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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2010

Open Access 01-12-2010 | Research article

Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study

Authors: Yara Almerie, Muhammad Q Almerie, Hosam E Matar, Yasser Shahrour, Ahmad Abo Al Chamat, Asmaa Abdulsalam

Published in: BMC Pregnancy and Childbirth | Issue 1/2010

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Abstract

Background

Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities.

Methods

Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions.

Results

There were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU).

Conclusion

Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health care professionals to manage infrequent but fatal conditions like sepsis. An urgent review of the referral system and the emergency obstetric care in Syria is highly recommended.
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Metadata
Title
Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study
Authors
Yara Almerie
Muhammad Q Almerie
Hosam E Matar
Yasser Shahrour
Ahmad Abo Al Chamat
Asmaa Abdulsalam
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2010
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-10-65

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