review · Frontiers in Public Health
Maternal near-miss events describe instances where women survive severe, life-threatening complications during pregnancy, childbirth, or shortly afterwards. An investigation in public hospitals across the North Shewa Zone in Ethiopia assessed the determinants of these critical events using a case-control design with two hundred and sixty-four women. Severe pre-eclampsia and postpartum haemorrhage represented the primary causes of near-miss admissions. Statistical analysis showed that medical disorders during pregnancy, delivery by caesarean section, transfers from other facilities, antenatal care visits, and the educational backgrounds of both women and their partners significantly increased the likelihood of a near-miss complication. In contrast, younger maternal age was linked to a lower risk. Addressing these determinants through earlier diagnosis of medical disorders, improved referral systems, and balanced use of obstetric interventions remains central to reducing life-threatening maternal emergencies.
Maternal near-miss incidents share direct causes with maternal deaths and serve as critical measures of obstetric care quality. In settings with high maternal mortality, clarifying specific clinical complications and systemic factors helps healthcare planners target interventions. Recognizing high-risk conditions such as pre-eclampsia and referral delays allows facilities to allocate clinical resources better and prevent avoidable maternal harm.
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Background A maternal near-miss (MNM) refers to a woman who presents with life-threatening complications during pregnancy, childbirth, or within 42 days of termination of pregnancy but survived by chance or due to the standard care she received. It is recognized as a valuable indicator to examine the quality of obstetrics care as it follows similar predictors with maternal death. Ethiopia is one of the sub-Saharan African countries with the highest rate of maternal mortality and morbidity. Thus, studying the cause and predictors of maternal near-miss is vital to improving the quality of obstetric care, particularly in low-income countries. Objective To identify determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia, 2020. Methods A facility-based unmatched case-control study was conducted on 264 women (88 cases and 176 controls) from February to April 2020. Data were collected using pretested interviewer-administered questionnaires and a review of medical records. Data were entered into Epi-data version 4.2.2 and exported to SPSS version 25 for analysis. Variables with a p -value <0.25 in the bivariable analysis were further analyzed using multivariable logistic regression analysis. Finally, variables with a p -value <0.05 were considered statistically significant. Result Severe pre-eclampsia (49.5%) and postpartum hemorrhage (28.3%) were the main reasons for admission of cases. Educational level of women (AOR = 4.80, 95% CI: 1.78–12.90), education level of husbands (AOR = 5.26; 95% CI: 1.46–18.90), being referred from other health facilities (AOR = 4.73, 95% CI: 1.78–12.55), antenatal care visit (AOR = 2.75, 95% CI: 1.13–6.72), cesarean section (AOR = 3.70, 95% CI: 1.42-9.60), and medical disorder during pregnancy (AOR = 12.06, 95% CI: 2.82–51.55) were found to significantly increase the risk of maternal near-miss. Whereas, the younger age of women significantly decreased the risk of maternal near miss (AOR = 0.26, 95% CI: 0.09–0.75). Conclusion Age, educational level, antenatal care follow-ups, medical disorder during pregnancy, mode of admission, and mode of delivery were significant predictors of maternal near-miss. Socio-demographic development, use of ANC services, early detection and management of medical diseases, reducing cesarean section, and improving the referral systems are crucial to minimizing the maternal near-miss.
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DOI: 10.3389/fpubh.2022.996885
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