Severe Obstetric Morbidity and Quality of Maternal Healthcare at a Tertiary Level Health Facility in Southern Nigeria

Background: In most women, pregnancy is often uncomplicated and will bring about the delivery of healthy babies at term. However, in some women, severe complications may occur during pregnancy, labour, or the postpartum period, which may be life-threatening for either the mother, baby, or both, thereby necessitating certain interventions to prevent morbidity or mortality.

Aim and Objectives: To evaluate the critical interventions, process indicators, as well as pregnancy outcomes of severe obstetric morbidity at the University of Port Harcourt Teaching Hospital (UPTH).

Materials and Methods: A retrospective cross-sectional study carried out at the department of Obstetrics and Gynaecology of the University of Port Harcourt Teaching Hospital. Stratified sampling method was used to select the folders of 610 women who were managed during pregnancy, labour or postpartum period, abortion and ectopic pregnancy between January 1, 2018, and December 31, 2020. Data collection tool was used to obtain information from folders and SPSS 25 used for analysis. Mean and standard deviation were used to summarize descriptive data, while test for association was done using chi square test and logistic regression.

Results: Blood transfusion was the most common 65 (52.9%) critical intervention. Process indicators were all optimal (100%) except for corticosteroid therapy (60%). Maternal near miss morbidity was significantly associated with prolonged hospital stay (p=0.001), preterm delivery (p=0.000), perinatal death (p=0.001), low birth weight (p=0.002), Special Care Baby Unit (SCBU) admission (p=0.002) and birth asphyxia (p=0.001).

Conclusion: Transfusion of blood and blood products was the most common critical interventions instituted for maternal near miss. Process indicators were all optimal, except for corticosteroid therapy for preterm births less than 34 weeks. It was also noted that interventional radiology was not performed. Caesarean delivery was the most common mode of delivery. Maternal near miss was associated with preterm birth, perinatal death, low birth weight, admission into SCBU, and severe birth asphyxia.