Frequency and Covariates of Maternal Near-Miss Events and Maternal Deaths in a Tertiary Care Hospital; A Cross-Sectional Study

Abstract

Objective: To determine the frequency and covariates of maternal near-miss events and maternal deaths in a tertiary care hospital.

Methodology: The present cross-sectional study was carried out at the Gynae-A unit of Mardan Medical Complex, Mardan, Pakistan, over a one-year period from January to December 2018. For data collection, we used a pre-designed proforma that included only those patients who fulfilled near-miss criteria according to the validated WHO near-miss criteria. This proforma prospectively recorded the patient demographic variables, including her age, parity, gestational age at presentation, and booking status. Later, the data was analyzed to determine the frequency and underlying causes of near-miss events and mortality in our unit. The study included 268 participants who met the WHO near-miss inclusion criteria in 2009.

Results: In the Gynae-A unit of Mardan Medical Complex, over one year, 9130 deliveries occurred from January to December 2018, resulting in 8966 live births. Among these total deliveries, there were 268 cases of near-miss Obstetric events and 11 cases of maternal deaths. Our unit’s calculated maternal near-miss incidence ratio was 29.35 per 1000 live births, and the maternal mortality index was 3.9%. The other important parameter which reflects the quality of obstetric care is the maternal near-miss-to-mortality ratio, which was found to be 24:1, highly predicting a relatively good quality of obstetric care at our obstetric unit.

Conclusion: Our unit’s maternal near-miss incidence ratio was 29.35 per 1000 live births, indicating the frequency of severe maternal complications. The ratio of one maternal death for every 24 near-miss events highlights our unit's high level of obstetric care and prevents maternal and perinatal mortalities. The study identified hemorrhage and hypertensive disorders as the main causes of maternal near-miss events and mortality. These findings strongly suggest that identifying women at risk and implementing all evidence-based preventive strategies and timely interventions can reduce maternal mortality and thus help in achieving sustainable development goals by improving overall maternal health.