scholarly journals Incidence of maternal near-miss in Kenya in 2018: findings from a nationally representative cross-sectional study in 54 referral hospitals

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Onikepe Owolabi ◽  
Taylor Riley ◽  
Kenneth Juma ◽  
Michael Mutua ◽  
Zoe H. Pleasure ◽  
...  
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Obstetric Care ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Live Births ◽  
Management Of Complications ◽  
Referral Hospitals ◽  
Nationally Representative

Abstract Although the Kenyan government has made efforts to invest in maternal health over the past 15 years, there is no evidence of decline in maternal mortality. To provide necessary evidence to inform maternal health care provision, we conducted a nationally representative study to describe the incidence and causes of maternal near-miss (MNM), and the quality of obstetric care in referral hospitals in Kenya. We collected data from 54 referral hospitals in 27 counties. Individuals admitted with potentially life-threatening conditions (using World Health Organization criteria) in pregnancy, childbirth or puerperium over a three month study period were eligible for inclusion in our study. All cases of severe maternal outcome (SMO, MNM cases and deaths) were prospectively identified, and after consent, included in the study. The national annual incidence of MNM was 7.2 per 1,000 live births and the intra-hospital maternal mortality ratio was 36.2 per 100,000 live births. The major causes of SMOs were postpartum haemorrhage and severe pre-eclampsia/eclampsia. However, only 77% of women with severe preeclampsia/eclampsia received magnesium sulphate and 67% with antepartum haemorrhage who needed blood received it. To reduce the burden of SMOs in Kenya, there is need for timely management of complications and improved access to essential emergency obstetric care interventions.

scholarly journals A prospective study on maternal near miss cases at a tertiary care hospital

2019 ◽  
Vol 9 (1) ◽  
pp. 300
Author(s):  
Karuna Kanta Das ◽  
Sasindra Kumar Das ◽  
Dhritimala Das
Keyword(s):  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Obstetric Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Respiratory Dysfunction ◽  
Live Births ◽  
Tertiary Center

Background: Pregnant women’s health status is not only reflected by mortality indicators alone hence the concept of Severe Acute Maternal Morbidity (SAMM) is appropriate for present health providing system. It helps to evaluate the quality of obstetric care in a particular institute. The main objectives of the study were to find a) Incidence of MNMM; b) Disorders underlying MNMM; c) Socio-demographic variables among MNMM; d) Facilities and skills needed to handle these near miss situations.Methods: A prospective hospital-based study was conducted in the department of obstetrics and gynaecology, Gauhati Medical College and Hospital, Guwahati during the period 1st June 2018 to 31st May 2019. Cases were identified based on maternal near miss operational guidelines December 2014.Results: Out of 16222 live births, 241 near miss cases were identified during the study. The maternal near miss incidence ratio is 14.86 per 1000 live births. The maternal near miss to maternal mortality ratio is 2.025. Most common cause of MNMM is hemorrhage (48.54%) followed by hypertension (19.5%), anemia (13.28%), sepsis (10.37%), cardiac dysfunction (6.2%), liver dysfunction (0.83%), renal dysfunction (0.83%) and respiratory dysfunction (0.41%).Conclusions: The large magnitude of MNM cases may be attributed to improper management of obstetric emergencies at the referring hospitals, poor referral practices, inefficient transport system, limited availability of blood products and poor utilization of health care services at the peripheral hospitals. In our tertiary center, with the help of multidisciplinary action to all the near miss cases we can reduce maternal mortality to a great extent.

scholarly journals A study of maternal near miss at a district teaching hospital: a retrospective observational study

2018 ◽  
Vol 7 (4) ◽  
pp. 1421 ◽  
Author(s):  
Manjunatha S. ◽  
Harsha T. N. ◽  
Damayanthi H. R.
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Who Criteria ◽  
Live Births ◽  
Mortality Ratio

Background: Maternal health is an integral part of health care system. Maternal mortality is an indicator of maternal health and health care delivery system. Severe morbid conditions require comprehensive approach. Hence the concept of Maternal Near Miss (MNM) has emerged. The data of maternal near miss helps to reduce the maternal death and helps to achieve the goals related to reduce the maternal mortality rate of the country as well as the world and to improve the quality of life of the woman population by a quality care. Objectives of present study were to identify and analyze the strategies undertaken in the management of maternal near miss and outcome, measures to improve the quality of care and to assess the various indicators of MNM.Methods: With the permission from the hospital administrators and after taking the ethical clearance from the institutional ethical committee, a retrospective observational study was conducted for the period of one year between January 2016 to December 2016 at district teaching hospital of Kodagu Institute of Medical Sciences, Madikeri, by collecting data from hospital records. Admissions to the ICU as well as wards which fit in to the WHO maternal near miss criteria were included and studied.Results: WHO criteria for the MNM was followed. In present study, there were 25 MNM cases and four Maternal Deaths out of 3347 live births giving a maternal mortality ratio of 119/100000 live births (LB), Maternal Near Miss ratio of 7.46/1000LB, MNM:1MD ratio is 6.25 and mortality index (MI) is 13.79%. Twenty five cases of obstetric emergencies with serious concerns for maternal health were selected out of 97 cases who met the WHO criteria for MNM (25.77%). Twelve cases (48%) received multiple blood-transfusions, 8 cases (32%) of sepsis, 7 (28%) of PPH, and 5 (20%) of hypertensive disorder of pregnancy (pre-eclampsia, eclampsia). There were 12 cases (48%) that had more than one inclusion criteria. Surgical intervention was required in 8 (32%) i.e. 2 peripartum hysterectomies, 2 laparotomies, 1 manual removal of placenta, 1 uterine reposition and 2 traumatic PPH repair.Conclusions: Maternal-Near-Miss (MNM/SAMM) and its relation to maternal mortality contribute as sensitive measures of pregnancy outcome than mortality alone. Proper documentation is of paramount importance in analysis of data, to make conclusions and recommendation. Prospective structured study is required to get a clear picture and to suggest corrective measures which can be taken as far as obstetric care is concerned, to reduce maternal mortality and to achieve the sustainable developmental Goal (SDG) of maternal mortality ratio <70/100000 LB by 2030.

scholarly journals The global prevalence of maternal near miss: a systematic review and meta-analysis

2019 ◽  
Vol 9 (4) ◽  
pp. 255-262
Author(s):  
Sedigheh Abdollahpour ◽  
Hamid Heidarian Miri ◽  
Talat Khadivzadeh
Keyword(s):  
Systematic Review ◽  
Maternal Health ◽  
Meta Analysis ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Organization

Background: Improving the maternal health is one of the world’s most challenging problems. Despite significant movements over the past decades, maternal health has been still considered as a central goal for sustainable development. Maternal near miss (MNM) cases experience long-term physical and psychological effects. To present a clear portrait of the current situation, we performed a systematic review and meta-analysis with the purpose to assess the worldwide prevalence of MNM. Methods: We conducted a systematic review on PubMed, Scopus and Web of Science electronic databases to find published papers in English, before March 2019 and regardless of the type of study. We, then, assessed the prevalence of MNM according to the World Health Organization(WHO) criteria. Finally, 49 papers were included in the study. Random effects meta-analysis was used to pool the available prevalence. The quality of studies was also evaluated. Results: The weighted pooled worldwide prevalence of MNM, was 18.67/1000 (95% CI: 16.28-21.06). Heterogeneity was explored using subgroup analyses based on the continent and the country. We used meta-regression of MNM on MD which resulted in adjusted R-squared as78.88%. Conclusion: The prevalence of MNM was considerable. Low- and middle-income countries should develop systematic approaches to improve quality of care in the facilities and to reducethe risk of MNM events, with the hope to women’s health.

scholarly journals Incidence of maternal near-miss events in a tertiary care hospital of Gujarat, India

2019 ◽  
Vol 9 (1) ◽  
pp. 145
Author(s):  
Vijay Kansara ◽  
Disha Vaja ◽  
Ajesh Desai
Keyword(s):  
Tertiary Care ◽  
Institutional Care ◽  
Rare Event ◽  
Obstetric Care ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Cross Sectional ◽  
Life Threatening

Background: Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, child birth and within 42 days after delivery, but survive by chance or good institutional care. For identifying near-miss cases five-factor scoring system was used. In 2009 WHO working group has standardized the criteria for selecting these cases. Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss.Methods: A facility-based cross-sectional study was conducted in the department of obstetrics and gynecology in GMERS medical college and hospital, Sola, Ahmedabad from January 1, 2019 to August 31, 2019. All maternal near-miss cases admitted to the hospital during the study period were recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant’s record.Results: During the period of study, 3235 deliveries were done at the institution while 16 cases of near-miss were identified. The prevalence of near-miss case in this study was 0.5%. Near-miss per 1000 delivery was 5%. Maternal death to near miss ratio was 1:2.67. The leading causes of maternal near miss were hypertensive disorders (62%) and haemorrhage (32%) The morbidity was high in un-booked cases.Conclusions: Maternal near miss is good alternative indicator of health care system. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization.

scholarly journals A study to assess proportion of the maternal near miss to maternal death in a tertiary care teaching hospital of North East India

2020 ◽  
Vol 9 (6) ◽  
pp. 2486
Author(s):  
Pradip Sarkar ◽  
Jahar Lal Baidya ◽  
Ashis Kumar Rakshit
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Live Births ◽  
Medical Disorders ◽  
Mortality Ratio

Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.

scholarly journals Maternal Near Miss Morbidity and Maternal Mortality in a Tertiary Referral Center in Turkey

2017 ◽  
pp. 1
Author(s):  
Dilek Uygur ◽  
Yaprak Engin Üstün ◽  
Özgür Kara ◽  
Kudret Erkenekli ◽  
Selcen Yüksel ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Maternal Mortality ◽  
Hospital Stay ◽  
Maternal Mortality Ratio ◽  
Length Of Hospital Stay ◽  
Hemoglobin Level ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Tertiary Referral ◽  
Live Births

<p><strong>Objective:</strong> The objective of the study is to present the maternal near miss and maternal mortality cases from a tertiary hospital and to evaluate the factors associated with the presence of maternal near miss.<br /><strong>Study Design:</strong> We performed a retrospective study, including all women who fulfilled the WHO criteria for maternal near miss or death between June 2009 and June 2014 at a tertiary referral education hospital. This study was conducted to evaluate the risk factors’ influence on near miss, multivariate logistic regression was used. Before setting logistic regression, univariate analyses were used to select candidate variables.<br /><strong>Results:</strong> During the 5-year study, there were 82924 deliveries and 81673 live births. We identified 202 maternal near miss events and 11 maternal deaths. The maternal near miss ratio was 2.47 per 1.000 live births and the maternal mortality ratio was 13.46 per 100.000 live births. There were 213 women with a severe maternal outcome ratio (SMOR) (near miss + maternal death), with a ratio of 2.6 cases/1.000 live birth. Near miss events were associated with length of hospital stay (p&lt;0.001), hemoglobin level (p=0.003). <br /><strong>Conclusion:</strong> By the help of the WHO near miss approach, we identified that near miss events were associated with length of hospital stay, hemoglobin level, cesarean section deliveries and parity.</p>

scholarly journals Determinants of Maternal Near Miss in Western Ethiopia

2020 ◽  
Vol 30 (2) ◽  
Author(s):  
Lemi Kumela ◽  
Temesgen Tilahun ◽  
Demeke Kifle
Keyword(s):  
Obstetric Care ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
P Value ◽  
Near Misses ◽  
Face To Face ◽  
Quality Of Obstetric Care ◽  
Health Organization

BACKGROUND: Analysis of maternal near miss events and identification of factors resulting in maternal death are vital to improve the quality of obstetric care in any given setting. This study is aimed to determine the magnitude of maternal miss and identify its determinants.METHODS: A hospital-based unmatched case-control study design was used. Sixty one maternal near misses (as cases) and 122 mothers who had a normal obstetric outcome (as controls) at obstetrics and gynecology ward of Nekemte Referral Hospital were included from May 1st , 2018 to July 31st, 2018. The criteria set by the World Health Organization were used to identify maternal near miss cases. The data were collected via face-to-face interviews using pretested structured questionnaires and analyzed using SPSS version 22. For every case, two controls were recruited. Descriptive statistics and logistic regressions were used. A 95% CI and p-value of <0.05 were considered to be statistically significant.RESULT: The magnitude of maternal near miss was 4.97%. Factors including multigravidity (AOR= 3.84, 95% CI: 1.23-11.91), lack of antenatal care (AOR=6.02, 95% CI: 1.55-23.28), delays in accessing health facility (AOR=12, 95% CI: 2.55-56.57) and induction of labor (AOR =9.4, 95% CI: 2.97-29.71) were strongly associated with maternal near miss. Hypertension during pregnancy (40.9%) and obstetric hemorrhage (39.3%) were identified as the major causes of maternal near miss.CONCLUSION: The magnitude of maternal near miss was high but lower compared to magnitude in other parts of Ethiopia, and numerous preventable determinant factors were identified.

scholarly journals Incidence and Correlates of Maternal Near Miss in Southeast Iran

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Tayebeh Naderi ◽  
Shohreh Foroodnia ◽  
Samaneh Omidi ◽  
Faezeh Samadani ◽  
Nouzar Nakhaee
Keyword(s):  
Maternal Morbidity ◽  
Tertiary Care ◽  
Termination Of Pregnancy ◽  
Near Miss ◽  
High Rate ◽  
Severe Maternal Morbidity ◽  
Maternal Near Miss ◽  
Live Births ◽  
Referral Hospitals ◽  
Set Up

This prospective study aimed to estimate the incidence and associated factors of severe maternal morbidity in southeast Iran. During a 9-month period in 2013, all women referring to eight hospitals for termination of pregnancy as well as women admitted during 42 days after the termination of pregnancy were enrolled into the study. Maternal near miss conditions were defined based on Say et al.’s recommendations. Five hundred and one cases of maternal near miss and 19,908 live births occurred in the study period, yielding a maternal near miss ratio of 25.2 per 1000 live births. This rate was 7.5 and 105 per 1000 in private and tertiary care settings, respectively. The rate of maternal death in near miss cases was 0.40% with a case:fatality ratio of 250 : 1. The most prevalent causes of near miss were severe preeclampsia (27.3%), ectopic pregnancy (18.4%), and abruptio placentae (16.2%). Higher age, higher education, and being primiparous were associated with a higher risk of near miss. Considering the high rate of maternal near miss in referral hospitals, maternal near miss surveillance system should be set up in these hospitals to identify cases of severe maternal morbidity as soon as possible.

Maternal near miss, mortality and their correlates at tertiary care hospital

2021 ◽  
pp. 1-15
Author(s):  
Tayyiba Wasim ◽  
Gul e Raana ◽  
Mustafa Wasim ◽  
Javeria Mushtaq ◽  
Zeenish Amin ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Maternal Mortality ◽  
Outcome Measures ◽  
Cardiac Disease ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Secondary Outcome ◽  
Massive Blood Transfusion ◽  
Live Births ◽  
Icu Admission

ABSTRACT        OBJECTIVE:  To determine the frequency and causes of maternal near miss and mortality among pregnant women. METHODS: This cross-sectional study was conducted Jan 2016 - Dec 2018. All near miss cases, admitted in Gynecology department of Services Hospital Lahore during the study period, were prospectively recruited. WHO criteria was used to identify maternal near miss cases. Primary outcome measures were frequency and causes of near miss and maternal mortality to near miss ratio. Secondary outcome measures were delays, need for massive blood transfusion, ICU admission, obstetric hysterectomy and hospital stay> 7 days. RESULTS: During the study period, there were 10,739 live births, 305 near miss cases and 29 maternal deaths. Frequency of near miss was 28.4/ 1000 live births and maternal mortality to near miss ratio was 1:10.5. There were 215(70.4%) unbooked patients and 23(79.3%) of them died (p<0.001). Hemorrhage accounted for 150 (49.18%), hypertensive disorders 102 (33.44%),cardiac disease 25 (8.28%) and infection for 12 (3.97%) near miss cases respectively. Maternal mortality was significantly low for hemorrhage, hypertension, sepsis and cardiac disease; 6 vs 150, 8 vs102, 3vs 12 and 10 vs 25 respectively (p<0.001). Massive blood transfusion was given to 20.98%patients, 15.74% underwent hysterectomy, 32.13% required ICU admission. First and second delay was seen in 78.6% of patients with 86.2% deaths (p<0.001) CONCLUSION: Hemorrhage and hypertension are major reasons for near miss but timely intervention can prevent mortality. Strengthening care at primary and secondary level can reduce the burden of maternal morbidity.  Continuous....

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