The Magnitude and causes of maternal Near -miss in St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Abstract

<p><strong>Background</strong>:&nbsp;Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, child birth and within 42 days after delivery, but survive by chance or good institutional care. Investigating severe maternal morbidity (near-miss) is a newly recognized tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. Thus,this study is conducted with the aim of assessing the magnitude and causes of maternal near-miss in St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.</p> <p><strong>Methods</strong>:&nbsp;A cross-sectional study was conducted in the department of obstetrics and gynecology in St. Paul’s Hospital Millennium Medical College, a referral hospital in Addis Ababa, Ethiopia from January 1, 2020 G.C to June 30, 2020 G.C. There was consecutive entry of cases from records for all pregnant, recently delivered or aborted patients who appeared and were admitted to St. Paul’s Hospital Millennium Medical College in the study period. The World Health Organization (WHO) criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over six months period per 1000 deliveries occurring during the same study period was calculated to determine the incidence of maternal near-miss. For each case of near miss, data were collected on underlying causes of obstetric complications, type of organ-system dysfunction/failure and timing of near-miss event with respect to admission.</p> <p><strong>Results</strong>:&nbsp;During the six months study period, there were a total of 46 Near-miss cases and a total of 5095 live births in the hospital making the incidence of maternal near miss ratio 9.02 per 1000 live births. Majority (87%) of the near -miss cases occurred before arrival to the hospital and 13% cases were in hospital near-misses. The major causes of Near miss were hypertensive disorders of pregnancy and obstetric hemorrhage. Among the near miss cases,28.3%(13 cases) of them didn’t receive any ANC.</p> <strong>Conclusions: </strong>majorityof the near-misses were before arrival to the hospital which shows the importance of improving our referral systems and improve prehospital barriers.