The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

The Ratio of Severe Maternal Outcome and its Related Factors in an Academic Hospital from October 2019 to October 2020

Document Type : Original Article

Authors
Mostafa Zemorshidi 1
Nayereh Ghomian 2
Majid Khadem-Rezaiyan 3
1 General Practitioner, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Assisstant Professor, Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/ijogi.2022.20425
Abstract
Introduction: Based on the Millennium Development Goals, the maternal mortality rate should be reduced by two-thirds of 2010 until 2030 (in Iran below 10 per 100,000 live births). Since it is necessary to identify the risk factors of death and survive the near death mothers, this study was performed with aim to evaluate the ratio of severe maternal outcome and its related factors.
Methods: This cross-sectional study was performed in an academic hospital of Mashhad in 2019-2020. Pregnant women and women who in the first 42 days after delivery (puerperium) suffered from a severe complication but survived, and also cases that led to maternal death entered the study by census method. Using a checklist of the Ministry of Health organization, demographic data, risk factors, pregnancy complications, outcome of complications, vital interventions and ICU admission and outcomes of pregnancy and mother were extracted from the patient's file.
Results: During one year, severe maternal outcome ratio was 50.26 per 1000 live births and near death mothers ratio was 45.60 per 1000 live births. The most common risk factors were hypertension (22%) and bleeding in the current pregnancy (19%), and the most common life-threatening complications were severe bleeding during pregnancy and postpartum (32%), and severe preeclampsia (22%). The most common critical intervention used was ICU admission (62%) and blood/blood products transfusion (37%). The most common organ failure was respiratory disorders (29%) and coagulopathy (20%). The most common cause of death was COVID-19 (30%).
Conclusion: Hypertension and bleeding are the most important risk factors during pregnancy and the most important life-threatening complications in cases of near death mothers. With proper prevention and treatment measures and education of mothers and medical team, the mortality due to these complications can be reduced.
Keywords
Live birth
Maternal morbidity
Maternal mortality
Near death mothers
  1. World Health Organization. Trends in maternal mortality: 1990 to 2008.
  2. Campbell OM, Graham WJ, Lancet Maternal Survival Series steering group. Strategies for reducing maternal mortality: getting on with what works. The lancet 2006; 368(9543):1284-99.
  3. Say L, Souza JP, Pattinson RC. Maternal near miss–towards a standard tool for monitoring quality of maternal health care. Best practice & research Clinical obstetrics & gynaecology 2009; 23(3):287-96.
  4. World Health Organization. Report on the World Health Organization working group on the classification of maternal deaths and severe maternal morbidities. Geneva: World Health Organization; 2009.
  5. Vogel JP, Fawole B, Adeniran AS, Adegbola O, Oladapo OT. The burden of severe maternal outcomes and indicators of quality of maternal care in Nigerian hospitals: a secondary analysis comparing two large facility‐based surveys. BJOG: An International Journal of Obstetrics & Gynaecology 2019; 126:49-57.
  6. Abdollahpour S, Miri HH, Khadivzadeh T. The global prevalence of maternal near miss: a systematic review and meta-analysis. Health promotion perspectives 2019; 9(4):255.
  7. Zargar M, Marfou J, Afrakhteh A, Nasehi N. Severe Maternal Morbidity and Near Misses in Two Tertiary Referral Hospitals in Iran. Jentashapir Journal of Health Research. 2015 Apr 1;6(2).
  8. Murphy CM, Murad K, Deane R, Byrne B, Geary MP, McAuliffe FM. Severe maternal morbidity for 2004–2005 in the three Dublin maternity hospitals. European Journal of Obstetrics & Gynecology and Reproductive Biology 2009; 143(1):34-7.
  9. Sayinzoga F, Bijlmakers L, van der Velden K, van Dillen J. Severe maternal outcomes and quality of care at district hospitals in Rwanda–a multicentre prospective case-control study. BMC pregnancy and childbirth 2017; 17(1):1-9.
  10. Moudi Z, Arabnezhad L, Ansari H, Tabatabaei SM. Severe maternal morbidity among women with a history of cesarean section at a tertiary referral teaching hospital in the southeast of Iran. Public health 2019; 175:101-7.
  11. Xiong L, Zeng M, Wang A, Xie D, Kong F, Liu Z. Analysis of the Severe Maternal Outcomes between Resource-Poor and Resource-Rich Hospitals in China’s Hunan Province from 2012 to 2018. BioMed Research International 2020; 2020.
  12. Souza JP, Cecatti JG, Parpinelli MA, Serruya SJ, Amaral E. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: a cross sectional study. BMC pregnancy and childbirth 2007; 7(1):1-8.
  13. Adisasmita A, Deviany PE, Nandiaty F, Stanton C, Ronsmans C. Obstetric near miss and deaths in public and private hospitals in Indonesia. BMC Pregnancy and Childbirth 2008; 8(1):1-9.
  14. Filippi V, Ronsmans C, Gohou V, Goufodji S, Lardi M, Sahel A, et al. Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals. Acta obstetricia et gynecologica Scandinavica 2005; 84(1):11-6.
  15. Oladapo OT, Sule-Odu AO, Olatunji AO, Daniel OJ. "Near-miss" obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reproductive health 2005; 2(1):1-9.
  16. Mustafa R, Hashmi H. Near-miss obstetrical events and maternal deaths. J Coll Physicians Surg Pak 2009; 19(12):781-5.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 25, Issue 3
May 2022
Pages 60-68