AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 36 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | Comparing two maternal near miss criteria in an academic hospital in Johannesburg, South Africa: A retrospective cross-sectional study periods (old: August 2018 to July 2019 vs new: August 2019 to July 2020) was conducted at an academic hospital in Johannesburg, SouthAfrica. Records of womenwith pregnancy related complications including life-threatening conditions, intensive care unit (ICU) admissions and emergency surgery due to complications of pregnancy, or organ dysfunction are collected by the department during the daily audit meetings. This information was used to retrieve patients’ clinical records from the Patient Record Department. All women who met the near miss inclusion criteria for each period were included except those with missing files. The collected data included, demographics, pregnancy and other clinical information, was deidentified and captured into the RedCap system. Categorical variables were described using frequencies and percentages, whilst continuous variables were summarised using means (with standard deviations) for parametric data and medians (with interquartile range) for non-parametric data. Maternal mortality rates were computed by dividing the number of maternal deaths by the number of live births during the reporting period and then scaling it to 100 000. Differences between baseline characteristics, maternal and neonatal outcomes between the two near miss reporting periods, were evaluated using T-test (parametric data), Mann-Whitney test (non-parametric) and Chi Square test (categorical variables). All data analyses were conducted in Stata 15.0 ® (StataCorp, 4905 Lakeway Drive, College Station, Texas 77845 USA). A p-value of <0.05was regarded as statistically significant. Ethics clearance was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand (M200975). Permission to access patient files was obtained from the Chief Executive Officer (CEO) of the hospital. RESULTS There was a total of 114 near misses during the two-study periods combined, however 18 (15.8%) files were excluded, leaving only 96 (84.2%) for analysis. These files were excluded because of the following: six were not found on the hospital records system, one was a duplication and 11 did not meet the near miss criteria. There were, therefore, 38 women in the old (August 2018- July 2019) and 58 women in the new criteria group (August 2019 – July 2020). The women who suffered near misses in this study were younger, single, overweight, HIV negative and Black Africans (Table 1). The three leading causes of MNM in both groups were obstetric haemorrhage (OH), hypertensive disorders in pregnancy (HDP), and existing medical conditions (Table 2). The characteristics of the study population were comparable between the two periods (Table 1). Although more MNM were identified with the new criteria, less MD occurred and as a result, maternal mortality index was lower during the second compared to the first period (Table 3). There were 50% more deaths in the first (eight) compared to the second period (four), as seen in Table 2. Consequently the (MNM to MMR was more in the former (5:1) compared to the later (14:1). Although the actual number of deaths was not statistically significant, the maternal mortality ratio (MMR) was higher in the first compared to the second period (Table 2). Table 1: Baseline characteristics of patients enrolled in in the study stratified according to near miss criteria Description Old Criteria (N=38) Mean (SD) or median (IQR) or n (%) New criteria (N=58) Mean (SD) or median (IQR) or n (%) P-value* Mean age (SD) years 30.8 (5.9) 30.7 (5.7) 0.91 Nationality 0.59 RSA 19 (50.0) 29 (50.0) Zimbabwe 11(28.9) 15 (25.9) Mozambique 1 (2.6) 3 (5.2) Malawi 1 (2.6) 3 (5.2) DRC 0 (0.0) 3 (5.2) Other 6 (15.8) 5 (8.6) Relationship 0.89 Married 7 (18.4) 8 (13.8) Single 26 (68.4) 42 (72.4) Other 5 (12.2) 7 (8.8) Employed 10 (26.3) 18 (31.0) 0.89 Race African 37 (96.7) 57 (96.5) 0.21 Unknown 1 (3.3) 1 (3.5) Parity 2(1-3) 2(0-3) 0.49 Gravidity 3 (2-4) 3(1-4) 0.55 Booked 23 (60.5) 30(51.7) 0.54 Rh positive 37 (97.4) 54 (93.1) 0.59 HIV positive 13 (34.2) 17 (29.8) 0.29 RPR positive 0 (0.0) 1(1.8) 0.39 Booking Hb (n=64) 12.0 (10.4-12.9) 11.1(8.5-13.4) 0.58 Gestational age at booking (n=51) 21 (15-25) 23 (16-30) 0.43 BMI (n=42) 29.7(23.7-34.6) 30.4(27.2-36.4) 0.28 Table 2: Conditions associated with maternal near misses Description First period N=38 n (%) or median (IQR) Second period N=58 n (%) or median (IQR) P-value* Indication (51) 0.31 Haemorrhage 8 (34.8) 11 (39.3) APH 4 (17.4) 7 (25.0) PPH 4 (17.4) 4 (14.3) Hypertensive related 5 (21.7) 2 (7.1) Existing medical conditions 3 (10.7) 4 (14.3) Caesarean section complications 7 (30.4) 10 (35.7) Infections 0 (0) 1 (3.6)