Maternal near miss in low‐resource areas

Abstract

Objective To describe the Global Network Near-Miss Maternal Mortality System and its application in seven sites. Methods In a population-based study, pregnant women eligible for enrollment in the Maternal and Newborn Health Registry at seven sites (Democratic Republic of the Congo; Guatemala; Belagavi and Nagpur, India; Kenya; Pakistan; and Zambia) between January 2014 and April 2016 were screened to identify those likely to have a near-miss event. The WHO maternal near-miss criteria were modified for low-resource settings. The ratio of near-miss events to maternal deaths was calculated. Results Among 122 707 women screened, 18 307 (15.0%) had a potential near-miss event, of whom 4866 (26.6%; 4.0% of all women) had a near-miss maternal event. The overall maternal mortality ratio was 155 per 100 000 live births. The ratio of near-miss events to maternal deaths was 26 to 1. The most common factors involved in near-miss cases were the hematologic/coagulation system, infection, and cardiovascular system. Conclusion By using the Global Network Near-Miss Maternal Mortality System, large numbers of women were screened for near-miss events, including those delivering at home or a low-level maternity clinic. The 4.0% incidence of near-miss maternal mortality is similar to previously reported data. The ratio of 26 near-miss cases to 1 maternal death suggests that near miss might evaluate the impact of interventions more efficiently than maternal mortality.

A global view of severe maternal morbidity: moving beyond maternal mortality

“…A maternal near miss is identified when a woman develops one or more signs of organ dysfunction as described by 25 clinical, laboratory, or management criteria [ 48 ]. However, the applicability of the WHO criteria to low resource settings where certain laboratory and management tests/procedures are not routinely available is disputed and many countries must modify the WHO criteria for their settings [ 49 – 51 ]. For example, a study in Ethiopia modified the definition of SMM to include any woman who received 1 or more units of blood instead of 5 or more units of blood as the WHO suggests [ 51 , 52 ].…”

“…However, the applicability of the WHO criteria to low resource settings where certain laboratory and management tests/procedures are not routinely available is disputed and many countries must modify the WHO criteria for their settings [ 49 – 51 ]. For example, a study in Ethiopia modified the definition of SMM to include any woman who received 1 or more units of blood instead of 5 or more units of blood as the WHO suggests [ 51 , 52 ]. The Global Network also modified the WHO definition by adding transfusion of any volume and excluding all WHO laboratory criteria for their definition of SMM [ 51 ].…”

“…For example, a study in Ethiopia modified the definition of SMM to include any woman who received 1 or more units of blood instead of 5 or more units of blood as the WHO suggests [ 51 , 52 ]. The Global Network also modified the WHO definition by adding transfusion of any volume and excluding all WHO laboratory criteria for their definition of SMM [ 51 ]. The other definitions utilized in LMICs, such as Geller et al [ 33 ] and Filippi et al [ 53 ] are much simpler than the WHO criteria and generally use clinical or management criteria, such as diagnosis of eclampsia or emergency hysterectomy to identify SMM.…”

“…However, Brazil is progressing towards a national surveillance system with the Brazilian Network for Surveillance of Severe Maternal Morbidity, which identifies SMM cases in 27 hospitals throughout the country [ 56 ]. Additionally, the Global Network Near-Miss Mortality System is conducting population-based surveillance of SMM at seven district/province level sites in Africa, Asia and Central America [ 51 ]. The majority of SMM studies that do take place occur in a single hospital, a single city or a single province/state and only rarely include multiple regions [ 57 – 60 ] This leads to vast differences in reported SMM rates between studies in the same country, such as the rate of SMM ranging from 9.6 to 120 per 1000 live births in two studies from India [ 55 , 60 ].…”

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

“…There are few data available on the occurrence of maternal near‐miss in community settings. A recent analysis by Goldenberg and colleagues used a more pragmatic set of near‐miss criteria to identify severe maternal outcomes among 122 707 women in maternal registry data in seven lower‐income countries (43% of whom delivered in a hospital) . They reported an overall MMR of 187 per 100 000 live births, with 18 307 (15.0%) women experiencing at least one near‐miss event (equivalent to a mortality index of 3.85%) …”