Severe acute obstetric morbidity (near-miss): a review of the relative use of its diagnostic indicators
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To assess the most commonly employed diagnostic indicators of severe maternal morbidity (obstetric near-miss).
Review of the literature from January 1989 to August 2008.
Fifty-one manuscripts met the eligibility criteria, and 96 indicators were utilized at least once. Admission to intensive care unit (n = 28 studies) was the indicator most frequently utilized, followed by eclampsia and hemorrhage (n = 27), blood transfusion (n = 26) and emergent hysterectomy (n = 24).
Considering these findings, a trial version of a 13-item instrument for diagnosing obstetric near-miss is proposed. It includes the indicators eclampsia, severe hypertension, pulmonary edema, cardiac arrest, obstetrical hemorrhage, uterine rupture, admission to intensive care unit, emergent hysterectomy, blood transfusion, anesthetic accidents, urea >15 mmol/l or creatinine >400 mmol/l, oliguria (<400 ml/24 h) and coma. Further studies should focus on consensual definitions for these indicators and evaluate the psychometric proprieties of this trial version.
KeywordsMaternal mortality Pregnancy complications Morbidity Medical audit Near-miss
MER is partially supported by CNPq, Grant 306939/2003–7.
Conflict of interest statement
- 1.World Health Organization Maternal mortality in (2005) estimates developed by WHO, UNICEF, UNFPA, and the World Bank. WHO Press, World Health Organization, Geneva, 2007Google Scholar
- 2.United Nations Population Fund Maternal mortality update (2002) A focus on emergency obstetric care. New York: United Nations Population Fund, 2003Google Scholar
- 4.Say L, Pattinson RC, Gulmezoglu AM (2004) WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health 1(1):3Google Scholar
- 10.Pattinson RC, Buchmannb E, Mantelc G, Schoond M, Reese H (2003) Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries? Br J Obstet Gynaecol 110:889–893Google Scholar
- 14.Ronsmans C, Filippi V (2004) Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. World Health Organization, GenevaGoogle Scholar
- 22.Prual A, Bouvier-Colle MH, de Bernis L, Bréart G (2000) Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. Bull World Health Organ 78(5):593–602Google Scholar
- 30.Dias de Souza J, Cecatti J, Parpinelli M (2005) Factors associated with the severity of maternal morbidity for the characterization of near miss. Rev Bras Ginecol Obstet 27:197–203Google Scholar
- 42.Rizvi F, Mackey R, Barrett T, McKenna P, Geary M (2004) Successful reduction of massive postpartum haemorrhage by use of guidelines and staff education. Br J Obstet Gynaecol 111:495–498Google Scholar
- 46.Bouvier-Colle M, Varnoux N, Groupe MOMS-B (2001) Maternal mortality and severe morbidity in 3 French regions: results of a European multicentric survey (MOMS). J Gynecol Obstet Biol Reprod (Paris) 30:S5–S9Google Scholar
- 47.Callaghan WM, Mackay AP, Berg CJ (2008) Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991–2003. Am J Obstet Gynecol 199(133):e131–e138Google Scholar
- 56.Ben Hamouda S, Khoudayer H, Ben Zina H et al (2007) Severe maternal morbidity. J Gynecol Obstet Biol Reprod (Paris) 36:694–698Google Scholar
- 66.Bowling A (1997) Other methods using both qualitative and quantitative approaches: case studies, consensus methods, action research and document research. In: Bowling A (ed) Research methods in health. Investigating health and health services. Buckingham: Open University Press, Philadelphia, pp 358–385Google Scholar
- 69.Streiner DL, Norman GR (2003) Health measurement scales: a practical guide to their development and use. Oxford University Press, OxfordGoogle Scholar
- 70.Brown TA (2006) Confirmatory factor analysis for applied research. The Guilford Press, New YorkGoogle Scholar