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Incidence, causes and correlates of maternal near‐miss morbidity: a multi‐centre cross‐sectional study
Author(s) -
Oppong SA,
Bakari A,
Bell AJ,
Bockarie Y,
Adu JA,
Turpin CA,
Obed SA,
Adanu RM,
Moyer CA
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 - 10.1111/1471-0528.15578
Subject(s) - cross sectional study , incidence (geometry) , medicine , maternal morbidity , pediatrics , pregnancy , mathematics , pathology , geometry , biology , genetics
Objective To explore the incidence and factors associated with maternal near‐miss. Design Cross‐sectional study with an embedded case–control study. Setting Three tertiary referral hospitals in southern Ghana. Population All women admitted to study facilities with pregnancy‐related complications or for birth. Methods An adapted version of the WHO Maternal Near Miss Screening Tool was used to identify maternal near‐miss cases. These were compared with unmatched controls (uncomplicated deliveries) in a ratio of 1:2. Main outcome measures Incidence of maternal near‐miss, maternal near‐miss to maternal mortality ratio, and cause of and factors associated with maternal near‐miss. Results Out of 8433 live births, 288 maternal near‐miss cases and 62 maternal deaths were identified. In all, 454 healthy controls were recruited for comparison. Maternal near‐miss and maternal death incidence ratios were 34.2 (95% CI 30.2–38.1) and 7.4 (95% CI 5.5–9.2) per 1000 live births, respectively with a maternal near‐miss to mortality ratio of 4.6:1. Cause of near‐miss was pre‐eclampsia/eclampsia (41.0%), haemorrhage (12.2%), maternal sepsis (11.1%) and ruptured uterus (4.2%). A major factor associated with maternal near‐miss was maternal fever within the 7 days before birth ( OR 5.95, 95% CI 3.754–9.424). Spontaneous onset of labour was protective against near‐miss ( OR 0.09 95% CI 0.057–0.141). Conclusion For every maternal death, there were nearly five maternal near‐misses. Women having a fever in the 7 days before delivery were six times more likely to experience a near‐miss than women not having fever. Tweetable abstract Maternal near‐miss exceeds maternal death by 5:1, with the leading cause of maternal near‐miss was pre‐eclampsia/eclampsia.