scholarly journals Women with maternal near-miss in the intensive care unit in Yangzhou, China: a 5-year retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Chen ◽  
Jiaoyang Shi ◽  
Yuting Zhu ◽  
Xiang Kong ◽  
Yang Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Postpartum Hemorrhage ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Near Misses ◽  
Live Births ◽  
Cesarean Birth

Abstract Background Analysis of “maternal near-misses” is expected to facilitate assessment of the quality of maternity care in health facilities. Therefore, this study aimed to investigate incidence, risk factors and causes of maternal near-misses (MNM) admitted to the intensive care unit (ICU) within five years by using the World Health Organization’s MNM approach. Methods A five-year retrospective study was conducted in Subei People’s Hospital of Yangzhou, Jiangsu Province from January 1, 2015 to December 31, 2019. Risk factors in 65 women with MNM in the intensive care unit (ICU) were explored by using chi-square tests and multivariable logistic regression analysis. Causes and interventions in MNM were investigated by descriptive analysis. Results Average maternal near-miss incidence ratio (MNMIR) for ICU admission was 3.5 per 1000 live births. Average maternal mortality ratio (MMR) was 5 per 100,000 live births. MI for all MNM was 0.7%. Steady growth of MNMIR in ICU was witnessed in the five-year study period. Women who were referred from other hospitals (aOR 3.32; 95%CI 1.40–7.32) and had cesarean birth (aOR 4.96; 95%CI 1.66–14.86) were more likely to be admitted in ICU. Neonates born to women with MNM admitted in ICU had lower birthweight (aOR 5.41; 95%CI 2.53–11.58) and Apgar score at 5 min (aOR 6.39; 95%CI 2.20–18.55) compared with women with MNM outside ICU. ICU admission because of MNM occurred mostly postpartum (n = 63; 96.9%). Leading direct obstetric causes of MNM admitted in ICU were hypertensive diseases of pregnancy (n = 24; 36.9%), followed by postpartum hemorrhage (n = 14; 21.5%), while the leading indirect obstetric cause was heart diseases (n = 3; 4.6%). Conclusions Risk factors that were associated with MNM in ICU were referral and cesarean birth. Hypertensive disease of pregnancy and postpartum hemorrhage were the main obstetric causes of MNM in ICU. These findings would provide guidance to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for cesarean birth.

scholarly journals Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

2020 ◽  
Author(s):  
Ying Chen ◽  
Jiaoyang Shi ◽  
Yuting Zhu ◽  
Xiang Kong ◽  
Yang Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Icu Admission ◽  
Medical Institutions ◽  
Incidence Risk

Abstract BackgroundThe maternal near-miss (MNM) criterion formulated by the WHO can dynamically evaluate the obstetric quality and maternal health in medical institutions. The study aims to explore the incidence, risk factors, and causes of MNM cases admitted to the intensive care unit (ICU) within 5 years.MethodsThis study is a retrospective study. The data of MNM admitted to the ICU comes from the medical records of Subei People's Hospital in Yangzhou from 2015 to 2019. The study subjects meet at least one World Health Organization (WHO) criterion of MNM. The MNM who had not been admitted to the ICU in the same year served as the control group. We use descriptive analysis, Chi-Square test and Fisher’s exact test for data analysis.Results151 women met the WHO criteria of MNM and there was one maternal death in 2016. The average maternal near-miss rate（MNMR）for ICU admission was 3.5 per 1,000LBs, and the average MNM morbidity was 0.36%. The average maternal mortality ratio (MMR) was 5 per 100,000LBs. The 5-year research period witnessed moderate growth in MNM admitted to the ICU. The region, referral, gravidity, prenatal examination, and mode of delivery were significantly related to the MNM admitted to the ICU(p<0.05). Concerning neonatal characteristics, there is a significant difference in preterm birth rate and low Apgar scores at 1 min and 5 min(p<0.05). The direct obstetric causes were the primary cause of MNM, regardless of the ICU admission. The leading direct obstetric causes of MNM admitted to the ICU were obstetric hemorrhage diseases(38.8%)，following hypertension diseases(18.8%), while the leading indirect obstetric cause of MNM admitted to the ICU was heart-related diseases (7.2%). MNM for the ICU admission were mostly postpartum (96.9%), who underwent multiple interventions.ConclusionsICU is one of the most important endpoints of MNM management. In the context of "universal two-child", medical institutions should strengthen multidisciplinary joint treatment. In the future, it needs to be expanded to multi-center research to determine the criteria for MNM admitted to the ICU.

scholarly journals Neonatal near miss in the intensive care unit

2020 ◽  
Vol 73 (6) ◽  
Author(s):  
Maria Rita Guimarães Maia ◽  
Rosângela Aparecida Pimenta Ferrari ◽  
Alexandrina Aparecida Maciel Cardelli ◽  
Ieda Harumi Higarashi ◽  
Maria Dalva de Barros Carvalho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Statistical Analysis ◽  
Scientific Evidence ◽  
Near Miss ◽  
Chi Square ◽  
Cross Sectional ◽  
Live Births ◽  
Neonatal Near Miss

ABSTRACT Objective: To analyze near miss cases among newborns hospitalized in the Intensive Care Unit. Methods: An observational, cross-sectional, retrospective study using the STROBE guideline. Data were collected from 1,101 records of live births (newborns). Statistical analysis used the Epi-Info program 3.3.2 and Chi-square and Fisher’s exact tests. Results: A total of 162 newborns were hospitalized, of which 63 had at least one criterion of near miss. The variables that remained associated with neonatal near miss were weight <1.750 g, gestational age <33 weeks and Apgar at 5 minutes <7, pragmatic criteria to identify cases of neonatal near miss morbidity. Conclusion: Prematurity and low birth weight were the factors that contributed most to the near miss outcome among newborns hospitalized in intensive care, a rate two and a half times higher than the number of deaths, according to scientific evidence.

scholarly journals Comparison between near miss criteria in a maternal intensive care unit

2018 ◽  
Vol 52 (0) ◽  
Author(s):  
Alana Santos Monte ◽  
Liana Mara Rocha Teles ◽  
Mônica Oliveira Batista Oriá ◽  
Francisco Herlânio Costa Carvalho ◽  
Helen Brown ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Maternal Death ◽  
High Sensitivity ◽  
High Specificity ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Chi Square ◽  
Cross Sectional

ABSTRACT Objective: The aim of this study was to compare the incidence of different criteria of maternal near miss in women admitted to an obstetric intensive care unit and their sensitivity and specificity in identifying cases that have evolved to morbidity. Method: A cross-sectional analytical epidemiological study was conducted with women admitted to the intensive care unit of the Maternity School Assis Chateaubriand in Ceará, Brazil. The Chi-square test and odds ratio were used. Results: 560 records were analyzed. The incidence of maternal near miss ranged from 20.7 in the Waterstone criteria to 12.4 in the Geller criteria. The maternal near-miss mortality ratio varied from 4.6:1 to 7.1:1, showing better index in the Waterstone criteria, which encompasses a greater spectrum of severity. The Geller and Mantel criteria, however, presented high sensitivity and low specificity. Except for the Waterstone criteria, there was an association between the three other criteria and maternal death. Conclusion: The high specificity of Geller and Mantel criteria in identifying maternal near miss considering the World Health Organization criteria as a gold standard and a lack of association between the criteria of Waterstone with maternal death.

scholarly journals Evaluation of Clinical Characteristics and Outcomes of Obstetric Patients Admitted to Intensive Care Unit

2018 ◽  
Vol 6 (1) ◽  
pp. 11-16
Author(s):  
Deepak Shrestha ◽  
Shreyashi Aryal ◽  
Sebina Baniya
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Loss ◽  
Gestational Age ◽  
Near Miss ◽  
Hypertensive Disorder ◽  
Obstetric Hemorrhage ◽  
Surgical Interventions ◽  
Emergency Cesarean

Introduction: The need for critical care support and admission to intensive care unit (ICU) in obstetric population is infrequent. The proportion ranges from 0.1 to 8.5%. Yet, obstetric admissions to ICU and mortality continue to have a significant impact on overall maternal health care. The study of epidemiology and predictors of obstetric admissions to ICU will prove a useful proxy for better understanding maternal near miss events and mortality. Methods: This was a case control study reviewing all the obstetric cases admitted to ICU over a study period of five years. The individual files were recovered from the record section and data pertaining to referral status, demographics, clinical profile and ICU information were retrieved. The ICU data comprised of the length of ICU stay, indications for admission, interventions required, and outcomes. The data were then compared to historical controls. Results: A total of 80 patients were admitted to ICU accounting for 0.84% of total deliveries and 4.6% of total ICU admissions. Mean age was 24.84 years, mean gestational age was 32.33 weeks, and mean blood loss was 707.27 ml. Hypertensive disorder of pregnancy followed by obstetric hemorrhage were the most common indications. Lower gestational age, increased blood loss, emergency cesarean sections, and surgical interventions were noteworthy risk factors for ICU admissions. There was a mortality rate of 5%. Conclusion: Hypertensive disorders account for the most number of admissions to ICU followed by obstetric hemorrhage. Lower gestational age, increased blood loss and emergency cesarean section are notable risk factors for ICU admission.

scholarly journals Applying the new concept of maternal near-miss in an intensive care unit

Clinics ◽  
2012 ◽  
Vol 67 (3) ◽  
pp. 225-230 ◽  
Author(s):  
FA Lotufo ◽  
MA Parpinelli ◽  
SM Haddad ◽  
FG Surita ◽  
JG Cecatti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Near Miss ◽  
Maternal Near Miss

scholarly journals Maternal near miss among women admitted in major private hospitals in eastern Ethiopia: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shegaw Geze Tenaw ◽  
Nega Assefa ◽  
Teshale Mulatu ◽  
Abera Kenay Tura
Keyword(s):  
Retrospective Study ◽  
Cesarean Section ◽  
Antenatal Care ◽  
Termination Of Pregnancy ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Chronic Hypertension ◽  
Eastern Ethiopia ◽  
Private Hospitals ◽  
Live Births

Abstract Background Since maternal mortality is a rare event, maternal near miss has been used as a proxy indicator for measuring maternal health. Maternal near miss (MNM) refers to a woman who nearly died but survived of complications during pregnancy, childbirth or within 42 days of termination of pregnancy. Although study of MNM in Ethiopia is becoming common, it is limited to public facilities leaving private facilities aside. The objective of this study was to assess MNM among women admitted in major private hospitals in eastern Ethiopia. Methods An institution based retrospective study was conducted from March 05 to 31, 2020 in two major private hospitals in Harar and Dire Dawa, eastern Ethiopia. The records of all women who were admitted during pregnancy, delivery or within 42 days of termination of pregnancy was reviewed for the presence of MNM criteria as per the sub-Saharan African MNM criteria. Descriptive analysis was done by computing proportion, ratio and means. Factors associated with MNM were assessed using binary logistic regression with adjusted odds ratio (aOR) along with its 95% confidence interval (CI). Results Of 1214 pregnant or postpartum women receiving care between January 09, 2019 and February 08, 2020, 111 women developed life-threatening conditions: 108 MNM and 3 maternal deaths. In the same period, 1173 live births were registered, resulting in an MNM ratio of 92.1 per 1000 live births. Anemia in the index pregnancy (aOR: 5.03; 95%CI: 3.12–8.13), having chronic hypertension (aOR: 3.13; 95% CI: 1.57–6.26), no antenatal care (aOR: 3.04; 95% CI: 1.58–5.83), being > 35 years old (aOR: 2.29; 95%CI: 1.22–4.29), and previous cesarean section (aOR: 4.48; 95% CI: 2.67–7.53) were significantly associated with MNM. Conclusions Close to a tenth of women admitted to major private hospitals in eastern Ethiopia developed MNM. Women with anemia, history of cesarean section, and old age should be prioritized for preventing and managing MNM. Strengthening antenatal care and early screening of chronic conditions including hypertension is essential for preventing MNM.

scholarly journals Effect of maternal near miss on neonatal mortality in selected hospitals: Prospective cohort study, Southeast Ethiopia

2021 ◽  
Vol 9 ◽  
pp. 205031212110422
Author(s):  
Ahmednur Adem Aliyi ◽  
Negussie Deyessa ◽  
Mengistu Yilma Dilnessie
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Confidence Interval ◽  
Neonatal Mortality ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
History Of

Objective: The objective of this study was to assess effect of maternal near miss on neonatal mortality. Methods: Prospective cohort study was conducted on 384 pregnant women who came for delivery to purposely selected hospitals. The cohort was made up of 128 exposed (near miss) mothers and 256 non-exposed (non-near-miss) mothers. Women who came for delivery were only included. Those who came for services other than delivery such as abortion care, women who developed life-threatening condition not related to delivery, and those who come from no phone network area were excluded. A purposive sampling technique was used by including all mothers with near miss consecutively until the required sample size was obtained. Two non-near-miss mothers were selected using lottery for every near-miss mother. Survival analysis was done for both groups using Cox regression to look for effect of maternal near miss on neonatal mortality. Verbal informed consent from study participants was obtained. Results: A total of 354 (118 with near miss and 236 without near miss) women completed the follow-up time, yielding response rate of 92.2%. Of all, 55 (15.5%) of them have previous history of abortion, 44 (12.4%) were admitted to the intensive care unit during delivery, and 22 (6.2%) have history of past delivery of still birth. Severe preeclampsia with intensive care unit admission and severe anemia with transfusion of greater than 2 units of blood were common complications leading to maternal near miss. There were 17 (48 per 1000 live birth) neonatal death at the end of the study, of which 15 occurred among mothers with near miss. Monthly income (adjusted hazard ratio = 998, 95% confidence interval = 0.996–0.999), fetal presentation (adjusted hazard ratio = 6.48, 95% confidence interval = 1.84–22.73), APGAR score (adjusted hazard ratio = 0.746, 95% confidence interval = 0.620–0.898), and being near miss mother (adjusted hazard ratio = 8.40, 95% confidence interval = 1.638–43.118) were significantly affecting neonatal mortality. Conclusion: Maternal near miss and other fetal and general maternal characteristics have effect on occurrence of neonatal mortality. Therefore, due attention should be given to these factors for improvement of neonatal survival.

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