Learning from the Pregnant Mothers Just Escaped from Death: Maternal Near-Misses in Sri Lanka

Session: Optimal Learning from Maternal Deaths and Near Misses: How Can We Facilitate Change?

Presenter: Kapila Jayaratne, Family Health Bureau, Ministry of Health, Sri Lanka
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Background: Nearly 54000 women with pregnancy-related complications present to healthcare services in Sri Lanka every year. Country reports a low maternal mortality with 100-140 deaths annually. Further improvements of survival of women should be on maternal near-misses. We aimed to ascertain incidence and management of severe maternal complications in selected hospitals.

Methods: We selected 14 health facilities in the Western, Southern and Eastern provinces based on a multistage cluster sampling method. We collected information from medical records of all women admitted for delivery and those with severe complications. We used the WHO near-miss criteria to assess occurrence of severe maternal complications and assess outcome indicators and potentially confounding factors.

Results: From 14 health facilities in seven districts, 18,129 women were recruited and 17,988 live births were reported. Mean age of study sample was 28.3(SD 5.7) years. At least one major pregnancy complication was reported by 862(4.8%) and of them (n=75, 8.7%) had organ dysfunctions. Obstetric haemorrhage was the commonest complication (n=354, 2%), followed by hypertensive disorders (n=233, 1.3%) and heart disease (n=124,0.68%). Commonly required interventions were oxytocin for post-partum haemorrhage (n=201, 23.3%) and transfusion of blood products (n=183, 21.2%). Maternal near-miss ratio and intra-hospital maternal mortality ratio was 405.8 and 16.7 per 100,000 live births. The estimated severe maternal outcome ratio was 423(95%CI 328-517) per 100,000 live births. Still birth ratio, early neonatal death ratio and perinatal death ratio in selected hospital settings were 6.1, 4.7 and 10.7 per 1000 live births respectively.

Conclusions: Our study provides an evaluation of the implementation status of critical life-saving interventions in the continuum of maternal and perinatal care in Sri Lanka. Results indicate that markers of severe maternal morbidity can be incorporated into routine data collection systems, and provide a standardized evaluation of quality of care in local health facilities when number of maternal deaths declines.