Clinical pattern, associated factors and management outcomes of maternal near-miss at the Regional Referral Hospital, Tanzania: A Cross-sectional Study

Background: Preventable maternal mortality cases account for up to 80% of maternal deaths posing a great obstacle in achieving the Sustainable Development Goal 3.1, whereby Low- and Middle-income countries are disproportionately affected. Potential life-threatening conditions (PLTCs) remain a public health and clinical concern globally. In Tanzania, the prevalence of maternal near miss (MNM) has been reported to be between 23.6 /1000 and 36/1000 live births among all women. This study assessed the clinical pattern, associated factors and management outcome of maternal near miss among women with potential life-threatening conditions. 
Methods: This was a hospital based analytical cross-sectional study among 343 study participants. Frequencies and percentages, Chi-square and logistic regression tests were used to summarize categorical variables and factors associated with maternal near miss among study participants using SPSS, 26th Version with statistical significance at p-value <0.05.
Results: 343 (12.3% of all admissions) participants had PLTCs, 126 cases were identified to be MNM cases (institutional prevalence = 4.5%). Women with PTLCs were clinically characterized by post-partum hemorrhage (PPH) 110 (32.1%), Pregnancy Induced Hypertension 103 (30%), sepsis 31 (24.5%), ante-partum hemorrhage (9%) and ruptured uterus 15 (4.4%). Level of education and Severe anemia on admission were significantly associated with MNM. The medical intervention profile among MNM cases involved CSD (45.24%), 62.69% required blood transfusion, 31.75% required admission to the ICU, 18.25% needed a laparotomy and 10.32% underwent cesarian hysterectomy. 
Conclusion: Life threatening conditions which can lead to maternal near miss, are still prevalent in Tanzania. Prevention and control of maternal anemia and other fatal conditions is essential. Comprehensive Emergency Obstetric Care (CEmOC) should be strengthened at referral hospitals. The potential role of “3 delay model” towards development of different life-threatening conditions including MNM should be explored in Tanzania.