Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study

Abstract

Background: Since maternal near miss (MNM) could act as a surrogate of maternal death, the implementation of MNM audit at hospital level can provide an opportunity to study maternal morbidity at a large scale. Objectives: The current study aimed at investigating severe maternal outcomes (SMO; i.e. MNM + maternal death [MD]) in a referral hospital. Methods: A prospective, facility-based, cross sectional study was conducted from 22 June to 22 December 2017. The current study was performed in a tertiary referral teaching hospital in Zahedan, Iran. The study population included all pregnant females with a gestational age of 22 weeks giving birth in this hospital or referred to this center for delivery, as well as females within 42 days of pregnancy termination. The World Health Organization maternal near-miss criteria were used to identify MNM and analyze the data. Logistic regression was used to predict SMO risk factors. Results: Overall, 3527 deliveries and 3480 live births were reported in the hospital under investigation. Severe maternal outcomes were observed in 68 cases. The rate of MNM was 13.79 per 1000 live births; furthermore, the ratio of MNM to mortality was 12:1. Binary analysis showed that hemoglobin level, place of residence, parity, history of cesarean section (CS), insurance coverage, and type of delivery were the significant decisive factors in SMO. Moreover, severe hemorrhage and hypertensive disorders were the common causes of SMO. Conclusions: According to the collected data, MNM indicators were high in the under study hospital. Therefore, it seems necessary to adopt context-based interventions at hospital level to find and manage mothers prone to SMO during pregnancy and childbirth.