Epidemiology analysis of the incidence of severe maternal outcomes between level 2 and 3 hospitals in China’s Hunan province from 2012 to 2018

Abstract Background: This facility-based study analyzed the epidemiology and incidence of maternal near-miss (MNM) and mortality by hospital level as part of Hunan province’s efforts to raise the quality of hospital care for women. Methods: We used data for MNM and mortality cases for 2012–2018 from 17 hospitals (12 level 2 facilities, five level 3 facilities) that receive referrals for obstetric complications in Hunan province. Data were drawn from China’s National Maternal Near Miss Surveillance System, and collected using the World Health Organization near-miss tool. We calculated the ratio of severe maternal outcomes (SMO) (i.e., MNM and maternal death [MD] cases), mortality index (MI), and MNM to mortality ratio (MNM:MD), and epidemiological factors, organ dysfunction, and maternal complications stratified by hospital level. Chi-square tests to examine differences between groups and total ratios and 95% CI were calculated. Results: There were 518 SMO cases (489 MNM and 29 MD) among 279407 live births (LBs) and 1299 SMO cases(1262 MNM and 37 MD) among 232386 LBs in level 2 and 3 facilities. The total MNM ratio in level 2 and 3 hospitals was 1.75 (95%CI: 1.60–1.91) and 5.43 (95%CI: 5.14–5.74) per 1000 LBs, respectively. There were differences in SMO cases between level 2 and 3 hospitals in maternal age, education, parity, antenatal visits, and history of cesarean sections. In MNM cases, coagulation dysfunction was the main organ dysfunction (level 2 hospitals: 59.10%; level 3 hospitals: 79.32%), and the main maternal complications were obstetric hemorrhage (level 2 hospitals: 71.98%) and hepatopathy (level 3 hospitals: 69.49%). For MD cases, the main maternal complications were neurologic dysfunction (level 2 hospitals: 41.38%) and coagulation dysfunction (level 3 hospitals: 42.55%). Anemia was the main maternal complication for SMO cases in both level 2 (69.69%) and 3 (68.59%) hospitals. Conclusions: MNM and MD is higher in level 3 hospitals compared with level 2 hospitals. The obstetric emergency capacity of level 3 hospitals is higher than that of level 2 hospitals. Future government policies should consider upgrading the obstetric emergency treatment capacity in level 2 hospitals or to re-distinguish the social functions of different medical institutions.