Data from: Determinants of maternal near misses in Morocco: too late, too far, too sloppy?

Background: In Morocco, there is little information on the circumstances surrounding maternal near misses. This study aimed to determine the incidence, characteristics, and determinants of maternal near misses in Morocco.
Method:A prospective case-control study was conducted at 3 referral maternity hospitals in the Marrakech region of Morocco between February and July 2012. Near-miss cases included severe hemorrhage, hypertensive disorders, and prolonged obstructed labor. Three unmatched controls were selected for each near-miss case. Three categories of risk factors (sociodemographics, reproductive history, and delays), as well as perinatal outcomes, were assessed, and bivariate and multivariate analyses of the determinants were performed. A sample of 30 near misses and 30 non-near misses was interviewed.
Results:The incidence of near misses was 12‰ of births. Hypertensive disorders during pregnancy (45%) and severe hemorrhage (39%) were the most frequent direct causes of near miss. The main risk factors were illiteracy [OR = 2.35; 95% CI: (1.07–5.15)], lack of antenatal care [OR = 3.97; 95% CI: (1.42–11.09)], complications during pregnancy [OR = 2.81; 95% CI:(1.26–6.29)], and having experienced a first phase delay [OR = 8.71; 95% CI: (3.97–19.12)] and a first phase of third delay [OR = 4.03; 95% CI: (1.75–9.25)]. The main reasons for the first delay were lack of a family authority figure who could make a decision, lack of sufficient financial resources, lack of a vehicle, and fear of health facilities. The majority of near misses demonstrated a third delay with many referrals. The women’s perceptions of the quality of their care highlighted the importance of information, good communication, and attitude.
Conclusion:Women and newborns with serious obstetric complications have a greater chance of successful outcomes if they are immediately directed to a functioning referral hospital and if the providers are responsive.

背景：目前摩洛哥关于孕产妇危急重症（maternal near misses）的相关发生情况的研究资料较为匮乏。本研究旨在明确摩洛哥地区孕产妇危急重症的发生率、临床特征及影响因素。方法：2012年2月至7月，研究团队于摩洛哥马拉喀什地区的3家转诊性产科医院开展前瞻性病例对照研究。本研究纳入的危急重症病例包括重度出血、妊娠期高血压疾病及持续性梗阻性难产。每例危急重症病例选取3名非匹配对照。研究评估了三类危险因素：社会人口学特征、生育史及就诊延误情况，并对围产结局进行记录，同时针对影响因素开展双变量及多变量分析。最终纳入30例危急重症病例及30例非危急重症对照完成访谈。结果：分娩人群中孕产妇危急重症发生率为12‰。妊娠期高血压疾病（45%）与重度出血（39%）为危急重症最常见的直接诱因。主要危险因素包括：文盲状态（OR=2.35；95%CI：1.07~5.15）、未接受产前检查（OR=3.97；95%CI：1.42~11.09）、妊娠期合并症（OR=2.81；95%CI：1.26~6.29），以及曾出现首阶段延误（OR=8.71；95%CI：3.97~19.12）与第三阶段延误的首阶段表现（OR=4.03；95%CI：1.75~9.25）。首阶段延误的主要原因包括：无具备决策权限的家庭负责人、经济资源不足、缺乏交通工具，以及对医疗机构存在畏惧心理。多数危急重症病例存在多次转诊相关的第三阶段延误。孕产妇对医疗服务质量的主观评价凸显了诊疗信息告知、良好沟通及服务态度的重要性。结论：若罹患严重产科并发症的孕产妇及新生儿能够被及时转运至具备有效救治能力的转诊医院，且医护人员能够提供响应性诊疗服务，则其获得良好临床结局的概率将显著提升。