AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 38 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 ICU are very ill compared to those admitted ward. However, during the second period, equal number of deaths occurred in ICU and the ward. This was unexpected because one expects women admitted to the ward to have less severe disease. We suspect that this could have been due to lack of access to ICU beds during the Covid 19 pandemic. In terms of foetal outcomes (Table 8), there were no statistically significant differences between the two groups. Live births between the two groups in this study were also similar (9034 vs 9074). Overall, 67 (69.8%) of the near misses and deaths ended with live births. There was no statistical difference in terms of total number of stillbirths between the two groups. However, when separated into fresh vs macerated stillbirths, there were more fresh stillbirths (8 vs 6) in the first group and more macerated stillbirths (2 vs 10) in the second group. The difference was statistically significant for both fresh and macerated still births (p-value of 0.03 each). Only one baby was an early neonatal death, from the first group. Of note, in the first group, three of the four stillbirths were related to abruption placentae. In the second group, three of the seven stillbirths had abruption placentae. The above suggests that abruption placentae were a major contributor for the stillbirths. It is not certain whether the above had anything to with difficulties in accessing healthcare during the Covid 19 pandemic. Table 6: Blood results at admission or near miss Description First period N=38 Second period N=58 P-value* WCC 16.2(9.1-239) 15.0 (9.9-19.9) 0.45 HB 9.1 (7.2-11.1) 9.2 (6.2-12.0) 0.68 Plts 141 (87-207) 228 (104-342) 0.04 Urea 3.7 (2.2-6.0) 3.9 (3-8.8) 0.28 Creatinine 73.5 (58-150) 72 (57-133) 0.87 AST 37 (31-127) 37 (20-86) 0.43 ALT 37 (14-107) 21 (10-42) 0.13 LDH 1623 (257-2989) 1451 (780-2628) 1.00 INR 1.30 (1.06-1.69) 1.04 (0.99-1.13) 0.003 Table 7: Maternal deaths Description First period N=8 n (%) Second period N=4 n (%) P-value* Death 0.03 ICU 6 (75.0) 2 (50.0) Ward 2 (25.0) 2 (50.0) Cause of death (12) 0.36 3 (37.5) 0 (0) Shock – septic and hypovolaemic 2 (25.0) 0 (0) HELLP syndrome related DKA with hypertension complications 0 (0) 2 (50.0) Hypoxic brain injury 2 (25.0) 1 (25.0) Other Table 8: Foetal outcomes associated with maternal near miss over the two periods Description First period N=38 n (%) or median (IQR) Second period N=58 n (%) or median (IQR) P-value* Amount of foetuses 0.16 Singletons 30 (78.9) 45 (77.6) Twins 2 (5.3) 0 (0.0) Unknown 6 (15.8) 13 (22.4) Sonar done during pregnancy 17 (50.0) 33 (62.3) 0.16 EGA at sonar 26 (14-32) 28 (18-35) 0.38 Viable at time of near miss 30 (81.1) 40 (68.9) 0.19 Alive at birth (n=67) 19 (65.5) 22 (57.9) 0.53 SB 10 (34.5) 16 (42.1) 0.52 SB type FSB 8 (80) 6 (37.5) 0.03 MSB 2 (20.0) 10 (62.3) 0.03 Birth weight (g) 1970 (980-2810) 1900 (1100-2900) 0.93 Apgar @ 1 min 4 (0-8) 5 (0-9) 0.06 Apgar @ 5 min 6 (0-9) 7 (0-10) 0.10 Admitted to NICU (n=67) 8 (27.6) 7 (18.4) 0.37 ENND 1 (3.5) 0 (0.0) 0.35 DISCUSSION 1. Principle findings Maternal near misses provide useful information regarding the causes and contributing factors for maternal deaths, quality of maternal health and maternal healthcare services as both have similar causes and contributing factors. [2] Furthermore, maternal near misses are five times more common than maternal deaths and therefore provide opportunities to gather more useful information because the woman is alive to explain what had happened and where possible problems occurred. [9,13] While there is no universal criteria for near misses, the WHO MNM criteria is used in many centres around the world based on the belief that it identifies the most serious category of the MNM cases. [14] The WHO criteria has been tested in many countries including South Africa. [15] While useful there are concerns that the WHO criteria might not be as effective in low- and middle-income countries and this has led to its modification in 2011. [6,11,16] In this study, the women who suffered near misses were younger, single, overweight, HIV negative and Black Africans. Soma Pillay et al also showed that more MNM and MD occurred in HIV negative women. [8] Unfortunately, in most studies, the demographics were not discussed, and therefore we were unable to compare with this study. Half of the women in each group were South Africans and the rest from other African countries (Table 1). This is higher than the numbers reported in the national population census. [17] This suggests a disproportionate representation of migrant women from other African countries among the near misses at the study site. This observation might be due to the difficulties that migrant pregnant women face when trying