scholarly journals Feto-maternal outcomes in near miss events in obstetrics

2021 ◽  
Vol 11 (1) ◽  
pp. 172
Author(s):  
Apoorva Kamboj ◽  
Kavita Mandrelle
Keyword(s):  
Maternal Morbidity ◽  
Tertiary Care ◽  
Obstetric Care ◽  
Near Miss ◽  
North India ◽  
World Health ◽  
Maternal Near Miss ◽  
Retrospective Diagnosis ◽  
Near Miss Maternal Morbidity

Background: Maternal near miss is defined by world health organization as a woman, who being close to death survives a complication occurring during pregnancy, delivery or upto 42 days after her end of pregnancy.It is a retrospective diagnosis. Evaluation of near miss maternal morbidity and mortality is a surveillance method to assess the quality of obstetric care and determinants of poor maternal outcome. It is an indicator of quality of obstetrical care. Aims and objectives for current study was to evaluate the cause of near miss maternal morbidity in our hospital which occurred either in admitted patients or were referred from elsewhere and to study the maternal and fetal outcomes in all near miss cases.Methods: A retrospective review of obstetrical records as well as prospective analysis was done at Christian medical college and hospital, a tertiary care teaching institute in North India and referral centre. The study was done for a period of one year from November 2018 to October 2019 retrospectively and for 6 months from November 2019 to April 2020 prospectively. The maternal near miss cases were taken as per WHO criteria.Results: The age ranged from 19 years to 49 years with maximum belonging to age group of 20-24 years. Maximum number of cases was primigravida and was in third trimester. The primary obstetric complication evaluated were hypertensive disorders followed by hematological diseases, viral hepatitis, haemorrhage, and obstructed labour or ruptured uterus.Conclusions: All the causes of MNM observed in this study are preventable causes, which can be identified timely and treated early to prevent maternal mortality, thereby, improving obstetrical and neonatal outcome.

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.

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 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 A cross sectional study on severe acute maternal morbidity near-miss at tertiary care centre in Hyderabad, Telangana, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1761
Author(s):  
Mahesh Kumar Mummadi ◽  
Sowmya Javvaji
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Maternal Morbidity ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Severe Acute Maternal Morbidity ◽  
Life Threatening

Background: A maternal near-miss case is defined by World Health Organization (WHO) as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” Severe acute maternal morbidity (SAMM) is the acronym for the more popular term of ‘near-miss’ cases. There are approximately 118 life threatening events of “near miss mortality” or SAMM for each maternal death. Analysing near miss cases can prevent maternal death.Methods: It is a retrospective study based on medical records. Sample size is all the pregnant cases admitted in Department of Obstetrics and Gynecology in AIMSR, Hyderabad, Telangana, India over the period of January 2015- June 2017 (two and half years) i.e. 2276. All records were gathered and each record that satisfy near miss criteria/maternal mortality were segregated, data has been collected on the occurrence of severe pregnancy-related complications or those who require critical interventions and admission to intensive care unit as per the proforma (according to WHO near miss questionnaire). Data entry done in MS Excel and analyzed using Epi Info.Results: Total MNM/SAMM patients were 85 out of 2276 pregnant women (3.7%). The duration of the stay, potential life-threatening conditions (PTLC), critical interventions, organ dysfunctions, mode of delivery, treatment for PPH, hypertensive disorders and associated conditions among SAMM patients were calculated. SAMM patients who has severe post-partum hemorrhage PPH were 24.7%, severe pre-eclampsia was 31.7%, eclampsia was 2.4%, patients with both severe PPH and eclampsia were 2.4%.Conclusions: Near misses can be prevented to some extent by spreading awareness about possible obstetric complications and risk stratification. The WHO tool for analysis of maternal near miss or SAMM can identify more preventable causes of maternal death. Prospective monitoring of maternal morbidity may be useful in identifying determinants of severe maternal mortality.

scholarly journals Magnitude of Severe Acute Maternal Morbidity and Associated Factors Related to Abortion: A Cross-Sectional Study in Hawassa University Comprehensive Specialized Hospital, Ethiopia, 2019

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Mequanent Tariku
Keyword(s):  
Maternal Morbidity ◽  
Cross Sectional Study ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Delayed Presentation ◽  
Cross Sectional ◽  
Severe Acute Maternal Morbidity ◽  
Specialized Hospital ◽  
Hawassa University

Background. Abortion-related mortality is decreasing, but the complication is still causing a significant morbidity to mothers especially in developing countries. Recently, suitable criteria to assess maternal near miss for sub-Saharan countries were adapted in harmony with the previous World Health Organization near-miss criteria. The aim of this study was to assess the magnitude of severe acute maternal morbidity and associated factors related to abortion in Hawassa University Comprehensive Specialized Hospital, Ethiopia. Method. An institution-based cross-sectional study was conducted among 337 women who sought abortion services at Hawassa University Comprehensive Specialized Hospital from January 1 to October 30, 2019. The participants were selected conveniently. Data was collected by using prospective morbidity methodology with pretested anonymous structured English questionnaire. The collected data were then entered into SPSS version 20 for analysis. Variables with p value ≤ 0.2 in the bivariate analysis, not collinear, were entered to multivariable regression. The strength of association is presented by odds ratio and 95% confidence interval. p value less than 0.05 was used as a cut-off point to determine statistically significant association. Results. The magnitude of severe acute maternal morbidity and maternal near miss is found to be 35.6 and 17.7%, respectively. Factors significantly associated with severe acute maternal morbidity were as follows: women uneducated (AOR: 3.02; 95% CI 1.24-7.33), second-trimester pregnancy (1.89-9.14), and delayed presentation (AOR: 4.32, 95% CI 1.76-10.59). Conclusion. Severe acute maternal morbidity and maternal near miss related to abortion are high despite the availability of safe termination. Near-miss cases could be better traced by using reasonably adapted World Health Organization near-miss criteria for sub-Saharan countries. Lack of education, increased gestational age, and delayed presentation had increased severe acute maternal morbidity associated with abortion which may need further education on health care seeking culture of the community.

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 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.

Maternal Near Miss and Quality of Obstetric Care in a Tunisian Tertiary Level Maternity

2016 ◽  
Vol 20 (4) ◽  
pp. 44-50 ◽  
Author(s):  
Meriam El Ghardallou ◽  
Thouraya Nabli Ajmi ◽  
Afef Mkhazni ◽  
Chekib Zedini ◽  
Sawssen Meddeb ◽  
...  
Keyword(s):  
Obstetric Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Tertiary Level ◽  
Quality Of Obstetric Care
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