Case series of maternal mortality and maternal near miss due to severe acute respiratory syndrome coronavirus 2

The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes the COVID-19 pandemic has affected every household of the remotest part of North East India, Mizoram. The pregnant women do not have a higher chance of getting infected, yet the infection seems to be more severe. We are reporting five cases of maternal death and two cases of maternal near miss in ZMC of Mizoram. Case 1 to 5 were maternal death due to COVID-19. All of them were multigravida within the age group of 27–41 years with a period of gestation 24–37 weeks. The presenting complaints were fever and cough more than 3 days with an investigation report revealing raised C-reactive protein (CRP) and severe pneumonia. Case 6 (Near miss) was 20 years, primigravida at term pregnancy in labor with a history of fever for 2 days with an investigation report revealing raised CRP and severe pneumonia, the baby was delivered asphyxiated and died. Case 7 (Near miss) was 17 years old primigravida at term pregnancy admitted as asymptomatic COVID-19 positive, elective caesarean section was done for Obstetrics indication, the patient later developed fever and moderate pneumonia on 5 days of hospitalization, she also developed eclampsia on 7th hospital day, she survived after intensive care in the intensive care unit.

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Comparison between near miss criteria in a maternal intensive care unit

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2017038703404 ◽

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.

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Impact of COVID-19 infection on maternal near miss cases in tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212649 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2671

Author(s):

Niranjan Chavan ◽

Shalini Mahapatra ◽

Sneha Venkateswaran ◽

Jui Ponkshe ◽

Arun H. Nayak

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Pregnant Women ◽

Maternal Death ◽

Tertiary Care ◽

Near Miss ◽

Maternal Near Miss ◽

Control Group ◽

Tertiary Referral Hospital ◽

Health Crisis ◽

Increased Risk

Background: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to a health crisis. Since the beginning of the severe acute respiratory syndrome (SARS-CoV-2) or COVID-19 outbreak, it has been argued whether pregnant women are at increased risk of severe infection.1 The objective of this study was to summarize the effect of COVID-19 on maternal near miss cases.Methods: This single-centre prospective observational study, included all consecutive pregnant women with COVID-19 infection admitted to Lokmanya Tilak Municipal Medical College and General Hospital (Mumbai, India), a tertiary referral hospital, from 1 April 2020, to 20 December 2020. In this study, a total of 46 patients were included in near miss cases, who required ICU admission with severe morbidity. Of these, 8 patients were COVID-19 positive and remaining 38 patients were included in control group (COVID-19 negative). The course of each of their stay in ward was noted and findings were compared in both the groups. Results: During their course in ICU it was found that 6 COVID-19 patients had maternal death representing 75% and 12 non-COVID-19 patients had maternal death representing 31.57%. Conclusions: The mortality rate from the above results concludes that in this study mortality appeared to be higher in COVID-19 infection. Multi-centre retrospective analysis with larger population size is required in order for this to be statistically significant.

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375. COVID 19 infection in a Massachusetts community hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.570 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S257-S258

Author(s):

Raul Davaro ◽

alwyn rapose

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Essential Hypertension ◽

Severe Acute Respiratory Syndrome ◽

High Mortality ◽

Case Series ◽

World Health ◽

Minimal Risk ◽

The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

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Maternal Near Miss in Patients with Systemic Lupus Erythematosus

10.21203/rs.3.rs-1010952/v1 ◽

2021 ◽

Author(s):

Arlley Cleverson Belo Silva ◽

Sue Yazaki Sun ◽

Felipe Favorette Campanharo ◽

Letícia Tiemi Morooka ◽

José Guilherme Cecatti ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Maternal Death ◽

Lupus Erythematosus ◽

Neonatal Death ◽

Near Miss ◽

Maternal Near Miss ◽

Control Group ◽

Systemic Lupus ◽

Increased Risk ◽

Life Threatening

Abstract Introduction: Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with coexisting SLE may have severe life-threatening risks. Severe maternal morbidities (SMM) include maternal death, maternal near miss (MNM), and potentially life-threatening conditions (PLTC). This study aimed to determine the prevalence of SMM in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods: This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at São Paulo Hospital , Brazil, from 2005 to 2015. The pregnant women were divided in control group without complications, group with PLTC, and group with MNM. Results: Out of 149 pregnancies, there were 14 cases of MNM (9.4%), 56 cases of PLTC (37.6%), and no maternal death. The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with control group [p=0.0042; OR (95% CI): 12.05 (1.5-96.6) for MNM group and p=0.0001; OR (95% CI): 4.84 (2.2-10.8) for PLTC group]. SMM increases the risk of longer hospitalization [p<0,0001; OR (95% CI): 18.8 (7.0-50.6) and p <0.0001; OR (95% CI): 158.17 (17.6-1424,2) for PLTC and MNM, respectively], newborns with low birth weight [p=0.0006; OR (95% CI): 3.67 (1.7-7.9) and p=0.0009; OR (95% CI): 17.68 (2-153.6) for PLTC and MNM group, respectively] as well as renal diseases [PLTC (58.9%, 33/56; p = 0.0069) and MNM (78.6%, 11/14; p = 0.0026)]. MNM cases presented increased risk for neonatal death [p=0.0128; OR (95% CI): 38.4 (3.3-440.3)], stillbirth and miscarriage [p=0.0011; OR (95% CI): 7.68 (2.2-26.3)]. Conclusion: SLE was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes, such as prematurity, neonatal death, miscarriage and fetal loss.

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

HEALTH OF WOMAN ◽

10.15574/hw.2017.125.27 ◽

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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Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1708095 ◽

2020 ◽

Vol 42 (03) ◽

pp. 124-132

Author(s):

Fabiano M. Soares ◽

José Paulo Guida ◽

Rodolfo Carvalho Pacagnella ◽

João Paulo Souza ◽

Mary Ângela Parpinelli ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Maternal Death ◽

Maternal Morbidity ◽

Secondary Analysis ◽

Individual Characteristics ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Cross Sectional ◽

Inadequate Care

Abstract Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. Results Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. Conclusion The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180165 ◽

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.

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Evaluation of associated risk factors of near miss obstetrics cases at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175931 ◽

2018 ◽

Vol 7 (2) ◽

pp. 408

Author(s):

Madan Khadka ◽

Dhruba Kumar Uprety ◽

Rubina Rai

Keyword(s):

Risk Factors ◽

Maternal Death ◽

Near Miss ◽

Maternal Near Miss ◽

Care Hospital ◽

Hypertensive Disorders ◽

Life Threatening ◽

Associated Risk Factors ◽

Surgical Condition ◽

Ruptured Uterus

Background: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near miss obstetric cases.Methods: A prospective observational study was done from August 1, 2014 to July 30, 2015 in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by 5 factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, complication of abortion, ruptured uterus, medical/surgical condition and sepsis.Results: A total of 9,727 delivery were attended during the study period from August 2014 to July 2014. There were 6307 (71.5%) vaginal delivery and 2777 (28.5%) caesarean section and 181 perinatal death with total of 9,546 livebirth. 162 near miss and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions of 172, Severe maternal outcome ratio of 18.64, Maternal near-miss: mortality ratio: 10.1:1, Mortality index: 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9% and cardiovascular and coagulation dysfunction as a major life-threatening condition and sepsis (25%) was the major cause of mortality.Conclusions: Haemorrhage and hypertensive disorders are the leading causes of near miss event. Evaluation of associated risk factor can be potential tool for reduction of maternal morbity and mortality.

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