Abstract
BackgroundMaternal ‘near miss’ can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care.MethodsA prospective descriptive study was carried out from October 1 2016 to 31 December 2016, using the WHO criteria for maternal ‘near miss’ at the two tertiary public hospitals which receive referrals of all obstetric complications in Harare city, Zimbabwe. The objective was to calculate the ratio of maternal ‘near miss’ and associated factors. All pregnant women who developed life threatening complications classified as maternal near miss using the WHO criteria were recruited and followed up for six weeks from discharge, delivery or termination of pregnancy or up to the time of death.ResultsDuring this period there were 11,871 births. One hundred and twenty three (123) women developed severe maternal outcomes, 110 were maternal ‘near miss’ morbidity and 13 were maternal deaths. The maternal ‘near miss’ ratio was 9.3 per 1000 deliveries, the mortality index (MI) was 10.6% and the maternal mortality ratio was 110 per 100,000 deliveries. The major organ dysfunction among cases with severe maternal outcomes (SMO) was cardiovascular dysfunction (76.9%). The major causes of maternal near miss were obstetric haemorrhage (31.8%), hypertensive disorders (28.2%) and complications of miscarriages (20%). The intensive care unit (ICU) admission rate was 7.3 per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission.ConclusionThe MNM ratio was comparable to that in the region. Obstetric haemorrhage was a leading cause of severe maternal morbidity though with less mortality when compared to hypertensive disorders and abortion complications. Zimbabwe should adopt maternal near miss ratio as an indicator for evaluating its maternal health services.
Highlights
Maternal ‘near miss’ can be a proxy for maternal death and it describes women who nearly died due to obstetric complications
There were 9 out of 123 cases of severe maternal outcomes admitted into intensive care unit (ICU), giving an ICU admission rate of 7.3 cases per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission
The Maternal near miss (MNM) ratio of 9.3 per thousand deliveries was comparable to other reports in the region
Summary
Maternal ‘near miss’ can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care. The primary indicator of maternal health care and quality of obstetric care is Maternal Mortality Ratio (MMR) [5]. By monitoring only maternal deaths at institutions, very few lessons can be learnt to prevent further deaths. Quality of obstetric care can be assessed using either outcome indicators like maternal mortality ratio, or MNM
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