ABSTRACT
Resumen: Objetivo: Presentar la evidencia científica más reciente referente a la definición, diagnóstico y consecuencias de morbilidad extrema en obstetricia (MEO). Metodología de búsqueda: Búsqueda en PubMed, The Cochrane Library, OVID, Science Direct, Google Académico, Artemisa, LILACS e Imbiomed de artículos publicados en inglés y español entre los años 2005 a 2018 con las siguientes palabras clave: severe maternal morbidity, near miss morbidity, severe acute maternal morbidity, obstetric near miss and maternal near miss. Se excluyeron estudios cualitativos. Resultados: La MEO (o near miss) se refiere a cualquier complicación aguda que puede presentarse en el embarazo, labor o hasta seis semanas después de haber concluido el embarazo, estas complicaciones ponen en riesgo la vida de la madre, pero no resulta en su muerte. Los indicadores de MEO fueron desarrollados con base a la incidencia y presencia de trastornos hemorrágicos, hipertensivos y otras alteraciones sistémicas y condiciones maternas graves que pueden tener un impacto en la salud de la madre. En la actualidad, se sugiere que el estudio de los indicadores de MEO son de más utilidad que los de muerte materna. Conclusiones: El ejercicio de la práctica médica con base en la mejor evidencia científica, el estudio y la mejora de la calidad de la práctica clínica, de la planificación familiar, la asesoría prenatal y los programas hospitalarios son estrategias que permitirán ayudar a disminuir los casos de MEO.
Abstract. Objective: To provide the most recent scientific evidence about definitions, diagnosis and consequences of severe maternal morbidity (SMM). Research methodology: We searched databases in PubMed, The Cochrane Library, OVID, Science Direct, Google Scholar, Artemisa, LILACS and Imbiomed from 2005 to 2018 with the following keywords: severe maternal morbidity, near miss morbidity, severe acute maternal morbidity, obstetric near miss and maternal near miss. The search was restricted to articles written in the English and Spanish language and published from 2005 to 2018. Qualitative studies were excluded. Results: SMM or maternal near miss event refers to 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 six weeks of termination of pregnancy. The indicators for SMM were developed and based on the incidence and presence of hemorrhagic disorders, hypertensive disorders, other systemic disorders and severe maternal conditions which could have an impact on maternal health. Nowadays it is suggested that the study of indicators for SMM is a more useful indicator of obstetric care than mortality. Conclusions: Use of best evidence-based practices, studying and improving the effectiveness and quality of clinical practice, family planning, prenatal check-up, and hospital obstetric care programs are strategies that could help to reduce cases of SMM.
ABSTRACT
OBJECTIVE: The objective of this study is to explore the usefulness of neonatal near miss in low- and middle-income countries by examining the incidence of neonatal near miss and pre-discharge neonatal deaths across various obstetric risk categories in 17 hospitals in Benin, Burkina Faso and Morocco. METHODS: Data were collected on all maternal deaths, maternal near miss, neonatal near miss (based on organ-dysfunction markers), Caesarean sections, stillbirths, neonatal deaths before discharge and non-cephalic presentations, and on a sample of births not falling in any of the above categories. RESULTS: The burden of stillbirth, pre-discharge neonatal death or neonatal near miss ranged from 23 to 129 per 1000 births in Moroccan and Beninese hospitals, respectively. Perinatal deaths (range 17-89 per 1000 births) were more common than neonatal near miss (range 6-43 per 1000 live births), and between a fifth and a third of women who had suffered a maternal near miss lost their baby. Pre-discharge neonatal deaths and neonatal near miss had a similar distribution of markers of organ dysfunction, but unlike pre-discharge neonatal deaths most neonatal near miss (63%, 81% and 71% in Benin, Burkina Faso and Morocco, respectively) occurred among babies who were not considered premature, low birthweight or with a low 5-min Apgar score as defined by WHO's pragmatic markers of severe neonatal morbidity. CONCLUSION: Whether the measurement of neonatal near miss adds useful insights into the quality of perinatal or newborn care in settings where facility-based intrapartum and early newborn mortality is very high is uncertain. Perhaps the greatest advantage of adding near miss is the shift in focus from failure to success so that lessons can be learned on how to save lives even when clinical conditions are life-threatening.
