Severe Maternal Morbidity and Near Misses in Two Tertiary Referral Hospitals in Iran

Background: Investigating severe maternal morbidity/near miss is a newly recognized tool which identifies women at the highest risk of maternal death and helps allocate resources, especially in developing countries. Objectives: This study aimed to document the prevalence and causes of severe maternal morbidity (SMM) at two educational hospitals in Ahvaz, Khuzestan, Iran. Patients and Methods: In this prospective study, we found and selected SMM patients based on organ failure criteria from patients admitted in two educational hospitals of Ahvaz Jundishapur University of Medical Sciences during 2009 - 2010. Until recovery discharge or death, the diagnosis and management of these patients were under observation of obstetricians. The main outcome was maternal mortality ratio, SMM rate (SMMR). Results: Totally, there were 12,149 deliveries, eight maternal deaths and 226 SMM cases. This study showed the SMMR of 18.6/1000 live births, an MMR of 65.8/100000 live births, and case fatality ratio of 1/28 or 3.5%. Severe preeclampsia and hemolysis elevated liver enzymes low platelet count syndrome (HELLP) (38%), hemorrhage (23%) and ectopic pregnancy (14%) were the top causes of SMM. Similar to HELLP syndrome (25%) hemorrhage (25%), sepsis (25%) was the commonest cause of mortality; 39% of patients were referred from primary or secondary health care units; 85% of the cases needed intensive care unit admissions. Conclusions: SMM analysis provides valuable information on obstetric care. This study highlighted the need to improve antenatal care, which would help early identification of high-risk pregnancies. Every SMM could progress to maternal mortality if is not suspected, diagnosed and managed on its golden time.