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WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss).

ABSTRACT: AIM: To determine the prevalence of severe acute maternal morbidity (SAMM) worldwide (near miss). METHOD: Systematic review of all available data. The methodology followed a pre-defined protocol, an extensive search strategy of 10 electronic databases as well as other sources. Articles were evaluated according to specified inclusion criteria. Data were extracted using data extraction instrument which collects additional information on the quality of reporting including definitions and identification of cases. Data were entered into a specially constructed database and tabulated using SAS statistical management and analysis software. RESULTS: A total of 30 studies are included in the systematic review. Designs are mainly cross-sectional and 24 were conducted in hospital settings, mostly teaching hospitals. Fourteen studies report on a defined SAMM condition while the remainder use a response to an event such as admission to intensive care unit as a proxy for SAMM. Criteria for identification of cases vary widely across studies. Prevalences vary between 0.80% - 8.23% in studies that use disease-specific criteria while the range is 0.38% - 1.09% in the group that use organ-system based criteria and included unselected group of women. Rates are within the range of 0.01% and 2.99% in studies using management-based criteria. It is not possible to pool data together to provide summary estimates or comparisons between different settings due to variations in case-identification criteria. Nevertheless, there seems to be an inverse trend in prevalence with development status of a country. CONCLUSION: There is a clear need to set uniform criteria to classify patients as SAMM. This standardisation could be made for similar settings separately. An organ-system dysfunction/failure approach is the most epidemiologically sound as it is least open to bias, and thus could permit developing summary estimates.

SUBMITTER: Say L

PROVIDER: S-EPMC516581 | biostudies-literature | 2004 Aug

REPOSITORIES: biostudies-literature

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WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss).

Say Lale L Pattinson Robert C RC Gülmezoglu A Metin AM

Reproductive health 20040817 1

AIM: To determine the prevalence of severe acute maternal morbidity (SAMM) worldwide (near miss). METHOD: Systematic review of all available data. The methodology followed a pre-defined protocol, an extensive search strategy of 10 electronic databases as well as other sources. Articles were evaluated according to specified inclusion criteria. Data were extracted using data extraction instrument which collects additional information on the quality of reporting including definitions and identifica ...[more]

PMID: 15357863

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Project description:There is international interest in monitoring severe events in the obstetrical population, commonly referred to as maternal near miss or severe maternal morbidity. These events can have significant consequences for individuals in this population and further study can inform practices to reduce both maternal morbidity and mortality. Numerous surveillance systems exist but we lack a standardized approach. Given the current inconsistencies and the importance in monitoring these events, this study aimed to identify and compare commonly used surveillance methods. In June 2018, we systematically searched MEDLINE, EMBASE, and CINAHL using terms related to monitoring/surveillance and maternal near miss/severe maternal morbidity. We included papers that used at least three indicators to monitor for these events and collected data on specific surveillance methods. We calculated the rate of maternal near miss/severe maternal morbidity in hospitalization data obtained from the 2016 US National Inpatient Sample using five common surveillance methods. Of 18,832 abstracts, 178 papers were included in our review. 198 indicators were used in studies included in our review; 71.2% (n = 141) of these were used in <10% of included studies and only 6.1% (n = 12) were used in >50% of studies included in our review. Eclampsia was the only indicator that was assessed in >80% of included studies. The rate of these events in American hospitalization data varied depending on the criteria used, ranging from 5.07% (95% CI = 5.02, 5.11) with the Centers for Disease Control criteria and 7.85% (95% CI = 7.79, 7.91) using the Canadian Perinatal Surveillance System. Our review highlights inconsistencies in monitoring practices within and between developed and developing countries. Given the wide variation in monitoring approaches observed and the likely contributing factors for these differences, it may be more feasible for clinical and academic efforts to focus on standardizing approaches in developed and developing countries independently at this time. PROSPERO Registration: CRD42018096858.

Project description:BackgroundThis study investigates the frequency of near-miss events and compares correlates in the world's newest nation.MethodsA cross-sectional study was carried out to audit near-miss events and their causes. A total of 1,041 mothers were sampled. Data were gathered using World Health Organization near-miss evaluation tools according to morbidity and organ failure-based criteria. Intensive care unit admission criteria were not used (as there is no functional intensive care unit in Juba Teaching Hospital). Descriptive statistics and bivariate and multivariable logistic regression were used to analyze the data. The study adhered to the Declaration of Helsinki.ResultsNearly half (49.7%) of the clients were young pregnant women (aged 15-24 years), with a mean age of 25.07±5.65 years. During the study period, there were 994 deliveries, 94 near-misses, and 10 maternal deaths. This resulted in maternal near-miss and mortality rates of 94.1 per 1,000 and 1,007 per 100,000 live births, respectively. Severe maternal outcome and maternal near-miss rates were 10.47 per 1,000 (morbidity-based criteria) and 41.3 per 1,000 (organ failure-based criteria), respectively. The likelihood of mortality was 25% (95% CI 10%-51%) for a ruptured uterus, 9% (95% CI 4%-17%) for severe postpartum hemorrhage, and 11% (95% CI 3%-30%) for eclampsia. Anemia, hemorrhage, and dystocia were the highest contributory factors in the occurrence of maternal near-misses.ConclusionThe near-miss rate was high. Contributing factors were lack of resources, low quality of primary health care, and delays in care. All near-misses should be regarded as opportunities to improve the quality of maternity care. Health institutes should address delays in conducting interventions, referral barriers, and personnel gaps. Fully functional intensive-care units must be created in all facilities, including Juba Teaching Hospital and other hospitals. Notification policies for all near-miss cases should be in place in all health care units, with a "no shame, no blame" approach.

Project description:ImportanceSevere maternal morbidity is defined by potentially life-threatening conditions. The association between the number of severe maternal morbidity (SMM) indicators and maternal death is not known.ObjectiveTo quantify the association between the number of SMM indicators and maternal mortality.Design, setting, and participantsThis population-based cohort study used provincial databases for data on all live birth and stillbirth hospital deliveries among women in Ontario, Canada, from April 1, 2002, to February 18, 2017. Excluded from this cohort were those with invalid identification number, non-Ontario residency, maternal age younger than 10 years or older than 55 years or unknown, or gestational age fewer than 20 weeks or unknown as well as any out-of-hospital births, ectopic pregnancies, or spontaneous or induced abortions.ExposuresNumber of SMM indicators identified between 20 weeks' gestation and 42 days after the index delivery.Main outcomes and measuresMaternal death occurring from delivery to 42 days after the index delivery.ResultsOf the 1?953?943 total births among 1?211?396 women, 181 maternal deaths occurred within 42 days after birth, a rate of 9.3 per 100?000 births. Of the 181 women who died, 123 (68.0%) had at least 1 SMM indicator compared with 1.7% (33?152) of women who survived. Standardized differences suggested that women who died, compared with the women who lived, were older (mean [SD] age, 31.0 [6.2] years vs 30.1 [5.5] years; standardized difference, 0.15) and more likely to reside in a lower-income area (99 [54.7%] vs 832?231 [42.6%]; standardized difference, 0.24), be nulliparous (93 [51.4%] vs 880?386 [45.1%]; standardized difference, 0.13), and be of Afro-Caribbean origin (12 [6.6%] vs 64?948 [3.3%]; standardized difference, 0.15). The most frequent SMM indicators were intensive care unit admission (81 [44.8%]), invasive ventilation (77 [42.5%]), cardiac conditions (69 [38.1%]), complications of obstetric surgery or procedures (32 [17.7%]), and postpartum hemorrhage with blood transfusion (31 [17.1%]). The rate of maternal mortality increased exponentially with the number of SMM indicators: 0 indicators (3.0 per 100?000 births), 1 (71.7 per 100?000 births), 2 (385.9 per 100?000 births), 3 (1274.2 per 100?000 births), 4 (2236.8 per 100?000 births), 5 (4285.7 per 100?000 births), and 6 or more (9422.5 per 100?000 births). Adjusted relative risks for maternal death ranged from 20.1 (95% CI, 11.6-34.7) with 1 SMM indicator to 2192.0 (95% CI, 1287.0-3735.0) with 6 or more SMM indicators compared with 0 indicators.Conclusions and relevanceMaternal death may be associated with the number of SMM indicators and occur in certain identifiable groups of women; targeting preventable SMM indicators or limiting their progression may reduce the number of maternal deaths.

Project description:BackgroundNeonatal near miss (NNM) applies to cases where newborns almost died during the first 28 d of life but survived life-threatening conditions following birth. The most vulnerable time for infant survival is the neonatal stage, corresponding to almost 50% of deaths occurring at <5 y of age. No study indicates the overall pooled prevalence of NNM in Africa. Thus this review aimed to estimate the overall pooled prevalence of NNMs in Africa.MethodsArticles were retrieved through a comprehensive search strategy using PubMed/MEDLINE, Embase, Health InterNetwork Access to Research Initiative, Cochrane Library and Google Search. Data extraction was done independently by all authors. Forest plots and tables were used to represent the original data. The statistical heterogeneity was evaluated using I2 statistics. There was heterogeneity between the included articles. Therefore the authors used a meta-analysis of random effects to estimate the aggregate pooled prevalence of NNM in Africa. Funnel plot and Egger regression test methods were used to assess possible publication bias. R software version 3.5.3 and R studio version 1.2.5003 were used to analyse the data. The guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to publish this article. The review was registered on the International Prospective Register of Systematic Reviews (registration ID: CRD42021290223).ResultsThrough an exhaustive search, we found 835 articles. However, we considered only eight full-text articles to be included in this meta-analysis. The analysis of included studies showed that the overall pooled prevalence of NNM in Africa was 30% (95% confidence interval [CI] 16 to 44). The subgroup analysis by study year showed that the prevalence of NNM from 2012-2015 and 2018-2019 was 36% (95% CI 23 to 49) and 20% (95% CI 1 to 39), respectively.ConclusionThis finding suggests that the pooled prevalence of NNM is high in Africa as compared with other studies. Therefore the government and other stakeholders working on maternal and child health should assist in the design of interventions and strategies for improving the quality of neonatal care.

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WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss).

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WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss).

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