RESUMO
Background: Near miss cases share many characteristics with maternal deaths and can directly inform about obstacles that had to be overcome after the onset of an acute complication, hence providing valuable information on obstetric care. This allows for corrective action to be taken on identified problems to reduce related mortality and long-term morbidity
Objective: The purpose of this study was to determine the efficacy of possible interventions [in the form of monthly clinical audit for new near miss cases and feedback strategy] in reducing maternal near miss cases in El Galaa Teaching Hospital in Egypt and improving WHO indicators of maternal health
Methods: The study was conducted over 3 stages: Stage I [Formative Stage]: Is a retrospective study of maternal near miss cases over 1 year period, based on WHO criteria from 1/1/2016 to 1/1/2017. Stage II [Intervention stage]: This incorporated a monthly clinical audit for new near-miss cases and feedback strategy, using WHO case report forms, as well as engagement of opinion leaders for 1 year from 1/1/2017 to 1/1 2018 with 2 to 3 cases discussed monthly. Stage III [Assessment Stage]: Evaluating the clinical performance and frequency of near miss cases after intervention
Results: In this study, the majority of women with potentially life threatening conditions were referred from private obstetrician clinic, private hospitals and Ministry of Health to El Galaa hospital. The majority of Maternal near miss cases [67.9%] gave birth by Caesarean section, this was because of the severity of these patients' obstetric conditions usually requires urgent action. The main life threatening conditions among women in this study were hypertensive disorders of pregnancy 41% [24% Pre-eclampsia, 15% Eclampsia, 2% chronic hypertension]
Conclusion: Our intervention [near miss clinical audit] helped to improve the performance and quality of care provided to women with complications during pregnancy, as reflected on the maternal health outcome indicators. Therefore we recommend incorporating clinical audit process in all health facilities. The Maternal mortality index and Maternal near miss mortality ratio, two of the indicators recommended by WHO, can be used to monitor and assess the performance and health care level. Health managers and policy makers should use maternal health outcome indicators for allocation of resources and prioritization of investments