Severe Life-Threatening Pregnancy Complications, "Near Miss" and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study

Pregnancy and birth complications and long-term maternal mental health outcomes: A systematic review and meta-analysis

BACKGROUND

Few studies have examined the associations between pregnancy and birth complications and long-term (>12 months) maternal mental health outcomes.

OBJECTIVES

To review the published literature on pregnancy and birth complications and long-term maternal mental health outcomes.

SEARCH STRATEGY

Systematic search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PsycInfo®, PubMed® and Web of Science from inception until August 2022.

SELECTION CRITERIA

Three reviewers independently reviewed titles, abstracts and full texts.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and appraised study quality. Random-effects meta-analyses were used to calculate pooled estimates. The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The protocol was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022359017).

MAIN RESULTS

Of the 16 310 articles identified, 33 studies were included (3 973 631 participants). Termination of pregnancy was associated with depression (pooled adjusted odds ratio, aOR 1.49, 95% CI 1.20-1.83) and anxiety disorder (pooled aOR 1.43, 95% CI 1.20-1.71). Miscarriage was associated with depression (pooled aOR 1.97, 95% CI 1.38-2.82) and anxiety disorder (pooled aOR 1.24, 95% CI 1.11-1.39). Sensitivity analyses excluding early pregnancy loss and termination reported similar results. Preterm birth was associated with depression (pooled aOR 1.37, 95% CI 1.32-1.42), anxiety disorder (pooled aOR 0.97, 95% CI 0.41-2.27) and post-traumatic stress disorder (PTSD) (pooled aOR 1.75, 95% CI 0.52-5.89). Caesarean section was not significantly associated with PTSD (pooled aOR 2.51, 95% CI 0.75-8.37). There were few studies on other mental disorders and therefore it was not possible to perform meta-analyses.

CONCLUSIONS

Exposure to complications during pregnancy and birth increases the odds of long-term depression, anxiety disorder and PTSD.

PREVALENCE OF MATERNAL NEAR-MISS AND MATERNAL MORTALITY, THEIR DISTRIBUTION BY GESTATION AND GRAVIDITY AND CAUSES IN WOMEN WITH LIVE BIRTHS IN DISTRICT PESHAWAR, PAKISTAN

Background: Maternal near-miss (MNM) and maternal mortality (MM) are indicators for quality of health care system. The objectives of our study were to determine prevalence of MNM and MM and their distribution by gestation and gravidity and their causes in women with live births population of District Peshawar, Pakistan.Material Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar, Pakistan from January 2017 to June 2017. From assumed population of 185,676 pregnant women in District Peshawar, 10% prevalence of MNM, 1.0448% margin of error and 95%CL, sample size was calculated 3,115. All women with live birth were eligible. Presence of MNM and MM, causes of MNM and MM, gestational age and gravidity were six variables. Being nominal, all were analysed by count and ratio or percentage with 80%CI. MNM Ratio was calculated per 1,000 live births and MM Ratio per 100,000 live births.Results: Out of 3,115 women with live births, MNM cases were 494 with MNMR 158.59/1,000 (80%CI 150.19-166.97) and MM cases were 16 with MMR 513.64/100,000 population (95%CI 349.50-677.78). There were 232 MNM cases in ≤28 weeks and 262 in 28 weeks gestational age with similar MNMR between these groups. There were 244 MNM cases in primigravida and 250 in multigravida with similar MNMR between these groups. There were five MM cases in ≤28 weeks and 11 in 28 weeks gestational age with similar MMR between these groups. There were five MM cases in primigravida and 11 in multigravida with similar MMR between these groups as their CIs are overlapping. Haemorrhage was most common cause for MNM in 365 (11.7175%) cases and for MM in 8 (0.2568%) cases.Conclusion: The maternal near-miss ratio (MNMR) and maternal mortality ratio (MMR) are relatively higher in population of District, Peshawar, Pakistan. MNMR and MMR both have similar prevalence in ≤28 weeks and in 28 weeks gestational age groups and also similar in primigravida and in multigravida groups. Haemorrhage (antepartum and postpartum) was most common cause both for maternal near-miss (MNM) and maternal mortality (MM). 

"Near-Miss" Obstetric Events and Maternal Deaths in a Rural Tertiary Care Center in North India

Introduction Maternal near-miss and maternal mortality cases have common characters, especially in terms of risk factors. Both of them are indicators of the quality of health care services provided to pregnant women. Our center is a tertiary care center in a rural area of western Uttar Pradesh (U.P.) so we get a large number of referred cases from most of the rural areas of western U.P. and the adjoining areas of other states too, which sometimes end up in mortality. Thus this study was planned to find out the incidence of maternal near-miss events and compare the nature of near-miss events with maternal mortality. Goal and objectives The main objectives of the study were to determine the frequency of maternal near-miss events, observe the trend of near-miss events, and compare the nature of near-miss events with maternal mortality. Materials and methods It was a retrospective study conducted in the department of obstetrics and gynecology at Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, from July 2018 - June 2019, over a period of one year. Potentially life-threatening conditions and maternal mortalities were noted from the records of the hospital after taking ethical clearance from the institute. Near-miss cases were noted based on the Health and Family Welfare Government of India guidelines 2014. Data were collected and statistical analysis was performed using the Statistical Package of the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY). Results The maternal near-miss incidence ratio was 16.6/1000 live births, the maternal near-miss to mortality ratio was 1.9:1, and the mortality index was 0.34%. Hypertensive disorders of pregnancy were the most common causes of near-miss events (45.8%) followed by hemorrhage (23.6%) in this study. Conclusions Hypertensive disorders in pregnancy and hemorrhage were the two leading causes of near-miss events and mortality followed by sepsis. As the near-miss analysis indicates, the quality of health care and causes are almost similar to maternal mortality, so its registry should be done along with maternal mortality.

Erratum to "Severe Life-Threatening Pregnancy Complications, "Near Miss" and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study"

[This corrects the article DOI: 10.1155/2020/3697637.].