Maternal near miss and mortality in a tertiary care hospital in Rwanda.
BACKGROUND
To determine the prevalence and factors associated with severe ('near miss') maternal morbidity and mortality in the University Teaching Hospital of Kigali-Rwanda.


METHODS
We performed a cross sectional study of all women admitted to the tertiary care University Hospital in Kigali with severe "near miss" maternal morbidity and mortality during a one year period using the WHO criteria for 'near miss' maternal mortality. We assessed maternal demographic characteristics and disease processes associated with severe obstetric morbidity and mortality.


RESULTS
The prevalence of severe maternal outcomes was 11 per 1000 live births. The maternal near miss ratio was 8 per 1000 live births. The majority of severe obstetric morbidity and mortalities resulted from: sepsis/peritonitis (30.2%)--primarily following caesarean deliveries, hypertensive disease (28.6%), and hemorrhage (19.3%). Majority of our patients were found to be of lower socioeconomic status, refered from district hospitals to the tertiary care center, and resided in the eastern part of the country.


CONCLUSIONS
The main causes associated with MNH were peritonitis, hypertensive disorders and bleeding. The high prevalence of peritonitis may reflect suboptimal intraoperative and intrapartum management of high-risk patients at district hospitals. Direct causes of severe maternal outcome are still the most prevalent. The study identified opportunities for improvement in clinical care to reduce potentially these adverse outcomes.
Department of Obstetrics and Gynecology, University of Rwanda, Kigali, Rwanda. s.rulisa@gmail.com.
Stephen
S
Rulisa
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. umuziranenge2011@hotmail.com.
Immaculee
I
Umuziranenge
Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA. maria.small@duke.edu.
Maria
M
Small
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. j.j.m.van_roosmalen@lumc.nl.|Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands. j.j.m.van_roosmalen@lumc.nl.
Jos
J
van Roosmalen
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002585:Cesarean Section / Q000401:mortality; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000401:mortality*; D003906:Developing Countries; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D009017:Morbidity; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000401:mortality*; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D015995:Prevalence; D018570:Risk Assessment; D012432:Rwanda / Q000453:epidemiology; D063128:Tertiary Health Care; D055815:Young Adult