Incidence, causes and correlates of maternal near-miss morbidity: a multi-centre cross-sectional study

Objective: To explore the incidence and factors associated with maternal near-miss. Design: Cross-sectional study with an embedded case–control study. Setting: Three tertiary referral hospitals in southern Ghana. Population: All women admitted to study facilities with pregnancy-related complications or for birth. Methods: An adapted version of the WHO Maternal Near Miss Screening Tool was used to identify maternal near-miss cases. These were compared with unmatched controls (uncomplicated deliveries) in a ratio of 1:2. Main outcome measures: Incidence of maternal near-miss, maternal near-miss to maternal mortality ratio, and cause of and factors associated with maternal near-miss. Results: Out of 8433 live births, 288 maternal near-miss cases and 62 maternal deaths were identified. In all, 454 healthy controls were recruited for comparison. Maternal near-miss and maternal death incidence ratios were 34.2 (95% CI 30.2–38.1) and 7.4 (95% CI 5.5–9.2) per 1000 live births, respectively with a maternal near-miss to mortality ratio of 4.6:1. Cause of near-miss was pre-eclampsia/eclampsia (41.0%), haemorrhage (12.2%), maternal sepsis (11.1%) and ruptured uterus (4.2%). A major factor associated with maternal near-miss was maternal fever within the 7 days before birth (OR 5.95, 95%CI 3.754–9.424). Spontaneous onset of labour was protective against near-miss (OR 0.09 95% CI 0.057–0.141). Conclusion: For every maternal death, there were nearly five maternal near-misses. Women having a fever in the 7 days before delivery were six times more likely to experience a near-miss than women not having fever. Tweetable abstract: Maternal near-miss exceeds maternal death by 5:1, with the leading cause of maternal near-miss was pre-eclampsia/eclampsia.