Aliyi Ahmednur Adem, Deyessa Negussie, Dilnessie Mengistu Yilma
Department of Public Health, College of Medicine and Health Sciences, Madda Walabu University, Goba, Ethiopia.
Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
SAGE Open Med. 2021 Aug 30;9:20503121211042219. doi: 10.1177/20503121211042219. eCollection 2021.
The objective of this study was to assess effect of maternal near miss on neonatal mortality.
Prospective cohort study was conducted on 384 pregnant women who came for delivery to purposely selected hospitals. The cohort was made up of 128 exposed (near miss) mothers and 256 non-exposed (non-near-miss) mothers. Women who came for delivery were only included. Those who came for services other than delivery such as abortion care, women who developed life-threatening condition not related to delivery, and those who come from no phone network area were excluded. A purposive sampling technique was used by including all mothers with near miss consecutively until the required sample size was obtained. Two non-near-miss mothers were selected using lottery for every near-miss mother. Survival analysis was done for both groups using Cox regression to look for effect of maternal near miss on neonatal mortality. Verbal informed consent from study participants was obtained.
A total of 354 (118 with near miss and 236 without near miss) women completed the follow-up time, yielding response rate of 92.2%. Of all, 55 (15.5%) of them have previous history of abortion, 44 (12.4%) were admitted to the intensive care unit during delivery, and 22 (6.2%) have history of past delivery of still birth. Severe preeclampsia with intensive care unit admission and severe anemia with transfusion of greater than 2 units of blood were common complications leading to maternal near miss. There were 17 (48 per 1000 live birth) neonatal death at the end of the study, of which 15 occurred among mothers with near miss. Monthly income (adjusted hazard ratio = 998, 95% confidence interval = 0.996-0.999), fetal presentation (adjusted hazard ratio = 6.48, 95% confidence interval = 1.84-22.73), APGAR score (adjusted hazard ratio = 0.746, 95% confidence interval = 0.620-0.898), and being near miss mother (adjusted hazard ratio = 8.40, 95% confidence interval = 1.638-43.118) were significantly affecting neonatal mortality.
Maternal near miss and other fetal and general maternal characteristics have effect on occurrence of neonatal mortality. Therefore, due attention should be given to these factors for improvement of neonatal survival.
本研究的目的是评估孕产妇接近死亡对新生儿死亡率的影响。
对384名到特意选定医院分娩的孕妇进行前瞻性队列研究。该队列由128名暴露（接近死亡）的母亲和256名未暴露（非接近死亡）的母亲组成。仅纳入前来分娩的妇女。排除前来接受诸如堕胎护理等非分娩服务的妇女、出现与分娩无关的危及生命状况的妇女以及来自无电话网络地区的妇女。采用立意抽样技术，连续纳入所有接近死亡的母亲，直至获得所需样本量。每一名接近死亡的母亲通过抽签选取两名非接近死亡的母亲。使用Cox回归对两组进行生存分析，以研究孕产妇接近死亡对新生儿死亡率的影响。获得了研究参与者的口头知情同意。
共有354名妇女（118名接近死亡，236名未接近死亡）完成了随访，应答率为92.2%。其中，55名（15.5%）有既往堕胎史，44名（12.4%）在分娩期间入住重症监护病房，22名（6.2%）有既往死产史。伴有重症监护病房入住的重度子痫前期和输血超过2单位的重度贫血是导致孕产妇接近死亡的常见并发症。研究结束时，有17例（每1000例活产中有48例）新生儿死亡，其中15例发生在接近死亡的母亲中。月收入（调整后风险比=998，95%置信区间=0.996 - 0.999）、胎儿先露（调整后风险比=6.48，95%置信区间=1.84 - 22.73）、阿氏评分（调整后风险比=0.746，95%置信区间=0.620 - 0.898）以及作为接近死亡的母亲（调整后风险比=8.40，95%置信区间=1.638 - 43.118）对新生儿死亡率有显著影响。
孕产妇接近死亡以及其他胎儿和孕产妇一般特征对新生儿死亡的发生有影响。因此，应重视这些因素以提高新生儿存活率。
