Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania

Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Complications during pregnancy and childbirth remain a leading cause of critical illness and death among women of reproductive age in many low-income countries [1]. In recent years, the concept of maternal near-miss (MNM) has received growing attention as a way to assess severe maternal morbidity potentially leading to death. According to the World Health Organization (WHO), a MNM refers to “a woman who almost dies but survives a complication during pregnancy, childbirth, or within 42 days after termination of pregnancy” [2]. Until recently, different criteria have been used to define MNM [3]. In 2009, the WHO presented new criteria to define MNM in order to facilitate comparisons between different studies [2]. By representing aspects of organ dysfunction, the new criteria reflects true critical illness. Thus far, few published studies have applied the new criteria [4–8], and only three have been done in low-income countries [9–11].

In recent decades, caesarean section (CS) rates have increased rapidly worldwide, including in many low- and middle-income countries [12]. The causes behind this rise are not fully known, nor are the effects on maternal health, especially in low-resource settings where safety of the procedure is lower [13] and there is a lack of human and material resources [14]. We recently conducted a study at a university hospital in Tanzania that revealed a sharp increase in CS rates between 2000 and 2011, and found the rise was accompanied by a significant increase in the maternal mortality ratio (MMR) [15]. Several studies have reported increased risk of blood transfusion [16, 17], hysterectomy [16, 17], bleeding complications [18], infections [18], and maternal death [13, 16, 17, 19] among women undergoing CS. However, assessing the risks of CS versus vaginal birth is complicated, as adverse outcomes after CS might be confounded by the medical condition that lead to the operation. There are few publications with ideal study design to establish the causal relationship between CS and maternal morbidity and mortality [17, 19, 20].

Our aim was to describe the occurrence and panorama of MNM and death at a university hospital and a regional hospital in Tanzania, and explore their association with CS complications. We sought to provide valid estimates of the proportion of MNM and death directly attributed to CS complications and the risk for such outcomes per 1,000 operations.Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania

Publication (Name of Journal)

BMC Nephrology

DOI

https://doi.org/10.1186/1471-2393-14-244

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