Maternal near-miss and death and their

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dc.contributor.author Litorp, H
dc.contributor.author Kidanto, H.L
dc.contributor.author Rööst, M
dc.contributor.author Abeid, M
dc.contributor.author Nyström, L
dc.contributor.author Essén, B
dc.date.accessioned 2014-11-18T08:28:13Z
dc.date.available 2014-11-18T08:28:13Z
dc.date.issued 2014
dc.identifier.citation Mantel, G. D., Buchmann, E., Rees, H., & Pattinson, R. C. (1998). Severe acute maternal morbidity: a pilot study of a definition for a near‐miss. BJOG: An International Journal of Obstetrics & Gynaecology, 105(9), 985-990. en_GB
dc.identifier.issn /1471-2393/14/244
dc.identifier.uri http://hdl.handle.net/123456789/1491
dc.description.abstract Background: The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications. Methods: We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated. Results: We identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33–39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460–730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6–11) of the MNM events and 13% (95% CI 6.4–23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12–37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8–12) (risk ratio 3.2, 95% CI 1.5–6.6). Conclusions: The occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS. en_GB
dc.language.iso en en_GB
dc.publisher BMC Pregnancy and Childbirth en_GB
dc.relation.ispartofseries BMC Pregnancy and Childbirth 2014, 14:244;
dc.subject Maternal near-miss en_GB
dc.subject Maternal death en_GB
dc.subject Caesarean section en_GB
dc.subject Low-income country en_GB
dc.title Maternal near-miss and death and their en_GB
dc.type Article en_GB


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