Non‐obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

Abstract

Objective To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals.Design Secondary analysis of a nationwide cross-sectional study.Setting Forty-two tertiary health facilities.Population Women admitted with complications during pregnancy, childbirth or puerperium.Methods All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria.Main outcome measures Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). ResultsOf 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe nonobstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO.Conclusion Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications. Tweetable abstract Non-obstetric causes are important contributors to maternal deaths and life-threatening morbidities in Nigerian hospitals. Please cite this paper as: Adeniran AS, Ocheke AN, Nwachukwu D, Adewole N, Ageda B, Onile T, Umezulike AC, Aboyeji AP, Oladapo OT, for the Nigeria Near-miss and Maternal Death Surveillance Network. Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 (S3): 41-48.

Analysis of Extreme Maternal Morbidity at the Women´s Hospital of Aguascalientes

“…In the review of the main causes of extreme maternal morbidity, we found hypertensive disorders in first place with 57% followed by obstetric hemorrhage with 29%, which coincides with that reported by other authors in Latin America [17] and Morocco [18], although it is worth mentioning that it is different to that reported by other authors who mention as a first cause of extreme maternal morbidity to be obstetric hemorrhage [19][20][21][22]. This coincides with the high incidence of pre-eclampsia in our country along with the fact that in our study, no maternal deaths were registered, and demonstrates that even though morbidity due to this pathology has not decreased, the established management in our hospital has had an impact on reducing the rate of maternal deaths and reinforces the need to maintain close surveillance of these patients (Table 6).…”

Maternal Mortality Ratio in Low Income Developing Countries

“…MDs were also associated with lack of awareness, lower and elderly ages. Consequently, it led to poorer pregnancy outcomes [32]. Similar findings were observed in another study in which the association of anemia with maternal and neonatal outcomes was investigated.…”

“…It was observed that 9.4% (9401/100107) women admitted to the 42 tertiary hospitals in Nigeria for maternal complications had non-obstetric reasons. 4% (375/9401) of these complicated cases were MNM in 48% (183/375) and MD in 51.2% (192/375) [32]. Severe anemia contributed to 61.2% of MNM and 32.8% of MDs.…”

The right timing for surgical exploration is the key to saving lives: An analysis of near- miss mortality cases in a tertiary care hospital in North East India

“…Non obstetric causes found to be related to adverse maternal outcome were anaemia unrelated to haemorrhage, cancer, hepatic disease, neurological and CVS dysfunction. 7 In a study maternal near miss and death associated with abortive pregnancy outcome, it was found that 78 maternal death and 366 near miss occurred from abortion and ectopic pregnancy in 42 Nigerian referral hospitals in 1 year. 8 In our set up also, major causes of near miss are hypertensive disorder and obstetric haemorrhage but these cases are being highlighted as they presented as diagnostic dilemma and were a therapeutic challenge.…”