Maternal near miss and maternal mortality and their determinants among pregnant women at a rural tertiary centre in the Eastern Cape Province, South Africa: A cross-sectional study
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i7.2933Keywords:
near-miss, Maternal mortality, maternal near-missAbstract
Background. Maternal near miss (MNM) is a significant entity in the assessment of the quality of obstetric care, particularly at institutional level. It renders possible the assessment of events surrounding a woman surviving what would otherwise have been a fatal outcome during childbirth or within 42 days post termination of pregnancy. The World Health Organization (WHO) introduced a tool that eases the identification of such cases and the interventions that were offered during their care. There have been several assessments of maternal deaths within South Africa (SA), but no audit of maternal near-miss cases has been carried out in rural Eastern Cape Province.
Objectives. To establish the period prevalence of MNM and mortality index, and to compare near-miss cases with maternal mortality and to identify their risk factors and causes.
Methods. A prospective cross-sectional study was carried out at Nelson Mandela Academic Hospital, a rural tertiary hospital in the Eastern Cape Province, over a 6-month period between January 2019 and June 2019. All cases that met the WHO criteria for MNM, together with maternal mortality cases, were identified and included in the study.
Results. There was a total of 1 706 live births, 228 maternal near-miss cases and 24 maternal death cases. The institutional severe maternal outcome ratio was 147/1 000 live births, with an overall mortality index of 9.5%. The MNM ratio (MNMR) was 133.6/1 000 live births, the maternal mortality ratio was 1 406.8/100 000 live births and the MNM/maternal mortality ratio (MNMR/MMR) was 9.5:1. The stillbirth rate was found to be 95.0/1 000 births. The leading causes of MNM were eclampsia (47.8%), abruptio placentae (19.7%) and postpartum haemorrhage (8.3%), and the leading causes of maternal death were eclampsia (29.2%), puerperal sepsis (25%) and postpartum haemorrhage (12.5%).
Conclusion. The MNMR and the MMR found in this study were comparable with other reports from sub-Saharan Africa, although these ratios were notably higher than in urban areas within SA. The conditions that resulted in the highest fatality rate were potentially preventable, namely eclampsia and puerperal sepsis. Many patients with life-threatening conditions were low-risk patients, and this emphasises the need for more vigilant surveillance of patients during the antenatal, intrapartum and postpartum periods.
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