Maternal near‐miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

Abstract

Objective To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to lifethreatening postpartum haemorrhage (PPH) in Nigerian public tertiary hospitals.Design Secondary analysis of a nationwide cross-sectional study.Setting Forty-two tertiary hospitals.Population Women admitted for pregnancy, childbirth or puerperal complications.Methods All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period.Main outcome measures Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/ SMO).Results Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/ 100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH.Conclusions Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH. Tweetable abstract One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year. Please cite this paper as: Sotunsa JO, Adeniyi AA, Imaralu JO, Fawole B, Adegbola O, Aimakhu CO, Adeyemi AS, Hunyinbo K, Dada OA, Adetoro OO, Oladapo OT. Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 (S3): 19-25.

Regional Differences in Postnatal Care Service Utilisation and Child Morbidity in Nigeria: Evidence from 2018 Nigeria Demographic and Health Survey (NDHS)

“…It was also revealed that the socio-demographic characteristics of the respondents predicted child morbidity in Nigeria. This nding corroborates the work of Sotunsa et al [7] who found that there is a signi cant relationship between postnatal care utilization and maternal and child mortality in a population. This means that this can affect child morbidity.…”

“…Despite the importance of providing quality health care services by skilled health care professionals during and immediately after childbirth to mothers and infants, the postnatal periods are usually neglected by most mothers due to sociocultural factors associated with new-borns [3][4][5]. Meanwhile, studies have shown that mothers who attend health facilities during postnatal periods where skilled health professionals can identify, observe and manage any health challenge that may arise in the lives of the mothers and their new-born babies [6][7] stand a chance of preventing the occurrences of body and mental damages [8], as well as child morbidity and mortality than those who did not [9].…”

Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

“…Previous researchers had a similar observation. [ 13 14 ] The use of interventional radiology for the preoperative balloon catheterisation of uterine artery in cases of morbidly adherent placenta (performed in one patient in present study) is known to improve outcome. [ 15 ] As reported previously, PPH due to uterine atony and ruptured uterus had high mortality index in our set up.…”

Applying a Client-centered Approach to Maternal and Neonatal Networks of Care: Case Studies from Urban and Rural Nigeria

“…1 One study in 42 public hospitals in Nigeria found that postpartum hemorrhage (PPH), attributed largely to women arriving at the hospital already in critical condition, was responsible for a significant proportion of maternal deaths. 2 Nigeria is also the largest contributor to neonatal deaths (261,549 neonatal deaths, 12.5% of the global total) and stillbirths (301,267 stillbirths, 11.6% of the global total). [3][4][5] Three causes of neonatal death-preterm birth complications, birth asphyxia, and neonatal infections-accounted for over 80% of neonatal mortality.…”