In this prospective cohort study, we included all women with MNM according to the sub-Saharan Africa or original WHO MNM criteria. Identification of MNM was a two-step process—we first identified all women with potentially life-threatening conditions (PLTC) as defined by WHO (severe postpartum hemorrhage, severe pre-eclampsia, eclampsia, uterine rupture, severe complications of abortion, and sepsis/severe systemic infections); received critical interventions (use of blood products, laparotomy other than cesarean section); or were admitted to the intensive care unit [8 ]. At discharge, we then selected those who developed life-threatening complications, consisting of MNM and maternal deaths, according to the sub-Saharan Africa or original WHO MNM criteria [8 ,20 ]. Maternal near miss refers to a woman who nearly died but survived a life-threatening complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy [7 (link)]. Severe maternal outcome includes women with life-threatening complications who survived the complications (near miss) or died. Eligible women were identified by trained research assistant nurse-midwives working in both hospitals through daily visits of obstetric ward, intensive care unit, emergency room, and gynaecology ward. Identified cases were evaluated and confirmed by the first author (AKT). Sample size was estimated based on the annual deliveries and maternal mortality ratio according to the recommendation by the WHO [22 ]. Considering the existing maternal mortality ratio (412) and the annual number of deliveries in both hospitals, we expected 7000 live births and 30 maternal deaths in 16 months.
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