Tirusew Nigussie Kebede ^1* Kidist Abebe ¹ Ambachew Getahun Malede ² Abinet Sisay ³ Ayenew Yirdie ³ Worku Taye Getahun ² Tebabere Moltot ¹ Bezawit Melak Fente ⁴ Mesfin Tadese ¹ Tesfanesh Lemma ¹ Mulualem Silesh ¹ Solomon Hailemeskel Beshah ¹ Getaneh Dejen Tiche ⁵ Michael Amera ⁶ Moges Sisay Chekole ¹ Birhan Tsegaw Taye ¹

• ¹ Department of midwifery, school of nursing and midwifery Asrat Woldeyes Health science campus Debre Berhan University,, Debre Berhan, Ethiopia
• ² Department of midwifery, Debre Markos comprehensive specialized hospital, Debre Markos Ethiopia, Debre Markos, Ethiopia
• ³ Department of obstetrics and gynecology, Debre Markos comprehensive specialized hospital, Debre Markos Ethiopia, Dere Markos, Ethiopia
• ⁴ Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ⁵ Department of obstetrics and gynecology, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan Ethiopia, Debre Berhan, Ethiopia
• ⁶ Department of public health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan Ethiopia, Debre Berhan, Ethiopia

Background: Severe maternal outcome (SMO) encompasses women who survive life-threatening conditions either by chance or due to treatment quality, or who die. This concept assumes that severe maternal morbidity predicts mortality risk, enabling the analysis of risk factors for life-threatening outcomes and improving our understanding on the causes of maternal death. This study aims to determine the incidence of SMO and its leading causes in East Gojjam during a period of regional conflict.A prospective follow-up study was conducted at Debre Markos Comprehensive Specialized Hospital in East Gojjam from July 1, 2023, to February 30, 2024. The study included 367 women admitted with potentially life-threatening conditions, including 8 maternal deaths, using sub-Saharan Africa (SSA) and WHO Maternal Near-Miss (MNM) criteria. Data were entered into Epi Data v.4.6 and analyzed using SPSS v.27. The WHO MNM approach assessed SMO indicators and maternal health care quality were utilized.Results: During the eight-month period, there were 3,167 live births, 359 potentially life-threatening conditions (PLTC), and 188 SMO cases (180 MNM and 8 maternal deaths). The SMO ratio was 59.4 per 1,000 live births (95% CI: 51, 68 per 1,000 live births). The MNM to mortality ratio, mortality index, and maternal mortality ratio were 22.5:1, 4.2%, and 252.6 per 100,000 live births, respectively. Over 80% of women with SMO showed evidence of organ dysfunction upon arrival or within 12 hours of hospitalization.The leading causes of SMO were hypertensive disorders of pregnancy (HDP) and obstetric hemorrhage, including uterine rupture, with uterine rupture contributing to half of the maternal deaths.This study found that the incidence of SMO was comparable to that reported in most other studies. HDP was the primary cause of SMO, followed by obstetrical hemorrhage, consistent with other studies in Ethiopia. Uterine rupture was identified as the leading cause of maternal death. As this study was conducted in a single institution and in the period of severe armed conflict, it may not fully capture the range of maternal health issues across populations with varying healthcare access and socio-economic backgrounds. Caution should be exercised when generalizing these findings to the wider population.