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

Research paper by Hilda Tanimia, Skandarupan Jayaratnam, Glen L. Mola, Apeawusu B. Amoa, Caroline de Costa

Indexed on: 09 Mar '16Published on: 01 Jan '16Published in: Australian and New Zealand Journal of Obstetrics and Gynaecology



Abstract

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.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.Information about all cases that fitted the WHO definition of ‘near‐miss’ was collected prospectively.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.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.