Risk factors associated with maternal near miss in tertiary hospitals in Eskişehir, Türkiye: a case-control study

Maternal near miss (MNM) cases provide valuable insight into the quality and performance of maternal health services. Understanding the factors associated with MNM is crucial for developing effective public health interventions. This study aimed primarily to identify factors associated with MNM and secondarily to report the MNM ratio in tertiary hospitals in Eskişehir, Türkiye.

This retrospective, multicenter, case-control study was conducted at two tertiary hospitals in Eskişehir, Türkiye. The medical records of 10,360 women who gave birth between January 1, 2022, and December 31, 2023, were reviewed. A total of 53 MNM cases were identified based on the World Health Organization criteria defined by organ dysfunction and life-threatening conditions. For each case, three controls without serious complications were selected, resulting in 159 controls (1:3 ratio). Descriptive statistics, univariate analysis, and multivariate logistic regression were used to identify factors associated with MNM.

The incidence of MNM was calculated as 5.18 per 1,000 live births. The most common maternal complications were severe postpartum hemorrhage (45.2%), uterine rupture (34.0%), and severe preeclampsia (17.0%). The most commonly performed critical interventions were blood transfusion (73.6%), laparotomy (45.3%), and intensive care unit admission (30.2%). Coagulation/hematological dysfunction (58.5%) and uterine dysfunction (47.2%) were the most frequently observed MNM criteria. Multivariate analysis identified anemia (adjusted odds ratio [aOR] = 16.57; 95% CI: 7.19-38.19), previous cesarean delivery (aOR = 6.22; 95% CI: 2.18-17.77), short interpregnancy interval of two years or less (aOR = 3.68; 95% CI: 1.63-8.32), absence of antenatal care (aOR = 4.69; 95% CI: 1.44-15.21), and presence of chronic disease (aOR = 4.83; 95% CI: 2.11-11.04) as independent risk factors, while preterm birth (aOR = 12.86; 95% CI: 5.95-27.78) emerged as a strong clinical indicator associated with MNM.

The results of this study underscore the importance of early identification and management of modifiable risk factors for MNM. Strengthening antenatal care services, improving anemia screening and treatment, promoting evidence-based cesarean delivery practices, and ensuring postpartum family planning support may help improve maternal outcomes and reduce preventable maternal morbidity.