School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
J Glob Health. 2020 Jun;10(1):01041310. doi: 10.7189/jogh.10.010413.
Although maternal near miss (MNM) is often considered a 'great save' because the woman survived life-threatening complications, these complications may have resulted in loss of a child or severe neonatal morbidity. The objective of this study was to assess proportion of perinatal mortality (stillbirths and early neonatal deaths) in a cohort of women with MNM in eastern Ethiopia. In addition, we compared perinatal outcomes among women who fulfilled the World Health Organization (WHO) and the sub-Saharan African (SSA) MNM criteria.
In a prospective cohort design, women with potentially life-threatening conditions (PLTC) (severe postpartum hemorrhage, severe pre-(eclampsia), sepsis/severe systemic infection, and ruptured uterus) were identified every day from January 1st, 2016, to April 30th, 2017, and followed until discharge in the two main hospitals in Harar, Ethiopia. Maternal and perinatal outcomes were collected using both sets of criteria. Numbers and proportions of stillbirths and early neonatal deaths were computed and compared.
Of 1054 women admitted with PTLC during the study period, 594 women fulfilled any of the MNM criteria. After excluding near misses related to abortion, ectopic pregnancy or among undelivered women, 465 women were included, in whom 149 (32%) perinatal deaths occurred: 132 (88.6%) stillbirths and 17 (11.4%) early neonatal deaths. In absolute numbers, the SSA criteria picked up more perinatal deaths compared to the WHO criteria, but the proportion of perinatal deaths was lower in SSA group compared to the WHO (149/465, 32% vs 62/100, 62%). Perinatal mortality was more likely among near misses with antepartum hemorrhage (adjusted odds ratio (aOR) = 4.81; 95% CI = 1.76-13.20), grand multiparous women (aOR = 4.31; 95% confidence interval CI = 1.23-15.25), and women fulfilling any of the WHO near miss criteria (aOR = 4.89; 95% CI = 2.17-10.99).
WHO MNM criteria pick up fewer perinatal deaths, although perinatal mortality occurred in a larger proportion of women fulfilling the WHO MNM criteria compared to the SSA MNM criteria. As women with MNM have increased risk of perinatal deaths (in both definitions), a holistic care addressing the needs of the mother and baby should be considered in management of women with MNM.
尽管孕产妇严重可避免病例（MNM）通常被认为是“伟大的挽救”，因为女性存活了危及生命的并发症，但这些并发症可能导致孩子死亡或新生儿严重发病。本研究的目的是评估在埃塞俄比亚东部的一组 MNM 病例中围产儿死亡率（死产和早期新生儿死亡）的比例。此外，我们比较了符合世界卫生组织（WHO）和撒哈拉以南非洲（SSA）MNM 标准的女性的围产儿结局。
采用前瞻性队列设计，从 2016 年 1 月 1 日至 2017 年 4 月 30 日，每天在埃塞俄比亚哈拉尔的两家主要医院识别出有潜在危及生命情况（PLTC）（严重产后出血、严重产前（子痫前期）、败血症/严重全身感染和子宫破裂）的女性，并对其进行随访直至出院。使用两套标准收集孕产妇和围产儿结局。计算并比较死产和早期新生儿死亡的数量和比例。
在研究期间，有 1054 名女性因 PLTC 入院，其中 594 名女性符合任何 MNM 标准。排除与流产、异位妊娠或未分娩女性有关的可避免病例后，纳入了 465 名女性，其中 149 名（32%）围产儿死亡：132 名（88.6%）死产和 17 名（11.4%）早期新生儿死亡。从绝对数字上看，SSA 标准比 WHO 标准发现了更多的围产儿死亡，但 SSA 组的围产儿死亡比例低于 WHO 组（149/465，32%比 62/100，62%）。产前出血（调整优势比（aOR）=4.81；95%置信区间（CI）=1.76-13.20）、经产妇（aOR=4.31；95%CI=1.23-15.25）和符合任何 WHO 可避免病例标准的女性（aOR=4.89；95%CI=2.17-10.99）更有可能发生围产儿死亡。
WHO MNM 标准发现的围产儿死亡较少，尽管与 SSA MNM 标准相比，符合 WHO MNM 标准的女性发生围产儿死亡的比例更高。由于 MNM 女性有更高的围产儿死亡风险（两种定义均如此），因此在管理 MNM 女性时，应考虑全面的母婴护理，以满足她们的需求。
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