Factors associated with maternal mortality among patients meeting criteria of severe maternal morbidity and near miss

Lima, Hesly Martins Pereira; Carvalho, Francisco Herlânio Costa; Feitosa, Francisco Edson Lucena; Nunes, George C.

doi:10.1002/ijgo.12077

Cited by 15 publications

(16 citation statements)

References 23 publications

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“…It is important to point out that most studies work with the number of births in the denominator of the maternal morbidity ratio, whereas the WHO recommends using LBs, as we have done in our study. The mortality ratio in the maternal near miss cases was of 18%, which is compatible with what is found in the literature 11,[19][20][21][22] for countries with low and medium socioeconomic levels. It is necessary to develop a public policy to protect maternal and child health throughout all of the care levels to prevent complications or evolution into severe cases.…”

Section: Discussionsupporting

confidence: 90%

Gestational Outcomes in Patients with Severe Maternal Morbidity Caused by Hypertensive Syndromes

Pinheiro

Feitosa

Júnior

et al. 2020

Rev Bras Ginecol Obstet

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Purpose To evaluate the impact of the presence of criteria for severe maternal morbidity and maternal near miss associated with hypertensive disorders on maternal and perinatal outcomes in a maternity school. Methods The present is a sub-analysis of a larger study involving 27 centers in Brazil that estimated the prevalence of serious maternal morbidity and near miss. It is an analytical and cross-sectional study with a quantitative approach, involving 928 women who were cared for at Maternidade Escola Assis Chateaubriand (MEAC, in Portuguese), Universidade Federal do Ceará (UFC, in Portuguese), from July 2009 to June 2010. The women were diagnosed with near miss according to the World Health Organization (WHO) criteria. The sample was divided into 2 groups: patients with (n = 827) and without hypertension (n = 101). The results were considered statistically significant when p < 0.05. The Pearson chi-squared and Fisher Exact tests were used for the categorical variables, and the Mann–Whitney U test was used for the continuous variables. Results In total, 51 participants with maternal near miss criteria were identified, and 36 of them had hypertensive disorders. Of these, 5 died and were obviously excluded from the near miss final group. In contrast, we observed 867 cases with non-near miss maternal morbidity criteria. During this period, there were 4,617 live births (LBs) in the institution that was studied. Conclusion In the severe morbidity/maternal near miss population, the presence of hypertensive complications was prevalent, constituting a risk factor for both the mother and the fetus.

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Section: Discussionsupporting

confidence: 90%

Gestational Outcomes in Patients with Severe Maternal Morbidity Caused by Hypertensive Syndromes

Pinheiro

Feitosa

Júnior

et al. 2020

Rev Bras Ginecol Obstet

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“… * Although the WHO definition for prolonged unconsciousness stipulates any loss of consciousness lasting more than 12 hours, there is evidence that reduced oxygen saturation during loss of consciousness for greater than one hour is associated with maternal death [ 34 ]. …”

Section: Methodsmentioning

confidence: 99%

Evaluation of a call center to assess post-discharge maternal and early neonatal outcomes of facility-based childbirth in Uttar Pradesh, India

et al. 2018

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BackgroundMaternal and neonatal outcomes in the immediate post-delivery period are critical indicators of quality of care. Data on childbirth outcomes in low-income settings usually require home visits, which can be constrained by cost and access. We report on the use of a call center to measure post-discharge outcomes within a multi-site improvement study of facility-based childbirth in Uttar Pradesh, India.MethodsOf women delivering at study sites eligible for inclusion, 97.9% (n = 157,689) consented to follow-up. All consenting women delivering at study facilities were eligible to receive a phone call between days eight and 42 post-partum to obtain outcomes for the seven-day period after birth. Women unable to be contacted via phone were visited at home. Outcomes, including maternal and early neonatal mortality and maternal morbidity, were ascertained using a standardized script developed from validated survey questions. Data Quality Assurance (DQA) included accuracy (double coding of calls) and validity (consistency between two calls to the same household). Regression models were used to identify factors associated with inconsistency.FindingsOver 23 months, outcomes were obtained by the call center for 98.0% (154,494/157,689) consenting women and their neonates. 87.9% of call center-obtained outcomes were captured by phone call alone and 12.1% required the assistance of a field worker. An additional 1.7% were obtained only by a field worker, 0.3% were lost-to-follow-up, and only 0.1% retracted consent. The call center captured outcomes with a median of 1 call (IQR 1–2). DQA found 98.0% accuracy; data validation demonstrated 93.7% consistency between the first and second call. In a regression model, significant predictors of inconsistency included cases with adverse outcomes (p<0.001), and different respondents on the first and validation call (p<0.001).ConclusionsIn areas with widespread mobile cell phone access and coverage, a call center is a viable and efficient approach for measurement of post-discharge childbirth outcomes.

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“…In many developed countries, maternal mortality has declined to single digits, while cases of near misses are more and, therefore, useful for the evaluation of the current system [4][5][6]. 2013 where after social programs it has decreased to 43.3 per 1,000 live births 2; unlike at the international level, it has been observed that MM is overestimated, when evaluating mortality in women of reproductive age.…”

Section: Severe Obstetric Morbidity (Near Miss) Backgroundmentioning

confidence: 99%

Severe obstetric morbidity (near miss)

Manuel¹,

María²,

Rocío³

2019

J Gynecol Res Obstet

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Background: A case of "Near miss maternal" or severe obstetric condition is defi ned as the patient at risk of dying, which survives the complication that occurred during pregnancy, delivery or at the end of the puerperium; or women who have survived the risks that endanger their lives.Objective: to determine how many cases of severe obstetric morbidity and Material and methods: A retrospective study was conducted, obtaining 130 cases with severe obstetric morbidity and 26 maternal deaths. The average mortality rate was 5.78% and death rate .415. The main causes of severe morbidity were obstetric hemorrhage, hypertension associated with pregnancy and sepsis. Conclusion:An increase was observed in cases of severe maternal morbidity and decrease in maternal death; the establishment of a committee that evaluated and analyzed cases of severe obstetric morbidity improves the quality of care and treatment with a reduction in maternal death.

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Factors associated with maternal mortality among patients meeting criteria of severe maternal morbidity and near miss

Abstract: Among WHO's criteria for severe maternal morbidity and near miss, eclampsia, low oxygen saturation, ICU admission, intubation, mechanical ventilation, and cardiopulmonary resuscitation were most associated with maternal death. Use of magnesium sulfate was a protective factor.

Cited by 15 publications

References 23 publications

Gestational Outcomes in Patients with Severe Maternal Morbidity Caused by Hypertensive Syndromes

Gestational Outcomes in Patients with Severe Maternal Morbidity Caused by Hypertensive Syndromes

Evaluation of a call center to assess post-discharge maternal and early neonatal outcomes of facility-based childbirth in Uttar Pradesh, India

Severe obstetric morbidity (near miss)

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