Abstract
OBJECTIVE
To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals.
DESIGN
Secondary analysis of a nationwide cross-sectional study.
SETTING
Forty-two tertiary health facilities.
POPULATION
Women admitted with complications during pregnancy, childbirth or puerperium.
METHODS
All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria.
MAIN OUTCOME MEASURES
Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO).
RESULTS
Of 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe non-obstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO.
CONCLUSION
Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications.
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 (WHO).
TWEETABLE ABSTRACT
Non-obstetric causes are important contributors to maternal deaths and life-threatening morbidities in Nigerian hospitals.
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