scholarly journals The influence of the using “near-miss” on some obstetric bleeging indicators

2018 ◽  
Vol 67 (1) ◽  
pp. 13-19
Author(s):  
Guldzhahon K. Davlyatova ◽  
Marhabo Ya Kamilova ◽  
Dilnoza M. Rakhmatulloeva
Keyword(s):  
Maternal Mortality ◽  
Medical Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Case Review ◽  
Maternity Hospitals ◽  
Implementation Of Standards

The article reviews the use of maternal near-miss in maternity hospitals of Tajikistan and its effect on selected indicatior of maternal bleedings. The implementation of standards and the use of near miss case review in 20 maternity hospitals was shown to decrease the rate of maternal bleedings, especially hypotonic bleedings, the rate of critical hypotonic bleedings, the rate of hysterectomy, and the ratio between deaths due to maternal bleeding in these maternity hospitals and overall maternal bleeding mortality. Our results confirm, that the use of “near-miss” strategy improves the quality of maternal medical care and allows to decrease overall maternal mortality.

scholarly journals Monitoring in obstetric critical care (“maternal near miss”) in the Northwestern Federal District of the Russian Federation in 2018-2019

2021 ◽  
Vol 70 (1) ◽  
pp. 5-18
Author(s):  
Vitaly F. Bezhenar ◽  
Oleg S. Filippov ◽  
Leila V. Adamyan ◽  
Igor M. Nesterov
Keyword(s):  
Maternal Mortality ◽  
Medical Care ◽  
Russian Federation ◽  
Federal District ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Integral Model ◽  
Internal Quality ◽  
Quality Of Medical Care ◽  
The Russian Federation

This article presents data of monitoring critical obstetric conditions (maternal near miss) for the purpose of auditing the quality of medical care and prevention of maternal mortality, obtained on the basis of an analysis of statistical data from eleven federal subjects of the Northwestern Federal District of the Russian Federation for 2018-2019. We characterized the critical obstetric conditions that allow avoiding maternal mortality cases, which, in modern legal practice, most often require forensic examinations on the fact of providing obstetric and gynecological medical care of inadequate quality. We determined that the main causes of maternal mortality cases (83.1% in 2018 and 84.0% in 2019) were massive obstetric bleeding and complications of severe preeclampsia, which more often occurred during childbirth and the first days of the postpartum period. All patients who survived a near death condition belonged to the group of high obstetric and perinatal risk, but most of them were delivered in obstetric hospitals of the second level, with more than half of the women by caesarean section. We discussed the main ways of preventing and reducing the incidence of critical obstetric conditions and maternal mortality based on the improved modern integral model of internal quality control of medical care in obstetric institutions. We also discussed the findings based on the introduction into practice of medical, organizational and methodological (including telecommunication and other) technologies aimed at increasing professional competencies in the regions of the country. Special attention is drawn in this article to the need to systematize and develop uniform and clear criteria for assessing critical obstetric conditions.

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 Analysis of obstetric «near miss» cases in the Ryazan region

2019 ◽  
Vol 12 (4) ◽  
pp. 30-36 ◽  
Author(s):  
I. K. Мamontova ◽  
T. V. Shevlyakovа ◽  
E. I. Petrova
Keyword(s):  
Maternal Mortality ◽  
Medical Care ◽  
Near Miss ◽  
Critical Conditions ◽  
Normal Term ◽  
Caesarean Section Delivery ◽  
Term Delivery ◽  
Quality Of Medical Care ◽  
Uterine Scar

Although maternal mortality cases in Russia have become rare, the problem of their prevention remains relevant. To enforce the preventive measures, an analysis of critical conditions and «near miss» cases in obstetrics is commonly used. As a result, the quality of medical care in obstetric institutions improves. Aim: to assess the character and incidence of critical situations in obstetrics practice over the Ryazan region in 2015-2017 and to analyze the failures in medical care that led to such situations. Materials and methods. We analyzed 46 «near miss» cases and 1 case of maternal death recorded in the Ryazan region in 2015-2017. Results. The leading cause of critical conditions in obstetrics found in the Ryazan region was hemorrhage following an emergency caesarean section delivery. In most cases, bleeding was caused by pregnancy complications, although extragenital conditions also contributed to the development of the «near miss» situations. The main indication for emergency delivery was the premature detachment of a normally located placenta; in the normal term delivery, it was an inconsistent uterine scar after cesarean section and the accompanying pathology, such as placenta accreta. Conclusion. Considering the «near miss» cases as a separate group of obstetrics conditions contributes to the prevention of maternal mortality and improves the healthcare standards in obstetric institutions.

scholarly journals Study of prevalence and factors associated with Maternal Near Miss (MNM) cases and maternal death at Rajiv Gandhi Government Women and Children Hospital, Pondicherry, India

2018 ◽  
Vol 7 (3) ◽  
pp. 1048
Author(s):  
Rakesh H. J. ◽  
Valsa Diana
Keyword(s):  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Health Centre ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Family Welfare ◽  
Good Opportunity ◽  
Live Births ◽  
Women And Children

Background: Maternal mortality is a critical event to assess the quality of a health care system. Analysing the maternal near miss provides a good opportunity for assessing the factors responsible for maternal mortality in that area. The objective of this study was to study the clinic-etiological profile of severe maternal morbidity/near miss case in a tertiary public maternity hospital using criteria from maternal near miss review operational guidelines Ministry of Health and Family Welfare, Government of India (2014).Methods: A prospective observational study included patients admitted to Rajiv Gandhi Government Women and Children Hospital, Pondicherry between August 2016 and July 2017. The patients who met Near Miss Criteria (a set of Clinical, Laboratory and Management based criteria) given by MoH and FW, Government of India (2014) were enrolled; their clinical and investigation parameters were recorded.Results: Out of 9583 live births, 27 (0.281%) were near-miss cases. The maternal near miss incidence ratio was low 2.81 /1000 live births, because of strict criterion of labelling near-miss cases. Maternal near miss to mortality ratio was 13.5:1, and mortality index was 6.89%, lower the index, indicates better quality of care. The mean age of the near-miss patients was 27.75 years. Most of the patients of near-miss were of multipara n = 17 (62.96%). Majority n = 16 (59.25%) of patients were at term gestation. The major causes of near miss were severe haemorrhage n = 11 (42%), Hypertension n = 9 (35%) and rupture uterus n = 4 (15%). Major intervention peripartum hysterectomy was needed in n = 7 (27%) and stepwise devascularisation only in another n = 5 (19 %) of near miss cases.Conclusions: Haemorrhage was the leading cause of near miss events. The study of maternal near miss provides an insight into the causes of maternal mortality in this region. The maternal morbidity and mortality can be reduced by providing proper antenatal care at primary and community health centre level and good intensive care and using maternal early warning system (MEWS) at tertiary level. Maternal near miss ratio is worth presenting in national indices.

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.

Quality of life after maternal near miss: A systematic review

2021 ◽  
Author(s):  
Ida Erika Wieborg Von Rosen ◽  
Rayan Mohamud Shiekh ◽  
Bariki Mchome ◽  
Chunsen Wu ◽  
Khalid S. Khan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Near Miss ◽  
Maternal Near Miss

scholarly journals Hypertension in Pregnancy Still Remains a Serious Complication Causing Severe Morbidity and Mortality of Mother

2016 ◽  
Vol 30 (2) ◽  
pp. 92-97
Author(s):  
Arife Simsek ◽  
Seyfettin Uludag ◽  
Ali Benian ◽  
Abdullah Tuten
Keyword(s):  
Maternal Mortality ◽  
Care Center ◽  
Tertiary Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
Mortality Index ◽  
Retrospective Examination

Objective(s): The aim of this study is to evaluate frequency and nature of maternal deaths and maternal near-miss cases in a tertiary care hospital.Materials and Methods: A retrospective examination was conducted on records of the16.612 women who delivered in a tertiary care center, over a ten-year period (1997-2006). The flow chart recommended by Say et al was used in the analysis of the maternal near-miss cases.Results: The ratios of mortality related with pregnancy, maternal mortality and maternal nearmiss were 68.11/100.000, 61.29/100.000 and 17.09/1000, respectively. The ratio of maternal near- miss to maternal mortality was 27.8 and the mortality index was 3.46%. Hypertensive disorders were the leading cause of maternal deaths and maternal near-miss events.Conclusion: Hypertensive disorders were still leading cause of maternal deaths and maternal near-miss events.Absence of antenatal care and disrupted referral chains were major problems.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 92-97

scholarly journals Factors associated with maternal near-miss at public hospitals of South-East Ethiopia: An institutional-based cross-sectional study

2021 ◽  
Vol 17 ◽  
pp. 174550652110606
Author(s):  
Ashenafi Mekonnen ◽  
Genet Fikadu ◽  
Kenbon Seyoum ◽  
Gemechu Ganfure ◽  
Sisay Degno ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Rural Areas ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Near Miss ◽  
Early Marriage ◽  
Maternal Near Miss ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional

Introduction: Maternal near-miss precedes maternal mortality, and women are still alive indicating that the numbers of near-misses occur more often than maternal mortality. This study aims to assess the prevalence of maternal near-miss and associated factors at public hospitals of Bale zone, Southeast Ethiopia. Methods: Facility-based cross-sectional study design was carried out from 1 October 2018 to 28 February 2019, among 300 women admitted to maternity wards. A structured questionnaire and checklist were used to collect data. Epi-info for data entry and statistical package for social science for analysis were used. The descriptive findings were summarized using tables and text. Adjusted odds ratio with 95% confidence interval and p-value < 0.05 were used to examine the association between the independent and dependent variables. Result: The prevalence of maternal near-miss in our study area was 28.7%. Age < 20 years, age at first marriage < 20 years, husbands with primary education, and being from rural areas are factors significantly associated with the prevalence of maternal near-miss. The zonal health department in collaboration with the education department and justice office has to mitigate early marriage by educating the community about the impacts of early marriage on health.

Critical cases of maternal mortality - a severe obstetrical complication, reflecting the quality of medical services provided

2017 ◽  
pp. 27-30
Author(s):  
Yu.V. Dondyuk ◽  
Keyword(s):  
Maternal Death ◽  
Maternal Morbidity ◽  
Obstetric Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Republic Of Moldova ◽  
Mortality Index ◽  
The Republic

Maternal near miss and maternal death audit has become an esssential process in the context of obstetric care in both developed and developing countries. The objective: of the present study was to assess the quality of medical services provided within the multilevel regionalized Perinatal Health System in the Republic of Moldova, by identifying the inconsistencies with existing standards of medical care, in cases of severe obstetric complications and maternal deaths. Materials and methods. All cases of maternal near miss cases and maternal deaths recorded in the Secondary and Tertiary Perinatal Centers of the Republic of Moldova during the period 2009–2014 were analyzed retrospectively. To assess the quality of obstetric care, the following indices have been calculated: maternal near miss/ maternal deaths ratio; the mortality index for each obstetric condition/ complication. Results. During a period of 6 years, in 11 Secondary and Tertiary Perinatal Centers of the Republic of Moldova there were registered 154 651 births, 2881 cases of maternal near miss and 21 maternal deaths. The General Mortality index was 0.72%, and the Mortality Index by direct obstetric morbidity was 0.48%. 92.86% of maternal deaths through direct obstetric causes were avoidable, and the proportion of near miss cases with substandard care was 81.85%. The most frequent gaps (82.48%) were caused by human factors, such as insufficient team work, communication deficiency, lack of knowledge and clinical skills necessary to properly recognize and treat critical obstetric patients, delay and errors in diagnosis and treatment, non-compliance with clinical protocols. Conclusions. The excessively high proportion of avoidable factors highlighted in the study is alarming and implies the need for more extensive activities and the development of strategies focused on ensuring the presence of qualified medical workers in medical institutions, which will allow the provision of qualitative care and safety for patients in the Republic of Moldova, reducing maternal morbidity and mortality. Key words: severe maternal morbidity, maternal near miss, maternal death, maternal mortality.

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