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Maternal near‐miss and death among women with hypertensive disorders in pregnancy: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey
Author(s) -
Adamu AN,
Okusanya BO,
Tukur J,
Ashimi AO,
Oguntayo OA,
Tunau KA,
Ekele BA,
Oladapo OT
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15427
Subject(s) - medicine , eclampsia , maternal death , pregnancy , childbirth , obstetrics , pediatrics , case fatality rate , incidence (geometry) , epidemiology , population , genetics , physics , environmental health , optics , biology
Objective To investigate life‐threatening maternal complications related to hypertensive disorders of pregnancy ( HDP ) in Nigerian public tertiary hospitals. Design Secondary analysis of a nationwide cross‐sectional study. Setting Forty‐two tertiary hospitals. Population Women admitted for pregnancy, childbirth or puerperal complications. Method All cases of severe maternal outcome ( SMO : maternal near‐miss or maternal death) due to HDP were prospectively identified using the WHO criteria over a 1‐year period. Main outcome measures Incidence of SMO , health service events, case fatality rate, and mortality index (% of maternal death/ SMO ). Results Out of 100 107 admissions for maternal complications, 6753 (6.8%) women had HDP . Pre‐eclampsia ( PE ) (54.5%) and eclampsia (E) (30.4%) were the most common HDP recorded. SMO occurred in 587 women with HDP : 298 maternal near‐misses and 289 maternal deaths. The majority (93%) of the women with SMO due to HDP were admitted in a critical condition. The median diagnosis–definitive intervention interval was over 4 hours in a quarter of women who died from HDP . For PE and E, case fatality rates were 1.9 and 10.4%, respectively, although both conditions had a similar mortality index of 49.3%. Lack of antenatal care and place of residence further than 5 km from the hospital were associated with maternal death. Conclusions Severe maternal outcomes from HDP were due to late presentations and health system challenges. To reduce maternal deaths from HDP , health system strengthening that would engender early hospital presentation and prompt treatment is recommended. Funding The original research that generated the data for this secondary analysis was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction ( HRP ), a co‐sponsored programme executed by the World Health Organization ( WHO ). We have no other funding issue to declare for our study. Tweetable abstract Eclampsia is the leading cause of maternal death in Nigerian hospitals.