Abstract
BackgroundInvestigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities.MethodsRetrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions.ResultsThere were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU).ConclusionNear-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health care professionals to manage infrequent but fatal conditions like sepsis. An urgent review of the referral system and the emergency obstetric care in Syria is highly recommended.
Highlights
Investigating severe maternal morbidity is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries
Despite the high maternal mortality ratios in many of the centres in resource-poor settings, maternal deaths are rare in absolute numbers per centre
During the 2-year period reviewed, there were 28 025 hospital deliveries, 27 350 live births, 901 near-miss cases and 15 maternal deaths. This resulted in a total maternal mortality ratio (MMR) of 54.8/100 000 live births
Summary
Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. Evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Despite the high maternal mortality ratios in many of the centres in resource-poor settings, maternal deaths are rare in absolute numbers per centre. This does not allow detailed quantification of the associated risk factors and determinants that are locally important. Because surviving a near-miss occurs mainly because of the care provided, reviewing near-misses has the potential of highlighting deficiencies and positive elements in the obstetric care of any health system [6]
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