Describing the causes of near-miss maternal morbidity and mortality at Kenyatta National Hospital, Nairobi

Abstract

Background: Over half a million women die every year from pregnancy related complications. Maternal mortality ratios (MMR) vary by institution, country and continent with Africa experiencing the greatest burden: 1,100 per 100,000 live births. Characterizing near miss morbidity is an objective, realistic and cost effective tool for monitoring the quality of obstetric care and for assessing the incidence of life threatening obstetric complications. Objective: Determine causes of near miss maternal morbidity and mortality at Kenyatta National Hospital, describe the maternal and foetal morbidity and mortality associated with near-miss morbidities and maternal mortalities and identify gaps in management of cases of near miss morbidities and maternal mortalities. Study design: This is a cross-sectional descriptive study. Near miss cases were identified from daily rounds and followed up prospectively until discharge or death. Study site: Labour ward, ward lD, ante-natal/post-natal wards; renal unit, ICU and HDU of Kenyatta National Hospital. This hospital' is the national referral hospital and largest hospital in East and Central Africa with a bed capacity of 2,000 beds. Study population: We enrolled a total of 142 pregnant women and women within six weeks after delivery or termination of pregnancy with near miss morbidity or maternal mortality. Methods: A descriptive review of all near miss and maternal mortality cases between June and October 2008 until sample size was reached. Patients were recruited using disease specific criteria (majority), management specific criteria and organ system dysfunction criteria. Once recruited the women were followed up until discharge or death with data recorded on the daily follow-up form and questionnaire. Results: 142 women with near miss morbidity and maternal mortality were recruited giving a prevalence of 4.7%. The near miss to mortality ratio was 4.7 with a mortality index on 0.176. Hypertension and HIV/AIDS were the leading causes of death (32.0%), though hemorrhage was the leading cause of near -miss morbidity (36.8%). Only 2.8% of cases were KNH clinic attendees and none of them died. Babies of women with near miss morbidity and of women who died had poor neonatal outcomes- still births 30%; admission to New Born Unit (MBU) 30% and neonatal deaths 15%. Conclusions: Hypertension and HIV/AIDS are the leading causes of maternal mortality, whereas hemorrhage was the primary cause of morbidity. Women presenting in the postpartum period and women who delivered vaginally had a 3 fold risk of death.