scholarly journals Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Samira Maerrawi Haddad ◽  
Jose Guilherme Cecatti ◽  
Joao Paulo Souza ◽  
Maria Helena Sousa ◽  
Mary Angela Parpinelli ◽  
...  
Keyword(s):  
Health Services ◽  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
World Health ◽  
Severe Maternal Morbidity ◽  
Factors Associated ◽  
Mortality Ratio

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.

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

2016 ◽  
Vol 136 (3) ◽  
pp. 337-343 ◽  
Author(s):  
Hesly M.P. Lima ◽  
Francisco Herlânio C. Carvalho ◽  
Francisco Edson L. Feitosa ◽  
George C. Nunes
Keyword(s):  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Near Miss ◽  
Severe Maternal Morbidity ◽  
Factors Associated

scholarly journals EVALUATION OF OBSTETRIC NEAR MISS & MATERNAL DEATHS IN A TERTIARY CARE TEACHING HOSPITAL

2021 ◽  
pp. 1-2
Author(s):  
B. Harika ◽  
Bhavishya Gollapalli
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Maternal Health Services ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Mortality Ratio

Background: Maternal Mortality is a critical indicator to assess the quality of services provided by a health care system.The concept of severe acute maternal morbidity (SAMM) has been found to complement the assessment of maternal health services, since pregnant women’s health status is not reflected by mortality indicators alone . Maternal near miss cases are more common than maternal deaths. Methods: A Retrospective analysis of maternal near miss cases and maternal deaths was undertaken in the Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh over a period of two years. This study was conducted to find out maternal near miss and maternal deaths. Results: There were 2000 deliveries, 66 MNM cases and 2 maternal deaths during the study period. The Maternal Near Miss Incidence Ratio (MNMIR) ratio was 33%.The maternal near miss to mortality ratio was 33% for each maternal death. The Maternal Mortality Ratio (MMR) was 100 per 1 lakh live births in our study. Conclusion: We suggest near miss approach to evaluate and improve the quality of care provided by the health care system. By reviewing the near miss cases we can learn about the processes and their deficiencies that are in place for the care of pregnant women.

scholarly journals Maternal near miss review: a brief appraisal

2017 ◽  
Vol 6 (5) ◽  
pp. 1703 ◽  
Author(s):  
Sheeba Marwah ◽  
Manjula Sharma
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Health Care Services ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Services ◽  
Mortality Ratio

Recuperation of maternal health is mandatory for realms signatory to millennium declaration, as MDG 5A aims at reduction in maternal mortality ratio by three quarters between 1990 and 2015. MM is frequently described as “Just the Tip of The Iceberg” with a vast base of maternal morbidity that still remains largely undescribed. Hence, the concept of maternal near miss (MNM) or severe acute maternal Morbidity (SAMM) was instituted in maternal health care to complement information acquired from MDR. Here we present a succinct review to enlighten and update the readers about the concept of maternal near miss and its advantage in providing the modern-day obstetricians and the administrators an edge over maternal mortality in gauging the quality of health care delivered at each facility. This would thus be instrumental in helping them formulating policies to enhance the health care services at each level across the nation.

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 Lessons from the Field Beyond the Numbers: Narratives of Professionals on Women who Experienced Severe Maternal Morbidity

2019 ◽  
Vol 41 (06) ◽  
pp. 379-386
Author(s):  
Carina Fernanda Robles Angelini ◽  
Rodolfo de Carvalho Pacagnella ◽  
Carla Silveira ◽  
Carla Betina Andreucci ◽  
Elton Carlos Ferreira ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Near Miss ◽  
Gender Violence ◽  
Reproductive Capacity ◽  
Severe Maternal Morbidity ◽  
Maternal Condition ◽  
Psychosocial Consequences ◽  
And Gender ◽  
Perception Of Care

Objective Several factors might affect the health and the quality of life of women who had a severe maternal morbidity (SMM) or a maternal near-miss (MNM) episode. The objective of the present study was to explore the perspectives of the professionals on the repercussions of SMM or of MNM after interviewing women who survived such episodes. Method Selected cases that captured the attention of professionals were reported. The professionals built individually 10 narratives, which were analyzed with the technique of content analysis. Results According to the perspectives of the professionals, women surviving a severe maternal condition and their families experienced clinical and psychosocial consequences. Some cases portrayed the intense psychological distress in mourning for the loss of the fetus or of their reproductive capacity and changes in family dynamics generating emotional overload, depression, and gender violence. Conclusion The analysis of narratives may offer an idea on the complexity of the perception of care by professionals and on the need for an interdisciplinary follow-up of women surviving an SMM or an MNM episode.

scholarly journals Obstetric near miss events and maternal deaths in a tertiary care hospital

2018 ◽  
Vol 7 (2) ◽  
pp. 519
Author(s):  
Vrinda Patil ◽  
Vidya Kamath ◽  
Rathnamala M. Desai
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Mortality Index ◽  
Mortality Ratio ◽  
Life Threatening

Background: Maternal mortality is one of the important indicators of maternal health. Objectives of present study were to determine the frequency of maternal near miss, maternal near miss incidence ratio, maternal near miss to mortality ratio and mortality index and to study the risk factors associated with near miss events.Methods: A retrospective analysis of severe maternal morbidity from January 2015 to December 2015 was studied. Data was collected from women with pregnancy related life-threatening complications, near miss cases and maternal deaths.Results: The total number of deliveries were 5247. The numbers of maternal deaths were 12. Maternal mortality ratio was 228 per one lakh deliveries. There were 5.3 near miss events for every 1 maternal death. The nature and course of near miss cases were analysed. Severe maternal odds ratio was 14.48. Mortality index was 15.78%. Maternal near miss incidence ratio was 12.19.Conclusions: Near Miss Mortality indicator is helpful in identifying the life-threatening conditions and thus aiming to prevent maternal mortality. Hypertensive disorders and its complications are the leading causes of near miss events. Sepsis is the main cause of maternal death.

scholarly journals Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011–2015)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gebretsadik Shibre ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Dina Idriss-Wheeler ◽  
Mpho Keetile ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Statistical Significance ◽  
Maternal Mortality Ratio ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Regional Disparities ◽  
World Health ◽  
Demographic And Health Surveys ◽  
Mortality Ratio

Abstract Background Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country’s antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania. Methods Using the World Health Organization’s Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance. Results Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern. Conclusion A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.

scholarly journals Análisis de la mortalidad materna de los años 2013 a 2015 en el estado de Yucatán

2018 ◽  
Vol 30 (1) ◽  
Author(s):  
Rodrigo Gaspar Díaz Novelo ◽  
Luis Orlando Bobadilla Rosado ◽  
Lizbeth Sabrina Fajardo Ruiz ◽  
Nina Méndez Domínguez ◽  
Salvador Gómez Carro
Keyword(s):  
Maternal Mortality ◽  
Preventive Measures ◽  
Maternal Mortality Ratio ◽  
National Average ◽  
The State ◽  
Hypertensive Disorders ◽  
Mortality Ratio ◽  
The Caribbean ◽  
America Latina

ResumenIntroducción: La mortalidad materna se considera un indicador significativo de la calidad de los servicios de salud, así, se conoce que aproximadamente un 95% de estas muertes en América Latina y el Caribe son prevenibles.Objetivos: Determinar si la Razón de Muerte Materna (RMM) en Yucatán es mayor a la media nacional durante los años 2013 a 2015.Material y Métodos: Estudio transversal observacional en mujeres embarazadas que fallecieron por causas directas relacionadas con el embarazo durante los años 2013 a 2015 en el estado de Yucatán. Se utilizaron datos del Instituto Nacional de Estadística y Geografía (INEGI).Resultados: En el 2013 se encontró que la RMM en Yucatán fue 38,11% mayor en comparación con la nacional, en el 2014 la RMM en este mismo estado fue 34,68% mayor en comparación con la del país y en el 2015 la RMM fue 21,14% mayor que la mexicana. Las principales causas de muerte en el estado concuerdan con lo expuesto en la bibliografía, siendo éstas los desórdenes hipertensivos y las hemorragias.Conclusiones: La RMM durante los años 2013 a 2015 en el estado de Yucatán fue mayor a la media nacional. Es importante implementar medidas preventivas que permitan reducir esta disparidad en términos de mortalidad materna en el estado de Yucatán.Palabras clave: Muerte Materna, Salud Pública, Prevención Secundaria, Salud MaternaTítulo corto: Análisis de la mortalidad materna en Yucatán. ABSTRACT.Introduction. Maternal Mortality is considered a significant indicator of the quality of the health services in any country. It is known that approximately 95% of these deaths in Latin America and the Caribbean are preventable.Objectives. Our objective is to determine whether or not the Maternal Mortality Ratio (MMR) in Yucatan is higher than the national mean during the years 2013 to 2015.Materials and methods. Transversal-observational study in pregnant women who died from direct causes related to pregnancy during the years 2013 to 2015 in Yucatan. Data from the National Institute of Statistics and Geography (INEGI) were used.Results. In 2013 the MMR in Yucatan was 38,11% higher than the national mean, in 2014 the MMR of this state was 34,68% higher in comparison to the national mean and in 2015 the MMR was 21,14% higher than the national mean. The main causes of dead in the state of Yucatan are in agreement with the national causes which are hypertensive disorders and  hemorrhagic disorders.Conclusions. The MMR during the years 2013 to 2015 in the state of Yucatan was higher than the national average. It is important to implement preventive measures to reduce this disparity in terms of maternal mortality in the state of Yucatán.Keywords: Maternal Mortality, Public Health, Secondary Prevention, Maternal Health. 

scholarly journals A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics

2016 ◽  
Vol 8 (4) ◽  
pp. 261-265
Author(s):  
Smiti Nanda ◽  
Shaveta Yadav
Keyword(s):  
Observational Study ◽  
Maternal Mortality ◽  
Prospective Observational Study ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Deaths ◽  
Live Births ◽  
Mortality Index ◽  
Severe Maternal Outcome ◽  
Mortality Ratio

ABSTRACT Purpose To study the incidence and causes of near-miss cases and maternal deaths (MDs) and also search the level of delay. Materials and methods The prospective observational study was carried out in the Department of Obstetrics and Gynecology for a period of one and a half year (September 2012 to February 2014). For identifying near-miss events, disease-specific criteria were used. Near-miss cases were identified among women with pregnancy-related complications whose diagnoses were meeting the criteria. Detailed information of maternal mortalities and near-miss cases for demographic features, underlying causes, treatment received, and level of delay were also obtained. Results There were 15,170 obstetric admission, 13,851 live births, 184 near-miss cases, and 60 MDs during the study period. The maternal near-miss (MNM) rate was 13.2/1,000 live births and maternal mortality ratio was 433.1/100,000 live births. The mortality index (MD/MNM+MD) was reported as 25%. The maternal mortality to near-miss ratio was 1:3.07. Severe maternal outcome rate (MNM/MNM+MD) was 17.6/1,000 live births. Hemorrhage (54.89%) was the leading cause of nearmiss events followed by hypertension (24.45%) and anemia (13.59%). Hypertension (26.66%) was responsible for most of the MDs followed by anemia (25%), hemorrhage (20%), and puerperal sepsis (10%). The most common level of delay was found on the part of women and/or family to seek help. Conclusion Hypertension, hemorrhage, and anemia are leading causes of maternal morbidity and mortality. Lessons need to be learnt from cases of near-miss, which can serve as a useful tool in making strategies and putting efforts to reduce maternal mortality. How to cite this article Yadav S, Nanda S. A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics. J South Asian Feder Obst Gynae 2016;8(4):261-265.

Sign in / Sign up

Export Citation Format

Share Document