Maternal near-miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey

A. I. Adanikin; O. U.J. Umeora; E. Nzeribe; A. T. Agbata; C. Ezeama; F. O. Ezugwu; G. O. Ugwu; J. I. Ikechebelu; O. T. Oladapo

doi:10.1111/1471-0528.15699

Maternal near-miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey

A. I. Adanikin
, O. U.J. Umeora
, E. Nzeribe
, A. T. Agbata
, C. Ezeama
, F. O. Ezugwu
, G. O. Ugwu
, J. I. Ikechebelu
, O. T. Oladapo

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research
World Health Organization
Federal Teaching Hospital Abakaliki
Federal Medical Centre, Owerri
Nnamdi Azikiwe University
Enugu State University Teaching Hospital

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals. Design: Secondary analysis of a nationwide cross-sectional study. Setting: Forty-two tertiary hospitals. Population: Women admitted for pregnancy-related complications. Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria. Main outcome measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance. Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3–7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival. Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival. Tweetable abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year.

Original language	English
Pages (from-to)	33-40
Number of pages	8
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	126
Issue number	S3
Early online date	3 May 2019
DOIs	https://doi.org/10.1111/1471-0528.15699
Publication status	E-pub ahead of print - 3 May 2019
Externally published	Yes

Funding

The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, were funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization. We have no other funding to declare for our study. We acknowledge the contributions of all members of the Nigeria Near-miss and Maternal Death Surveillance Network?the hospital and regional coordinators, data collectors, and all staff of the participating hospitals. The manuscript represents the views of the named authors only. The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, were funded by the UNDP/UNFPA/UNICEF/WHO/ World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization. We have no other funding to declare for our study.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Abortion
abortive outcome
ectopic pregnancy
maternal death
maternal near-miss
severe maternal outcome

ASJC Scopus subject areas

Obstetrics and Gynaecology

Access to Document

10.1111/1471-0528.15699

Cite this

Adanikin, A. I., Umeora, O. U. J., Nzeribe, E., Agbata, A. T., Ezeama, C., Ezugwu, F. O., Ugwu, G. O., Ikechebelu, J. I., & Oladapo, O. T. (2019). Maternal near-miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG: An International Journal of Obstetrics and Gynaecology, 126(S3), 33-40. Advance online publication. https://doi.org/10.1111/1471-0528.15699

Maternal near-miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. / Adanikin, A. I.; Umeora, O. U.J.; Nzeribe, E. et al.
In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 126, No. S3, 03.05.2019, p. 33-40.

Research output: Contribution to journal › Article › peer-review

Adanikin, AI, Umeora, OUJ, Nzeribe, E, Agbata, AT, Ezeama, C, Ezugwu, FO, Ugwu, GO, Ikechebelu, JI & Oladapo, OT 2019, 'Maternal near-miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 126, no. S3, pp. 33-40. https://doi.org/10.1111/1471-0528.15699

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abstract = "Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals. Design: Secondary analysis of a nationwide cross-sectional study. Setting: Forty-two tertiary hospitals. Population: Women admitted for pregnancy-related complications. Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria. Main outcome measures: Prevalence of SMO, mortality index (\% maternal death/SMO), case fatality rate, time until death after admission, and health service performance. Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9\%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1\%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3–7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival. Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival. Tweetable abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year.",

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T2 - a secondary analysis of the Nigeria Near-miss and Maternal Death Survey

AU - Adanikin, A. I.

AU - Umeora, O. U.J.

AU - Nzeribe, E.

AU - Agbata, A. T.

AU - Ezeama, C.

AU - Ezugwu, F. O.

AU - Ugwu, G. O.

AU - Ikechebelu, J. I.

AU - Oladapo, O. T.

PY - 2019/5/3

Y1 - 2019/5/3

N2 - Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals. Design: Secondary analysis of a nationwide cross-sectional study. Setting: Forty-two tertiary hospitals. Population: Women admitted for pregnancy-related complications. Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria. Main outcome measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance. Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3–7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival. Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival. Tweetable abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year.

AB - Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals. Design: Secondary analysis of a nationwide cross-sectional study. Setting: Forty-two tertiary hospitals. Population: Women admitted for pregnancy-related complications. Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria. Main outcome measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance. Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3–7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival. Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival. Tweetable abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year.

KW - Abortion

KW - abortive outcome

KW - ectopic pregnancy

KW - maternal death

KW - maternal near-miss

KW - severe maternal outcome

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DO - 10.1111/1471-0528.15699

M3 - Article

C2 - 31050874

AN - SCOPUS:85065309525

SN - 1470-0328

VL - 126

SP - 33

EP - 40

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - S3

ER -

Maternal near-miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey

Abstract

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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Cite this