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Rojas-Suarez J, Santacruz J, Pajaro Y, Maza F, de Mucio B, Sosa C, Serruya S, Pérez M, Contreras S, Annicchiarico W, Dueñas Castell C, Salcedo F, Méndez RR, Escobar-Vidarte M, López C, Lavalle O, Mendoza W, Ochoa C, Moreno A, Saint-Hillaire E, Castro R, Gómez H, Peña E, Urroz L, Quintela V, Colomar M, Paternina A. Development of a new definition of maternal near miss based on organ dysfunction in Latin America and the Caribbean: A prospective multicenter cohort study. Int J Gynaecol Obstet 2024. [PMID: 39096017 DOI: 10.1002/ijgo.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/06/2024] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND There has been debate over whether the existing World Health Organization (WHO) criteria accurately represent the severity of maternal near misses. OBJECTIVE This study assessed the diagnostic accuracy of two WHO clinical and laboratory organ dysfunction markers for determining the best cutoff values in a Latin American setting. METHODS A prospective multicenter cohort study was conducted in five Latin American countries. Patients with severe maternal complications were followed up from admission to discharge. Organ dysfunction was determined using clinical and laboratory data, and participants were classified according to severe maternal outcomes. This study compares the diagnostic criteria of Latin American Centre for Perinatology, Network for Adverse Maternal Outcomes (CLAP/NAMO) to WHO standards. RESULTS Of the 698 women studied, 15.2% had severe maternal outcomes. Most measured variables showed significant differences between individuals with and without severe outcomes (all P-values <0.05). Alternative cutoff values suggested by CLAP/NAMOs include pH ≤7.40, lactate ≥2.3 mmol/L, respiratory rate ≥ 24 bpm, oxygen saturation ≤ 96%, PaO2/FiO2 ≤ 342 mmHg, platelet count ≤189 × 109 × mm3, serum creatinine ≥0.8 mg/dL, and total bilirubin ≥0.67 mg/dL. No significant differences were found when comparing the diagnostic performance of the CLAP/NAMO criteria to that of the WHO standards. CONCLUSION The CLAP/NAMO values were comparable to the WHO maternal near-miss criteria, indicating that the WHO standards might not be superior in this population. These findings suggest that maternal near-miss thresholds can be adapted regionally, improving the identification and management of severe maternal complications in Latin America.
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Affiliation(s)
- Jose Rojas-Suarez
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
- Departamento Medico, Corporación Universitaria Rafael Núñez, Cartagena, Colombia
| | - Jose Santacruz
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
- Universidad de los Andes, Bogotá, Colombia
| | - Yasaira Pajaro
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Fabian Maza
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Bremen de Mucio
- Latin American Center for Perinatology/Women Reproductive Health Unit, Panamerican Health Organization, Montevideo, Uruguay
| | - Claudio Sosa
- Latin American Center for Perinatology/Women Reproductive Health Unit, Panamerican Health Organization, Montevideo, Uruguay
| | - Suzanne Serruya
- Latin American Center for Perinatology/Women Reproductive Health Unit, Panamerican Health Organization, Montevideo, Uruguay
| | - Mario Pérez
- Hospital Pereira Rossell, Montevideo, Uruguay
| | - Sandra Contreras
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Walter Annicchiarico
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
- Clínica de Maternidad Rafael Calvo de Cartagena, Cartagena, Colombia
| | - Carmelo Dueñas Castell
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Francisco Salcedo
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
- Clínica de Maternidad Rafael Calvo de Cartagena, Cartagena, Colombia
| | - Rogelio Rafael Méndez
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, Colombia
- Clínica de Maternidad Rafael Calvo de Cartagena, Cartagena, Colombia
| | | | - Carlos López
- Hospital Divina Misericordia, Magangué, Colombia
| | - Oscar Lavalle
- Clínica Santacruz de Bocagrande, Cartagena, Colombia
| | | | | | - Amanda Moreno
- Hospital Materno Infantil Boliviano-Japonés, Trinidad, Bolivia
| | | | | | | | | | - Lucia Urroz
- Hospital Pereira Rossell, Montevideo, Uruguay
| | | | - Mercedes Colomar
- Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay
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Verma A, Choudhary R, Chaudhary R, Kashyap M. Maternal Near-Miss and Maternal Mortality in a Tertiary Care Center of Western Uttar Pradesh: A Retrospective Study. Cureus 2023; 15:e42697. [PMID: 37654928 PMCID: PMC10465351 DOI: 10.7759/cureus.42697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Maternal mortality is an important indicator to assess the quality of services provided by the health care system. However, maternal near-misses as well as maternal mortality are also indicators of how well the health care system serves pregnant women. To improve our healthcare system in terms of investigative capacity, infrastructure, and personnel, a near-miss registry can provide important information on gaps in pregnancy facilities. This will help us to identify the requirements for referral facility improvements and the need for various health awareness programs. We, therefore, designed this study to analyze the various near-miss events in mothers and compare them with maternal mortality. METHODS Present study was conducted in the Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (L.L.R.M.) Medical College associated with Sardar Vallabh Bhai Patel (S.V.B.P.) Hospital Meerut, Uttar Pradesh (UP), India for a period of one year and data were collected retrospectively from January 2022 to January 2023. All patients with life-threatening conditions such as excessive bleeding during pregnancy, hypertensive disorders of pregnancy (HDP), and septicemia that occurred during pregnancy or childbirth or within 42 days of termination of pregnancy and required ICU admissions, were included in the study. The total number of deliveries during the study period was 4,360 with 4,333 live births (LB). The total number of eligible cases was 79, out of which 52 were identified as maternal near misses and 27 were maternal mortality. Various maternal mortality and near-miss indices were analysed and statistical analysis was done using the SPSS version 21 (IBM Corp., Armonk, NY, USA). RESULTS Our hospital's maternal mortality ratio (MMR) was 623/1lakh (0.623%), which is higher than the probability due to the deficiency of appropriate medical services in the nearby areas of western UP. The number of maternal near misses per 1000 LB (maternal near-miss ratio [MNMR]) was 12/1000 LB and the severe maternal outcome rate (SMOR) was 18/1000 LB (1.82%). In our study, hemorrhage and hypertensive disorder in pregnancy were the leading cause of morbidity and mortality followed by sepsis and severe anemia. Among organ dysfunction cardiac illness followed by respiratory dysfunction was the leading cause of morbidity and mortality. CONCLUSION It is clear that there is a high burden of maternal near-miss in developing countries. There should be the establishment of well-equipped referral units at the periphery with trained manpower. The establishment of obstetrical high-dependence units (HDUs), rapid availability of blood and blood products, training of staff, and availability of multidisciplinary teams can minimize maternal mortality and morbidity.
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Affiliation(s)
- Aruna Verma
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Renu Choudhary
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Rachna Chaudhary
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Monika Kashyap
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
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Egal JA, Kiruja J, Litorp H, Osman F, Erlandsson K, Klingberg‐Allvin M. Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria: A prospective cross-sectional study in a national referral hospital. Int J Gynaecol Obstet 2022; 159:856-864. [PMID: 35490394 PMCID: PMC9790269 DOI: 10.1002/ijgo.14236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/21/2022] [Accepted: 04/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland. METHODS A prospective cross-sectional study was conducted from April 15, 2019 to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data were collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions, and ratios. RESULTS The MNM ratios were 56 (SSA criteria) and 13 (WHO criteria) per 1000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric hemorrhage (13%), pregnancy-related infection (10%), and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum hemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after 3 h. CONCLUSION There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for healthcare providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.
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Affiliation(s)
- Jama Ali Egal
- College of Medicine and Health ScienceUniversity of HargeisaHargeisaSomaliland,Institution of Health and WelfareDalarna UniversityDalarnaSweden
| | - Jonah Kiruja
- College of Medicine and Health ScienceUniversity of HargeisaHargeisaSomaliland,Institution of Health and WelfareDalarna UniversityDalarnaSweden
| | - Helena Litorp
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden,Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Fatumo Osman
- Institution of Health and WelfareDalarna UniversityDalarnaSweden,Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
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Jikamo B, Adefris M, Azale T, Alemu K. The effect of preeclampsia on adverse maternal outcomes in Sidama region, Ethiopia: a prospective open cohort study. Sci Rep 2022; 12:19300. [PMID: 36369533 PMCID: PMC9652349 DOI: 10.1038/s41598-022-24034-7] [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: 06/23/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Ethiopia has made improvements in the reduction of maternal mortality; the high burden of preeclampsia remains a concern in the Sidama region. This study aimed to measure the effect of preeclampsia on adverse maternal outcomes and identify risk factors among women with preeclampsia in Sidama region. A prospective open cohort study was conducted from August 8, 2019, to October 1, 2020. We enrolled a total of 1015 the pregnant women who had preeclampsia and normotensive women at ≥ 20 weeks of gestation and followed them until 42 days after delivery. A log-binomial logistic regression model was used to estimate the incidence of adverse maternal outcomes and its risk factors. There were 276 adverse maternal outcomes observed in the preeclampsia group compared to 154 adverse maternal outcomes in the normotensive group (P < 0.001). Women with severe features of preeclampsia had a 43% (aRR = 1.43, 95% CI 1.3-1.58) higher risk for adverse maternal outcomes compared to women without severe features of preeclampsia. Women without severe features of preeclampsia had a 39% (aRR = 1.39, 95% CI 1.2-1.76) higher risk for adverse maternal outcomes compared to women in the normotensive group. More adverse maternal outcomes occurred among women with preeclampsia after controlling for confounders.
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Affiliation(s)
- Birhanu Jikamo
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.192268.60000 0000 8953 2273Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations Ethiopia
| | - Mulat Adefris
- grid.59547.3a0000 0000 8539 4635Department of Gynecology and Obstetrics Gondar University Hospital, School of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- grid.59547.3a0000 0000 8539 4635Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Gomes F, Ashorn P, Askari S, Belizan JM, Boy E, Cormick G, Dickin KL, Driller‐Colangelo AR, Fawzi W, Hofmeyr GJ, Humphrey J, Khadilkar A, Mandlik R, Neufeld LM, Palacios C, Roth DE, Shlisky J, Sudfeld CR, Weaver C, Bourassa MW. Calcium supplementation for the prevention of hypertensive disorders of pregnancy: current evidence and programmatic considerations. Ann N Y Acad Sci 2022; 1510:52-67. [PMID: 35000200 PMCID: PMC9306576 DOI: 10.1111/nyas.14733] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/27/2021] [Accepted: 11/14/2021] [Indexed: 12/13/2022]
Abstract
Most low‐ and middle‐income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500‐mg doses/day). WHO recommends 1.5–2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low‐dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost‐effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron‐containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food‐based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.
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Affiliation(s)
- Filomena Gomes
- Nutrition Science Program New York Academy of Sciences New York City New York
- NOVA Medical School Universidade NOVA de Lisboa Lisboa Portugal
| | - Per Ashorn
- Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
| | | | - Jose M. Belizan
- Institute for Clinical Effectiveness and Health Policy/CONICET Buenos Aires Argentina
| | - Erick Boy
- International Food Policy Research Institute Washington District of Columbia
| | - Gabriela Cormick
- Institute for Clinical Effectiveness and Health Policy/CONICET Buenos Aires Argentina
| | | | | | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health Boston Massachusetts
| | - G. Justus Hofmeyr
- University of Botswana Gaborone Botswana
- University of the Witwatersrand and Walter Sisulu University Mthatha South Africa
| | - Jean Humphrey
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland
| | | | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute Pune India
| | | | | | - Daniel E. Roth
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Julie Shlisky
- Nutrition Science Program New York Academy of Sciences New York City New York
| | | | | | - Megan W. Bourassa
- Nutrition Science Program New York Academy of Sciences New York City New York
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Tura AK, Aboul-Ela Y, Fage SG, Ahmed SS, Scherjon S, van Roosmalen J, Stekelenburg J, Zwart J, van den Akker T. Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9281. [PMID: 33322495 PMCID: PMC7764538 DOI: 10.3390/ijerph17249281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/10/2023]
Abstract
With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235 Harar, Ethiopia;
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Yasmin Aboul-Ela
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235 Harar, Ethiopia;
| | - Semir Sultan Ahmed
- Department of Obstetrics and Gynaecology, Hiwot Fana Specialized University Hospital, P.O. Box 235 Harar, Ethiopia;
| | - Sicco Scherjon
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
- Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, 9700 AD Groningen, The Netherlands;
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, 7416 SE Deventer, The Netherlands;
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
- Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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