A descriptive study of maternal "near misses" and maternal deaths at the Chris Hani Baragwanatrh academic hospital, South Africa: a retrospective study

Abstract

Background: Maternal mortality and morbidity are essential components in monitoring level of obstetric care within institutions. Since death from childbirth is uncommon, auditing of maternal morbidity (near miss) which occurs more frequently permits for more lessons to be learnt on pathophysiological processes that can lead to mortality. An in-depth understanding of factors that contributes to both maternal near miss and death, permits identification of areas of weaknesses within the system and can assist with development of policies to improve maternal care. Objective: To compare causes of maternal deaths and near misses at CHBAH. Methods: A retrospective study was carried out at CHBAH, including all women who met the criteria for severe maternal outcome between January 2014 and December 2015. Results: There were 62185 deliveries, and 307 cases of SMO (250 near misses and 57 maternal deaths) during the period of the study. The iMMR was 91.66/100 000 live births and the MNMR was 4.02/1000 live births. The mortality index was 18.57%. Medical disorders, hypertension, obstetric hemorrhage and non-pregnancy related infections were the main causes of death. The common causes of near miss was obstetric hemorrhage followed by puerperal sepsis. The commonest identification criteria of near miss was massive blood transfusion followed by ventilation not for anaesthetic reasons. Conclusion: This study showed hypertension, hemorrhage in gynaecology, venous-thromboembolism, medical disorders were more likely to be causes of death than near misses. Obstetric hemorrhage and puerperal sepsis were more likely to be the causes of near misses than causes of death. An important factor associated with death was no antenatal care.