Maternal near miss approach to evaluate quality of care in Alborz province, Iran

Ghazivakili, Zohreh; Lotfi, Razieh; Kabir, Kourosh; nia, Roohangiz Norouzi; Naeeni, Masoumeh Rajabi

doi:10.1016/j.midw.2016.08.009

Cited by 14 publications

(17 citation statements)

References 16 publications

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“…In addition, in the current study, the ICU admission rate was 1.33% among all females, which was higher than the rate (0.7%) reported in Alborz province, Iran (15). According to the WHO, the minimum acceptable overall rate of ICU admission is 0.5%.…”

Section: Discussioncontrasting

confidence: 77%

“…In the current study, the rate of SMO12 among all the cases with SMO was 83.82% of which 28.07% were referred from other health facilities, showing that referral cases were higher in the current study than that of a previous study performed in Alborz province (3%) (15). The referral hospital under study receives and manages complicated cases, sometimes in deteriorated critical conditions, referred from other healthcare centers.…”

Section: Discussioncontrasting

confidence: 51%

“…According to a multicountry study performed by the WHO, the overall MNM ratio in the current study can be placed into the category of countries with "very high MM ratio" (14). Additionally, at the national level, the current study results (MNM ratio of 13.79 per 1000 live births) were much higher than those of the Alborz province (4.97 per 1000 live births), an economically advantaged province near Tehran, the capital of Iran (15).Since both of these studies used the same (i.e. organ dysfunction) criteria to determine MNM cases, the results can reflect the true disparities of maternal health outcomes in the country.…”

Section: Discussionmentioning

confidence: 61%

See 2 more Smart Citations

Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study

2018

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Background: Since maternal near miss (MNM) could act as a surrogate of maternal death, the implementation of MNM audit at hospital level can provide an opportunity to study maternal morbidity at a large scale. Objectives: The current study aimed at investigating severe maternal outcomes (SMO; i.e. MNM + maternal death [MD]) in a referral hospital. Methods: A prospective, facility-based, cross sectional study was conducted from 22 June to 22 December 2017. The current study was performed in a tertiary referral teaching hospital in Zahedan, Iran. The study population included all pregnant females with a gestational age of 22 weeks giving birth in this hospital or referred to this center for delivery, as well as females within 42 days of pregnancy termination. The World Health Organization maternal near-miss criteria were used to identify MNM and analyze the data. Logistic regression was used to predict SMO risk factors. Results: Overall, 3527 deliveries and 3480 live births were reported in the hospital under investigation. Severe maternal outcomes were observed in 68 cases. The rate of MNM was 13.79 per 1000 live births; furthermore, the ratio of MNM to mortality was 12:1. Binary analysis showed that hemoglobin level, place of residence, parity, history of cesarean section (CS), insurance coverage, and type of delivery were the significant decisive factors in SMO. Moreover, severe hemorrhage and hypertensive disorders were the common causes of SMO. Conclusions: According to the collected data, MNM indicators were high in the under study hospital. Therefore, it seems necessary to adopt context-based interventions at hospital level to find and manage mothers prone to SMO during pregnancy and childbirth.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 61%

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Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study

2018

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“…A razão de near miss materno do presente estudo (5,4 casos por mil nascidos vivos) se aproxima dos indicadores observados em pesquisas realizadas no Brasil e em demais países de baixa e média rendas 15,16,17,18,19,20,21 .…”

Section: Discussionunclassified

Morbidade materna grave em hospitais públicos de Ribeirão Preto, São Paulo, Brasil

et al. 2020

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Resumo: Este estudo objetivou investigar a ocorrência de morbidade materna grave, os critérios diagnósticos mais frequentes e a qualidade da assistência obstétrica nos hospitais públicos de Ribeirão Preto, São Paulo, Brasil. Trata-se de uma pesquisa quantitativa de vigilância das morbidades maternas graves, utilizando os critérios da Organização Mundial da Saúde (OMS) para condições potencialmente ameaçadoras à vida e near miss materno. Os casos foram identificados entre 1º de agosto de 2015 e 2 de fevereiro de 2016. Participaram 259 mulheres com morbidade materna grave (condições potencialmente ameaçadoras à vida/near miss materno) durante o ciclo gravídico-puerperal, internadas para o parto nas quatro instituições públicas com assistência obstétrica no município. Realizou-se análise descritiva a partir das frequências absolutas e relativas dos critérios diagnósticos para condições potencialmente ameaçadoras à vida e near miss materno, além da descrição das mulheres pesquisadas (caracterização sociodemográfica, antecedentes obstétricos, assistência pré-natal e ao parto). Indicadores de qualidade da assistência estabelecidos pela OMS a partir da morbimortalidade também foram calculados. Ocorreram 3.497 partos, 3.502 nascidos vivos em todos os hospitais do município, 2 mortes maternas e 19 near miss materno. A razão do near miss materno foi de 5,4 casos por 1.000 nascidos vivos, e a razão de mortalidade materna foi de 57,1 óbitos por 100 mil nascidos vivos. A taxa de mortalidade entre os casos com desfecho materno grave (somados os casos de near miss materno e morte materna) foi de 9,5%. Observou-se importante frequência de casos de condições potencialmente ameaçadoras à vida e near miss materno no presente estudo. A ocorrência de óbitos por causas hemorrágicas mostra a necessidade de melhoria da qualidade da assistência prestada. Os resultados poderão contribuir para o aprimoramento da política local de assistência obstétrica.

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“…We found the major causes of SMO were anemia, hypertensive disorder, and obstetric hemorrhage. Hypertensive disorder and cardiovascular dysfunction were the most frequent conditions among MNM cases in Alborz province of Iran, where medical resources are undeveloped [38]. In the stetting of the present study, hypertensive disorders related to MNM cases in level 2 hospitals and anemia in level 3 hospitals need more attention to prevent SMO cases in Hunan province.…”

Section: Clinical Disordersmentioning

confidence: 63%

Epidemiology analysis of the incidence of severe maternal outcomes between level 2 and 3 hospitals in China’s Hunan province from 2012 to 2018

Liu

Xiong

Wang

et al. 2020

Preprint

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Background: This facility-based study analyzed the epidemiology and incidence of maternal near-miss (MNM) and mortality by hospital level as part of Hunan province’s efforts to raise the quality of hospital care for women. Methods: We used data for MNM and mortality cases for 2012–2018 from 17 hospitals (12 level 2 facilities, five level 3 facilities) that receive referrals for obstetric complications in Hunan province. Data were drawn from China’s National Maternal Near Miss Surveillance System, and collected using the World Health Organization near-miss tool. We calculated the ratio of severe maternal outcomes (SMO) (i.e., MNM and maternal death [MD] cases), mortality index (MI), and MNM to mortality ratio (MNM:MD), and epidemiological factors, organ dysfunction, and maternal complications stratified by hospital level. Chi-square tests to examine differences between groups and total ratios and 95% CI were calculated. Results: There were 518 SMO cases (489 MNM and 29 MD) among 279407 live births (LBs) and 1299 SMO cases(1262 MNM and 37 MD) among 232386 LBs in level 2 and 3 facilities. The total MNM ratio in level 2 and 3 hospitals was 1.75 (95%CI: 1.60–1.91) and 5.43 (95%CI: 5.14–5.74) per 1000 LBs, respectively. There were differences in SMO cases between level 2 and 3 hospitals in maternal age, education, parity, antenatal visits, and history of cesarean sections. In MNM cases, coagulation dysfunction was the main organ dysfunction (level 2 hospitals: 59.10%; level 3 hospitals: 79.32%), and the main maternal complications were obstetric hemorrhage (level 2 hospitals: 71.98%) and hepatopathy (level 3 hospitals: 69.49%). For MD cases, the main maternal complications were neurologic dysfunction (level 2 hospitals: 41.38%) and coagulation dysfunction (level 3 hospitals: 42.55%). Anemia was the main maternal complication for SMO cases in both level 2 (69.69%) and 3 (68.59%) hospitals. Conclusions: MNM and MD is higher in level 3 hospitals compared with level 2 hospitals. The obstetric emergency capacity of level 3 hospitals is higher than that of level 2 hospitals. Future government policies should consider upgrading the obstetric emergency treatment capacity in level 2 hospitals or to re-distinguish the social functions of different medical institutions.

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Maternal near miss approach to evaluate quality of care in Alborz province, Iran

Cited by 14 publications

References 16 publications

Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study

Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study

Morbidade materna grave em hospitais públicos de Ribeirão Preto, São Paulo, Brasil

Epidemiology analysis of the incidence of severe maternal outcomes between level 2 and 3 hospitals in China’s Hunan province from 2012 to 2018

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