Profile of maternal near miss and determinant factors in a Teaching Hospital, Southwestern Nigeria

Authors

  • Olusola P. Aduloju Department of Obstetrics and Gynecology, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
  • Tolulope Aduloju Department of Medical Social Services, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
  • Oluwadare M. Ipinnimo Department of Obstetrics and Gynecology, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20183752

Keywords:

Determinant factors, EKSUTH, Maternal near miss, Maternal death, Southwestern Nigeria

Abstract

Background: Maternal near miss (MNM) concept is becoming a tool for the assessment of severe maternal morbidity. The study examined the profile of MNM cases and their determinant factors.

Methods: A cross-sectional study of pregnant women with near miss cases and maternal death using the WHO criteria between 1st January 2015 and 31st December 2016. Relevant data were collected with using a structured data form, analyzed using SPSS version 22 and logistic regression was done to determine factors associated with MNM.

Results: The MNM incidence ratio was 17.4/1000 live births with overall mortality index of 17.5%. Hemorrhage (39.4%) was the commonest cause of MNM while uterine rupture (42.8%) was the most common cause of maternal death. Also, uterine rupture had the highest mortality index of 33.3%. Older age group, low education, rural dwellers and unbooked status of women were the significant determinants of MNM, p <0.05. The overall maternal death to near miss ratio was 1:4.7. The worst perinatal outcome occurred in women who suffered maternal death.

Conclusions: The study showed suboptimal level of care for women with life threatening conditions. There is a need to develop evidence-based protocol for their management and provision of high dependency unit.

References

Pattinson RC, Buchmann E, Mantel G, Schoon M, Rees H. Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries? Br J Obstet Gynecol. 2003;110:889-93.

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Say L, Pattinson RC, Gulmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1:3.

Tunçalp Ö, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG. 2012;119:653-61.

Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ. 2001;322:1089-93.

Mantel GD, Buchmann E, Rees H, Pattinson RC. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. Br J Obstet Gynecol. 1998;105:985-90.

WHO, World Health Organization. Evaluating the Quality of Care for Severe Pregnancy Complications: The WHO Near-Miss Approach for Maternal Health. Geneva: WHO 2001. Available at http://apps.who.int/iris/bitstream/10665/44692/2/9789241502221 eng.pdf accessed on March 10, 2017

Say L, Souza JP, Pattinson RC. Maternal near miss - towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynecol. 2009;23:287-96.

Pattinson R, Say L, Souza JP, Van Den Broek N, Rooney C. WHO Working Group on Maternal Mortality and Morbidity Classifications: WHO maternal death and near-miss classifications. Bull World Health Org. 2009;87:734.

Oladapo OT, Sule-Odu AO, Olatunji AO, Daniel OJ. “Near-miss” obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reprod Health. 2005;2:9.

World Health Organization. ICD-10: International statistical classification of diseases and health-related problems. In Tenth Revision Volume 2. Geneva: WHO 1993 Available at http://www.who.int/classifications/icd/ICD10volume2_en_2010.pdf accessed on March 10, 2017

Tunçalp O, Hindin MJ, Adu-Bonsaffoh K, Adanu RM. Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana. Int J Gynecol Obstet. 2013;123:58-63.

Nelissen EJT, Mduma E, Ersdal HL, Evjen-Olsen B, van Roosmalen JJM, Stekelenburg J. Maternal near miss and mortality in a rural referral hospital in northern Tanzania: A cross-sectional study. BMC Pregnancy Childbirth. 2013;13:141.

Chhabra P. Maternal near miss: an indicator for maternal health and maternal care. Ind J Comm Med. 2014;39:132-7.

Rulisa S, Umuziranenge I, Small M, van Roosmalen J. Maternal near miss and mortality in a tertiary care hospital in Rwanda. BMC Pregnancy Childbirth. 2015;15:203.

Kalisa R, Rulisa S, van den Akker T, van Roosmalen J. Maternal Near Miss and quality of care in a rural Rwandan hospital. BMC Pregnancy Childbirth. 2016;16:324.

Lotufo FA, Parpinelli MA, Haddad SM, Surita FG, Cecatti JG. Applying the new concept of maternal near-miss in an intensive care unit. Clinics. 2012;67:225-30.

Litorp H, Kidanto LH, Rööst M, Abeid M, Nyström L, Essén B. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy Childbirth. 2014;14:244.

Ali AA, Khojali A, Okud A, Adam GK, Adam I. Maternal near-miss in a rural hospital in Sudan. BMC Pregnancy Childbirth. 2011;11:48.

Jabir M, Abdul-Salam I, Suheil DM, Al-Hill W, Abul-Hassan S, Al-Zuheiri A et al. Maternal near miss and quality of maternal health care in Baghdad, Iraq. BMC Pregnancy Childbirth. 2013;13:11.

van den Akker T, Beltman J, Leyten J, Mwagomba B, Meguid T, Stekelenburg J et al. The WHO maternal near miss approach: consequences at Malawian District level. PLoS One 2013;8:e54805.

Pattinson RC, Hall M (2003). Near misses: a useful adjunct to maternal death enquiries. Br Med Bull. 2003;67:231-43.

Jyoti B, Garima S. Clinical and etiological study of maternal near-miss at a tertiary referral hospital of Central India. Ind J Obstet Gynecol Res. 2016;3:28-31.

Duley L, Gülmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with preeclampsia. The Cochrane Database Syst Rev. Art. 2003 No.: CD000025.

Adisasmita A, Deviany PE, Nandiaty F, Stanton C, Ronsmans C. Obstetric near miss and deaths in public and private hospitals in Indonesia. BMC Pregnancy Childbirth. 2008;8:10.

Prual A, Huguet D, Gabin O, Rabe G. Severe obstetric morbidity of the third trimester, delivery and early puerperium in Niamey (Niger). Afr J Reprod Health. 1998;2:10-9.

Filippi V, Ronsmans C, Gohou V, Goufodji S, Lardi M, Sahel A et al. Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals. Acta Obstet Gynecol Scand. 2005;84:11-6.

Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1:3.

World Health Organization. WHO statement on caesarean section rates. WHO Geneva 2015. Available at http//:apps.who.int/WHO.RHR.5.02 eng.pdf accessed on August 2, 2017.

Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol. 2008;199:3.

van den Akker T, Mwagomba B, Irlam J, Van Roosmalen J (2009). Using audits to reduce the incidence of uterine rupture in a Malawian district hospital. Int J Gynaecol Obstet. 2009;107:289-94.

World Health Organization. WHO recommendations for the prevention of postpartum hemorrhage. WHO 2007 Available at http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502eng.pdf accessed on March 12, 2012.

Zeeman GG. Obstetric critical care: a blueprint for improved outcomes. Crit Care Med. 2006;34:S208-S214.

Naderi T, Foroodnia S, Omidi S, Samadani F, Nakhaee N. Incidence and correlates of maternal near miss in Southeast Iran. Int J Reprod Med. 2015;Article ID 914713:5.

Mpembeni RNM, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D et al. Use pattern of maternal health services and determinants of skilled care during delivery in southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth. 2007;7:29.

Sunday-Adeoye I, Kalu CA. Pregnant Nigerian women’s view of caesarean section. Niger J Clin Pract. 2011;14:276-9.

Gedefaw M, Gebrehana H, Gizachew A, Taddess F. Assessment of maternal near miss at Debre Markos referral hospital, Northwest Ethiopia: Five Years’ Experience. Open J Epidemiol. 2014;4:199-207.

Abdella A. Maternal mortality trend in Ethiopia. Eth J Health Dev. 2010;24:115-22.

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Published

2018-08-27

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Original Research Articles