Maternal Near Miss Surveillance System Research Articles

Pregnancy complications associated with maternal near-miss in an undeveloped province in south-central China, 2012–2022

ObjectiveTo explore the relationship between pregnancy complications and maternal near-miss (MNM).MethodsData were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012–2022. The MNM ratio refers to the number of MNM per 1000 live births, and maternal mortality refers to the number of maternal deaths per 100,000 live births. Chi-square trend tests (χ2trend) were used to determine trends in proportions by year. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM.ResultsOur study included 780,359 women with 731,185 live births, a total of 2461 MNMs, and 52 maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23–3.50), and the maternal mortality was 7.11 per 100,000 live births (95%CI: 5.18–9.04). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). From 2012 to 2022, the proportion of coagulation/hematological dysfunction among MNM increased from 49.14% in 2012 to 86.39% in 2022, which was the only cause of MNM that showed an increased trend (χ2trend = 7.43, P = 0.01). Results of multivariate logistic regression analysis showed that 10 pregnancy complications were risk factors for MNM: hemorrhage disorder (aOR = 21.50, 95%CI: 19.64–23.54), infections (aOR = 1.91, 95%CI: 1.64–2.22), hypertension (aOR = 4.50, 95%CI: 4.08–4.98), heart disease (aOR = 14.96, 95%CI: 11.51–19.44), embolic disease (aOR = 171.70, 95%CI: 94.08-313.36), liver disease (aOR = 1.54, 95%CI: 1.25–1.90), anaemia (aOR = 4.72, 95%CI: 4.29–5.19), renal disease (aOR = 5.44, 95%CI: 4.00-7.40), pulmonary disease (aOR = 14.85, 95%CI: 8.33–26.50), and connective tissue disease (aOR = 5.15, 95%CI: 3.06–8.66).ConclusionThe MNM ratio was relatively low in Hunan Province. Several pregnancy complications increased the risk of MNM. It is helpful for clinical counseling and public health policies, which may contribute to preventing MNM.

Risk factors for maternal near-miss in an undeveloped province in south-central China, 2012–2022

ObjectiveTo explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach.MethodsData were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012–2022. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM.ResultsOur study included 780,359 women with 731,185 live births, a total of 2461 (0.32%) MNMs, 777,846 (99.68%) non-MNMs, and 52 (0.006%) maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23–3.50). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). Results of multivariate logistic regression analysis showed risk factors for MNM: maternal age > = 30 years old (aOR > 1, P < 0.05), unmarried women (aOR = 2.21, 95%CI: 1.71–2.85), number of pregnancies > = 2 (aOR > 1, P < 0.05), nulliparity (aOR = 1.51, 95%CI: 1.32–1.72) or parity > = 3 (aOR = 1.95, 95%CI: 1.50–2.55), prenatal examinations < 5 times (aOR = 1.13, 95%CI: 1.01–1.27), and number of cesarean sections was 1 (aOR = 1.83, 95%CI: 1.64–2.04) or > = 2 (aOR = 2.48, 95%CI: 1.99–3.09).ConclusionThe MNM ratio was relatively low in Hunan Province. Advanced maternal age, unmarried status, a high number of pregnancies, nulliparity or high parity, a low number of prenatal examinations, and cesarean sections were risk factors for MNM. Our study is essential for improving the quality of maternal health care and preventing MNM.

Characteristics and fetal outcomes of pregnant women with hypertensive disorders in China: a 9-year national hospital-based cohort study

Hypertensive disorders of pregnancy (HDP) are a growing concern and a challenge for maternity care providers as the prevalence of hypertension continues to increase. However, optimal management of HDP is unclear. Therefore, we aimed to explore the differences in adverse fetal outcomes among women with different subtypes of HDP and different blood pressure (BP) levels, to provide evidence-based management of HDP. We obtained data from China's National Maternal Near-Miss Surveillance System from 2012 to 2020. Associations between BP management and adverse fetal outcomes, stratified by the four subtypes of HDP, were assessed using logistic regression analysis with a robust variance estimator. For the period, a total of 393,353 pregnant women with HDP were included in the study; 8.51% had chronic hypertension, 2.27% had superimposed preeclampsia, 50.17% had preeclampsia or eclampsia, and 39.04% had gestational hypertension. The BP levels at delivery admission were mostly (61.14%) of non-severe stage 2 (systolic BP 140-159mm Hg and/or diastolic BP 90-109mm Hg) hypertension by American Heart Association classification. A high rate of adverse fetal outcomes was observed among women with HDP, especially among those aged < 20 or > 35 y or those diagnosed with superimposed preeclampsia. Compared with those with normal BP levels at delivery admission, we found an upward curve with increased risk among pregnant women with more severe BP levels, including the risk of preterm birth and small for gestational age (SGA) fetus. The odds ratios (ORs) of stillbirth, neonatal death, and low Apgar scores associated with severe stage 2 hypertension increased significantly. In addition, the association between BP at admission and fetal outcomes differed among women with varying HDP subtypes. Pregnant women with preeclampsia or eclampsia had an increased risk for preterm birth (adjusted OR [aOR], 1.33 [95% confidence interval {CI}, 1.07 ~ 1.65]) and SGA (aOR, 1.37 [95% CI, 1.10 ~ 1.71]) even when the admission BP was at stage 1 level. Greater attention should be paid to cases involving preeclampsia superimposed on chronic hypertension and pregnant women aged < 20 or > 35 y to mitigate the burden of adverse fetal outcomes caused by HDP.

Prevalence of maternal near miss and adverse pregnancy outcomes in Zhejiang province

To explore the prevalence of maternal near miss (MNM) and adverse pregnancy outcomes in Zhejiang province by MNM surveillance system. A cross-sectional study was conducted during 2012 and 2013. All MNM cases were recruited from the MNM surveillance system. The information was reported by direct network report system, including personal information, obstetric complications, maternal rescue measures, rescue process and severe maternal and perinatal outcomes. A total of 826 MNM patients were recruited. The MNM rate was 5.6 cases/1 000 live births (LB). Maternal gestational hypertension was the most common disease among MNM, accounting for 19.9% (n = 164) . The second prevalent one was insufficient uterine contraction, accounting for 19.6% (n = 162). Placenta previa was the third one accounting for 17.7% (n = 146). Among adverse pregnancy outcomes, 139 cases underwent hysterectomy (n = 139, 16.8%). There were 81 perinatal deaths with a perinatal mortality of 10.4%. And 279 cases (39.9%) were preterm. MNM surveillance system is valuable for grasping the prevalence of MNM. And it helps to reduce MNM rate by improving the quality of obstetrics and lower the preterm rate and perinatal mortality.