ObjectiveTo investigate the burden and causes of life‐threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.DesignNationwide cross‐sectional study.SettingForty‐two tertiary hospitals.PopulationWomen admitted for pregnancy, childbirth and puerperal complications.MethodsAll cases of severe maternal outcome (SMO: maternal near‐miss or maternal death) were prospectively identified using the WHO criteria over a 1‐year period.Main outcome measuresIncidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO).ResultsParticipating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near‐misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre‐eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life‐threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21–215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non‐availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care.ConclusionsImproving the chances of maternal survival would not only require timely application of life‐saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.Tweetable abstractOf 998 maternal deaths and 1451 near‐misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Background/Objective: To determine the pattern of eclampsia and its contribution to maternal mortality at the Federal Medical Centre, Birnin Kudu, Jigawa State in Northern Nigeria. Method: A 4-year retrospective review of the case records of all women who presented with eclampsia at the center. All the case records were retrieved from the medical record department and analyzed. Results: There were 207 cases of eclampsia out of 2197 deliveries during the period giving an incidence of 9.42%. 171(82.6%) of the patients were unbooked. Majority (58.5%) of the patients were aged less than 20 years. The highest frequency (78.3%) was recorded in the primigravida. Delay before reaching the hospital was established in 116(56%) of patients. The condition was antepartum in 68(32.9%), intrapartum in 112(54.1%) and postpartum in 27(13%). 107(51.7%) of the patients were delivered by cesarean section. Twenty two (10.6%) of the mothers died. Eclampsia was the commonest cause of maternal mortality and contributed 43.1% of all maternal deaths. 180(87%) of the babies were delivered alive while 27(13%) died. Conclusion: Eclampsia is a major cause of maternal mortality. There is need for health education on the need for patients to avail themselves of antenatal care. Key words: Eclampsia, maternal mortalityRésumé Fond/Objectif: Pour détermine la distribution de l'éclampsie et sa contribution a la mortalité maternelle au centre de santé médical fédéral de Birnin Kudu, état de Jigawa au Nord du Nigeria. Méthodologie: Ceci est une revue rétrospective pendant quatre ans des cas reportes de toutes les femmes qui se sont présentées avec l'éclampsie a ce centre. Tous ces rapports ont été obtenu au département des rapports médicaux et ont été analyses. Résultats: Il y a eu 207 cas d'éclampsie permis 2197 naissances. Ceci donne une incidence de 9.42%. 171 (82.6%) de tous ces patients n'ont pas fait de visite prénatale. La majorité des patients (58.5%) étaient ages de moins de 20 ans. La fréquence la plus élevée (78.3%) a été obtenu parmi les primigravid. Le retard avant de se présenter au centre de santé a été étable chez 116 (56%) des patients. La condition était prénatale chez 68 (32.9%), intra natale chez 112 (54.1%) et postnatale chez 27 (13%). Chez 107 (51.7%) patients, l'accouchement s'est fait par caesarienne. 22 (10.6%) de maman étaient decedees. L'éclampsie était la cause de la mortalité maternelle la plus élevée et a contribue a 43.1% de tous les décès maternels. 180(87%) bébés sont nés vivant alois que 27(13%) étaient mort nes. Conclusion: L'éclampsie est la cause majeure de la mortalité maternelle. Les patients ont besoin d'être éduques et aussi d'aller aux visites prénatales.

Background: Pre-eclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. There is need to provide the most effective management to pre-eclamptic and eclamptic patients. There is now evidence that magnesium sulphate is the most effective anticonvulsant. Method: In this article, a literature review was made on the contribution of pre-eclampsia and eclampsia to maternal mortality and how it can be curtailed by the use of magnesium sulphate. Results: The drug is administered by the Pritchard or Zuspan regimen, although modifi cations in the two protocols have been reported. Conclusion: A Nigerian national protocol has been developed on its use. There is need for further training of health workers on how to use this important drug.