{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:09:30Z","timestamp":1792512570701,"version":"4.5.0"},"reference-count":24,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2019,3,21]],"date-time":"2019-03-21T00:00:00Z","timestamp":1553126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,6]]},"abstract":"Objective<\/jats:title>To investigate the burden and health service events surrounding severe maternal outcomes (SMO<\/jats:styled-content>) related to life\u2010threatening postpartum haemorrhage (PPH<\/jats:styled-content>) in Nigerian public tertiary hospitals.<\/jats:p><\/jats:sec>Design<\/jats:title>Secondary analysis of a nationwide cross\u2010sectional study.<\/jats:p><\/jats:sec>Setting<\/jats:title>Forty\u2010two tertiary hospitals.<\/jats:p><\/jats:sec>Population<\/jats:title>Women admitted for pregnancy, childbirth or puerperal complications.<\/jats:p><\/jats:sec>Methods<\/jats:title>All cases of SMO<\/jats:styled-content> [maternal near miss (MNM<\/jats:styled-content>) or maternal death (MD<\/jats:styled-content>)] due to PPH<\/jats:styled-content> were prospectively identified using WHO<\/jats:styled-content> criteria over a 1\u2010year period.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Incidence of SMO<\/jats:styled-content>, health service events, case fatality rate (CFR<\/jats:styled-content>) and mortality index (MI<\/jats:styled-content>: % of death\/SMO<\/jats:styled-content>).<\/jats:p><\/jats:sec>Results<\/jats:title>Postpartum haemorrhage occurred in 2087 (2.2%) of the 94\u00a0835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO<\/jats:styled-content> (103 MD<\/jats:styled-content>; 251 MNM<\/jats:styled-content>). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH<\/jats:styled-content> had the highest maternal mortality ratio (112\/100\u00a0000 live births) and the recorded MI<\/jats:styled-content> (29.1%) and CFR<\/jats:styled-content> (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO<\/jats:styled-content> were admitted in a critical condition with over 50% being referred. MD<\/jats:styled-content> was more likely when PPH<\/jats:styled-content> led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life\u2010saving interventions was not statistically different between the cases of MD<\/jats:styled-content> and MNM<\/jats:styled-content>, close to one\u2010quarter of women who died received critical intervention at least 4\u00a0hours after diagnosis of life\u2010threatening PPH<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO<\/jats:styled-content> in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH<\/jats:styled-content>.<\/jats:p><\/jats:sec>Funding<\/jats:title>The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, was funded by the UNDP<\/jats:styled-content>\/UNFPA<\/jats:styled-content>\/UNICEF<\/jats:styled-content>\/WHO<\/jats:styled-content>\/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP<\/jats:styled-content>), a cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study.<\/jats:p><\/jats:sec>Tweetable abstract<\/jats:title>One hundred and three maternal deaths and 251 near\u2010misses resulted from PPH<\/jats:styled-content> in 42 Nigerian tertiary facilities in 1\u00a0year.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15624","type":"journal-article","created":{"date-parts":[[2019,3,21]],"date-time":"2019-03-21T18:06:01Z","timestamp":1553191561000},"page":"19-25","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Maternal near\u2010miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near\u2010miss and Maternal Death Survey"],"prefix":"10.1111","volume":"126","author":[{"given":"JO","family":"Sotunsa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Benjamin Carson (Snr) School of Medicine Babcock University Ilishan\u2010Remo Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AA","family":"Adeniyi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Federal Teaching Hospital Ido\u2010Ekiti Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JO","family":"Imaralu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Benjamin Carson (Snr) School of Medicine Babcock University Ilishan\u2010Remo Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Fawole","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University College Hospital Ibadan Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Adegbola","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Lagos University Teaching Hospital Idi\u2010Araba Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CO","family":"Aimakhu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University College Hospital Ibadan Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AS","family":"Adeyemi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology College of Health Sciences Ladoke Akintola University of Technology Osogbo Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Hunyinbo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Federal Medical Centre Abeokuta Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OA","family":"Dada","sequence":"additional","affiliation":[{"name":"Centre for Research in Reproductive Health Sagamu Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OO","family":"Adetoro","sequence":"additional","affiliation":[{"name":"Centre for Research in Reproductive Health Sagamu Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OT","family":"Oladapo","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12636"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2014.08.023"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01859.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7294.1089"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69380-X"},{"key":"e_1_2_11_7_1","first-page":"QEO1","article-title":"Recent advances in the management of major postpartum haemorrhage \u2013 a review","volume":"11","author":"Rani PA","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"e_1_2_11_8_1","unstructured":"FindlayG MartinI CarterS SmithN WeymanD MasonM.Trauma: who cares? 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