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

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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Maternal ‘near miss’ at Royal Darwin Hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/ajo.12436 ◽

2016 ◽

Vol 56 (4) ◽

pp. 381-386 ◽

Cited By ~ 9

Author(s):

Skandarupan Jayaratnam ◽

Alice Burton ◽

Kirsten Fiona Connan ◽

Caroline de Costa

Keyword(s):

Maternal Morbidity ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Maternity Unit

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Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity

BioMed Research International ◽

10.1155/2019/2594343 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11

Author(s):

K. G. Fernandes ◽

M. L. Costa ◽

S. M. Haddad ◽

M. A. Parpinelli ◽

M. H. Sousa ◽

...

Keyword(s):

Maternal Mortality ◽

Skin Color ◽

Maternal Morbidity ◽

White Women ◽

Maternal Outcome ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Maternal Outcomes ◽

Severe Maternal Outcome

Background. Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity. Methods. This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PRadj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race. Results. Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis. Conclusion. Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.

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