Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study

Abstract

BackgroundMaternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria.MethodsA prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss.ResultsThe incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 – 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 – 4.17)], Emergency caesarian section [OR=3.72; 95% CI: (0.93 – 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 – 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 – 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 – 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 – 13.4)] was the most significant adverse perinatal outcomes associated with near miss event.ConclusionsThe analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore the findings should contribute to Nigeria’s effort to achieving MDG 4 and 5.

Near-miss cases admitted to a maternal intensive care unit,Alexandria,Egypt

“…Together, they were the reasons for admission for 64% of the women. This finding is consistent with earlier studies (22)(23)(24)(25). The high incidence of hypertensive disorders of pregnancy in the studied women may be due to poor dietary habits, lack of exercise and more stressful conditions in pregnancy.…”

Maternal Near Miss and Still birth in developing countries: A Systematic Review with Meta-Analysis

“…In some of the African countries like Gambia, Nigeria and Sudan a higher risk of still birth was also observed among women of near miss when compared to women without near miss [17][18][19][20]. Hence, this is indicative of the link between still birth and maternal near miss.…”

“…The studies that were included in this Meta-analysis used different identification criteria to define the exposure(maternal near miss).One of the studies used the WHO criteria [29], some used disease based [17,28],the other disease plus management based [19] and the rest used pragmatic definitions [15]. Using different identification criteria to identify maternal near miss cases might have its own impact for the observed heterogeneity of the studies.…”

“…Three of the studies were from Africa and the rest two were from Latin America. Two of the studies were case control [17,28], 1 cohort [15] and the rest two were cross sectional [19,29].The study which was done in Nigeria by Adeoye and his friends used disease specific criteria to identify maternal near miss cases. It was a case control study done on 64 near miss cases and 256 controls.…”

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

“…Several studies have demonstrated individual medical comorbidities, such as pre-existing asthma, hypertension, malignancy, chronic ischaemic and congenital heart disease, chronic renal disease, systemic lupus erythematosus, hypercoagulability states, human immunodeficiency virus and diabetes mellitus, to be associated with both severe maternal morbidity and mortality, 25,153,[162][163][164][165][166][167][168] but the extent of the population risk attributable to medical comorbidities as a whole in the UK has not previously been quantified. Uptake of antenatal care was found to be poorer among women with medical comorbidities in our study population, which could increase the adverse effects associated with these conditions.…”