Determinants of Maternal Near Miss: A Facility-Based Case-Control Study in Luanda, Angola

Background Understanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola. Methods A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value <0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI). Results Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89). Conclusions According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting. Key messages • Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola. • Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.

ObjectiveAssess the primary causes and preventability of maternal near misses (MNM) and mortalities (MM) at the largest tertiary referral hospital in Rwanda, Kigali University Teaching Hospital (CHUK).MethodsWe reviewed records for all women admitted to CHUK with pregnancy-related complications between January 1st, 2015 and December 31st, 2015. All maternal deaths and near misses, based on WHO near miss criteria were reviewed (Appendix A). A committee of physicians actively involved in the care of pregnant women in the obstetric-gynecology department reviewed all maternal near misses/ pregnancy-related deaths to determine the preventability of these outcomes. Preventability was assessed using the Three Delays Model.[1] Descriptive statistics were used to show qualitative and quantitative outcomes of the maternal near miss and mortality.ResultsWe identified 121 maternal near miss (MNM) and maternal deaths. The most common causes of maternal near miss and maternal death were sepsis/severe systemic infection (33.9%), postpartum hemorrhage (28.1%), and complications from eclampsia (18.2%)/severe preeclampsia (5.8%)/. In our obstetric population, MNM and deaths occurred in 87.6% and 12.4% respectively. Facility level delays (diagnostic and therapeutic) through human error or mismanagement (provider issues) were the most common preventable factors accounting for 65.3% of preventable maternal near miss and 10.7% maternal deaths, respectively. Lack of supplies, blood, medicines, ICU space, and equipment (system issues) were responsible for 5.8% of preventable maternal near misses and 2.5% of preventable maternal deaths. Delays in seeking care contributed to 22.3% of cases and delays in arrival from home to care facilities resulted in 9.1% of near misses and mortalities. Cesarean delivery was the most common procedure associated with sepsis/death in our population. Previous cesarean delivery (24%) and obstructed/prolonged labor (13.2%) contributed to maternal near miss and mortalities.ConclusionThe most common preventable causes of MNM and deaths were medical errors, shortage of medical supplies, and lack of patient education/understanding of obstetric emergencies. Reduction in medical errors, improved supply/equipment availability and patient education in early recognition of pregnancy-related danger signs will reduce the majority of delays associated with MNM and mortality in our population.

Background: Review of the care provided to women who nearly died but survived complications occurring during pregnancy, childbirth, or the postnatal period, known as maternal near miss (MNM). It is one of the recommended approaches to improve the quality of care (QoC) especially in settings with few maternal deaths. Oman has a well-established maternal deaths surveillance system, but there has not been a significant decline in the maternal mortality ratio, and the majority of maternal deaths are considered preventable. In addition, the burden of severe maternal morbidity is unknown. This study explores the potential of MNM review to improve quality of care in Oman. The objectives are to determine the incidence, underlying causes of, and factors associated with MNM in Oman, to assess QoC and make recommendations for its improvement. Method: Existing WHO guidelines and criteria were reviewed, and a systematic review of the literature was conducted to establish criteria for the identification of MNM in Oman. A national survey with in-depth review of MNM cases was implemented. MNM cases were identified from 23 hospitals across all 11 governorates, capturing more than 90% of total deliveries in the country. Between October 2016 and September 2017 all cases fulfilling the MNM criteria were reviewed at the hospital and regional levels by trained reviewers. 50% of cases were reviewed additionally by the National Maternal Mortality Review Committee and a panel of international experts. The level of agreement between various levels of reviewers was determined using Cohen’s kappa coefficient. Results: During the one-year period of data collection a total of 25 maternal deaths and 312 MNM cases were reported, given an MNM incidence of 4.0 per 1000 women giving birth (deliveries), and a ratio of MNM: maternal mortality of 10.3:1. Hypertensive disorders (44%), obstetric haemorrhage (23%), and non-obstetric complications (18%) were the most common underlying causes of MNM. Previous caesarean sections (20.0%), medical disorders (20.0%), and grand-multiparity (20.0%) were the main contributory conditions to MNM. Overall there was good care given (43.6%). In up to 36.5% of cases improved care could have made a difference to the outcome. The most commonly identified associated factors were related to the healthcare team providing care (50.0%), in particular inappropriate management (28.2%) and failure to initially recognise the seriousness of the condition (25.6%). Factors related to the women themselves included non-adherence to prescribed treatment, delay in seeking care was associated with around one third of MNM events. Factors related to organisation of care were recorded in about a quarter of all MNM events with non-availability or outdated policy and guidelines identified as the most common identified factors. Conclusion: The study used a participatory process to develop criteria for identify MNM and a system for reviewing these. It demonstrated it is feasible to complement maternal deaths review with MNM review. The most common…

The maternal nearmiss approach is a valuable tool for assessing the quality of care among women experiencing severe maternal morbidity. Objective: We aimed to estimate the frequency of maternal near-miss and maternal death. Methods: A cross-sectional study was conducted in two referral hospitals in Angola, from June 10 to September 8, 2022, and included women who met at least one WHO near-miss criterion. Descriptive analysis provided indicators of maternal near-near miss and maternal death. Results: There were 12,746 live births, 245 maternal near-miss, and 86 maternal deaths, resulting in a maternal near-miss ratio of 19.2 per 1000 live births and a maternal mortality ratio of 674.7 per 100,000 live births. The ratio of maternal near-miss to maternal death and the mortality index were 2.8:1 and 26.0%, respectively. Bleeding (n=128; 38.7%) and hypertensive disorders (n=80; 24.2%) were the most frequent causes of maternal nearmiss and maternal death. Anemia was the commonest underlying cause of maternal near-miss (n=231; 94.3%) and maternal death (n=78; 90.7%). A higher mortality index was observed among women with sepsis (36.6%) and complications of abortion (36.7%). Lower family income (p<0.001), being referred from other hospitals (p=0.024), and prolonged delays in seeking care (p=0.0319) were related to maternal death. Conclusions: The primary and underlying causes of severe maternal outcomes are preventable. Community interventions focused on overcoming barriers in seeking care should be prioritized for early management of obstetric complications. Access to routine reproductive health services and antenatal care is crucial for preventing unintended pregnancies and the early diagnosis of potentially life-threatening conditions.

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.

The investigation of Maternal Near-Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran. A prospective case-control study was conducted on 250 women referred to the maternity ward of Nohom-e-Dey hospital in Torbat-e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near-miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported. A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant. Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.

BackgroundMaternal mortality is a significant global issue, but maternal morbidity, leading to lasting disability, is more prevalent. The World Health Organization (WHO) developed the Maternal Near Miss (MNM) tool to complement maternal mortality measures and improve maternal health outcomes.ObjectiveThis study compares MNM incidence and magnitude between a secondary health facility and a tertiary health facility in Abuja, Nigeria.MethodsA 12-month prospective study identified MNM cases using WHO clinical criteria. Data on MNM cases were collected and analyzed using descriptive and comparative statistics. The chi-square test and rate ratio analysis were employed to compare MNM incidences between the facilities.ResultThe secondary health facility had 1,340 live births, 148 MNM cases (110.5 per 1,000 live births), and 2 maternal deaths (mortality index of 1.33%) while the tertiary health facility had 796 live births, 220 MNM cases (276.4 per 1,000 live births), and no maternal deaths (mortality index of 0). Significant differences were observed in the distribution of MNM cases as rate ratio analysis showed women at the tertiary facility were 2.5 times more likely to experience MNM compared to those at the secondary facility [Rate Ratio = 2.53; 95% CI: [1.98–3.24]; p < 0.05].DiscussionThe higher MNM incidence at the tertiary facility likely reflects its role as a referral center for high-risk cases. Despite higher MNM rates, the tertiary facility’s effective management prevented maternal deaths, contrasting with the secondary facility’s mortality outcomes.ConclusionThis study reveals significant disparities in MNM incidence and distribution between secondary and tertiary healthcare facilities in Abuja, Nigeria. The higher MNM incidence at the tertiary facility underscores its crucial role in managing severe maternal complications and high-risk cases, reflecting the challenges faced by secondary facilities in handling complex maternal health issues.

BackgroundWomen from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Our aim was to investigate whether care quality for MNM differed between Iranians and Afghans and identify potential preventable attributes of MNM.MethodsAn MNM audit study was conducted from 2012 to 2014 at three university hospitals in Tehran. Auditors evaluated the quality of care by reviewing the hospital records of 76 MNM cases (54 Iranians, 22 Afghans) and considering additional input from interviews with patients and professionals. Main outcomes were frequency of suboptimal care and the preventable attributes of MNM. Crude and adjusted odds ratios with confidence intervals for the independent predictors were examined.ResultsAfghan MNM faced suboptimal care more frequently than Iranians after adjusting for educational level, family income, and insurance status. Above two-thirds (71%, 54/76) of MNM cases were potentially avoidable. Preventable factors were mostly provider-related (85%, 46/54), but patient- (31%, 17/54) and health system-related factors (26%, 14/54) were also important. Delayed recognition, misdiagnosis, inappropriate care plan, delays in care-seeking, and costly care services were the main potentially preventable attributes of MNM.ConclusionsAfghan mothers faced inequality in obstetric care. Suboptimal care was provided in a majority of preventable near-miss events. Improving obstetric practice and targeting migrants’ specific needs during pregnancy may avert near-miss outcomes.

BackgroundSince 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.MethodsAn 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).ResultsOf 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.ConclusionsClose 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.

Timely treatment of tuberculosis is imperative for its control. This can get delayed due to delay in care seeking, diagnosis or treatment initiation. The study aims to find out the magnitude of delays in care seeking, diagnosis or treatment initiation, and understand the reasons behind these delays in Wardha district of Maharashtra, India. A mixed methods study was conducted among 275 patients selected from those enrolled under Revised National Tuberculosis Control Programme in 2014. We collected information regarding the duration of delays and generated a free list of reasons for delays in care seeking and diagnosis. The free list items were then subjected to pile sorting. Two-dimensional scaling and hierarchical clustering analysis were performed to identify the various domains of reasons for delays. The median delay in initial care seeking and diagnosis was 10 days each, and that for treatment initiation was 2 days. The domains identified for delay in care seeking were negligence toward health, health conditions, facility-related issues, and household and social reasons. The domains identified for delay in diagnosis were system-related reasons; and patient-related reasons, each of them further having two subdomains. Interventions for reducing the knowledge gap and stigma, increasing the accessibility of services, active case finding; capacity building of providers, quality assured sputum microscopy, and communication skills will help reduce these delays.

Background:Use of maternal near-miss (MNM) cases as an adjunct has been advocated to understand the processes of obstetric care because they share similar pathways as maternal deaths. Identifying the predictors and care pathway is crucial to improve the quality of care and end preventable maternal deaths.Materials and Methods:This case–control study was conducted at a tertiary care facility in Kolkata from May 2019 to March 2020. Women admitted with complications during pregnancy, childbirth, or within 42 days of postpartum, who met the World Health Organization (WHO) near-miss criteria, were identified as cases, and equivalent age-group matched controls were recruited. Sample size of 60 cases and 60 controls was estimated, assuming a power of 80%, level of significance 0.05, and case–control ratio of 1. After obtaining approval from the institutional ethics committee and informed written consent from the participants, data was collected through face-to-face interview and review of records. Statistical analysis including care pathway analysis (using three-delay model) was performed using Statistical Package for Social Sciences version 16.Results:Joint family type (adjusted odds ratio [AOR] [CI] = 5.06 [1.48, 7.28]), lack of antenatal checkups (AOR [CI] = 7.85 [1.47, 12.09]), previous history of cesarean section (AOR [CI] = 3.94 [1.09, 14.33]), first delay in seeking care (AOR [CI] = 13.84 [3.62, 32.83]), and preexisting medical disorders (AOR [CI] = 11.03 [4.62, 22.80]) were identified as significant predictors of MNM in the adjusted model. Significant difference in the proportion of first and second delays in the care pathway was observed between cases and controls.Conclusions:Identification of risk factors of MNM and pattern of delays in the care pathway will help improving quality of obstetric care.

Pregnancy is considered to be a physiological process but many women lose their lives during the process of pregnancy and child birth due to complications. These complications need to be anticipated, prevented and managed appropriately so as to avert a maternal death. A maternal death cannot occur suddenly and in most of the cases it is preceded by some events which if not recognised timely and managed appropriately lead to maternal death. A woman’s lifetime risk of death varies depending on the facilities available and the standard of Obstetric care she receives. Maternal mortality ratio (MMR) has been used since decades to report and compare the maternal health care globally. MMR has dropped by 38% from base line in 2017 with the improvement of health care services and the goal for 2030 is set to every country to achieve a further reduction in MMR so that no country should have an MMR of more than 140 per 100,000 live births. To recognize and treat the complications appropriately there emerged criteria for severe maternal morbidity and maternal near miss. These are used interchangeably but there are subtle differences. Morbidity indices are used in recent literature and research to compare the standard of care across the World. Maternal near miss ratio and mortality index are the two important indicators that reflect the maternal health and give scope for improvement. This chapter deals with the indicators of severe maternal morbidity and maternal near-miss and their utility. Preamble: The dream of every pregnant woman and the prospective mother is to give a healthy child to the family, bring up the child in to an adult and thus contribute the development of the Nation and propagation of human race. Mother is the Nucleus of the family and thus it is very important to save her life in the process of child bearing and rearing.

Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes. Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from ulcer recognition to baseline study visit). Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current ulcer. Previous care seekers were older, had more episodes of ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV. Interventions to help shorten the duration between ulcer recognition and health care seeking for men with GUD are needed.

BackgroundA maternal near-miss is a situation in which a woman was on the verge of death but survived a life-threatening obstetric complication that happened during pregnancy, childbirth, or within 42 days after the pregnancy's termination. Survivors of near-miss events share several features with mothers who have died and identifying determinants of maternal near miss will aid in improving the capacity of the health system to reduce severe maternal morbidity and mortality. Therefore, this study was designed to identify determinants of maternal near miss incidents among women hospitalized to tertiary hospitals in Mogadishu, Somalia.MethodsA facility-based unmatched case–control study was conducted in four tertiary hospitals in Mogadishu from May 1 to July 31, 2021. A total of five hundred thirty-three (178 cases and 355 controls) study participants were involved in the study. The discharge period, cases were recruited consecutively as they emerged, whereas controls were chosen using systematic sampling approach based on every fifth interval of those delivered through normal spontaneous vaginal delivery. Women who were hospitalized during pregnancy, delivery, or within 42 days of termination of pregnancy and met at least one of the maternal near-miss disease specific criteria were classified as cases, while women who were admitted and gave birth by normal vaginal delivery and resealed from the hospital without experiencing severe obstetric complications were considered controls. Participants were interviewed by well-trained research assistants using pre-tested structured questionnaire and the medical records were reviewed to identify maternal near-miss cases. Data were entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05.ResultsThe most common maternal near-miss morbidities identified were severe anemia (32%), severe pre-eclampsia (19.6%), severe ante partum haemorrhage (15.0%), abortion complications (8.4%), eclampsia (6.1%), ICU admission (5.6%), severe PPH (2.8%) and severe systemic infections (2.8%). The main factors associated with maternal near-miss were rural residency [OR = 2.685, 95%CI: (1.702–4.235)], age below 20 years [OR = 2.728, 95%CI: (1.604–4.5640)], unmarried [OR = 2.18, 2.18, 95%CI (1.247–3.81)], lack of formal education [OR = 2.829, 95%CI: (1.262–6.341)], husband’s unemployment [OR = 2.992, 95%CI: (1.886–4.745)], low family income [OR = 3.333, 95%CI (1.055–10.530)], first pregnancy before 18 years of age [OR = 3.091, 95% CI: (2.044–4.674)], short birth interval [OR = 5.922, 95%CI: (3.891–9.014)], previous history of obstetric complication [OR = 6.568, 95%CI: (4.286–10.066)], never attended ANC services [OR = 2.687, 95%CI: (1.802–4.006)], lack of autonomy in seeking medical help [OR = 3.538, 95%CI: (1.468–8.524)], delivery at non-health facility setting [OR = 4.672, 95%CI: (3.105–7.029)], experiencing the second delay [OR = 1.773, 95% CI: (1.212–2.595)] and stillbirth of the last pregnancy [OR = 5.543, 95%CI: (2.880–10.668)].Conclusionand recommendation.Lack of maternal education, lack of antenatal care, lack of autonomy to seek medical assistance, short birth interval, rural residence and delay in accessing obstetric services were identified as factors associated with maternal near-miss morbidity. As a result, the study suggests that those modifiable characteristics must be improved in order to avoid severe maternal complications and consequent maternal death.

Exposure to maternal near-misses has a massive effect on adverse perinatal outcomes. Hence, investigating the effect of maternal near-misses on perinatal outcomes can aid in the reduction of perinatal morbidity and mortality. The study is aimed at assessing the incidence of adverse perinatal outcomes among women exposed to maternal near-misses at Arsi Zone public hospitals in Ethiopia in 2022. The study included a prospective cohort of 335 women at Arsi Zone public hospitals from December 2021 to June 2022. Women who were admitted for management of pregnancy were followed. The exposed group was women with maternal near-misses screened based on disease-validated criteria. The nonexposed group was made up of women who delivered without complications. Trained data collectors used pretested, structured questionnaires to collect data from women. Pertinent data was also extracted from the clients' logbooks. Data was transferred from EpiData version 3.1 to SPSS version 25 for analysis, logistic regression was computed, and 95% confidence intervals were declared at a p value of 5% significance level. The incidence of adverse perinatal outcomes was higher in the exposed women than in the nonexposed women (56% versus 16%). Contrasted with the nonexposed, women exposed to maternal near-misses had a higher incidence of stillbirth (22% vs. 0.5%), low birth weight (13% vs. 3%), and preterm birth (12% vs. 2%). After adjusting for confounders, exposed women had a twofold increased risk of adverse perinatal outcomes compared to nonexposed women. Delivery mode, delay in seeking care, transport mode, and delay in receiving treatment were the risk factors for negative pregnancy outcomes. In exposed women, a higher incidence of adverse perinatal outcomes was linked to aforementioned risk factors. Evidence-based practice intended to decrease delays in providing maternal care services does indeed improve perinatal outcomes.