Risk factors of maternal near miss among females: A Systemic Review

Abstract

Background: Maternal near-miss (MNM) is a critical indicator for evaluating maternal healthcare quality, reflecting cases where women survive life-threatening obstetric complications. This review aimed to identify the leading risk factors associated with MNM based on recent global observational studies. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2020 and 2024. Observational studies assessing maternal near-miss and its risk factors using WHO or similar criteria were included. A total of 30 studies were reviewed from diverse settings, including low-, middle-, and high-income countries. Results: Hypertensive disorders (n=25 studies), obstetric hemorrhage (n=21), lack of antenatal care (n=18), and socio-demographic disadvantages such as rural residence and poor education (n=15) emerged as the most frequent risk factors. Additional contributors included anemia (n=14), previous cesarean section (n=12), and delays in accessing care. Protective factors identified were timely antenatal visits, spontaneous labor, and quality hospital-based multidisciplinary care. Conclusion: MNM remains highly prevalent, especially in LMICs, with preventable factors playing a dominant role. Targeted public health interventions to improve antenatal care coverage, early risk identification, and emergency obstetric services are essential to reduce the burden of MNM and improve maternal outcomes.