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Resumo Este estudo, de caráter misto e sequencial exploratório, objetivou identificar padrões relacionados a trajetória de mulheres gestantes e puérperas que evoluíram para situações de risco, desde sua chegada em um primeiro serviço de assistência até sua admissão em uma maternidade terciária. A fase quantitativa analisou 1.703 prontuários e registros de internação de mulheres assistidas em três maternidades terciárias da Região Metropolitana de Fortaleza, no Ceará, entre 2010 e 2019. Na fase qualitativa, realizada entre janeiro e setembro de 2020, participaram 14 mulheres sobreviventes ao Near Miss Materno (NMM), por meio da Entrevista Narrativa Autobiográfica de Schütze. Os achados desvelam como atrasos relacionados aos profissionais e ao sistema de saúde contribuíram para a peregrinação de gestantes e puérperas e, consequentemente, para os quadros de NMM. A peregrinação destas mulheres associa-se a problemas nas estruturas da rede de atenção e dos serviços de saúde. Assim, fazem-se necessários o uso de ferramentas de acompanhamento da qualidade do serviço prestado pelos profissionais de saúde, os processos assistenciais bem estabelecidos, as estruturas físicas e as Redes de Atenção à Saúde (RAS), que suportem o seguimento desses processos.
Abstract This mixed-method and sequential exploratory study aims to identify patterns related to the trajectory of pregnant and puerperal women who evolved to risk situations, from arrival in a first care service to admission to a tertiary maternity hospital. The quantitative phase analyzed 1,703 medical records and hospitalization records of women assisted in three tertiary maternity hospitals in the Metropolitan Region of Fortaleza, Ceará, from 2010 to 2019. The qualitative phase was conducted from January to September 2020 with 14 women survivors of Maternal Near Miss (MNM), using Schütze's Autobiographical Narrative Interview. The findings reveal how delays related to professionals and the health system contributed to the pilgrimage of pregnant and postpartum women and, consequently, to the MNM cases. The peregrination of these women is associated with problems in the structures of the Care Network and the services. Thus, it becomes necessary to use tools to monitor the quality of the service provided by health professionals and to provide well-established care processes, physical structures, and the healthcare networks that support the follow-up of these processes.
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In India, there is a mandate to increase institutional delivery, which has led to an overwhelming response in health-care delivery. The maternal mortality rate has been an essential yardstick, used by health-care planners to assess the quality of obstetric services. As of late, there has been a shift in focus to maternal near-misses (MNMs) as a more valuable indicator of maternal health than the maternal mortality rate. The aim of this research article was to compare various standardized tools to address MNM, namely, the World Health Organization MNM tool, The Government of India's facility-based MNM review tool, etc.
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BACKGROUND: Despite advances in medical sciences and increased awareness of measures for safe child birth, unacceptably high maternal morbidity and mortality continues in developing countries like India. Ours being a tertiary care centre, draws a lot number of high risk pregnancies and referrals. By auditing the near miss cases2 i.e., a critically ill pregnant or recently delivered woman who was on the verge of death but survived a problem during pregnancy, childbirth, or within 42 days of the pregnancy's termination, we aim to identify the causes, factors leading to near miss2 and the management given to near miss2 and maternal deaths. The AIMS AND OBJECTIVES: present study aims to determine the magnitude, as well as to identify the pattern of Maternal Near Miss2 (MNM), at Siddhartha Medical College, Vijayawada, during the study period of two years. To anal OBJECTIVES: yse 1)Adverse events leading to a maternal near-miss2, 2) Disorders underlying these cases, 3)Sociodemographic factors and 4)Contributing factors A hospital based retros METHODOLOGY: pective observational study to assess the frequency and nature of maternal near miss2 events among the obstetric cases managed at Siddhartha Medical College, Vijayawada over a period of two years. The followi RESULTS: ng are the major causes identified leading to maternal near miss2 during our study Severe Eclampsia 17%, Post-partum Haemorrhage 17%, Pulmonary Edema due to severe pre eclampsia3 9%, Antepartum Eclampsia 9%, HELLP 9%, Ruptured ectopic pregnancy 7%, Cardiac failure 7%, Postpartum Eclampsia 7%, Imminent Eclampsia 4%, Abruption 4%, Rupture uterus 2%. In our study Maternal near miss2 ratio incidence: 0.0254, Severe maternal outcomes ratio : 3, Maternal near miss2 to mortality ratio: 0.433 CONCLUSION: We observed in majority of the cases level 1 and level 2 delays in reporting to our institution
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Background & objectives: Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. Methods: This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. Results: The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. Interpretation & conclusions: The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.
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Abstract Objective Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM). Results The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5-96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2-10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0-50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6-1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7-7.9 and p = 0.0009; OR: 17.68; 95%CI: 2-153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3-440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2-26.3]). Conclusion Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.
Resumo Objetivo Lúpus eritematoso sistêmico (LES) pode causar danos irreversíveis aos órgãos. A gravidez com LES pode ter riscos para condições ameaçadoras à vida. O presente estudo teve como objetivo determinar a prevalência de MMG em pacientes com LES e analisar os parâmetros que contribuíram para os casos de maior gravidade. Métodos Trata-se de um estudo transversal retrospectivo a partir da análise de dados obtidos de prontuários de gestantes com LES atendidas em um Hospital Universitário no Brasil. As gestantes foram divididas em grupo controle sem intercorrências, grupo com condições potencialmente ameaçadoras a vida (CPAV) e grupo com near miss materno (NMM). Resultados A taxa de NMM foi de 112,9 por 1.000 nascidos vivos. A maioria dos casos de CPAV (83,9%) e NMM (92,9%) teve partos prematuros com risco aumentado estatisticamente significativo em comparação com o grupo controle (p = 0,0042; odds ratio [OR]: 12,05; intervalo de confiança [IC]: 1,5-96,6 para o grupo NMM e p = 0,0001; OR: 4,84; IC95%: 2,2-10,8 para o grupo CPAV). MMG aumenta o risco de maior tempo de internação (p < 0,0001; OR: 18,8; IC95%: 7,0-50,6 e p < 0,0001; OR: 158,17; IC95%: 17,6-1424,2 para os grupos CPAV e NMM, respectivamente), recémnascidos com baixo peso (p = 0,0006; OR: 3,67; IC95%: 1,7-7,9 e p = 0,0009; OR: 17,68; IC95%: 2-153,6 para os grupos CPAV e NMM, respectivamente), bem como doenças renais (CPAV: 58,9%; 33/56; p = 0,0069 e NMM: 78,6%; 11/14; p = 0,0026)]. Os casos de NMM apresentaram risco aumentado para óbito neonatal (p = 0,0128; OR: 38,4; IC95%: 3,3-440,3), natimorto e aborto espontâneo (p = 0,0011; OR: 7,68; IC95%: 2,2-26,3). Conclusão Lúpus eritematoso sistêmico foi significativamente associado à morbidade materna grave, internações mais longas e risco aumentado de desfechos obstétricos e neonatais ruins.
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Humans , Female , Pregnancy , Pregnancy, High-Risk , Brief, Resolved, Unexplained Event , Maternal Death , Lupus Erythematosus, SystemicABSTRACT
An observational study was performed at Purba Medinipur District Hospital, West Bengal, from April 1, 2018, to December 31, 2020, with an aim to find out the magnitude of maternal mortality and near miss cases and to assess the utilization of available maternal health care services by the deceased women and near miss cases. Result showed 4.5% women developed potentially life?threatening condition (PLTC) of which 21% women developed LTC. Maternal Near Miss (MNM) ratio was 9.46/1000 live birth and the MNM?to?Maternal Mortality ratio was 8.3:1 and the leading causes of MNM and maternal death were hemorrhage, pregnancy induced hypertension/eclampsia. The utilization of maternal health?care services revealed that there is a scope to increase the service delivery. Study finding indicates that health?care programs need to enhance the existing efforts to improve timely health seeking behavior of women
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Background:A maternal near miss case is defined as a “a woman who nearly died but survived a complication that occurred during pregnancy,child birth or within 42 days of termination of pregnancy”1.MMR is defined as ratio of number of maternal deaths per 1000 live births. All pregnant women deserve a good quality of care especially Emergency Obstetric Care including proper infrastructure, human resources that can detect and manage such complications earliest. The objective of this study was to evaluate the causes of maternal near miss cases, various management modalities performed and maternal and fetal outcome in near miss cases. Material And Methods:A retrospective study was carried out in obstetrics and gynaecology department of SCL municipal general hospital, Ahmedabad for identification of MNM as per MNM-R operational guidelines (2014) in a tertiary care hospital from August 2020 to March 2022. Result:Total deliveries during our study period were 9266 out of which 535 number of patients developed complications, 75 patients ended up becoming near miss cases and 30 maternal mortalities were observed.Hypertensive disorders (38.6%) followed by severe anemia (18.6%) and haemorrhage (13.3%) were the commonest underlying causes leading to MNM. More than one management modality was followed in one case. 25% of patients required blood transfusion. Out of which 11 patients required massive blood transfusion (>5 units of blood) and 16% of patients required blood products along with blood resulting from either severe anemia or altered coagulopathy (DIC). 69.3% of patients required ICU stay of <5 days and majority of patients required hospital stay of 9-14 days.63.6% of patients required ICU stay of 1-4 days.Live birth rate was 82.6%.Conclusion:Maternal health is the direct indicator of prevailing health status in a country. Reduction in maternal mortality is one of the targets of MILLENIUM DEVELOPMENT GOALS13for 2015 but in spite of full efforts by all the health care professionals, it still remains a challenge in developing countries.There should be prompt and proper management of high-risk groups by frequent antenatal visits. Aggressive management of each complication and close monitoring of women in labour, decision making in mode and time of termination of pregnancy are important to prevent further complications.
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Background:Pregnancy-related morbidity and mortality continue to have a huge impact on the lives of Indian women and their newborns. Any pregnant woman can develop life-threatening complications with little or no advance warning. All women need access to quality maternal health services that can detect and manage such complications1. Complications during pregnancy and childbirth remain a leading cause of death among women of reproductive age in India2. Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these estimated 67000 maternal and 10,00000 newborn deaths occur every year3. The maternal near-miss event was defined as “any acute obstetric complication that immediately threatens a woman’s survival but does not result in her death either by chance or because of hospital care she receives during pregnancy, labor or within 6 weeks of termination of pregnancy4.Maternal mortality data in practical terms is the tip of an iceberg while the maternal near-miss data is invisible and whic h is a very important tool to reduce maternal mortality.Material And Methods:This is a retrospective observational study carried out among 80 maternal near-miss cases who were admitted in obstetric ICU fulfilling criteria for identification for maternal near-miss cases as per Maternal Near Miss Review Operational Guideline (December 2014)in the Department of Obstetrics and Gynecology, in our tertiary care teaching hospital, between October 1, 2018, to October 31,2020.Patient fulfilling criteria for identification of near-miss cases as per Maternal Near miss Review Operational Guideline (December, 2014)Minimum 3 criteria were included in the study.Result:During the study period total of 18360 obstetric patients were admitted, out of which 80 patients ended up becoming maternal near-miss cases. Among them majority of patients were in age group of 18-25 years and occurrence was high in multipara women. In many patients more than one underlying disorder was present. Hemorrhage (67.5%) followed by a hypertensive disorder of pregnancy (30.0%) was the commonest presenting disorder in near-miss cases. In spite of being highly preventable, maternal sepsis (6.2%) also contributes to being a major cause of morbidity.In our study, 15% of near-miss cases had associated medical conditions. 5 % of cases (n=4) in the present study faced acute severe respiratory depression (ARDS) after getting infected with covid-19 infection. There was need for massive blood transfusions in 63.75 %, magnesium sulfate therapy in 17.25%, use of cardiotonic /vasopressor drugs in 10.0%, obstetric hysterectomy in 23.75 % of cases. More than one management modality was followed in many patients. All the near-miss cases were covered with broad spectrum antibiotic therapy. Total 21 near-miss cases (26.25%) were identified to have delays. Delay in the decision to seek care (Delay 1) occurred in 2.5% of women. Educational backwardness, ignorance of pregnancy itself, lack of regular antenatal care, and failure to give importance to warning signals may be the contributing factors. Delay in accessing adequate care (Delay 2) was identified in 7.5% of women. Conclusion: Hemorrhage, hypertensive disorders of pregnancy, abnormalities of labor, anemia, and sepsis are still major contributing factors for maternal near-miss cases. Anticipation, early diagnosis, and prompt treatment of maternal complications can reduce maternal morbidity and mortality. Sensitization of the population for proper utilization of available maternal health care facilities is very vital for reducing maternal near-miss cases.All the maternal near-miss cases are living le ssons, who de spite their misery show us our deficiencies.
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The Government of India released operational guidelines for Maternal Near Miss?Review (MNM?R) in December 2014 for implementation at all the tertiary hospitals in India. An implementation research study was conducted at two selected tertiary hospitals in Maharashtra to assess the feasibility of implementation of the MNM?R guidelines at these hospitals and document the experiences and challenges during this process. The study findings suggest that for implementation of MNMR guidelines at these tertiary hospitals, there is need of dedicated staff; revision of MNM facility based form and critical review of the criteria for identification of MNM cases. MNM meetings could not be conducted with Maternal Death Review Committee meetings as mentioned in the guidelines. More efforts are needed for follow?up of the implementation of the corrective measures recommended by the MNM Committee. The study findings indicate that it is feasible to implement the MNM?R guidelines at the tertiary hospitals, if the above points are considered at these hospitals.
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Objective@#To investigate the prevalence and types of maternal near miss in Hangzhou City from 2015 to 2020, so as to provide insights into early identification and interventions for maternal near miss.@*Methods@#The data of maternal near miss in 5 hospitals of Hangzhou City from 2015 to 2020 were collected from China's National Maternal Near Miss Obstetrics Surveillance System, and the incidence and mortality of maternal near miss, types of pregnancy-related complications/comorbidities and types of critical illness were descriptively analyzed.@*Results@#Totally 230 490 pregnant and lying-in women were recruited in 5 hospitals in Hangzhou City from 2015 to 2020, and there were 182 514 live births, 177 428 women with pregnancy-related complications/comorbidities, and 1 790 cases of maternal near miss with a 0.98% annual incidence rate. The incidence of maternal near miss was high in 2019 (1.18%). The hospital mortality and death index were respectively 3.29/105 and 0.33% among pregnant and lying-in women from 2015 to 2020, and there was no death found among pregnant and lying-in women from 2018 to 2020. The main pregnancy-related complications/comorbidities included anemia (79.33%), obstetric hemorrhagic disorders (69.83%), and gestational hypertension (16.65%). The main critical illness among maternal near miss included coagulation dysfunction (87.23/104), cardiovascular dysfunction (20.44/104), and respiratory dysfunction (9.70/104).@*Conclusions@#The incidence of maternal near miss was high and the hospital mortality appeared a reduction tendency among pregnant and lying-in women in Hangzhou City from 2015 to 2020. Coagulation dysfunction is the primary critical illness among maternal near miss, and the management of anemia and hemorrhagic diseases requires to be improved.
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Resumo: Este estudo objetiva analisar a compreensão das mulheres que vivenciaram a morbidade materna aguda grave (near-miss materno) sobre a assistência obstétrica recebida. Trata-se de uma pesquisa de abordagem qualitativa, com referencial metodológico da história oral temática, realizada por meio de entrevistas presenciais. Participaram do estudo doze mulheres de diferentes regiões brasileiras e que vivenciaram o near-miss materno, principalmente, por complicações de síndromes hipertensivas, hemorragias e infecções. Das memórias coletivas emergidas, identificou-se a violência obstétrica na forma de: I. abuso físico; II. intervenções não consentidas ou aceitas com base em informações parciais ou distorcidas; III. cuidado não confidencial ou privativo; IV. tratamento não digno e abuso verbal; e V. abandono, negligência ou recusa de atendimento. Em conclusão, a violência obstétrica pode somar-se aos eventos que culminarão no near-miss materno e, nesse sentido, é potencialmente ameaçadora da vida.
Abstract: This study aims to analyze the understanding of women who experienced the maternal near-miss about obstetric care received. It was a research of a qualitative approach, with a methodological reference of the thematic oral history, carried out through interviews with women who lived maternal near-miss. Twelve women from different Brazilian regions were interviewed and who experienced maternal near-miss, mainly due to complications of hypertensive syndromes, hemorrhages and infections. From the emerged collective memories, obstetric violence was identified in the form of: I. physical abuse; II. interventions not consented or accepted based on partial or distorted information; III. non-confidential or private care; IV. non-dignified care and verbal abuse; and V. abandonment, negligence or refusal of care. In conclusion, that obstetric violence can added to the events that will culminate in maternal near-miss and, in this sense, it is potentially life threatening.
Resumen: Este estudio tiene como objetivo analizar la comprensión de las mujeres que experimentaron morbilidad materna aguda severa (near-miss materno) sobre la atención obstétrica recibida. Se trata de una investigación con enfoque cualitativo, con un marco metodológico de historia oral temática, realizada a través de entrevistas presenciales. Participaron en el estudio 12 mujeres de diferentes regiones brasileñas que experimentaron near-miss materno, principalmente debido a complicaciones de síndromes hipertensivos, hemorragias e infecciones. A partir de las memorias colectivas surgidas, se identificó la violencia obstétrica en forma de: I. maltrato físico; II. intervenciones no consentidas o aceptadas con base en información parcial o distorsionada; III. atención no confidencial o privada; IV. trato indigno y abuso verbal; y V. abandono, negligencia o negativa a asistir. En conclusión, la violencia obstétrica puede se sumar a los eventos que culminarán en un casi accidente materno y, en este sentido, es potencialmente mortal.
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Humans , Female , Pregnancy , Parenting , Near Miss, Healthcare , Obstetric Violence , Midwifery , Women's HealthABSTRACT
Maternal morbidity and mortality continue to emerge across the globe especially in lower-income countries. This study aimed at exploring in-depth perceptions of near-miss experiences among Rwandan women and how these experiences can be used to develop strategies for health policy implementation. Using qualitative inductive research based on grounded theory, we analyzed 27 indepth interviews that were conducted with women with documented records of maternal near-miss events. Women were knowledgeable about pregnancy complications and the benefits of antenatal care. Near-miss events that occurred either before or during hospitalization. Women recognized their own involvement their near-miss events by delaying care seeking. They also mentioned delays due to healthcare providers delaying transfers, misdiagnosing the events, and delaying to intervene even at the time the diagnosis was made. Women acknowledged the life-saving role of outreach programs and community health workers. We that pregnancy outcomes would be improved in this population of women with education on pregnancy complications, training of community health workers, and sustained mentorship program. (Afr J Reprod Health 2022; 26[5]: 63-71).
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Indicators of Morbidity and Mortality , Depth Perception , Near Miss, Healthcare , Pregnancy Complications , Pregnant Women , Maternal DeathABSTRACT
Introdução: Near miss materno é a ocorrência de um evento de quase morte de uma mulher, no período da gestação, parto ou até 42 dias após o parto. O monitoramento do near miss materno permite a identificação das fragilidades e proposição de ações para redução da mortalidade materna. Objetivo: Produzir uma tecnologia validada para o monitoramento e investigação de near miss materno. Método: Pesquisa metodológica que partiu de um formulário de notificação de casos de near miss materno, aplicado desde 2018, pela Secretaria de Estado da Saúde. Foi desenvolvida no período de maio de 2019 a julho de 2020, respeitados os princípios de ética em pesquisa; aprovada pelo Comitê de Ética em Pesquisa do Setor de Ciências da Saúde da Universidade Federal do Paraná e pelo Comitê de Ética em Pesquisa Hospital do Trabalhador da SESA-PR, em março de 2020. Foi desenvolvida em três etapas: 1ª Etapa: Reconstrução do Formulário com qualificação do conteúdo (referencial teórico e profissionais de gestão). 2ª Etapa: Validação do conteúdo e formato do Formulário por especialistas (pesquisadores na temática, profissionais da assistência materno-infantil da atenção primária e hospitalar e, gestores regionais da atenção à saúde materno-infantil). 3ª Etapa: Teste Piloto do Formulário pelos usuários (notificadores de near miss materno). Os mesmos receberam o formulário na plataforma REDCap (Research Eletronic Data Capture). Resultados: Na 1ª Etapa o Formulário passou a contar com 12 Blocos, estabelecidos segundo os critérios da OMS e, em evidências sugeridas por estudiosos da temática, incluindo de maneira abrangente as informações relacionadas ao ciclo-gestacional e à atenção pré-natal, parto e puerpério. Na 2ª Etapa, participaram da validação 24 juízes/especialistas, sendo 22 enfermeiros (91,7%), um médico e um pesquisador, todos com experiência em notificação ou monitoramento ou pesquisa em near miss materno. O Índice de Validade de Conteúdo geral foi de 96,3%. A consistência interna, medida pelo alfa de Cronbach, obteve um índice maior que 0,80 em todos os Blocos. Na 3ª Etapa, o teste piloto foi aplicado a quatro notificadores que, em unanimidade, consideraram o formulário adequado para a notificação. Conclusões: O Produto desta Pesquisa é uma Tecnologia para Monitoramento e Investigação do near miss materno, para aplicação no Paraná como um instrumento confiável e válido. Entende-se que a validação do formulário ampliou as informações para além das investigações intrahospitalares, de maneira a percorrer amplamente a Linha de Cuidado Materno. Esta tecnologia define um modelo de notificação que poderá ser aplicado, replicado e/ou ajustado para outros cenários brasileiros, igualmente objetivando um impacto social de qualidade no processo gravídico-puerperal com sobrevida materna e do concepto.
Introduction: Maternal near-miss is the occurrence of a woman's near-death event, during pregnancy, childbirth, or up to 42 days after delivery. The monitoring of maternal near-miss allows the identification of weaknesses and the proposition of actions to reduce maternal mortality. Objective: To produce a validated technology for the monitoring and investigation of the maternal near-miss. Method: Methodological research that started from a notification form of maternal near-miss cases, applied since 2018 by the State Department of Health. It was developed from May 2019 to July 2020, respecting the principles of ethics in research; approved by the Research Ethics Committee of the Health Sciences Sector of the Federal University of Paraná and by the Research Ethics Committee of the SESA-PR, Hospital do Trabalhador, in March 2020. It was developed in three stages. 1st Stage: Reconstruction of the Form with content qualification (theoretical framework and management professionals). 2nd Stage: Validation of the content and format of the Form by specialists (researchers in the theme, professionals in maternal and child care in primary and hospital care, and regional managers in maternal and child health care). 3rd Stage: Pilot Test of the Form by users (maternal near-miss notifiers). They received the Form on the REDCap platform (Research Electronic Data Capture). Results: In the 1st Stage, the Form now has 12 sections established according to WHO criteria, and in evidence suggested by scholars of the theme, including comprehensively the information related to the gestational cycle and prenatal care, childbirth, and puerperium. In the 2nd Stage, 24 judges/specialists participated in the validation, 22 nurses (91.7%), one doctor, and one researcher, all with experience in notification or monitoring or research in maternal near-miss. The overall Content Validity Index was 96.3%. The internal consistency, measured by Cronbach's alpha, obtained an index greater than 0.80 in all sections. In the 3rd Stage, the pilot test was applied to four notifiers who, unanimously, considered the form appropriate for notification. Conclusions: The Product of this Research is a Technology for Monitoring and Investigation of the maternal near-miss, for application in the state of Paraná as a reliable and valid tool. It is understood that the validation of the form expanded the information beyond the in-hospital investigations, in order to cover the Maternal Care Line widely. This technology defines a notification model that can be applied, replicated, and/or adjusted for other Brazilian scenarios, also aiming for a quality social impact on the pregnancy-puerperal process with maternal and fetus survival.
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Humans , Female , Pregnancy , Pregnancy , Maternal Mortality , Environmental Monitoring , Patient Safety , Near Miss, Healthcare , Technology , Morbidity , Validation Study , Maternal HealthABSTRACT
Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.
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Background: Relaparotomy in obstetrics following caesarean section or laparotomy is associated with high morbidity and mortality and hence, considered as maternal near miss. Selection of patient for the same is crucial. This study was done to know the incidence, indications, the risk factors, intraoperative procedures and mortality rates of relaparotomy.Methods: A retrospective analysis of relaparotomy after primary obstetric surgery over a period of two and half years (June 2016 to November 2018) was done in department of obstetrics and gynecology of Rajendra Institute of Medical Sciences, Ranchi, India.Results: During study period 28 cases of relaparotomy (18 inhouse and 10 referred cases) were identified. The incidence of relaparotomy was 0.24%. Intraperitoneal hemorrhage (39.2%) was commonest indication of reoperations followed by PPH (17.8%), rectus sheath hematoma (14.8%) and burst abdomen (10.7%). Obstructed labor (32.1%) was commonest indication of primary cesarean. Hysterectomy was required in 8 cases (25.7%), evacuation of blood for hemoperitoneum was required in another 8 cases. Most cases of hemorrhage were reopened within 24 hours, whereas most case of the rectus sheath hematoma, burst abdomen, and broad ligament hematoma were reopened between 5-9 days.Conclusions: Relaparotomy is often a lifesaving procedure. Decision to perform and manage relaparotomy should always be done by senior obstetricians. Meticulous surgical techniques to secure hemostasis at time of primary surgery should be adopted. Strict postoperative vigilance, is of utmost importance for early detection of intraperitoneal hemorrhage and other complications requiring relaparotomy as timely intervention.
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Background: Blood transfusion is recognised as one of the eight essential components of the comprehensive emergency obstetric care module which has been designed to reduce maternal morbidity and mortality rates after major obstetric hemorrhage and anemia.Methods: This is a prospective observational study conducted between April1, 2016 to September 30, 2018 in department of obstetrics and gynecology, Government Medical College, Patiala. The MNM cases given transfusion were analysed in respect of number of antenatal visits, type of admission, distance of place of first referral unit from tertiary health care facility, amount of blood transfused, indications of blood transfusion, causes of haemorrhage and intervention performed.Results: During this period, there were 123 cases of MNM, 90 patients required blood transfusion and were considered in this study. Maximum number of cases (94.45%) were between 20-35 years of age. Majority of cases were primipara (52.22%). 47.77% cases were in 3rd trimester, 33.33% postnatal cases and 16.66% cases were in first trimester. 88.88% cases requiring transfusion belong to low socioeconomic status. There was no antenatal visit in 80% cases who required blood transfusion. 78.8% patients required more than 4packed red cell transfusions. Haemorrhage was the indication in 60% cases for blood transfusion and anaemia in 40% cases. Postpartum haemorrhage (28.4%) was most common indication for blood transfusion followed by ruptured ectopic pregnancy (27.77%), antepartum haemorrhage (11.11%), rupture uterus (7.4%), rectus sheath hematoma (5.55%), placenta accreta (5.55%) and inversion uterus (3.7%). Surgical interventions were performed in 51 cases.Conclusions: Prevention and timely treatment of anaemia must receive attention by more active participation in term of antenatal check-ups. Skilled management of patients at the first referral units is advocated. There should be familiarity with the local protocol of relevant members of staff for management of massive hemorrhage. All major hemorrhages should be reviewed to ensure that there is no delay in provision of blood products.
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Background:Maternal near miss is one of the related concepts to maternal mortality where women survive merely by chance, luck, or by good hospital care. The present study was aimed to fill the prevailing knowledge gap on maternal near miss ratio and events and identify factors associated with near miss in selected health facilities of berak woreda.To determine associated factors of maternal near miss in selected health facilities of Berak woreda, Oromia national regional state, Ethiopia.Methods:Institutional based case control study was conducted in selected health facilities of barek woreda to asses determinant factors of maternal near miss among delivered women. Data of 1272 (344 cases and 928 controls) women were included in the analysis registered from 11 September 2014to 30 March 2018. Cases were women due to severe acute maternal morbidity while controls were women for normal labor. Simple random sampling technique was used in the delivery unit. The data were collected using WHO standard tool. Data were entered using epi data version 3.1 and exported to SPSSV.20 for data analysis.Results:Majority of cases were due to obstructed labor 270 (78.8%) followed by hemorrhage 33 (9.6%), preeclampsia 29 (8.14%), abortion 6 (1.74%), anemia 3 (0.87%), congenital heart disease2 (0.58%) and gestational infection1 (0.29%).Conclusions:Independent variables residence, duration of labor, ANC utilization, past obstetrics complication and number of live births were statistically significant with the outcome variable near miss. Maternal health policy needs to be concerned preventing major cause of near miss
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Abstract Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. Results Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. Conclusion The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.
Resumo Objetivo Avaliar o efeito da utilização de unidades de terapia intensiva (UTIs) na mortalidade materna (MM) entre mulheres com morbidade materna grave (MMG). Materiais e Métodos Foi realizada uma análise secundária de um estudo transversal de vigilância de morbidade materna grave em 27 centros de referência obstétrica no Brasil. O foco desta análise foi a associação entre a utilização de UTI e morte materna segundo características individuais e condições de gravidade. Análises múltiplas considerando as variáveis uso de UTI, idade, etnia, adequação do cuidado e índice de desenvolvimento humano foram realizadas para identificar os fatores associados à morte materna e near-miss materno. Resultados Dos 82.388 partos ocorridos durante o período de estudo, 9.555 (11,6%) mulheres apresentaram MMG, e a razão de MM foi de 170,4/100 mil nascidos vivos. Neste grupo, 8.135 (85,1%) pacientes foram atendidas em instituições com disponibilidade de leitos de UTI, mas apenas 2.059 (25,3%) foram de fato admitidas em leitos de UTI. Na análise de regressão multivariada, quando se considerou a gravidade do caso pelo maternal severity score (pontuação de severidade materna, MMS, na sigla em inglês), houve uma grande redução da força de associação entre utilização de UTI e morte materna, além da inadequação do cuidado e não disponibilidade de UTI na instituição. Na avaliação considerando apenas os casos de maior gravidade (desfecho materno grave, DMG), observou-se o mesmo padrão de associação entre UTI e MM. Nos modelos utilizados, apenas a inadequação do cuidado e o MSS apresentam associação significativa com a MM. Conclusão O presente estudo aponta que as principais variáveis associadas à morte materna são a gravidade e a adequação do manejo do caso, mais frequentes nas internações em UTI. A utilização dos leitos de UTI sem a estratificação da gravidade da paciente pode não trazer benefícios esperados para uma parte das mulheres.
Subject(s)
Humans , Female , Pregnancy , Child , Adolescent , Adult , Young Adult , Pregnancy Complications/mortality , Prenatal Care , Patient Acceptance of Health Care , Intensive Care Units/statistics & numerical data , Severity of Illness Index , Brazil , Maternal Mortality , Regression Analysis , Middle AgedABSTRACT
Splenic rupture is a very rare entity during pregnancy and puerperium. It has a very high maternal mortality if not diagnosed and managed in time. Here we are presenting a very rare case of splenic haemorrhage on day 5 lower segment caeserian section which was diagnosed and managed at RIMS, Ranchi, Jharkhand, India.
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Background: Pregnant women’s health status is not only reflected by mortality indicators alone hence the concept of Severe Acute Maternal Morbidity (SAMM) is appropriate for present health providing system. It helps to evaluate the quality of obstetric care in a particular institute. The main objectives of the study were to find a) Incidence of MNMM; b) Disorders underlying MNMM; c) Socio-demographic variables among MNMM; d) Facilities and skills needed to handle these near miss situations.Methods: A prospective hospital-based study was conducted in the department of obstetrics and gynaecology, Gauhati Medical College and Hospital, Guwahati during the period 1st June 2018 to 31st May 2019. Cases were identified based on maternal near miss operational guidelines December 2014.Results: Out of 16222 live births, 241 near miss cases were identified during the study. The maternal near miss incidence ratio is 14.86 per 1000 live births. The maternal near miss to maternal mortality ratio is 2.025. Most common cause of MNMM is hemorrhage (48.54%) followed by hypertension (19.5%), anemia (13.28%), sepsis (10.37%), cardiac dysfunction (6.2%), liver dysfunction (0.83%), renal dysfunction (0.83%) and respiratory dysfunction (0.41%).Conclusions: The large magnitude of MNM cases may be attributed to improper management of obstetric emergencies at the referring hospitals, poor referral practices, inefficient transport system, limited availability of blood products and poor utilization of health care services at the peripheral hospitals. In our tertiary center, with the help of multidisciplinary action to all the near miss cases we can reduce maternal mortality to a great extent.