title: Severe maternal outcomes and their predictors among Pakistani women in the WHO Multicountry Survey on Maternal and Newborn Health.
abstract: OBJECTIVE
  To determine the incidence of, and the demographic and obstetric factors associated with, severe maternal outcome (SMO) among women presenting at healthcare facilities in Pakistan.
  
  
  METHODS
  A cross-sectional study was conducted in 16 healthcare facilities across Pakistan that had been selected for the WHO Multicountry Survey on Maternal and Newborn health. The hospital records of women who delivered at a participating facility or were admitted with SMO (defined as maternal death or near miss) within 7 days of delivery/abortion were reviewed for a period of 2-3 months in 2011. The incidence of SMO, its associated demographic and obstetric characteristics, and the influence of various maternal health interventions were assessed.
  
  
  RESULTS
  Among 13 175 included women, 132 (1.0%) had an SMO (94 [0.7%] near miss and 38 [0.3%] died). The maternal mortality ratio was 299 deaths per 100 000 live births. Major causes of SMO included postpartum hemorrhage (64 [48.5%] women), hypertensive disorders (34 [25.8%]), and ruptured uterus (9 [6.8]). Illiteracy, anemia, and several obstetric complications (e.g. eclampsia) were significant contributors.
  
  
  CONCLUSIONS
  Improving education, nutrition, and uniform implementation of obstetric care protocols are needed for better maternal and neonatal health in Pakistan.
authors.affiliation: Maternal and Child Health Centre Unit I, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
authors.forename: Syeda B
authors.initials: SB
authors.lastname: Mazhar
authors.affiliation: Maternal and Child Health Centre Unit I, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
authors.forename: Afshan
authors.initials: A
authors.lastname: Batool
authors.affiliation: Maternal and Child Health Centre Unit I, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Electronic address: nglemanuel@yahoo.com.
authors.forename: Angela
authors.initials: A
authors.lastname: Emanuel
authors.affiliation: Obstetrics and Gynaecology Unit II, Jinnah Hospital, Allama Iqbal Medical College, Lahore, Pakistan.
authors.forename: Arif T
authors.initials: AT
authors.lastname: Khan
authors.affiliation: Department of Obstetrics and Gynaecology, Jinnah Post Graduate Medical College, Karachi, Pakistan.
authors.forename: Shireen
authors.initials: S
authors.lastname: Bhutta
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D000068104:Infant Health / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008428:Maternal Mortality; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors; D014944:World Health Organization; D055815:Young Adult
keywords: Maternal mortality; Maternal near miss; Pakistan; Severe maternal outcome