Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study

Abstract

Background: Since maternal near miss (MNM) could act as a surrogate of maternal death, the implementation of MNM audit at hospital level can provide an opportunity to study maternal morbidity at a large scale. Objectives: The current study aimed at investigating severe maternal outcomes (SMO; i.e. MNM + maternal death [MD]) in a referral hospital. Methods: A prospective, facility-based, cross sectional study was conducted from 22 June to 22 December 2017. The current study was performed in a tertiary referral teaching hospital in Zahedan, Iran. The study population included all pregnant females with a gestational age of 22 weeks giving birth in this hospital or referred to this center for delivery, as well as females within 42 days of pregnancy termination. The World Health Organization maternal near-miss criteria were used to identify MNM and analyze the data. Logistic regression was used to predict SMO risk factors. Results: Overall, 3527 deliveries and 3480 live births were reported in the hospital under investigation. Severe maternal outcomes were observed in 68 cases. The rate of MNM was 13.79 per 1000 live births; furthermore, the ratio of MNM to mortality was 12:1. Binary analysis showed that hemoglobin level, place of residence, parity, history of cesarean section (CS), insurance coverage, and type of delivery were the significant decisive factors in SMO. Moreover, severe hemorrhage and hypertensive disorders were the common causes of SMO. Conclusions: According to the collected data, MNM indicators were high in the under study hospital. Therefore, it seems necessary to adopt context-based interventions at hospital level to find and manage mothers prone to SMO during pregnancy and childbirth.

Near Miss Obstetric Events and Its Correlates at a Teaching Hospital in South-South, Nigeria

“…Gravidity and Parity were also identified as independent determinants of maternal near miss, as multigravid and multiparous women were more likely to experience a maternal near miss condition. Similar observations were made in South Sudan, Western Ethiopia, Northern Ethiopia, Iran, and India [15,19,[21][22][23]. Hence, there may be a need to increase awareness, broaden access and overcome known barriers to family planning services, to limit the number of pregnancies, thereby reducing near miss morbidities.…”

“…Human immunodeficiency virus (HIV/AIDS) infection, tuberculosis, anaemia, and cardiac disease in pregnancy are examples of indirect causes [7,9,11,12]. Studies have shown that the predictors of maternal near miss are advanced maternal age, race, illiteracy, polygamous family, low socioeconomic status, rural residency, fewer or no antenatal care (ANC) follow-up, multiple pregnancies, high parity, previous caesarean delivery, caesarean delivery in the current pregnancy, pre-existing medical conditions, lack of referral, lack of insurance coverage, anaemia, and extremes of body weight [5,[13][14][15][16][17][18][19][20][21][22][23].…”