Abstract:

Background: Severe maternal outcome (SMO) has been used as a complementary indicator of maternal health. SMO is among the major public health problems that threaten maternal and newborn health with limited hospital based studies. Therefore this study determines the associated factors leading to severe maternal outcomes in women with obstetric related conditions as well as the case fatality rates and their causes.

Methods: A prospective cohort study was conducted between November 2021 and May 2022, where 287 women admitted with obstetric related conditions were included with the use of SSA maternal near miss tool. Descriptive statistics were used to calculate demographic, clinical characteristics and the case fatality rates. For factors associated with SMO Chi square and Fishers exact test were used a p-value <0.05 being considered significant. All variables with a p-value of <0.05 were then subjected to multivariate analysis.

Results: During this study period there were 287 women admitted due to obstetric related conditions, 175 women were identified with SMO. There were 138(78.9%) maternal near miss and 37(21.1%) maternal deaths. During this period there were 3,071 live births. The maternal near miss ratio was 44.9 per 1000 live births, the mortality index was 0.21 and the maternal mortality ratio was 1024 per 100,000 live births. There was 3.7 MNM for every 1 MD. The major causes of SMO were hypertensive disorders (27.5%), obstetric hemorrhage (17.1%), sepsis (7.3%) and anemia (4.5%) with the highest case fatality rate seen in women with anaemia (46.4%) followed by abortion complications (33.3%) and sepsis (28.6%). Factors strongly associated with SMO included referral from other facilities {OR 6.1, 95%CI [2.38 – 16.1]} p-value <0.001, delayed intervention more than 30 minutes {OR 6.3, 95% CI [1.16 – 34.6]} p-value 0.03 and admission in AICU/HDU {OR 33[7.24 – 159.5]} p-value <0.001.

Conclusion: Near-miss to mortality ratio was low showing 3.7 near-miss for every 1 death, therefore indicating substandard care. Our study results depict a leading cause of SMO as hypertensive disorder, with the highest cause fatality rate seen in women with anemia. Women who received delayed intervention of more than 30 minutes, those who were referred from other facilities and those admitted in intensive care units had bad outcomes. Therefore establishment of individualized care for each woman is of paramount importance as well as strengthening per protocol management with respect to the case fatality rates as well as assessment and improving allocation of resources dedicated to the obstetric care.