A global view of severe maternal morbidity: moving beyond maternal mortality

Abstract

BackgroundMaternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs).Severe maternal morbidity in high-income countriesSince the WHO recommended that HICs with low maternal mortality ratios begin to examine SMM to identify systems failures and intervention priorities, researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders. Of the countries that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify “high risk” status, delays in diagnosis, and delays in treatment.Severe maternal morbidity in low and middle income countriesThe highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. Case reviews are rare, but have revealed patterns of substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity.Effects of SMM on delivery outcomes and infantsSevere maternal morbidity not only puts the woman’s life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Adverse delivery outcomes occur at a higher frequency among women with SMM. Reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn.ConclusionIncreasing global maternal morbidity is a failure to achieve broad public health goals of improved women’s and infants’ health. It is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability.

Incidence and Predictors of Maternal and Perinatal Mortality among Women with Severe Maternal Outcomes: A Tanzanian Facility-Based Survey for Improving Maternal and Newborn Care

“…Similar findings have been reported in the previous study conducted in Nigeria [25]. e similarity of these findings in relation to high SMO and poor perinatal outcomes might be explained by the fact that all these countries are located in SSA, the region known with a high burden of severe maternal morbidity and mortality [2,26]. Furthermore, the similar factors associated with these problems have been reported among all countries within this region [27].…”

“…Maternal and perinatal mortality are the crucial indicators used globally to assess, monitor, and evaluate maternal and newborn health [1], and countries have made improvements towards the achievement of Sustainable Development Goals (SDGs) [2]. ese two events are rare in high-income countries but more experienced in low-and middle-income countries (LMICs), which contribute nearly 99% and 98% of all maternal and perinatal deaths worldwide, respectively [3,4].…”

Analyses of severe acute maternal morbidity in Slovakia during years 2012–2016

“…Maternal mortality and severe acute maternal morbidity are observed indicators of health care quality in the country (2,7,11). Incidence of SAMM in the world vary from 6.0/1,000 live births in Australia till 13.9/1,000 live births in France, and in developing countries even higher, however everything depends from the defi nition and which causes of SAMM are included to observation (2,12,13). Incidence of SAMM in Netherlands (with similar defi nition as SOSS) was slightly higher (7.1/1,000 births) than in Slovakia (14).…”

“…This emergency situation occurred during the pregnancy, labour or within 42 days after the end of pregnancy (1). According to used criteria worldwide incidence of SAMM is differ (2).…”

Morbilidad extrema (near-miss) en obstetricia. Revisión de la literatura

“…Los criterios diagnósticos de MEO de la OMS han sido empleados mundialmente para el estudio e implementación de proyectos de mejora en la calidad de atención hospitalaria; sin embargo, su aplicación en países en vías de desarrollo ha sido cuestionada, debido a que muchos hospitales no cuentan con todos los estudios de laboratorio que se incluyen en dichos criterios (14) .…”