A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project

Abstract

BackgroundAuditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system.MethodsFrom October to December 2005, all cases of maternal death (MD), near-miss (NM), fetal deaths (FD), and early neonatal deaths (END), occurring in Campinas, Brazil, were audited by maternal mortality committees.ResultsA total of 4,491 liveborn infants (LB) and 159 adverse perinatal events (35.4/1000 LB) were revised, consisting of 4 MD (89/100.000 LB) and 95 NM (21.1/1000 LB), 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB) and 28 END (6.2/1000 LB) occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage.ConclusionAuditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care.

Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

“…Regarding hemorrhage and high blood pressure, studies have reported an increased risk of perinatal death 25,26 , prematurity, low birth weight, and asphyxia at birth 15 among infants of mothers with hypertension in pregnancy, still a common condition during pregnancy 27,28 , and of mothers with vaginal hemorrhage prior to labor 17,29 .…”

Incidence of Maternal “Near-Miss” Events in a Tertiary Care Hospital of Central Gujarat, India

“…Maternal near-miss (MNM) cases occur more often than maternal deaths and may give more information because the woman herself can be a source of data [10]. MNM cases have similar pathways as maternal deaths, with the advantages of offering a larger number of cases for analysis, greater acceptability of individuals and institutions since death did not occur [11].…”

The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework

“…25 Reasons for this include structural and process deficiencies -delayed referral, the high cost of emergency obstetric care or lack of public transport. 34 The flaws in the referral system lead to patients being shunted from one facility to another, 13,33 when facilities are unable to deal with obstetric complications 35 or they lack trained health professionals. The number of referrals onwards before a woman reaches an appropriate facility influences survival.…”