Monitoring Maternal Near Miss/Severe Maternal Morbidity: A Systematic Review

Abstract Objectives: to analyze frequency, characteristics and causes of severe maternal morbidity (maternal near miss) in Brazil. Methods: a systematic review on quantitative studies about characteristics, causes, and associated factors on severe maternal morbidity (maternal near miss). The search was done through MEDLINE (maternal near miss or severe maternal morbidity and Brazil) and LILACS (maternal near miss, maternal morbidity). Data were extracted from methodological characteristics of the article, criteria for maternal morbidity and main results. Near miss ratios and indicators were described and estimated. Results: we identified 48 studies: 37 were on hospital based; six were based on health surveys and five were based on information systems. Different definitions were adopted. Maternal near miss ratio ranged from 2.4/1000 LB to 188.4/1000 LB, depending on the criteria and epidemiological scenario. The mortality rate for maternal near miss varied between 3.3% and 32.2%. Hypertensive diseases and hemorrhage were the most common morbidities, but indirect causes have been increasing. Flaws in the healthcare were associated to near miss and also sociodemographic factors (non-white skin color, adolescence/ age ≥ 35 years old, low schooling level). Conclusions: the frequency of maternal near miss in Brazil is high, with a profile of similar causes to maternal mortality. Inequities and delays in the healthcare were identified as association.

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The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity

PLoS ONE ◽

10.1371/journal.pone.0044129 ◽

2012 ◽

Vol 7 (8) ◽

pp. e44129 ◽

Cited By ~ 85

Author(s):

Joao Paulo Souza ◽

Jose Guilherme Cecatti ◽

Samira M. Haddad ◽

Mary Angela Parpinelli ◽

Maria Laura Costa ◽

...

Keyword(s):

Maternal Morbidity ◽

Severity Index ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Index Model

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Maternal health improvement through root cause analysis of severe maternal morbidity (maternal near miss) in Isfahan, Iran

Journal of Education and Health Promotion ◽

10.4103/jehp.jehp_769_19 ◽

2020 ◽

Vol 9 (1) ◽

pp. 145

Author(s):

Marjan Beigi ◽

Sepideh Zhali ◽

Shahnaz Kohan ◽

AzarDanesh Shahraki

Keyword(s):

Maternal Health ◽

Maternal Morbidity ◽

Root Cause Analysis ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Health Improvement ◽

Cause Analysis ◽

Root Cause

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Correction: The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity

PLoS ONE ◽

10.1371/annotation/ca8ccfaa-71c2-4bb8-8b15-121af175a43f ◽

2013 ◽

Vol 8 (11) ◽

Author(s):

Joao Paulo Souza ◽

Jose Guilherme Cecatti ◽

Samira M. Haddad ◽

Mary Angela Parpinelli ◽

Maria Laura Costa ◽

...

Keyword(s):

Maternal Morbidity ◽

Severity Index ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Index Model

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Severe maternal morbidity and maternal near miss in a tertiary hospital of Delhi

The National Medical Journal of India ◽

10.4103/0970-258x.295967 ◽

2019 ◽

Vol 32 (5) ◽

pp. 270

Author(s):

Pragti Chhabra ◽

Kiran Guleria ◽

SanjivKumar Bhasin ◽

Komal Kumari ◽

Shalini Singh ◽

...

Keyword(s):

Maternal Morbidity ◽

Tertiary Hospital ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss

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Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross- sectional multicenter study

BMC Pregnancy and Childbirth ◽

10.1186/1471-2393-14-77 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 21

Author(s):

Fernando César Oliveira ◽

◽

Fernanda Garanhani Surita ◽

João Luiz Pinto e Silva ◽

José Guilherme Cecatti ◽

...

Keyword(s):

Multicenter Study ◽

Maternal Morbidity ◽

Near Miss ◽

Reproductive Age ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Cross Sectional

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Characteristics and preventability of Obstetric ICU admissions in Far North Queensland

10.21203/rs.2.13943/v1 ◽

2019 ◽

Author(s):

Skandarupan Jayaratnam ◽

Sebastian Jacob-Rodgers ◽

Caroline deCosta

Keyword(s):

Maternal Morbidity ◽

Post Partum ◽

Clinical Status ◽

Developed Countries ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Near Misses ◽

Icu Admission ◽

Far North

Abstract Background The rarity of maternal deaths in developed countries has increased interest in reviewing cases of severe maternal morbidity or maternal ‘near miss’. Assessment and determining preventability among near misses is therefore important in improving the provision of maternity care. The aims of this study were to (i) describe the epidemiology of intensive care unit (ICU) admission in Far North Queensland (ii) determine the validity of the WHO near miss criteria in determining cases of severe maternal morbidity and (iii) determining preventability of severe maternal outcomes of pregnant and post-partum patients requiring admission to the ICU. Methods Retrospective observational study included all patients pregnant or within 42 days of termination of pregnancy admitted to the Cairns Hospital ICU between 1st January 2013 and 31 December 2017. Cases were reviewed by a team of Obstetricians using the modified Geller model of preventability to determine reasons for admission to ICU and to determine whether the ‘near miss’ was preventable or not.Results Sixty-nine out of 12081 (0.6%) women admitted for Obstetric care were transferred to the ICU with a total of 31 cases fulfilled WHO near miss criteria. The most common primary obstetric related diagnosis for ICU admission were hypertensive disease of pregnancy and obstetric haemorrhage. Indirect obstetric causes contributed to approximately 40% of ICU admissions. Among the 31 cases of WHO near miss, 10 cases were deemed preventable with the most common reason for preventability related to lack of recognition of high-risk clinical status. Conclusion Maternal ‘near miss’ and rates of Obstetric admission to the ICU at Cairns Hospital are reassuringly low. An audit of near miss cases describing preventability is feasible and informs areas for improvement in the management of ‘near miss’ cases.

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