Near-misses at the Port Moresby General Hospital: a descriptive study

Abstract

Background: The World Health Organization (WHO) defines 'maternal near-miss' as 'a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of her pregnancy'. With declining rates of maternal mortality, near-miss analysis is being examined in both developed and developing country settings for the assessment of obstetric care.

Aims: Over a 15-month period, details of cases that could be classified as 'near-misses' were collected at Port Moresby General Hospital (PMGH), to assess the practicality of collecting such data routinely and determine near-miss rates for the hospital.

Materials and methods: Information about all cases that fitted the WHO definition of 'near-miss' was collected prospectively.

Results: During the audit period, there were 13 338 live births at PMGH; 131 women presented with a life-threatening condition of whom 122 met WHO criteria for 'maternal near-miss'; there were nine maternal deaths. The maternal mortality ratio was 67.5/100 000 live births, the maternal near-miss index ratio 9.1/1000 live births and the combination of maternal deaths and near-misses gave a severe maternal outcome ratio of 9.8/1000 live births. Main causes of the 'near-misses' were obstetric haemorrhage, hypertensive disorders and infections. Grandmultiparity, nulliparity, no antenatal attendance and age beyond 30 years were associated with maternal near-misses.

Conclusion: Assessment of near-misses equivalent to that provided in developed countries is possible in less well-resourced settings such as PMGH. Knowledge of causes of near-misses will assist health professionals to anticipate or prevent devastating maternal morbidities and thereby improve maternal and perinatal outcomes.

Keywords: maternal morbidity; maternal mortality; near-miss.