Maternal near misses from two referral hospitals in Uganda: a prospective cohort study on incidence, determinants and prognostic factors

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.

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“…WHO also developed a tool to classify near miss . Subsequently, numerous studies have used these criteria to define near miss worldwide …”

Section: Introductionmentioning

confidence: 99%

Maternal near miss in low‐resource areas

Goldenberg

Saleem

Ali

et al. 2017

Intl J Gynecology & Obste

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“…Apparently, the maximum SOFA score performs better than a score for each individual organ/system dysfunction. This could be explained by the interdependence of organ/system function and the fact that several organ/systems are simultaneously or consequently involved during critical obstetric illness [16]. Such multiple organ/system involvement may be subtle or unrecognized.…”

Section: Discussionmentioning

confidence: 99%

“…The detailed methods have been described elsewhere [16]. Briefly the study involved women with severe maternal morbidity (SMM) admitted to the high dependency obstetric unit (HDU), between March 1, 2013 and January 28, 2014.…”

Section: Methodsmentioning

confidence: 99%

“…Prior studies have revealed high maternal morbidity and mortality related to severe obstetric complications in our setting [16,17]. While withholding treatment in cases requiring ICU care increases maternal morbidity and mortality, unnecessary admissions lead to wastage of scanty resources and deny those who qualify the opportunity to receive necessary prompt care [18,19].…”

Section: Introductionmentioning

confidence: 99%

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The Utility of the Sequential Organ Failure Assessment Score in Predicting Mortality in Critically Ill Obstetric Patients Admitted to a High Dependency Unit in Uganda

Kaye¹

2017

IPCB

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Background: Most maternal deaths result from severe maternal morbidity (SMM with subsequent organ/system dysfunction and organ failure. The objective was to assess the performance of Sequential Organ Failure Assessment (SOFA) score in cases of SMM admitted to the high dependency obstetric unit.Methods: Organ/system dysfunction and failure were assessed according to the maximum score for the six components (respiratory, neurological, renal, hepatic, cardiovascular and coagulation system). The total maximum SOFA score was estimated using the worst result each component on a single day. The distribution of SOFA scores was assessed for normality by using the Shapiro Wilk Test, [p=003]. The mean maximum SOFA scores for each organ/system were computed according to according to outcome (survival or death), using the Mann-Whitney test. The sensitivity, specificity, and the area under the curve (AUC) for each organ/system were evaluated. A Receiver Operator Characteristic (ROC) curve was fitted using maximum likelihood estimates for the total maximum SOFA score, in order to assess the sensitivity, specificity and discriminatory abilities of the maximum SOFA scores. Results:Of the 425 patients with SMM, 345 (81.2%, 95%CI 71.8-82.4) survived while 80 (18.8%, 95% CI: 12.9, 22.6) did not survive. All the non-survivors and 64 (18.5%) of the survivors presented with multiple organ/system dysfunction. Nonsurvivors were more likely to present with more severe and with multiple organ/ system dysfunction. The maximum total SOFA score had good discrimination in the respiratory, cardiovascular and neurological systems, but poor discrimination in the renal, hepatic and coagulatory systems. The total maximum SOFA score displayed an area under the curve (AUC) of 0.83 (95% CI: 0.56, 1.00), with a cutoff value of at least 8.0 sensitivity of 86.7%, and specificity of 90.0%. Conclusion:The total maximum SOFA score showed good predictive and discriminative abilities for maternal mortality in women with severe maternal morbidity.

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“…[20][21][22] Nonetheless, there are still great challenges that surpass individual analyses of each case and refer to a larger dimension, the population's reality of life, greatly influenced by the Brazilian reality, whose society is comprised of multiple cultures. Consequently, this context emphasizes the importance of studying factors associated with MM for the adequate formulation of strategies aimed at the reduction of this event.…”

Section: Discussionmentioning

confidence: 99%

Maternal mortality in the indigenous and non-indigenous population in Pará: contribution to the surveillance of deaths

et al. 2017

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Se pudo comprobar 884 óbitos maternos, correspondientes a la Razón de Mortalidad Materna 60,7 por 100 mil nacidos vivos de no indígenas y 135,8 de 100 mil nacidos vivos de indígenas. El edema, la proteinuria y los trastornos de hipertensión en el embarazo, parto y puerperio corresponden a 30,5% (n = 270). Conclusión e implicaciones para la práctica: La mortalidad materna es aún un grave problema de salud pública en el estado, demostrando claramente que las indígenas requieren de una mayor atención, ya que presentaron índices más elevados de mortalidad materna si lo compara con no indígenas.

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Maternal near misses from two referral hospitals in Uganda: a prospective cohort study on incidence, determinants and prognostic factors

Cited by 58 publications

References 38 publications

Maternal near miss in low‐resource areas

Maternal near miss in low‐resource areas

The Utility of the Sequential Organ Failure Assessment Score in Predicting Mortality in Critically Ill Obstetric Patients Admitted to a High Dependency Unit in Uganda

Maternal mortality in the indigenous and non-indigenous population in Pará: contribution to the surveillance of deaths

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