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Haddad SM, Souza RT, Cecatti JG. Management of maternal pulse and blood pressure abnormalities during labour and childbirth: evidence-based algorithms for intrapartum care decision support. BJOG 2024; 131 Suppl 2:67-78. [PMID: 35411679 DOI: 10.1111/1471-0528.16776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
AIMS To develop evidence-based clinical algorithms for assessment and management of abnormal maternal pulse and blood pressure during the intrapartum period. POPULATION Low risk singleton, term, pregnant women in labour. SETTING Institutional births in low- and middle-income countries. SEARCH STRATEGY A review of the literature was performed to retrieve evidence-based guidelines, systematic reviews, and papers on maternal pulse and blood pressure during labour. We searched a number of international clinical guidelines and PubMed using the corresponding key terms in November 2018 and updated the search in May 2020. CASE SCENARIOS Four common intrapartum case scenarios of abnormal pulse and blood pressure were identified for which algorithms were developed: hypertension, hypotension, tachycardia and bradycardia. Algorithms were constructed after reviewing guidelines and relevant papers, with input from a panel of experts. Thresholds for upper and lower limits of normal maternal pulse and blood pressure measurements are defined, evidence-based interventions for the initial management of abnormal parameters are described (resuscitation and monitoring) and guidance is provided on exploration of the potential causes for each case scenario, with links to pathways for their management. CONCLUSIONS Evidence-based algorithms to support the identification, and management of deviations in pulse and blood pressure during intrapartum care have been developed for hypertension, hypotension, tachycardia and bradycardia. The algorithms focus on initial resuscitation and monitoring, with an exploration of causes and early identification of underlying maternal conditions. These algorithms will help provide a standardised approach to investigation and management of these abnormal parameters to guide clinical practice. TWEETABLE ABSTRACT Algorithms for abnormal maternal pulse and blood pressure during labour allow standardised approach to early identification and management of complications. TWEETABLE ABSTRACT
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Affiliation(s)
- S M Haddad
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - R T Souza
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - J G Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Mulongo SM, Kaura D, Mash B. A mixed methods study on continuity and care coordination based on the obstetric near miss approach. Health SA 2024; 29:2421. [PMID: 38726055 PMCID: PMC11079400 DOI: 10.4102/hsag.v29i0.2421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/12/2024] [Indexed: 05/12/2024] Open
Abstract
Background The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among these women, those who survive (near-miss cases) can offer insights into the determinants, providing valuable lessons for understanding underlying factors. Aim To investigate elements of continuity and coordination leading to obstetric near misses. Setting A major referral hospital and its referral pathway in Kenya. Methods Explanatory sequential mixed-methods design. Results Near-miss survivors had lower continuity and coordination of care indices during antenatal visits (COCI = 0.80, p = 0.0026), (modified continuity of care index [MCCI] = 0.62, p = 0.034), and those with non-life-threatening morbidity in the first trimester were more likely to experience a near miss (aOR = 4.34, p = 0.001). Facilities in the western region had a higher burden of near misses compared to the Eastern region. Qualitatively, three deductive themes were identified: sequential coordination, parallel coordination and continuity, along with factors classified as access. In mixed integration, poor continuity indices were explained by quality of interpersonal relationships and woman centredness. Poor coordination was explained by inadequate teamwork between providers in referring and referral facilities and between primary health facilities and the community. Higher near-miss rates in the western region resulted from differences in human and physical resources. Conclusion Promoting woman-centred care, teamwork, improving communication and introducing innovative coordination roles like case and care managers can enhance continuity and coordination of maternal healthcare. Contributions This study contributes to our understanding of the challenges of continuity and coordination in maternal healthcare in resource-poor settings by applying the WHO operationalisation of continuity and coordination using mixed methodology.
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Affiliation(s)
- Samuel M Mulongo
- Department of Nursing, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Doreen Kaura
- Department of Nursing, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bob Mash
- Department of Family and Emergency Medicine, Stellenbosch University, Cape Town, South Africa
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Oberlin A, Wallace J, Moore JL, Saleem S, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Liechty E, Bucher S, Patel AB, Hibberd PL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Goldenberg RL. Examining maternal morbidity across a spectrum of delivery locations: An analysis of the Global Network's Maternal and Neonatal Health Registry. Int J Gynaecol Obstet 2023; 160:797-805. [PMID: 35949060 PMCID: PMC9911556 DOI: 10.1002/ijgo.14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To better understand maternal morbidity, using quality data from low- and middle-income countries (LMICs), including out-of-hospital deliveries. Additionally, to compare to the WHO estimate that maternal morbidity occurs in 15% of pregnancies, which is based largely on hospital-level data. METHODS The Global Network for Women's and Children's Health Research Maternal Newborn Health Registry collected data on all pregnancies from seven sites in six LMICs between 2015 and 2020. Rates of maternal mortality and morbidity and the differences in morbidity across delivery location and birth attendant type were evaluated. RESULTS Among the 280 584 deliveries included in the present analysis, the overall maternal mortality ratio was 138 per 100 000, while 11.7% of women experienced at least one morbidity. Rates of morbidity were generally higher for deliveries occurring within hospitals (19.8%) and by physicians (23.6%). The lowest rates of morbidity were noted among women delivering in non-hospital healthcare facilities (5.6%) or with non-physician clinicians (e.g. nurses, midwives [5.4%]). CONCLUSION The present study shows important differences in reported maternal morbidity across delivery sites, with a trend towards lower morbidity in non-hospital healthcare facilities and among non-physician clinicians.
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Affiliation(s)
- Austin Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Jacqueline Wallace
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Janet L. Moore
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Edward Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Sheri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | | | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Elizabeth M. McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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Balachandran DM, Karuppusamy D, Maurya DK, Kar SS, Keepanasseril A. Indicators for maternal near miss: an observational study, India. Bull World Health Organ 2022; 100:436-446. [PMID: 35813510 PMCID: PMC9243687 DOI: 10.2471/blt.21.287737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To compare the incidence of maternal near miss using the World Health Organization (WHO) near-miss tool and six other criteria sets, including criteria designed for low-resource settings or specifically for India. Methods In a cohort study we used WHO severity indicators to identify women with potentially life-threatening conditions during pregnancy or childbirth admitted to a referral hospital in Puducherry, India, from May 2018 to April 2021. We analysed sociodemographic, clinical and laboratory data for each woman and calculated the incidence of maternal near miss and other process indicators for each set of criteria. Findings We analysed data on 37 590 live births; 1833 (4.9%) women were identified with potentially life-threatening conditions, 380 women had severe maternal outcomes and 57 died. Applying the different sets of criteria to the same data, we found the incidence of maternal near miss ranged from 7.6 to 15.6 per 1000 live births. Only the Global Network criteria (which exclude laboratory data that may not be available in low-resource settings) and the WHO criteria could identify all women who died. Applying the criterion of any number of units of blood transfusion increased the overall number of women identified with near miss. Conclusion The WHO and Global Network criteria may be used to detect maternal near miss in low-resource settings. Future studies could assess the usefulness of blood transfusion as an indicator for maternal near miss, especially in low- to middle-income countries where the indicator may not reflect severe maternal morbidity if the number of units received is not specified.
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Affiliation(s)
- Divya Mecheril Balachandran
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
| | - Dhamotharan Karuppusamy
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
| | - Dilip Kumar Maurya
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
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Beyene T, Chojenta C, Smith R, Loxton D. Severe Maternal Outcomes and Quality of Maternal Health Care in South Ethiopia. Int J Womens Health 2022; 14:119-130. [PMID: 35140528 PMCID: PMC8820457 DOI: 10.2147/ijwh.s341912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the incidence of severe maternal outcomes (SMO) and quality of maternal health care in south Ethiopia. Methods A facility-based prospective study was conducted in three hospitals among all women who presented while pregnant, during and after childbirth between 12 July and 26 November 2018. Participants were followed from the time of admission to discharge. The World Health Organization (WHO) maternal near-miss (MNM) approach was used to assess SMO indicators and quality of maternal health care. Results Of 2880 live births, 315 had potentially life-threatening conditions and 108 had SMOs (90 MNM and 18 maternal deaths). The SMO incidence ratio was 37.5 per 1000 live births (95% CI 30.6–44.4) and MNM incidence ratio was 31.3 per 1000 live births (95% CI 24.9–37.7). The ratio of near-miss to maternal deaths was 5:1. The hospitals’ maternal mortality ratio (MMR) was 625 per 100,000 live births. Most (82.1%) SMO cases were referred from other health facilities. The most common cause of SMO was eclampsia (37%) followed by postpartum haemorrhage (33.3%). The highest mortality index (MI) was among women with sepsis (27.3%). The intensive care unit (ICU) admission rate was 13% for women with SMO and 83.3% of maternal deaths occurred without ICU admission. Conclusion The SMO ratio was comparable to other studies in the country. Most women with SMO were referred from other health facilities, which demonstrate the presence of the first delay (seeking care) and/or the second delay (reaching care) in the study area. The study suggests that effectively using the ICU, reducing delays, and improving the referral system may reduce SMO and improve the quality of care in the hospitals. Furthermore, continuous reviewing of SMO is needed to learn what treatment was given to women who experienced complications in the hospitals.
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Affiliation(s)
- Tesfalidet Beyene
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia.,College of Medicine and Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Catherine Chojenta
- Centre for Women's Health Research, University of Newcastle, Newcastle, NSW, Australia
| | - Roger Smith
- The Mothers and Babies Research Centre at the Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, University of Newcastle, Newcastle, NSW, Australia
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Drechsel KC, Adu-Bonsaffoh K, Olde Loohuis KM, Srofenyoh EK, Boateng D, Browne JL. Maternal near-miss and mortality associated with hypertensive disorders of pregnancy remote from term: A multicenter observational study in Ghana. AJOG GLOBAL REPORTS 2022; 2:100045. [PMID: 36275498 PMCID: PMC9564034 DOI: 10.1016/j.xagr.2021.100045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal death rates remain high in many low- and middle-income countries. Hypertensive disorders of pregnancy account for 18% of maternal mortality in Ghana. The maternal near-miss approach was designed to evaluate severe (acute) complications in pregnancy, which is useful to detect potential areas for clinical care improvement. OBJECTIVE This study aimed (1) to determine the incidence of severe maternal complications, maternal near-miss cases, and mortality cases associated with hypertensive disorders of pregnancy remote from term and (2) to assess the health system's performance indicators for the management of hypertensive disorders of pregnancy remote from term in middle-income country referral hospitals. STUDY DESIGN This study was nested in the ongoing Severe Preeclampsia adverse Outcome Triage study, a multicenter observational cohort study, and included women recruited from December 1, 2017, to May 31, 2020, from 5 referral hospitals in Ghana. Women aged >16 years, admitted to the hospital with hypertensive disorders of pregnancy, with gestational age between 26 and 34 weeks were eligible. Near miss was defined according to the World Health Organization and sub-Saharan African near-miss criteria. Descriptive statistics of pregnancy and maternal and perinatal outcomes up to 6 weeks after delivery of women with severe maternal outcomes were presented for maternal deaths and maternal near-miss casigurees and compared with that of women without severe maternal outcomes. The health system's maternal and perinatal performance indicators were calculated. RESULTS Overall, 447 women with hypertensive disorders of pregnancy were included in the analyses with a mean maternal age of 32 (±5.8) years and mean gestational age at recruitment of 30.5 (±2.4) weeks. Of these patients, 46 (10%) had gestational hypertension, 338 (76%) had preeclampsia, and 63 (14%) had eclampsia. There were 148 near-miss cases (33.1%) and 12 maternal deaths (2.7%). Severe maternal outcomes constituted complications from severe preeclampsia (80/160 [50%]) and eclampsia (63/160 [39.4%]). Concerning organ dysfunction, hematologic and respiratory dysfunctions constituted 59/160 [38.6%] and 23/160 [14.8%] respectively. Nearly all women had a cesarean delivery (347/447 [84%] and 140/160 [93%] in the severe maternal outcome group) and delivered prematurely (83%, with 178/379 [93%] at <32 weeks of gestation). Stillbirth and neonatal deaths occurred in 63 of 455 women (14%) and 81 of 392 women (19%), respectively, constituting a stillbirth ratio of 161 per 1000 live births and neonatal mortality rate of 207 per 1000 live births as there were 392 live births in this cohort. Overall, the intensive care unit admission rate was 12.7% (n=52/409); moreover, 45 of 52 women (86.5%) admitted to the intensive care unit had severe maternal outcomes. The maternal death ratio was 3100 per 100,000 live births, the maternal near-miss–to–mortality ratio was 12.3, and the mortality index was 8%. CONCLUSION Maternal near miss and maternal and perinatal mortalities were common in women with hypertensive disorders of pregnancy remote from term in referral hospitals in Ghana. Providing appropriate patient-centered and multidisciplinary quality care for these women is crucial in improving pregnancy outcomes. Context-tailored interventions should be considered in the clinical management of complications associated with hypertensive disorders of pregnancy in resource-limited settings. Further research on interventions to improve timely referral and reduce in-hospital delays in care provision is recommended to facilitate emergency care services for women with hypertensive emergencies.
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Affiliation(s)
- Katja C.E. Drechsel
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
| | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana (Dr Adu-Bonsaffoh)
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana (Dr Adu-Bonsaffoh)
- Corresponding author: Kwame Adu-Bonsaffoh, MD.
| | - Klaartje M. Olde Loohuis
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
| | - Emmanuel K. Srofenyoh
- Department of Obstetrics and Gynecology, Greater Accra Regional Hospital, Ghana Health Service, Accra, Ghana (Dr Srofenyoh)
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
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Teka H, Yemane A, Berhe Zelelow Y, Tadesse H, Hagos H. Maternal near-miss and mortality in a teaching hospital in Tigray region, Northern Ethiopia. WOMEN'S HEALTH 2022; 18:17455057221078739. [PMID: 35196926 PMCID: PMC8883400 DOI: 10.1177/17455057221078739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: This study seeks to examine the prevalence of maternal morbidities and deaths in Ayder Comprehensive Specialized Hospital from 1 July 2018 to 30 June 2019. Methods: This was a cross-sectional study. Total purposive sampling method was employed to collect data prospectively using modified World Health Organization criteria for baseline assessment of maternal near-miss and mortality. Pregnant women or those who are within 42 days postpartum/any form of pregnancy termination that satisfy the inclusion criteria were enrolled. Results: A total of 691 mothers were recorded as having severe maternal complications. Out of these, 170 women developed severe maternal outcome, ending with 146 maternal near-miss cases and 24 maternal deaths. The maternal near-miss ratio and maternal mortality ratio were 28.5 per 1000 live births and 469.1 per 100,000 live births, respectively. The overall mortality index was 14%. The top underlying causes of severe maternal complications were the infamous triads of preeclampsia (n = 303, 43.8%), obstetric hemorrhage (n = 166, 24.0%) and sepsis (n = 130, 18.8%). About 62.5% of mothers who died were not admitted to intensive care unit. Conclusion: This study found that the infamous triads of preeclampsia, obstetric hemorrhage and sepsis persist as the commonest causes of severe maternal complications in the study area. A significant number of women with severe maternal outcome were not admitted to intensive care unit. It also highlights that the severe maternal complications, severe maternal outcome, maternal near-miss ratio and mortality index in the study area are disproportionately higher than the global average. These staggering numbers call for a system re-thinking at multiple junctures.
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Affiliation(s)
- Hale Teka
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Awol Yemane
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Habtom Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Hadgay Hagos
- Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Ethiopia
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Zhang S, Qi Y, Xue X, Zhang X, Cao Q, Fang Y, Ge M. A retrospective study of maternal near miss in the Critical Maternal Care Center in Suqian City, Jiangsu Province, China: A single-center study. Health Sci Rep 2021; 4:e407. [PMID: 34693028 PMCID: PMC8516031 DOI: 10.1002/hsr2.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND AIMS Through a retrospective study of maternal near miss (MNM) cases treated by the Suqian Critical Maternal Care Center in Suqian City, Jiangsu Province, we summarized the most common diseases that caused MNM, treatment measures, and short-term prognosis in this region. The purpose of the research is to improve the clinical evidence of maternal health care in the region. METHODS The study is a retrospective descriptive study. Among the pregnant women admitted to the Critical Maternal Care Center from 1 January 2015, to 31 December 2019, the pregnant women with severe pregnancy complications or comorbidities were identified as the research subjects. The study subjects were divided into an MNM group and a control group according to the MNM criteria recommended by the WHO.A retrospective analysis of the study subject data, including causes and clinical manifestations of MNM, treatment measures, and short-term prognosis, was conducted. RESULTS The total number of deliveries was 27 619. There were 145 women in the control group and 65 women in the MNM group. The number of MNM cases accounted for 2.4% (65/27619) of the total number of deliveries. Placenta previa, postpartum hemorrhage, and hypertension accounted for 72.3% (47/65) of the causes of MNM cases observed. In the MNM group, the most common clinical manifestation was bleeding (80.0%, 52/65). Sixty-three patients underwent massive blood transfusion (96.9%, 63/65), and 36 underwent hysterectomy (55.4%,36/65). The prevalence of interventional procedures and unplanned secondary operations in the MNM group was higher than that in the control group. CONCLUSIONS The top three causes of MNM were placenta previa, postpartum hemorrhage, and hypertension in pregnancy in Suqian area. Sufficient blood sources, convenient and fast blood transfusion procedures, and the use of large amounts of blood transfusion technology have an important impact on the success of treatment. Hysterectomy is still the main method of MNM treatment.
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Affiliation(s)
- Shumin Zhang
- Department of Obstetrics and Gynecology, Suqian Hospital of Nanjing Drum Tower Hospital GroupThe Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Critical Maternal Care Center in Suqian CityJiangsu ProvinceChina
| | - Yalan Qi
- Department of Obstetrics and Gynecology, Suqian Hospital of Nanjing Drum Tower Hospital GroupThe Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Critical Maternal Care Center in Suqian CityJiangsu ProvinceChina
| | - Xiumei Xue
- Department of Obstetrics and Gynecology, Suqian Hospital of Nanjing Drum Tower Hospital GroupThe Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Critical Maternal Care Center in Suqian CityJiangsu ProvinceChina
| | - Xiaojing Zhang
- Department of Obstetrics and Gynecology, Suqian Hospital of Nanjing Drum Tower Hospital GroupThe Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Critical Maternal Care Center in Suqian CityJiangsu ProvinceChina
| | - Qingling Cao
- Department of Obstetrics and Gynecology, Suqian Hospital of Nanjing Drum Tower Hospital GroupThe Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Critical Maternal Care Center in Suqian CityJiangsu ProvinceChina
| | - Yuelan Fang
- Department of Obstetrics and Gynecology, Suqian Hospital of Nanjing Drum Tower Hospital GroupThe Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Critical Maternal Care Center in Suqian CityJiangsu ProvinceChina
| | - Mingming Ge
- Department of Obstetrics and Gynecology, Suqian Hospital of Nanjing Drum Tower Hospital GroupThe Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Critical Maternal Care Center in Suqian CityJiangsu ProvinceChina
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Heitkamp A, Meulenbroek A, van Roosmalen J, Gebhardt S, Vollmer L, de Vries JI, Theron G, van den Akker T. Maternal mortality: near-miss events in middle-income countries, a systematic review. Bull World Health Organ 2021; 99:693-707F. [PMID: 34621087 PMCID: PMC8477432 DOI: 10.2471/blt.21.285945] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To describe the incidence and main causes of maternal near-miss events in middle-income countries using the World Health Organization's (WHO) maternal near-miss tool and to evaluate its applicability in these settings. METHODS We did a systematic review of studies on maternal near misses in middle-income countries published over 2009-2020. We extracted data on number of live births, number of maternal near misses, major causes of maternal near miss and most frequent organ dysfunction. We extracted, or calculated, the maternal near-miss ratio, maternal mortality ratio and mortality index. We also noted descriptions of researchers' experiences and modifications of the WHO tool for local use. FINDINGS We included 69 studies from 26 countries (12 lower-middle- and 14 upper-middle-income countries). Studies reported a total of 50 552 maternal near misses out of 10 450 482 live births. Median number of cases of maternal near miss per 1000 live births was 15.9 (interquartile range, IQR: 8.9-34.7) in lower-middle- and 7.8 (IQR: 5.0-9.6) in upper-middle-income countries, with considerable variation between and within countries. The most frequent causes of near miss were obstetric haemorrhage in 19/40 studies in lower-middle-income countries and hypertensive disorders in 15/29 studies in upper-middle-income countries. Around half the studies recommended adaptations to the laboratory and management criteria to avoid underestimation of cases of near miss, as well as clearer guidance to avoid different interpretations of the tool. CONCLUSION In several countries, adaptations of the WHO near-miss tool to the local context were suggested, possibly hampering international comparisons, but facilitating locally relevant audits to learn lessons.
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Affiliation(s)
- Anke Heitkamp
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, Francie Van Zijl Avenue, Cape Town, 7505, South Africa
| | - Anne Meulenbroek
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stefan Gebhardt
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, Francie Van Zijl Avenue, Cape Town, 7505, South Africa
| | - Linda Vollmer
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, Francie Van Zijl Avenue, Cape Town, 7505, South Africa
| | - Johanna I de Vries
- Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gerhard Theron
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, Francie Van Zijl Avenue, Cape Town, 7505, South Africa
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TorkmannejadSabzevari M, Eftekhari Yazdi M, Rad M. Lived experiences of women with maternal near miss: a qualitative research. J Matern Fetal Neonatal Med 2021; 35:7158-7165. [PMID: 34219597 DOI: 10.1080/14767058.2021.1945576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A near-miss experience has long-term and major impacts on mothers and their families. Therefore, evaluating the nature of maternal near-miss (MNM) could shed light on various aspects of the associated complications in women. The present study aimed to determine the lived experiences of women with MNM. METHODS AND MATERIALS This qualitative research was conducted using conventional content analysis on 10 mothers with an MNM experience, who were selected based on the inclusion criteria. Data were collected via semi-structured interviews about the experiences of the mothers during and after the near-miss incident. Data analysis was performed using the conventional content analysis technique. RESULTS Five main categories were extracted, including fears and concerns, failure to accept and adapt, tolerating physical and psychological pain and hardships, death experience, and medical team mismanagement. Regret and fear of raising the child with siblings, fear of the re-marriage of the spouse, and fear of complications and costs were among the subcategories of fears and concerns. Lack of adaptation to the complications and prolonged mourning were the subcategories of failure to accept and adapt, and the subcategories of tolerating physical and psychological pain and hardships were a sense of guilt, tolerating physical pain, hopelessness, irritability, hatred toward the medical team, and postpartum depression. In addition, returning to normal life, and seeing/actually feeling death were the subcategories of the death experience. The subcategories of the medical team mismanagement included medical errors, lack of support/negligence, communication problems, and distrust of the medical center. DISCUSSION According to the results, the mothers were faced with multiple problems, including fears and concerns, failure to adapt to the problem, and numerous physical and psychological issues after an MNM experience. However, they believed that medical errors, the improper communications of the medical team, and their negligence toward patients were among the factors intensifying the complications.
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Affiliation(s)
| | - Mitra Eftekhari Yazdi
- Department of Obstetrics and Gynecology, School of Medicine, Mobini Maternity Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mostafa Rad
- Medical Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Lavender T, Bedwell C, Kasengele CT, Kimaro D, Kuzenza F, Lyangenda K, Mills TA, Nsemwa L, Shayo H, Tuwele K, Wakasiaka S, Laisser R. Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania. BMJ Glob Health 2021; 6:bmjgh-2020-004725. [PMID: 33926891 PMCID: PMC8094336 DOI: 10.1136/bmjgh-2020-004725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Quality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points. Methods We used Strauss and Corbin’s grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia. In-depth interviews were conducted with 98 participants (48 women, 18 partners, 21 health-providers and 11 key stakeholders), resulting in data saturation. Analysis involved constant comparison, comprising three stages of coding: open, axial and selective. The process involved application of memos, reflexivity and positionality. Results Findings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman’s benefit, and were often caring against the odds, in challenging environments. Emergent categories were related to the core category: respectful care, an added extra, which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive. Conclusion Both quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women’s and health-provider voices are pivotal to the development of such interventions.
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Affiliation(s)
- Tina Lavender
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, Liverpool, UK
| | - Carol Bedwell
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, Liverpool, UK
| | | | - Debora Kimaro
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Flora Kuzenza
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Kutemba Lyangenda
- Department of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - Tracey A Mills
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, Liverpool, UK
| | - Livuka Nsemwa
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Happiness Shayo
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Khuzuet Tuwele
- Department of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - Sabina Wakasiaka
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Rose Laisser
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
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12
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Bresnahan BW, Vodicka E, Babigumira JB, Malik AM, Yego F, Lokangaka A, Chitah BM, Bauer Z, Chavez H, Moore JL, Garrison LP, Swanson JO, Swanson D, McClure EM, Goldenberg RL, Esamai F, Garces AL, Chomba E, Saleem S, Tshefu A, Bose CL, Bauserman M, Carlo W, Bucher S, Liechty EA, Nathan RO. Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries. BMC Public Health 2021; 21:952. [PMID: 34016085 PMCID: PMC8135981 DOI: 10.1186/s12889-021-10750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency. METHODS We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and hospital-based (facility) care for pregnant women, in general, with selective complication-related data collection in women participating in a large maternal health registry and clinical trial in five LMICs. We estimated average costs from a facility/health system perspective for outpatient and inpatient services. We converted all country-level currency cost estimates to 2015 United States dollars (USD). We compared average costs across countries for ANC visits, deliveries, higher-risk pregnancies, and complications, and conducted sensitivity analyses. RESULTS Our study included sites in five countries representing different regions. Overall, the relative cost of individual ANC and delivery-related healthcare use was consistent among countries, generally corresponding to country-specific income levels. ANC outpatient visit cost estimates per patient among countries ranged from 15 to 30 USD, based on average counts for visits with and without US. Estimates for antenatal screening US visits were more costly than non-US visits. Costs associated with higher-risk pregnancies were influenced by rates of hospital delivery by cesarean section (mean per person delivery cost estimate range: 25-65 USD). CONCLUSIONS Despite substantial differences among countries in infrastructures and health system capacity, there were similarities in resource allocation, delivery location, and country-level challenges. Overall, there was no clear suggestion that adding antenatal screening US would result in either major cost savings or major cost increases. However, antenatal screening US would have higher training and maintenance costs. Given the lack of clinical effectiveness evidence and greater resource constraints of LMICs, it is unlikely that introducing antenatal screening US would be economically efficient in these settings--on the demand side (i.e., patients) or supply side (i.e., healthcare providers). TRIAL REGISTRATION Trial number: NCT01990625 (First posted: November 21, 2013 on https://clinicaltrials.gov ).
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Affiliation(s)
- B W Bresnahan
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - E Vodicka
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J B Babigumira
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - A M Malik
- Aga Khan University, Karachi, Pakistan
| | - F Yego
- Moi University, Eldoret, Kenya
| | - A Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Z Bauer
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - H Chavez
- University of Francisco Marroquin, Guatemala City, Guatemala
| | | | - L P Garrison
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J O Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - D Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - E Chomba
- University of Zambia, Lusaka, Zambia
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina, Chapel Hill, NC, USA
| | - M Bauserman
- University of North Carolina, Chapel Hill, NC, USA
| | - W Carlo
- University of Alabama Birmingham, Birmingham, AL, USA
| | - S Bucher
- Indiana University, Indianapolis, IN, USA
| | | | - R O Nathan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Habte A, Wondimu M. Determinants of maternal near miss among women admitted to maternity wards of tertiary hospitals in Southern Ethiopia, 2020: A hospital-based case-control study. PLoS One 2021; 16:e0251826. [PMID: 33999941 PMCID: PMC8128231 DOI: 10.1371/journal.pone.0251826] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A maternal near-miss (MNM) refers to when a gravely ill woman survives a complication as a result of the standard of care she receives or by chance during gestation, childbirth, or within 42 days of the termination of pregnancy. Rescuers of near-miss events share several features with mothers who have died and identifying MNM determinants will aid in improving the capacity of the health system to reduce severe maternal morbidity and mortality. Ethiopia is one of the countries in sub-Saharan Africa with high maternal mortality and morbidity, but there is little evidence on determinants of a MNM based on a WHO criteria. Hence, this study aimed at identifying determinants of MNM among women admitted to tertiary hospitals in southern Ethiopia, 2020. METHODS A facilities-based unmatched case-control study was conducted in five selected tertiary hospitals found in central southern Ethiopia from February 1 to June 1, 2020. A total of 322 (81 cases and 241 controls) study participants were included in the study. At the time of their discharge, cases were recruited consecutively, while controls were selected using a systematic sampling method. The cases were women admitted to hospitals during pregnancy, childbirth, or 42 days following termination of pregnancy who met at least one of the WHO near-miss criteria. Whereas the controls comprised of women who were admitted during pregnancy, childbirth, or 42 days following termination of pregnancy and discharged without severe obstetric complications. Data collection was conducted using the interviewer-administered structured questionnaire and data abstraction tool. The data was coded and entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. Multivariable logistic regression analysis was conducted and determinants of MNM were established at p-value<0.05. RESULTS Severe postpartum hemorrhage (50.6%) and sepsis (23.4%) were the most common reasons for admission of cases. Lack of ANC [AOR = 3.25; 95%CI: 2.21,7.69], prior history of Cesarean section [AOR = 3.53; 95%CI:1.79,6.98], delaying more than 60 minute to access final place of care [AOR = 3.21; 95%CI:1.61,6.39], poor practice of Birth preparedness and complication readiness (BPCR) [AOR = 3.31; 95%CI:1.50,7.29], and history of preexisting medical disorders [AOR = 2.79; 95%CI:1.45,5.37] were identified as significantly determinants of maternal near miss. CONCLUSION AND RECOMMENDATION Stakeholders need to enhance their efforts for improving access to roads and transportations. Besides, women who have a prior history of Caesarean section, chronic medical conditions, and no ANC need special attention from their families and health care providers to proactively mitigate the occurrence of serious obstetric complications. More attention has to be paid to birth preparedness and complication readiness activities.
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Affiliation(s)
- Aklilu Habte
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Southern Ethiopia
| | - Merertu Wondimu
- School of Nursing and Midwifery, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Southwest Ethiopia
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Pandya ST, Chakravarthy K, Shah PJ, Trikha A. Obstetric anaesthesia as a career. Indian J Anaesth 2021; 65:43-47. [PMID: 33767502 PMCID: PMC7980249 DOI: 10.4103/ija.ija_1528_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Obstetric anaesthesia is emerging as one of the most demanding subspecialities of anaesthesia. Obstetric anaesthesiologists are now an integral part of the multidisciplinary team managing the high-risk obstetrics. It has been recognised that targeted training in obstetric anaesthesia helps to recognise the mothers who need special care and formulate specific plan for delivery. Among the subspecialties of anaesthesia, obstetric anaesthesia has the potential to get established early. Obstetric anaesthesiologists have the prospect of choosing either a team or an independent practice. Group practice with a multidisciplinary team can mitigate some of the constraints and allows professional fulfilment and enough time for personal, family and societal commitments. Obstetric anaesthesia is a well-paid and sought-after speciality, and a dynamic field that demands excellent clinical and interpretative skills in a rapidly changing environment.
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Affiliation(s)
- Sunil T Pandya
- PACCS Health Care Pvt Ltd., Department of Anaesthesiology and Critical Care, AIG Hospital, Gachibowli, Hyderabad, India.,Department of Anaesthesiology, Pain and Obstetric Critical Care, Fernandez Hospital, Hyderabad, India
| | - Kousalya Chakravarthy
- Department of Anaesthesia, MGMH Petlaburz, Osmania Medical College, Hyderabad, Telangana, India
| | - Pratibha Jain Shah
- Department of Anaesthesia, Pt JNM Medical College, Raipur, Chhattisgarh, India
| | - Anjan Trikha
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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15
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Abstract
Maternal mortality misses the morbidity associated with pregnancy and delivery. Maternal Near Miss is an alternate measure that reflects maternal morbidity and in areas with low maternal mortality improves comparability. Maternal Near Miss is a proxy indicator of the quality of healthcare services and helps in understanding health system failures with relation to obstetric care and addressing them. But regional variations in availability of resources have led to a dozen different adapted versions of WHO Maternal Near Miss criteria. This creates confusion and reduces comparability, nationally and internationally. A review of articles defining maternal near miss was conducted using a PubMed search to compare and assess the various definitions of MNM. The present article summarises the available criteria and discusses the advantages and drawbacks of WHO MNM criteria as compared to others. The objective is to impress the need to have comprehensive criteria that can be applied in different settings and ensure comparability.Impact statementWhat is already known on this subject? Many different definitions and criteria to diagnose Maternal Near Miss are available. They are diverse, thereby reducing comparability both nationally and internationally.What do the results of this study add? This article summarises the differences in the available definitions and classifying criteria. It also highlights the difficulty in usage of the criteria in different settings.What are the implications of these findings for clinical practice and/or further research? This calls for researchers working in areas of maternal health to further simplify the definitions and criteria used for identification of Maternal Near Miss to improve comparability and uniformity.
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Affiliation(s)
- Mohan Kumar M
- All India Institute of Medical Sciences, Raipur, India
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16
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Verschueren KJ, Kodan LR, Paidin RR, Samijadi SM, Paidin RR, Rijken MJ, Browne JL, Bloemenkamp KW. Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname. J Glob Health 2020; 10:020429. [PMID: 33214899 PMCID: PMC7649043 DOI: 10.7189/jogh.10.020429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maternal near-miss (MNM) is an important maternal health quality-of-care indicator. To facilitate comparison between countries, the World Health Organization (WHO) developed the "MNM-tool". However, several low- and middle-income countries have proposed adaptations to prevent underreporting, ie, Namibian and Sub-Sahara African (SSA)-criteria. This study aims to assess MNM and associated factors in middle-income country Suriname by applying the three different MNM tools. METHODS A nationwide prospective population-based cohort study was conducted using the Suriname Obstetric Surveillance System (SurOSS). We included women with MNM-criteria defined by WHO-, Namibian- and SSA-tools during one year (March 2017-February 2018) and used hospital births (86% of total) as a reference group. RESULTS There were 9114 hospital live births in Suriname in the one-year study period. SurOSS identified 71 women with WHO-MNM (8/1000 live births, mortality-index 12%), 118 with Namibian-MNM (13/1000 live births, mortality-index 8%), and 242 with SSA-MNM (27/1000 live births, mortality-index 4%). Namibian- and SSA-tools identified all women with WHO-criteria. Blood transfusion thresholds and eclampsia explained the majority of differences in MNM prevalence. Eclampsia was not considered a WHO-MNM in 80% (n = 35/44) of cases. Nevertheless, mortality-index for MNM with hypertensive disorders was 17% and the most frequent underlying cause of maternal deaths (n = 4/10, 40%) and MNM (n = 24/71, 34%). Women of advanced age and maroon ethnicity had twice the odds of WHO-MNM (respectively adjusted odds ratio (aOR) = 2.6, 95% confidence interval (CI) = 1.4-4.8 and aOR = 2.0, 95% CI = 1.2-3.6). The stillbirths rate among women with WHO-MNM was 193/1000births, with six times higher odds than women without MNM (aOR = 6.8, 95%CI = 3.0-15.8). While the prevalence and mortality-index differ between the three MNM tools, the underlying causes of and factors associated with MNM were comparable. CONCLUSIONS The MNM ratio in Suriname is comparable to other countries in the region. The WHO-tool underestimates the prevalence of MNM (high mortality-index), while the adapted tools may overestimate MNM and compromise global comparability. Contextualized MNM-criteria per obstetric transition stage may improve comparability and reduce underreporting. While MNM studies facilitate international comparison, audit will remain necessary to identify shortfalls in quality-of-care and improve maternal outcomes.
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Affiliation(s)
- Kim Jc Verschueren
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lachmi R Kodan
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Raëz R Paidin
- Department of Obstetrics, Diakonessen Hospital Paramaribo, Paramaribo, Suriname
| | - Sarah M Samijadi
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Rubinah R Paidin
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Marcus J Rijken
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kitty Wm Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Owolabi O, Riley T, Juma K, Mutua M, Pleasure ZH, Amo-Adjei J, Bangha M. Incidence of maternal near-miss in Kenya in 2018: findings from a nationally representative cross-sectional study in 54 referral hospitals. Sci Rep 2020; 10:15181. [PMID: 32939022 PMCID: PMC7495416 DOI: 10.1038/s41598-020-72144-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/26/2020] [Indexed: 02/08/2023] Open
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.
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Affiliation(s)
- Onikepe Owolabi
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA.
| | - Taylor Riley
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
| | - Kenneth Juma
- Population Dynamics, Sexual and Reproductive Health Unit, African Population Health and Research Center, Manga Close, Nairobi, Kenya
| | - Michael Mutua
- Population Dynamics, Sexual and Reproductive Health Unit, African Population Health and Research Center, Manga Close, Nairobi, Kenya
| | - Zoe H Pleasure
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
| | | | - Martin Bangha
- Population Dynamics, Sexual and Reproductive Health Unit, African Population Health and Research Center, Manga Close, Nairobi, Kenya
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García-Tizón Larroca S, Amor Valera F, Ayuso Herrera E, Cueto Hernandez I, Cuñarro Lopez Y, De Leon-Luis J. Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature. BMC Pregnancy Childbirth 2020; 20:224. [PMID: 32299375 PMCID: PMC7164222 DOI: 10.1186/s12884-020-02901-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality. Methods A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used. Results After the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%). Conclusions The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage. Trial registration PROSPERO ID: CRD 42019133464
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Affiliation(s)
- Santiago García-Tizón Larroca
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.
| | - Francisco Amor Valera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Esther Ayuso Herrera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Ignacio Cueto Hernandez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Yolanda Cuñarro Lopez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Juan De Leon-Luis
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.,Department of Public and Maternal-Infant Health, Complutense University, Madrid, Spain
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Oliveira TDC, Lucena TSD, Silva JMDOE, Nagliate PDC, Veríssimo RCSS, Sales MLDH. Adverse outcomes of childbirth in high-risk maternity hospitals. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract Objectives: to analyze adverse outcomes in teaching maternity hospitals in Maceió, Alagoas, Brazil. Methods: a cross-sectional, retrospective and analytical study was carried out with a random sample of 480 medical records of postpartum women in 2016 using the Adverse Outcome Index: in-hospital maternal death, neonatal in-hospital death> 2500g and> 37 weeks, uterine rupture, unplanned maternal admission to intensive care unit, delivery trauma to the newborn, return to the operating room, admission to an intensive neonatal unit with >2500g and > 37 weeks for more than one day, Apgar <7 at the fifth minute, maternal hemotransfusion and fourth-degree perineal laceration. The data were analyzed using the Statistical Package for Social Sciences software version 22.0. Results: the results showed a 21% rate of adverse outcomes, at a rate of 26.4 for every 1,000 births, with a greater occurrence of neonatal intensive care admission with>2500g and>37 weeks for more than one day (52. 5%), maternal blood transfusion (20.8%) and unplanned maternal admission in intensive care (17.8%). Conclusions: the evaluation of adverse outcomes evidenced a high proportion of births with undesirable results, which allowed the analysis of the outlook of unfavorable outcomes related to safety in maternity wards through the use of indicators.
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Turi E, Fekadu G, Taye B, Kejela G, Desalegn M, Mosisa G, Etafa W, Tsegaye R, Simegnew D, Tilahun T. The impact of antenatal care on maternal near-miss events in Ethiopia: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abdollahpour S, Heidarian Miri H, Khadivzadeh T. The global prevalence of maternal near miss: a systematic review and meta-analysis. Health Promot Perspect 2019; 9:255-262. [PMID: 31777704 PMCID: PMC6875559 DOI: 10.15171/hpp.2019.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Sedigheh Abdollahpour
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Mengistu TS, Turner J, Flatley C, Fox J, Kumar S. Impact of severe maternal morbidity on adverse perinatal outcomes in high-income countries: systematic review and meta-analysis protocol. BMJ Open 2019; 9:e027100. [PMID: 31213449 PMCID: PMC6588984 DOI: 10.1136/bmjopen-2018-027100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Severe maternal morbidity (SMM) includes conditions that are on a continuum of maternal morbidity to maternal death. Rates of SMM are increasing both in high-income countries (HICs) as well as in low/middle-income countries (LMICs). There is evidence that analysis of SMM trends and detailed investigation of factors implicated in these cases may reflect the standard of maternal healthcare both in HICs and LMICs. SMM is also associated with poorer perinatal outcomes. The aim of this protocol is to describe the proposed methodology for the synthesis and analyses of the data describing the relationship between SMM and adverse perinatal outcomes in a systematic review and meta-analysis. METHODS This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will be registered with the International Prospective Register of Systematic Reviews (PROSPERO). Original peer-reviewed epidemiologic/clinical studies of observational (cross-sectional, cohort, case-control) and randomised controlled trial studies conducted in high-income countries will be included. An electronic search of PubMed, Embase, CINAHL and Scopus databases will be performed without restricting publication date/year. Two authors will independently screen the titles, review abstracts and perform data extraction. Where possible, meta-analyses will be done to calculate pooled estimates. ETHICS AND DISSEMINATION As this is a protocol for systematic review and meta-analysis of published data, ethics review and approval are not required. The findings will be published in peer-reviewed journals and disseminated at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42019130933.
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Affiliation(s)
- Tesfaye S Mengistu
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - Jessica Turner
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - Jane Fox
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
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Vogel JP, Fawole B, Adeniran AS, Adegbola O, Oladapo OT. The burden of severe maternal outcomes and indicators of quality of maternal care in Nigerian hospitals: a secondary analysis comparing two large facility-based surveys. BJOG 2019; 126 Suppl 3:49-57. [PMID: 31090183 DOI: 10.1111/1471-0528.15698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare severe maternal outcomes (SMOs) from two multi-centre surveys in Nigerian hospitals, and to evaluate how the SMO burden affects quality of secondary and tertiary hospital care. DESIGN Two facility-based surveys of women experiencing SMO (maternal near-miss or maternal deaths). SETTING Sixteen secondary and five tertiary facilities in Nigeria [WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS)] and 42 public tertiary facilities in Nigeria (Nigeria Near-Miss and Maternal Death Survey). POPULATION 371 women in WHOMCS-Nigeria and 2449 women in Nigeria Near-Miss and Maternal Death Survey who experienced SMO. METHODS Secondary analysis and comparison of SMO data from two surveys, stratified by facility level. MAIN OUTCOME MEASURES Maternal mortality ratio (MMR) per 100 000 livebirths (LB), maternal near-miss (MNM) ratio per 1000 LB, SMO ratio per 1000 LB and mortality index (deaths/SMO). RESULTS Maternal mortality ratio and mortality indices were highest in tertiary facilities of the WHOMCS-Nigeria (706 per 100 000; 26.7%) and the Nigeria Near-Miss and Maternal Death Survey (1088 per 100 000; 40.8%), and lower in secondary facilities of the WHOMCS-Nigeria (593 per 100 000; 17.9%). The MNM ratio and SMO ratio were highest in secondary WHOMCS-Nigeria facilities (27.2 per 1000 LB; 33.1 per 1000 LB). CONCLUSIONS Tertiary-level facilities in Nigeria experience unacceptably high maternal mortality rates, but secondary-level facilities had a proportionately higher burden of severe maternal outcomes. Common conditions with a high mortality index (postpartum haemorrhage, eclampsia, and infectious morbidities) should be prioritised for action. Surveillance using SMO indicators can guide quality improvement efforts and assess changes over time. TWEETABLE ABSTRACT 2820 Nigerian women with severe maternal outcomes: high mortality in tertiary level hospitals, higher burden in secondary level.
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Affiliation(s)
- J P Vogel
- Maternal and Child Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - B Fawole
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A S Adeniran
- Department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - O Adegbola
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Pandit R, Jain V, Bagga R, Sikka P, Jain K. Applicability of WHO Maternal Severity Score (MSS) and Maternal Severity Index (MSI) Model to predict the maternal outcome in near miss obstetric patients: a prospective observational study. Arch Gynecol Obstet 2019; 300:49-57. [PMID: 30976972 DOI: 10.1007/s00404-019-05159-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/06/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the applicability of WHO Maternal Severity Score (MSS) and Maternal Severity Index (MSI) Model in near miss (NM) obstetric patients METHODS: It was a prospective observational study conducted at a tertiary health care center from July 2015 to Feb 2016. All patients fulfilling one or more WHO NM criteria were included. MSS and MSI were calculated for all NM patients on admission. They were then followed up till the final outcome (NM or death). Each NM parameter, system-wise MSS, total MSS and MSI were then associated with the final outcome. RESULTS Of 4822 patients, 1739 had potentially life-threatening conditions of which 174 were identified as NM. The average MSS and MSI of patients who remained NM was 4.41 and 11.67%, respectively, and those who died was 9.47 and 58.16%, respectively. Both were found to be significantly associated with the outcome (p < 0.001). MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC - 0.838 [95% CI 0.766-0.910]). However, of 25 NM criteria, only 17 NM criteria and 3 system dysfunctions (cardiovascular, respiratory and neurological) were found to associate significantly with the outcome. CONCLUSION MSS and MSI act as good prognostic tools to assess the severity of maternal complications and estimate the probability of death in NM patients. As all NM parameters are not equally predictive of severity of maternal morbidity, different scores per NM parameter and system should be assigned while calculating MSS for better prognostication.
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Affiliation(s)
- Rubina Pandit
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160011, India.
- Department of Reproductive Medicine, Cloudnine Hospital, Bangalore, India.
| | - Vanita Jain
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160011, India
| | - Rashmi Bagga
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160011, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160011, India
| | - Kajal Jain
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Severe Maternal or Near Miss Morbidity: Implications for Public Health Surveillance and Clinical Audit. Clin Obstet Gynecol 2019; 61:307-318. [PMID: 29642083 DOI: 10.1097/grf.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This chapter reviews the historical development of indicators to identify severe maternal morbidity/maternal near miss (SMM/MNM), and their use for public health surveillance, research, and clinical audit. While there has been progress toward identifying standard definitions for SMM/MNM within countries, there remain inconsistencies in the definition of SMM/MNM indicators and their application between countries. Using these indicators to screen for events that then trigger a clinical audit may both under identify select SMM/MNM (false negative)and over identify select SMM/MNM (false positive). Thus, indicators which support the efficient identification of SMM/MNM for the purpose of facility-based clinical audits are still needed.
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Kasahun AW, Wako WG. Predictors of maternal near miss among women admitted in Gurage zone hospitals, South Ethiopia, 2017: a case control study. BMC Pregnancy Childbirth 2018; 18:260. [PMID: 29940889 PMCID: PMC6019215 DOI: 10.1186/s12884-018-1903-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/18/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Maternal mortality and morbidity remain unacceptably high in developing countries. Behind every maternal death, many other women suffered from acute and chronic obstetric complications. Women who survive severe acute maternal morbidities/near miss have many characteristics in common with maternal death events particularly on risk factors. Ethiopia is among countries with high maternal mortality and morbidities in sub-Saharan Africa. However there is scarce evidence on risk factors of severe acute maternal morbidities in Ethiopia. Therefore this study aimed to identify predictors of maternal near miss among women admitted in Gurage zone hospitals, south Ethiopia, 2017. METHODS Hospital based case control study was conducted to assess predictors of maternal near miss among women admitted in five hospitals of Gurage zone, South Ethiopia. Data of 229 (77 cases and 152 controls) women were included in the analysis. Cases were women admitted due to severe acute maternal morbidity while controls were women admitted for normal labor or women admitted due to mild to moderate obstetric complications. Cases were identified by validated-disease specific criteria. Then, two controls were selected for each verified case using lottery method among eligible women. Data were collected using interviewer administered questionnaire and reviewing patients' records. Data were entered using Epi Info 7 and analyzed by SPSS 21. Multivariable logistic regression analysis was done to identify independent predictors of maternal near miss. RESULT Majority of cases were admitted due to dystocia (57.1%) and obstetric hemorrhage (26%). The median first delay (delay to seek health care) among cases and controls was six and 4 h respectively. Prior history of cesarean section {AOR 7.68, 95%CI, 3.11-18.96}, first delay {AOR 2.79, 95%CI, 1.42-5.50}, and being referred from other health facilities {AOR 7.47, 95% CI, 2.27-24.51} were independent predictors of maternal near miss. CONCLUSIONS Prior history of cesarean section, being referred from other health facilities and first delay were factors associated with maternal near miss. Timely health care seeking behavior of women is uncommon in the study area. Therefore primary health care programs need to enhance the existing efforts to improve timely health care seeking behavior of women.
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Affiliation(s)
- Abebaw Wasie Kasahun
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Wako Golicha Wako
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
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Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health 2018; 15:98. [PMID: 29945657 PMCID: PMC6019990 DOI: 10.1186/s12978-018-0527-2] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs). SEVERE MATERNAL MORBIDITY IN HIGH-INCOME COUNTRIES Since the WHO recommended that HICs with low maternal mortality ratios begin to examine SMM to identify systems failures and intervention priorities, researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders. Of the countries that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify "high risk" status, delays in diagnosis, and delays in treatment. SEVERE MATERNAL MORBIDITY IN LOW AND MIDDLE INCOME COUNTRIES The highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. Case reviews are rare, but have revealed patterns of substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity. EFFECTS OF SMM ON DELIVERY OUTCOMES AND INFANTS Severe maternal morbidity not only puts the woman's life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Adverse delivery outcomes occur at a higher frequency among women with SMM. Reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn. CONCLUSION Increasing global maternal morbidity is a failure to achieve broad public health goals of improved women's and infants' health. It is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability.
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Affiliation(s)
- Stacie E. Geller
- Departments of Obstetrics & Gynecology and Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL USA
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Abigail R. Koch
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Caitlin E. Garland
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - E. Jane MacDonald
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Francesca Storey
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Beverley Lawton
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
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