Low Incidence of Maternal Near-Miss in Zhejiang, a Developed Chinese Province: A Cross-Sectional Study Using the WHO Approach

Abstract

Background and Aim

Maternal near-miss (MNM) surveillance has been developed to identify severe complications in pregnancy since 2011 in China. However, very little is known about MNM in China. This study aims to explore the prevalence of MNM, the risk factors, and perinatal outcomes using the WHO near-miss approach in a developed Chinese province.

Materials and Methods

We used data from China’s National Maternity Near Miss Obstetrics Surveillance System for the period 2012 to 2017, which included 18 hospitals in Zhejiang Province. Chi-squared tests were used to compare the socio-demographic factors, obstetric complications and perinatal outcomes between women with and without MNM. Logistic regression was used to examine the independent risk factors for MNM.

Results

A total of 612,264 pregnant women were recruited. There were 3208 MNM cases and 34 maternal deaths. The MNM incidence ratio was low at 5.9 per 1,000 live births, with an MNM mortality ratio of 98:1 and mortality index of 1.1%. Among 3208 women with MNM, postpartum hemorrhage was the commonest cause at 76.3% followed by severe anemia at 23.7% and placenta previa at 23.0%. Embolism was identified as having the highest risk for MNM (AOR 46.0; 95% CI 19.1–110.7), followed by postpartum hemorrhage (AOR 41.0; 95% CI 35.7–47.0), and severe anemia (AOR 36.6; 95% CI 16.0–84.1). MNM cases were significantly associated with severe perinatal outcome, including premature birth, low birth weight, multiple fetuses, stillbirth rates and neonatal mortality.

Conclusion

Overall near-miss indicators suggested a relatively high quality of maternal health care in a developed province of China. The identified risk factors may be helpful in developing targeted interventions for improving maternal safety.

Keywords:

• maternal near-miss
• adverse perinatal outcomes
• clinical audit
• high-risk pregnancy
• pregnancy complication

Acknowledgments

YuanYing Ma and LiSan Zhang are joint first authors. Xinyu Wang and Therese Hesketh contributed equally to the correspondence work. We thank the professionals and managers in the study sites for their help in data collection and creating a data set.

Abbreviations

MNM, maternal near-miss; NMNMSS, National Maternal Near-Miss Surveillance System; MCH, Maternal and Child Health; MD, Maternal death; SMOR, Severe maternal outcome ratio; WHOMCS, WHO Multi-country Survey.

Ethics and Consent Statement

The study achieved 18 hospital’s authorization. There was no direct interaction with patients and no information was obtained direct from patients. Therefore, it was unnecessary to get informed consent from individual patients. All needed data are extracted from hospital’s electric medicine records without any patient identification.

Disclosure

The authors report no conflicts of interest in this works.

Additional information

Funding

This study was supported by grants from the National Science Foundation of China (No. 71804162) and Public Technology Application Research Project of Science and Technology Department of Zhejiang Province (Nos. 2016C33132 and 2017c33059).