Maternal near-miss and the risk of adverse perinatal outcomes: a prospective cohort study in selected public hospitals of Addis Ababa, Ethiopia

Ewnetu Firdawek Liyew,Birgitta Essén,Alemayehu Worku Yalew,Mesganaw Fantahun Afework

doi:10.1186/s12884-018-1983-y

Ewnetu Firdawek Liyew, Birgitta Essén + Show 2 more

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https://doi.org/10.1186/s12884-018-1983-y

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Abstract

BackgroundPresence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes, but not well-understood in low-income countries. The study aimed to ascertain the effect of maternal near-miss on the risk of adverse perinatal outcomes in Ethiopia.MethodsA prospective cohort study was conducted in five public hospitals of Addis Ababa, Ethiopia. Women admitted from May 1, 2015 to April 30, 2016 were recruited for the study. We followed a total of 828 women admitted for delivery or treatment of pregnancy-related complications along with their singleton newborn babies. Maternal near-miss was the primary exposure and was ascertained using the World Health Organization criteria. Women who delivered without complications were taken as the non-exposed groups. The main outcome was adverse perinatal outcomes. Data on maternal near-miss and perinatal outcomes were abstracted from medical records of the participants. Exposed and non-exposed women were interviewed by well-trained data collectors to obtain information about potential confounding factors. Logistic regressions were performed using Stata version 13.0 to determine the adjusted odds of adverse perinatal outcomes.ResultsA total of 207 women with maternal near-miss and 621 women with uncomplicated delivery were included in the study. After adjusting for potential confounders, women with maternal near-miss condition had more than five-fold increased odds of adverse perinatal outcomes compared to women who delivered without any complications (AOR = 5.69: 95% CI; 3.69–8.76). Other risk factors that were independently associated with adverse perinatal outcomes include: rural residence, history of prior stillbirth and primary educational level.ConclusionsPresence of maternal near-miss in women is an independent risk factor for adverse perinatal outcomes. Hence, interventions rendered at improvement in maternal health of Ethiopia can lead to an improvement in perinatal outcomes.

Highlights

Presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes, but not well-understood in low-income countries
Several studies have shown that the presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes such as stillbirth, preterm birth, low birth weight, early neonatal mortality, birth asphyxia, and admission to a Neonatal Intensive Care Unit (NICU) [2,3,4,5,6,7]
A study by Souza et al in their multi- country study in eight Latin American countries highlighted that the occurrence of maternal near-miss in women is associated with low birth weight, stillbirth, admission to neonatal Intensive care unit (ICU) and neonatal mortality [7]

Summary

Introduction

Presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes, but not well-understood in low-income countries. Several studies have shown that the presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes such as stillbirth, preterm birth, low birth weight, early neonatal mortality, birth asphyxia, and admission to a Neonatal Intensive Care Unit (NICU) [2,3,4,5,6,7]. A study from Nigeria reported a four-fold risk of stillbirth and a three-fold risk of low birth weight infant among women with maternal near-miss conditions compared to women who delivered without complications [5]. Majority of the studies used hospital records to abstract potential maternal characteristics which leads to lack of data on important confounding variables [4, 6] These confounders may be alternative explanations for an observed association between exposure and outcome variables. The findings of the current study are important to fill the knowledge gap, and it may provide reliable evidence for policy makers, programmers and health practitioners to improve perinatal health of Ethiopia

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