Determinants of maternal near-misses in Al-Najaf governorate, Iraq: A matched case-control study

Background Improving maternal health is one of the most significant global challenges. Consequently, studying the causes and factors contributing to maternal near-misses (MNMs) is crucial for enhancing the obstetric care quality. The aim of this study was to identify the factors related to MNMs among the study participants in Al-Najaf, Iraq. Methods Investigators carried out a matched case-control study in Al-Najaf Governorate from September 2023 to June 2024. The study included 429 participants (143 cases and 286 controls), each case was matched by age and residency with two controls in the same hospital. The data were collected using a modified WHO structured checklist through face-to-face interviews and medical records review in three selected hospitals. Multivariate conditional logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). STATA version 17 was used to analyze the data. Results Postpartum hemorrhage was the top cause, accounting for 56% of MNM cases. The odds of developing MNM among women with inadequate antenatal care (ANC) visits (<4 visits) were greater than those among women who had 8 or more ANC visits aOR = 4.1 (95% CI:1.31–12.7). Women with cesarean section history were almost seven-fold increased odds of experiencing a MNM event aOR = 6.69 (95% CI: 3.04-14.7). Women with any pregnancy complications history were almost eight-fold more likely to develop MNM aOR = 8.06 (95% CI: 2.17–29.8). Conclusions Inadequate antenatal care visits, pregnancy complication history, and a history of cesarean sections were statistically significant factors associated with experiencing MNMs.