 2004. Reduction of the present maternal mortality ratio may best be achieved by developing evidence-based protocols and improving the resources for managing severe morbidities due to hypertension and haemorrhage especially in critically ill unbooked patients. Tertiary care hospitals in Nigeria could also benefit from evaluation of their standard of obstetric care by including near-miss investigations in their maternal death enquiries.

Obstetric Emergencies: Role of Obstetric Drill for a Better Maternal Outcome

“…Our results are comparable to the incidence of 0.8-8.23 % reported for hospitals in resource poor settings in the WHO systematic review of severe acute maternal morbidity [3]. It was lower than that observed in a Nigerian study , where almost one in six women suffered life-threatening emergencies [4]. A much lower incidence of severe obstetric conditions has been reported from European countries and United Nation indicating an inverse association between incidences of emergency obstetric cases with the development status of a country [5].…”

Evaluation of Obstetric Near Miss and Maternal Deaths in a Tertiary Care Hospital in North India: Shifting Focus from Mortality to Morbidity

“…Prevalence of MNM was evaluated and for each group of primary obstetric complication leading to MNM, maternal morbidity was compared to maternal mortality, and prevalence ratio, case fatality ratio (CFR), and mortality index (MI) were calculated [8] …”

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

“…[169][170][171][172] Studies from different parts of the world, including the UK, show a higher risk of mortality among women who do not receive adequate antenatal care. 156,169,171,173 Although there is a debate about the role of antenatal care in preventing maternal deaths caused by acute conditions that emerge close to the time of delivery, its role in identifying pregnant women at high risk (such as women with hypertensive disorders, medical comorbidities, anaemia and infections) and lowering their risk of mortality is widely accepted. 174 Confidential enquiries into maternal deaths in the UK have identified that a number of women who die during or after pregnancy are substance misusers, although the association with maternal death has not been formally quantified before now.…”