When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country

摘要: Objective To investigate the burden and causes of life-threatening maternal complications quality emergency obstetric care in Nigerian public tertiary hospitals. Design Nationwide cross-sectional study. Setting Forty-two Population Women admitted for pregnancy childbirth puerperal complications. Methods All cases severe outcome (SMO: near-miss or death) were prospectively identified using WHO criteria over a 1-year period. Main measures Incidence SMO health service events case fatality rate mortality index (% death/SMO). Results Participating hospitals recorded 91 724 live births 5910 stillbirths. A total 2449 women had an including 1451 near-misses 998 deaths (2.7 1.6 1.1% respectively). The majority (91.8%) critical condition. Leading pre-eclampsia/eclampsia (23.4%) postpartum hemorrhage (14.4%). overall conditions was 40.8%. For all SMOs median time between diagnosis intervention 60 minutes (IQR: 21-215 minutes) but 21.9% it 4 hours. Late presentation (35.3%) lack insurance (17.5%) non-availability blood/blood products (12.7%) most frequent problems associated with deficiencies care. Conclusions Improving chances survival would not only require timely application life-saving interventions also their safe efficient equitable use. Maternal reduction strategies Nigeria should address hospital prioritize prevention at lower levels