scholarly journals Maternal near miss among women admitted in major private hospitals in eastern Ethiopia: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shegaw Geze Tenaw ◽  
Nega Assefa ◽  
Teshale Mulatu ◽  
Abera Kenay Tura
Keyword(s):  
Retrospective Study ◽  
Cesarean Section ◽  
Antenatal Care ◽  
Termination Of Pregnancy ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Chronic Hypertension ◽  
Eastern Ethiopia ◽  
Private Hospitals ◽  
Live Births

Abstract Background Since maternal mortality is a rare event, maternal near miss has been used as a proxy indicator for measuring maternal health. Maternal near miss (MNM) refers to a woman who nearly died but survived of complications during pregnancy, childbirth or within 42 days of termination of pregnancy. Although study of MNM in Ethiopia is becoming common, it is limited to public facilities leaving private facilities aside. The objective of this study was to assess MNM among women admitted in major private hospitals in eastern Ethiopia. Methods An institution based retrospective study was conducted from March 05 to 31, 2020 in two major private hospitals in Harar and Dire Dawa, eastern Ethiopia. The records of all women who were admitted during pregnancy, delivery or within 42 days of termination of pregnancy was reviewed for the presence of MNM criteria as per the sub-Saharan African MNM criteria. Descriptive analysis was done by computing proportion, ratio and means. Factors associated with MNM were assessed using binary logistic regression with adjusted odds ratio (aOR) along with its 95% confidence interval (CI). Results Of 1214 pregnant or postpartum women receiving care between January 09, 2019 and February 08, 2020, 111 women developed life-threatening conditions: 108 MNM and 3 maternal deaths. In the same period, 1173 live births were registered, resulting in an MNM ratio of 92.1 per 1000 live births. Anemia in the index pregnancy (aOR: 5.03; 95%CI: 3.12–8.13), having chronic hypertension (aOR: 3.13; 95% CI: 1.57–6.26), no antenatal care (aOR: 3.04; 95% CI: 1.58–5.83), being > 35 years old (aOR: 2.29; 95%CI: 1.22–4.29), and previous cesarean section (aOR: 4.48; 95% CI: 2.67–7.53) were significantly associated with MNM. Conclusions Close to a tenth of women admitted to major private hospitals in eastern Ethiopia developed MNM. Women with anemia, history of cesarean section, and old age should be prioritized for preventing and managing MNM. Strengthening antenatal care and early screening of chronic conditions including hypertension is essential for preventing MNM.

scholarly journals Determinants of maternal near-miss in private hospitals in eastern Ethiopia: A nested case–control study

2021 ◽  
Vol 17 ◽  
pp. 174550652110619
Author(s):  
Shegaw Geze Tenaw ◽  
Sagni Girma Fage ◽  
Nega Assefa ◽  
Abera Kenay Tura
Keyword(s):  
Antenatal Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Eastern Ethiopia ◽  
Private Hospitals ◽  
Near Misses ◽  
Medical Disorders ◽  
History Of ◽  
Sub Saharan ◽  
Nested Case Control

Objective: Maternal near-miss refers to a woman who nearly died but survived complications in pregnancy, childbirth, or within 42 days of termination of pregnancy. The study of maternal near-miss has become essential for improving the quality of obstetric care. The objective of this study was to identify the determinants of maternal near-miss among women admitted to major private hospitals in eastern Ethiopia. Method: An unmatched nested case–control study was conducted in major private hospitals in eastern Ethiopia from 5 March to 31 March 2020. Cases were women who fulfilled the sub-Saharan African maternal near-miss criteria and those admitted to the same hospitals but discharged without any complications under the sub-Saharan African maternal near-miss tool were controls. For each case, three corresponding women were randomly selected as controls. Factors associated with maternal near-misses were analyzed using binary and multiple logistic regressions with an adjusted odds ratio along with a 95% confidence interval. Finally, p-value < 0.05 was considered as a cut-off point for the significant association. Results: A total of 432 women (108 cases and 324 controls) participated in the study. History of prior cesarean section (AOR = 4.33; 95% CI = 2.36–7.94), anemia in index pregnancy (AOR = 4.38; 95% CI = 2.43–7.91), being ⩾ 35 years of age (AOR = 2.94; 95% CI = 1.37–6.24), not attending antenatal care (AOR = 3.11; 95% CI = 1.43–6.78), and history of chronic medical disorders (AOR = 2.18; 95% CI = 1.03–4.59) were independently associated with maternal near-miss. Conclusion: Maternal age ⩾ 35 years, had no antenatal care, had prior cesarean section, being anemic in index pregnancy, and have history of chronic medical disorders were the determinants of maternal near-miss. Improving maternal near-misses requires strengthening antenatal care (including supplementation of iron and folic acid to reduce anemia) and prioritizing women with a history of chronic medical illnesses. Interventions for preventing primary cesarean sections are crucial in this era of the cesarean epidemic to minimize its effect on maternal near-miss.

scholarly journals Women with maternal near-miss in the intensive care unit in Yangzhou, China: a 5-year retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Chen ◽  
Jiaoyang Shi ◽  
Yuting Zhu ◽  
Xiang Kong ◽  
Yang Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Postpartum Hemorrhage ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Near Misses ◽  
Live Births ◽  
Cesarean Birth

Abstract Background Analysis of “maternal near-misses” is expected to facilitate assessment of the quality of maternity care in health facilities. Therefore, this study aimed to investigate incidence, risk factors and causes of maternal near-misses (MNM) admitted to the intensive care unit (ICU) within five years by using the World Health Organization’s MNM approach. Methods A five-year retrospective study was conducted in Subei People’s Hospital of Yangzhou, Jiangsu Province from January 1, 2015 to December 31, 2019. Risk factors in 65 women with MNM in the intensive care unit (ICU) were explored by using chi-square tests and multivariable logistic regression analysis. Causes and interventions in MNM were investigated by descriptive analysis. Results Average maternal near-miss incidence ratio (MNMIR) for ICU admission was 3.5 per 1000 live births. Average maternal mortality ratio (MMR) was 5 per 100,000 live births. MI for all MNM was 0.7%. Steady growth of MNMIR in ICU was witnessed in the five-year study period. Women who were referred from other hospitals (aOR 3.32; 95%CI 1.40–7.32) and had cesarean birth (aOR 4.96; 95%CI 1.66–14.86) were more likely to be admitted in ICU. Neonates born to women with MNM admitted in ICU had lower birthweight (aOR 5.41; 95%CI 2.53–11.58) and Apgar score at 5 min (aOR 6.39; 95%CI 2.20–18.55) compared with women with MNM outside ICU. ICU admission because of MNM occurred mostly postpartum (n = 63; 96.9%). Leading direct obstetric causes of MNM admitted in ICU were hypertensive diseases of pregnancy (n = 24; 36.9%), followed by postpartum hemorrhage (n = 14; 21.5%), while the leading indirect obstetric cause was heart diseases (n = 3; 4.6%). Conclusions Risk factors that were associated with MNM in ICU were referral and cesarean birth. Hypertensive disease of pregnancy and postpartum hemorrhage were the main obstetric causes of MNM in ICU. These findings would provide guidance to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for cesarean birth.

scholarly journals Incidence and Correlates of Maternal Near Miss in Southeast Iran

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Tayebeh Naderi ◽  
Shohreh Foroodnia ◽  
Samaneh Omidi ◽  
Faezeh Samadani ◽  
Nouzar Nakhaee
Keyword(s):  
Maternal Morbidity ◽  
Tertiary Care ◽  
Termination Of Pregnancy ◽  
Near Miss ◽  
High Rate ◽  
Severe Maternal Morbidity ◽  
Maternal Near Miss ◽  
Live Births ◽  
Referral Hospitals ◽  
Set Up

This prospective study aimed to estimate the incidence and associated factors of severe maternal morbidity in southeast Iran. During a 9-month period in 2013, all women referring to eight hospitals for termination of pregnancy as well as women admitted during 42 days after the termination of pregnancy were enrolled into the study. Maternal near miss conditions were defined based on Say et al.’s recommendations. Five hundred and one cases of maternal near miss and 19,908 live births occurred in the study period, yielding a maternal near miss ratio of 25.2 per 1000 live births. This rate was 7.5 and 105 per 1000 in private and tertiary care settings, respectively. The rate of maternal death in near miss cases was 0.40% with a case:fatality ratio of 250 : 1. The most prevalent causes of near miss were severe preeclampsia (27.3%), ectopic pregnancy (18.4%), and abruptio placentae (16.2%). Higher age, higher education, and being primiparous were associated with a higher risk of near miss. Considering the high rate of maternal near miss in referral hospitals, maternal near miss surveillance system should be set up in these hospitals to identify cases of severe maternal morbidity as soon as possible.

scholarly journals Factors Associated with Maternal Near Miss among Women Admitted in West Arsi Zone Public Hospitals, Ethiopia: Unmatched Case-Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Fikadu Nugusu Dessalegn ◽  
Feleke Hailemichael Astawesegn ◽  
Nana Chea Hankalo
Keyword(s):  
Cesarean Section ◽  
Antenatal Care ◽  
Case Control Study ◽  
Case Control ◽  
Public Hospitals ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Factors Associated ◽  
Arsi Zone ◽  
Control Study

Background. Maternal near miss refers to a very ill pregnant or delivered woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal death; the most catastrophic end is frequently described as just “tip of the iceberg,” whereas maternal near-miss as the “base.” Therefore, this study aimed at assessing the factors associated with maternal near-miss among women admitted in public hospitals of West Arsi zone, Ethiopia. Methods. A facility-based unmatched case-control study was conducted from Mar 1 to Apr 30, 2019. Three hundred twenty-one (80 cases and 241 controls) study participants were involved in the study. Cases were recruited consecutively as they present, whereas controls were selected by systematic sampling method. Cases were women admitted to hospitals during pregnancy, delivery, or within 42 days of termination of pregnancy and fulfilled at least one of the maternal near-miss disease-specific criteria, while controls were women admitted and gave birth by normal vaginal delivery. The interviewer-administered structured questionnaire and data abstraction tool was used to collect data. Data were entered Epi data 3.1 and then transferred into SPSS 20 for analysis. Multivariable logistic regression was used, and the significance level was declared at p value ≤ 0.05. Results. The major maternal near-miss morbidities were severe obstetric hemorrhage (32.5%), pregnancy-induced hypertensive disorders (31.3%), and obstructed labor (26.3%), followed by 6.3% and 3.8% of severe anemia and pregnancy-induced sepsis, respectively. The odds of maternal near miss were statistically significantly associated with women’s lack of formal education [AOR=2.24, 95% CI: (1.17, 4.31)]. Not attending antenatal care [AOR=3.71, 95% CI: (1.10, 12.76)], having prior history of cesarean section [AOR=3.53, 95% CI: (1.49, 8.36)], any preexisting chronic medical disorder [AOR=2.04, 95% CI: (1.11, 3.78)], and having experienced first delay [AOR=5.74, 95% CI: (2.93, 11.2)]. Conclusions. Maternal education, antenatal care, chronic medical disorders, previous cesarean section, and first delay of obstetric care-seeking were identified as factors associated with maternal near-miss morbidity. Therefore, this finding implies the need to get better with those factors, to preclude severe maternal complications and subsequent maternal mortality.

scholarly journals The impact of antenatal care on maternal near-miss events in Ethiopia: A systematic review and meta-analysis

2020 ◽  
Vol 13 ◽  
pp. 100246
Author(s):  
Ebisa Turi ◽  
Ginenus Fekadu ◽  
Bedasa Taye ◽  
Gemechu Kejela ◽  
Markos Desalegn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antenatal Care ◽  
Meta Analysis ◽  
Near Miss ◽  
Maternal Near Miss ◽  
The Impact

scholarly journals MATERNAL NEAR MISS AND MATERNAL DEATHS IN KERALA, INDIA - A REVIEW

2020 ◽  
pp. 1-2
Author(s):  
Deepthy Balakrishnan
Keyword(s):  
Neurological Disorder ◽  
Maternal Morbidity ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Live Births ◽  
Tertiary Centre ◽  
Mortality Index ◽  
Severe Maternal Outcome ◽  
Mortality Ratio

Aim- To determine the prevalence and pattern of near miss cases/ severe acute maternal morbidity cases and maternal deaths in a tertiary centre. Materials and methods - WHO 2011 criteria was used for identication of near miss cases. Results- In the study period of 2 years, there were 131 cases of severe maternal outcome (105 near miss and 26 maternal deaths). Maternal near miss incidence ratio is 5.62/ 1000 live births. Maternal near miss to mortality ratio is 4.03:1. The mortality index is 19.8%. Hemorrhage was the leading cause of near miss cases (44.76%) followed by hypertension(27.6%) but indirect causes(42.3%) led to maximum number of maternal deaths followed by hemorrhage. Among the indirect causes, cardiac and neurological disorder caused maximum mortality. Conclusion - Hemorrhage and hypertension were the leading causes of near miss but maternal mortality was more due to indirect causes. So it's important to involve specialist doctors from other departments to improve care of mothers and hence reduce maternal deaths further.

scholarly journals Incidence of maternal near-miss in Kenya in 2018: findings from a nationally representative cross-sectional study in 54 referral hospitals

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Onikepe Owolabi ◽  
Taylor Riley ◽  
Kenneth Juma ◽  
Michael Mutua ◽  
Zoe H. Pleasure ◽  
...  
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Obstetric Care ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Live Births ◽  
Management Of Complications ◽  
Referral Hospitals ◽  
Nationally Representative

Abstract Although the Kenyan government has made efforts to invest in maternal health over the past 15 years, there is no evidence of decline in maternal mortality. To provide necessary evidence to inform maternal health care provision, we conducted a nationally representative study to describe the incidence and causes of maternal near-miss (MNM), and the quality of obstetric care in referral hospitals in Kenya. We collected data from 54 referral hospitals in 27 counties. Individuals admitted with potentially life-threatening conditions (using World Health Organization criteria) in pregnancy, childbirth or puerperium over a three month study period were eligible for inclusion in our study. All cases of severe maternal outcome (SMO, MNM cases and deaths) were prospectively identified, and after consent, included in the study. The national annual incidence of MNM was 7.2 per 1,000 live births and the intra-hospital maternal mortality ratio was 36.2 per 100,000 live births. The major causes of SMOs were postpartum haemorrhage and severe pre-eclampsia/eclampsia. However, only 77% of women with severe preeclampsia/eclampsia received magnesium sulphate and 67% with antepartum haemorrhage who needed blood received it. To reduce the burden of SMOs in Kenya, there is need for timely management of complications and improved access to essential emergency obstetric care interventions.

scholarly journals Indicators of maternal ‘near miss’ morbidity at different levels of health care in North India: A pilot study

2015 ◽  
Vol 14 (3) ◽  
pp. 254-257 ◽  
Author(s):  
Ravleen Kaur Bakshi ◽  
Pradeep Aggarwal ◽  
Debabrata Roy ◽  
Ruchira Nautiyal ◽  
Rakesh Kakkar
Keyword(s):  
Health Care ◽  
Health Centre ◽  
Medical Science ◽  
Maternal Outcome ◽  
Health Care Facilities ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Effective Measure ◽  
Live Births ◽  
Severe Maternal Outcome

Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Lie Threatening Conditions (PLTC) and ‘near miss’ obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for ‘near miss’. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal ‘near-miss’ and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal ‘near miss’ Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO ‘near miss’ approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.254-257

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