Facility Based Audit of Maternal Near Miss, Maternal and Neonatal Mortality in a Tertiary Hospital, South-West Nigeria: One-Year Review

Abstract

Background: There is a poor linkage between MPDSR audits on the one hand, and the quality improvement processes proffered by them. This usually leads to varied implementation of recommendations. Buy-in from the community and health facilities are needed for full implementation. To better identify and track causes of maternal and perinatal mortality, it is necessary to combine review of maternal near-miss morbidities with findings at MPDSR meetings. Objectives: A. Evaluate near-miss morbidity and near-miss to mortality ratio. B. To compare the nature of near-miss morbidity with maternal mortality. C. To compare findings of near-miss maternal morbidity with maternal mortality among women who registered for care and those who did not. Design: Retrospective study. Methods: Monthly review of data collected on maternal near-miss morbidity and maternal mortality at MPDSR meetings for all women who delivered at our facility from 1st December 2022 till 31st December 2023. Results: The near-miss incidence ratio was 70 per 1000 live births while the maternal mortality ratio was 1399 per 100000 live births. Hypertensive disorders of pregnancy and sepsis were responsible for 85.8% of maternal mortality. Despite contributing 62.4% to maternal near-miss events, obstetric haemorrhage was responsible for 14.2% of maternal mortality. Unbooked patients were responsible for 83% near-miss morbidity and 95% of mortality occurred in this same group. Conclusion: While we have made some progress in our care of women with Postpartum haemorrhage, hypertensive disorders of pregnancy remains a cause for concern for both maternal near-miss morbidity and maternal mortality. Health workers should be trained to recognise and promptly refer women with hypertensive disorders for expert care pre-delivery, intrapartum and postpartum. Antenatal care and facility delivery for all pregnant women remain the pathways towards reducing near-miss morbidity and maternal mortality ratio.