The Effect of Maternal Near-Miss on Adverse Perinatal Outcomes Among Women Admitted to Hospitals of Gurage Zone, Southwest Ethiopia: A Prospective Cohort Study

Abstract

Introduction: Perinatal outcomes refer to events affecting a newborn after fetal viability, typically from 28 weeks of gestation through the first seven days of life. Adverse perinatal outcomes include stillbirth, low birth weight, preterm birth, early neonatal death, perinatal mortality, admission to a neonatal intensive care unit, and birth asphyxia. Despite substantial reductions in under-five mortality over recent decades, neonatal mortality rates have shown minimal improvement in sub-Saharan Africa. Objective: This study aimed to assess the effect of maternal near-miss on adverse perinatal outcomes among women admitted to hospitals of Gurage Zone, Ethiopia. Method: A facility based prospective cohort study was conducted in Gurage zone public hospitals, from April 2022 to January 2023. The exposed groups were women admitted during pregnancy and childbirth in selected hospitals during the study period and fulfilled at least one of the near-miss conditions under the modified World Health Organization (WHO) near-miss criteria. Unexposed groups were women without any complications under the modified WHO near-miss criteria. The primary outcome of interest was the composite adverse perinatal outcome (stillbirth, low birth weight, preterm birth, early neonatal death, admission to the neonatal intensive care unit, and birth asphyxia). The perinatal period starts from 28 weeks of gestation to 7 days of life. Results: A total of 1032 women (258 with near misses and 774 without near misses) completed the follow-up time (completion of the perinatal period, discharge from the hospital, or development of the outcome). The incidence of composite adverse perinatal outcomes was 19.48% (37.98% exposed vs. 13.31% unexposed). After adjusting for potential confounders, the risk of adverse perinatal outcomes was higher among women with near-miss events (adjusted relative risks [ARR]: 2.36; 95% confidence interval [CI]: 1.74, 3.18). In addition, there was a higher risk of adverse perinatal outcomes among rural residents (ARR: 1.52; 95% CI: 1.14, 2.03), women with chronic hypertension (ARR 1.66; 95% CI: 1.05, 2.62), and anemia (ARR 1.60; 95% CI: 1.10, 2.31). Conclusions: The risk of adverse perinatal outcomes has remained higher among women with near-miss events, even after controlling for potential covariates. Adverse perinatal outcomes were also significantly higher among rural residents, women with chronic hypertension, and anemia. Therefore, interventions focusing on maternal risk factors are crucial for reducing adverse perinatal outcomes.