Factors associated with maternal mortality among patients meeting criteria of severe maternal morbidity and near miss

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors.Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed.Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P<0.001), delays related to quality of medical care (P=0.012), absence of blood derivatives (P=0.013), difficulties of communication between health services (P=0.004), and any delay during the whole process (P=0.039).Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

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Factors associated with severe maternal morbidity and near miss in the São FranciscoValley, Brazil: a retrospective, cohort study

BMC Pregnancy and Childbirth ◽

10.1186/1471-2393-14-91 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 19

Author(s):

Alvaro José Correia Pacheco ◽

Leila Katz ◽

Alex Sandro Rolland Souza ◽

Melania Maria Ramos de Amorim

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Maternal Morbidity ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Factors Associated

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Prevalence of Severe Maternal Morbidity and Factors Associated With Maternal Mortality in Ontario, Canada

JAMA Network Open ◽

10.1001/jamanetworkopen.2018.4571 ◽

2018 ◽

Vol 1 (7) ◽

pp. e184571 ◽

Cited By ~ 18

Author(s):

Joel G. Ray ◽

Alison L. Park ◽

Susie Dzakpasu ◽

Natalie Dayan ◽

Paromita Deb-Rinker ◽

...

Keyword(s):

Maternal Mortality ◽

Maternal Morbidity ◽

Severe Maternal Morbidity ◽

Factors Associated

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Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity

BioMed Research International ◽

10.1155/2019/2594343 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11

Author(s):

K. G. Fernandes ◽

M. L. Costa ◽

S. M. Haddad ◽

M. A. Parpinelli ◽

M. H. Sousa ◽

...

Keyword(s):

Maternal Mortality ◽

Skin Color ◽

Maternal Morbidity ◽

White Women ◽

Maternal Outcome ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Maternal Outcomes ◽

Severe Maternal Outcome

Background. Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity. Methods. This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PRadj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race. Results. Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis. Conclusion. Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.

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Monitoring Maternal Near Miss/Severe Maternal Morbidity: A Systematic Review

SSRN Electronic Journal ◽

10.2139/ssrn.3444404 ◽

2019 ◽

Author(s):

Natalie England ◽

Julia Madill ◽

Amy Metcalfe ◽

Laura Magee ◽

Stephanie Cooper ◽

...

Keyword(s):

Systematic Review ◽

Maternal Morbidity ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss

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Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-016-0980-2 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 7

Author(s):

Mohd Noor Norhayati ◽

Nik Hussain Nik Hazlina ◽

Abd. Aziz Aniza ◽

Zaharah Sulaiman

Keyword(s):

Maternal Morbidity ◽

Cross Sectional Study ◽

Severe Maternal Morbidity ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

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Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study

American Journal of Perinatology ◽

10.1055/s-0039-1694731 ◽

2019 ◽

Vol 38 (01) ◽

pp. 044-059 ◽

Cited By ~ 1

Author(s):

Eric J.M. Lentz ◽

Alison L. Park ◽

Alec W.R. Langlois ◽

Tianhua Huang ◽

Wendy S. Meschino ◽

...

Keyword(s):

Cohort Study ◽

Maternal Mortality ◽

Maternal Morbidity ◽

Protein A ◽

Population Based ◽

Severe Maternal Morbidity ◽

Adjusted Relative Risk ◽

Biochemical Screening ◽

High Concentration ◽

Increased Risk

Abstract Objective This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality. Study Design This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (>95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20 weeks' gestation up to 26 weeks thereafter. Results Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97–2.25) and DIA (aRR: 2.33; 95% CI: 1.98–2.74) > 95th versus ≤ 5th percentile of the MoM were especially associated with SMM or death. Conclusion Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.

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Frequency of and Factors Associated With Severe Maternal Morbidity

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000460390.44854.89 ◽

2015 ◽

Vol 35 (1) ◽

pp. 21-22

Author(s):

W.A. Grobman ◽

J.L. Bailit ◽

M.M. Rice ◽

R.J. Wapner ◽

U.M. Reddy ◽

...

Keyword(s):

Maternal Morbidity ◽

Severe Maternal Morbidity ◽

Factors Associated

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Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1708095 ◽

2020 ◽

Vol 42 (03) ◽

pp. 124-132

Author(s):

Fabiano M. Soares ◽

José Paulo Guida ◽

Rodolfo Carvalho Pacagnella ◽

João Paulo Souza ◽

Mary Ângela Parpinelli ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Maternal Death ◽

Maternal Morbidity ◽

Secondary Analysis ◽

Individual Characteristics ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Cross Sectional ◽

Inadequate Care

Abstract Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. Results Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. Conclusion The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.

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